Report on case-

Instituting New Training Programs

Managing Change in Organizations

Submitted byRubaiyet Aamrin Nishat Kaisar

Submitted toM. Nazmul A Majumdar

Introduction: A large Boston based teaching hospital recognized strong need for training and development, in the beginning they were uncertain of their level of management expertise, they had no hospital-based management skills development and training existed, they only had in-service technical education for nurses. Non-nursing managers covers three quarter of the management staff, so the hospital management decided to establish an effective training and development program for their management staffs. But initially it was not an easy task to develop the process; some top administrators opposed the idea and felt it was waste of money. After cost/benefit analysis the top management came to a decision and hired an outside consulting firm to give management training to all three levels of mangers. Initially some of the managers welcomed the program, some restricted and the third group was neutral. Those who were positive about the programs they implemented their knowledge in their work and these positive results were reinforced by newsletters and memos from the president and executive vice-president. As these programs were continuing its success therefore an in-house education system was demanded by the staffs, and their pressure made the executives determined for a full-time education function at the hospital. Therefore a training director was hired to create meaningful education program to help reach the hospitals short and long-term objectives so a training and development department was established. The director conducted need analysis and based on need he developed effective training programs, those who attended these programs become more enthusiastic and their practice of word of mouth encourages others to value the programs. The increased demand made the hospital management to think of developing a training center and hiring two additional trainers, they planned to make it a self-supporting cost center. But two separate departments were not cost justified, at the same time, director of nursing education resigned, after huge analysis and discussion they decided to merge two departments. They set up a committee identify nursing education needs and based on their requirements effective educational and management courses were developed. Global Perspective: Health care systems We have discussed healthcare systems of some major countries all around the world in the following: Canada: The Canadian health care system is publicly funded and consists of five general groups: the provincial and territorial governments, the federal government, physicians, nurses and allied health care professionals.

United States of America: The health care system in the United States is currently plagued by three major challenges. These include: rapidly escalating health care costs, a large and growing number of Americans without health coverage and an epidemic of substandard care. Germany: Approximately 92% of Germany's population receives health care through the country's statutory health care insurance program, Gesetzliche Krankenversicherung (GKV). GKV designed an organizational framework for health care in Germany and has identified and constructed the roles of payers, providers and hospitals. Private, for-profit companies cover slightly less than 8% of the population. Developing countries: Accessing good-quality health care services can be incredibly difficult for those living in developing countries, and more specifically, for those residing in rural areas. For many reasons, medical personnel and resources may not be available or accessible for such residents. As well, the issue of migrant health care workers is critical. Migrant health workers can be defined as professionals who have a desire and the ability to leave the country in which they were educated and migrate to another country. The workers are generally enticed to leave their birth country by generous incentive offers from the recruiting countries. HR Implication: While collectively the four main areas addressed in the discussion represent health care issues affecting and affected by human resources practices, they are not all equal in terms of their influence in each country. For instance, in Canada there are fewer health care issues surrounding the level of economic development or migration of health workers, whereas these issues are much more significant in developing countries. In the United States, the level of economic development is not a significant issue, but the accessibility of health care based upon an individual's financial situation certainly is, as evidenced by the more than 40 million Americans who have no health care coverage. Germany's issues with the size of its health care worker base have to do with too many physicians, whereas in Canada one of the issues is having too few physicians. Case Solution: Question: 1 Who will oppose the change and how strongly do they feel? Answer: As there were no hospital-based management skills development and training existed in this large Boston based hospital the management recognized the need for training and development. The significant change was the establishment of one training department that included nurses training.

For this change it is to be an accepted fact that most of the individuals resist change. Same things happen for this hospital also. Not all the top administrators totally supported the idea of a formal approach to training and development. Some managers welcomed the opportunity and other resisted. A third group remained neutral. We can say that it was a Structure focused change as it alters any of the basic components of an organizations structure i.e. new training department and new recruitments. And the pressure was the Blind resistance as some individuals reacted but not forever. So in any change situation is to use empathy to determine problem reaction to a contemplated or definite change. The opposition groups might strongly feeling about Adaptability of organizations to their environment, Cost containment, Control and power through managerially imposed performance target. Question: 2 How and when should the proposed changes be communicated? Answer: During the identification, development and implementation of strategic change initiative the change agent must help ensure that the reason for change, the new direction and how the change will affect individuals and groups within the organization are communicated in a very honest manner. Communication means to create understanding and not merely to send it is quite difficult to decide How the proposed changes be communicated. It might be written or oral communication depends on situation. As it was like a structural change, a written notice can suffice. It should be given to all managers first and then posted on bulletin boards of the organization. Here managers should give thought to the method of communicating before doing it. The hospital management reinforced through the internal newsletter and administrative memos from the president and executive vice-president.

Question:3 What are the best ways to get key people to participate in the change? Answer: If change is a process of taking an organization on a journey from its current state to a desired future state and dealing with all the problems that arise along the journey, then change is about leadership as well as management and the key people. And the best way of successful change will be the proper participation of those key people in the change. It can be the Alignment which is galvanizes people around the aspirations and objectives of the organization as they know what is to be done and understand how they as individuals contribute to the whole. Adaptability which enables tolerance for contrary views, a willingness to experiment and tolerate failure and learn from it and ability to respond quickly to change. 3

Managers can ask for inputs from the subordinates (i.e. either individually or as a group) considers the inputs then decides and informs subordinates of the decision The key people or the managers can conducts the problem solving conference with subordinates to reach a consensus.

Thats why the participative approach followed a significant change in hospital hiring practice, financial analysis and also the cost/benefit analysis was undertaken. Recommendation As there are different types of change, among them the change occurred in this hospital is planned/Developmental change. Because this change is undertaken to improve upon the current ways of operating and initiated to achieve a certain desirable output/performance i.e. the hospital based management skill development and educational needs. Whenever the decision is considered empathy should be used to determine how people will react to change and the need for communication should go through channels to be sure that each key person understands the change and the reasons for it. Finally the need for participation is very important as the people who have provided input into a decision are more likely to accept the change. References 1. Donald L. Kirkpatrick (2002), Managing Change Effectively: Approaches, Methods and Case Examples, Boston: Butterworth-Heinemann.

2. World Health Organization: [http://www.who.int.proxy.lib.uwo.ca:2048/whr/2000/en/whr00_ch4_en.pdf] website. World Health Report 2000. Health Systems: Improving Performance. Geneva. 2000.