Module title: Module 1: Managing Organisations & People

Program/location: MSc in Healthcare Management, BAHRAIN, Year 1, 2019-2020

Section A: 50%

Managing change is an important role for healthcare managers.

Assignment title: Drawing on relevant literature and applying a change model, critically discuss
this statement.

Student ID: 19108594

Date of submission: Tuesda, November, 12 2019

Word count: Part A: 2188

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 Table of Contents

▪ Introduction……………………………………………………………………………3

▪ Overview of managing change in healthcare organisations…………….…...… 3

▪ Brief overview of managing change models………………………………………4

▪ Kotter’s Model for managing change in healthcare organisations..…..……….. 5

▪ Conclusion……………………………………………………………………………. 8

▪ References…………………………………………………………………………….9

▪ Appendix……………………………………………………………………………...15

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Introduction

This assignment addresses the importance of manager roles in managing change in healthcare
organisations as change is an important part for improving the quality of organisation
functioning (Ionescu, Merut, & Dragomiroiu, 2014). Moreover, it is approved that the way of
managing change has a great effect on the performance of the organisation (khatoon & Farooq,
2016). This process of change needs to be managed by a skilled leader as his role is critical
for the success of the change (Antwi & Kale, 2014).

The author believes that managing change in a healthcare organisation needs good leader who
understands the complexity and multi-professionality of his/her organisation with paying
attention to the need for team working during the implementation of the change process and
be alert of internal and external factors that are approved in the literature to be influential in the
process of managing the change.

Overview of managing change in healthcare organisations

Change management is important for any organisation to achieve its goals. It is described as
the process that move an organisation from its present state to a targeted future state (Lorenzi
& Riley, 2000). Furthermore, managing change successfully is the foundation for progress and
quality improvement in the organisation and development of its employees (Ionescu, Merut, &
Dragomiroiu, 2014).

Managing change in a healthcare organisation varies from other organisations because of its
complexity. Fitzgerald et al. (2006), stated that there are three features of the health care
organisation that makes it complex: structure, function and personnel and each of these
features affects the process of the change. One of the explanations of its complexity, that it
gathers different professions including physicians, nurses, pharmacists, administrators and
others and each of these professions has his interest, perspectives and time horizons (Antwi &
Kale, 2014). The complex nature of the health care organisation requires managing its change
in a new way by linking all the factors that may influence the change (Barry, Dalton, & Eustace-
Cook, 2018).

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Managing change in healthcare is associated with the rapid change in healthcare settings to
cope with new advanced technology, quality and performance improvement (Campbell, 2008).
In a recent literature review on change management in health and social care which was done
by Barry et al. (2018), they stated that currently the focus is on leader’s skills, teams and
dynamic of organisations. Adding to that, considering factors the effect the process of change:
culture and social interaction, people and power, leadership and learning which were
highlighted as critical factors. They also found that recently the approach for managing change
in healthcare organisation is shifting toward whole-system-approach instead of person-
centered-approach.

Overview of managing change models

Many models have been developed for managing change in the 20th and 21st century. The
literature in the change management consider two core models of managing change, the first
one is the planned change management and the other one is the emergent change
management (Antwi & Kale, 2014).

In the period between 1950s and 1980s, the planned approach for managing change was the
dominant and was founded by Kurt Lewin (Burnes, 2004). In the planned models, the manager
develops the vision for the change where the change process takes place in a transitional
period between the previous phase and the new desired phase (Bamford & Daniel, 2005). Later
on, other planned change models were established based on Lewin’s model, like Lippitt seven-
phase model (Lippitt, 1958), Bullock and Batten’s four-phase model (Bullock & Batten, 1985)
and Kotter’s 8-step change model (Kotter & Cohen, 2012). (Refer to Appendix 1)

In planned change models there is a big emphasis on the role of the manager during the
implementation of the change process (Bamford & Daniel, 2005). In which they are responsible
for developing the pre-planned processes and objectives (Bamford & Forrester, 2003).
According to Lewin model, the present status ‘status quo’ is maintained by certain forces which
influence the group outcomes and the behaviours of the individuals (Burnes, 2004a), and
manager should be able to identify these forces to be able to change the old behaviour to a
new one (Antwi & Kale, 2014).

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Emergent change models are considered new approach and it doesn’t have enough theoretical
foundation, Pettigrew’s (Pettigrew, 1987) and Kanter et al.’s “Big Three” model (Kanter, 2003),
are examples of this type of change models. Emergent change is described as the continues
changes and adaptations that take place when people in the organisation deal with
emergencies in daily work (Weick, 2000). In this type of change, managers will face difficulties
in setting the strategies for the change as it is rapid and complex and the external environment
forces diminish the ability of the manager to direct the change (Bamford & Forrester, 2003).
Managers act as facilitators for the change and they will give up some authorities of decision-
making to the employee in the organisation (Bamford & Forrester, 2003).

In order to choose a model for managing the change, manager should consider the internal
and external factors. This was supported by Burnes (2004) who studied the case of XYZ
construction between 1996 and 2000 which used both planned and emergent models to
implement changes and he believed that organisation should integrate the two models in a
clever way with taking in consideration the internal and external factors.

Kotter’s model for managing change in healthcare organisation

Kotter model is the author’s choice for managing change in a healthcare organisation, as it
focuses on teamwork during managing and implementing the change (Kotter, 2005). This is
suitable for a complex multi-professional organisation like healthcare and it matches with the
focus nowadays on the importance of teams in initiating and implementing the change (By,
Kuipers, & Procter, 2018). In Addition, Denis, Langley, & Cazale (1996) stated that successful
change management in a healthcare organisation can be achieved with following collective
leadership approach and realizing its multiplicity of stakeholders.Kotter also emphasis on the
importance of accepting the employees for the change and involving them during the
implementation ("Kotter's 8 Step Model of Change", 2019). This was supported by Buchanan,
Claydon & Doyle (1999) as they emphasize on the importance of involving the staff from all
levels in public and private organisations in designing and implementing the change.

In 1996, John Kotter developed his 8 steps model which was built on Lewin’s model (Kotter,
2010). He established the 8 steps in order to overcome the mistakes that managers may do

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during initiating and implementation of the change (Robbins & Judge, 2018). (Refer to figure 2,
in appendix 1)

In Kotter model, the manager should be aware of negative feelings toward change that may
inhibit implementing the change at any stage like complacency, panic, anxiety, self-protective
immobilization, defiance, and hesitancy and he should follow strategies to change these
negative feeling into positive ones. In this way, employee’s behaviour toward change will be
improved and this will facilitate the change. (Kotter & Cohen, 2002).

Starting with developing a ‘sense of urgency’ the manager has to discuss the existing problem
with the concerned members in the organisation and convince them about the necessity of this
change with strong reasons ("Kotter's 8 Step Model of Change", 2019). Although conducting
proper diagnosis of the problem influence managing the change in a positive way (Armenakis
& Harris, 2009), creating a ‘sense of urgency’ was argued by Straw, Sandelands & Dutton
(1981) as they stated that it can cause fear among employees and increase resistance toward
the change.‘Sense of urgency’ in healthcare settings can be developed differently depending
on the desired change. Landro (2007) gave an example of creating ‘sense of urgency’ in
healthcare settings, in order to change the paper record into electronic record by creating a
video presentation of parents who are angry as their daughter died because of a medical error
as a result of poor documentation in the paper record.

Later on, the manager will form a coalition to set the vision and help employees to understand
the causes for the change. The coalition should include experts’ people, leaders, managers
and stakeholders who are important and trusted by top management (Kotter, 2005). This kind
of coalition is very important in managing change in healthcare. Campball (2008) explained the
importance of this coalition during inducing a change in patient recording system as it should
gather members from all related professions whom will be responsible to communicate the
vision of the change with the staff in their units. This was supported by a case study done by
Fiondella, Macchioni, Maffei, & Spanò (2016) to find how a change in the management
accounting systems (MAS) of healthcare organisation was implemented in an acceptable way
to the employee. They found that involving different professions in the change process led to
decrease the resistance toward change and improved the staff commitment of different
professions to the new change.

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The manager then engage the whole organisation in the process of implementing the change
by communicating the vision. The vision should be translated to the people of the organization
simply with considering the possible feeling such as anxiety or distrust toward the change.
(Webster, Webster,2017). The literature supports the importance of communicating the vision
to overcome their negative feelings and resistance toward the change. In a quantitative study
done by Dahl (2011) on 90,000 workers, he found that change in organisation was related to
increased intake of stress-related medications. On the other hand, when the change reasons
are explained fully to the employees and they find it significant, employees’ attitude toward the
change will be more appropriate (Lau & Woodman, 1995). In a study done by Shaw, Wild, &
Colquitt (2003) to explore the effect of explanation, they found that explaining the change
reasons clearly to the employees, caused 43% decrease in resisting this change. In contrast,
it was argued by Cole, Harris, & Bernerth (2006) that focusing on appropriateness and
implementation of the change were much more important than clarifying the vision of the
change.

When employees absorb the vision clearly, then the manager should have a motivational role
through empowering the employees to act and participate in implementing the change. This
can be achieved through supporting and training the employees to be able to overcome barriers
during the change process (Kotter,2005). The manager shouldn’t allow structural barriers such
as rules or job descriptions to be a barrier that prevents the employee from reacting with the
change process (Kotter,1996). Empowering employees was found to be strongly supported in
the literature (Stouten, Rousseau & Cremer, 2018). The participation of employees makes them
more ready to accept the change (Eby, Adams, Russell, & Gaby, 2000) and improve their self-
efficacy (Latham, Winters, & Locke, 1994). Later on, the manager will create short-term wins
and which will give positive impact on the potential of the coalition and the employees
(Kotter,1996). However, focusing on short-term wins can raise the rate of the change initiatives,
leaders should create balance between the effect of these wins and the long-term effects of the
change on the perception of the employees (Boga & Ensari, 2009). As the change process is
going on, more changes can be added to fulfil the vision in which mid-managers and the
empowered employee continue working to achieve the desired change while top management
focuses on the vision of the change (Kotter,1996).

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Finally, after achieving the desired change, the manager should ensure that change is
embedded in the culture of the organisation (“Kotter’s 8 Step Model of Change,” 2019) and
combining it with its daily activities (Kotter,2005). Kotter believes that when employees see the
success of the change, culture can be changed (Kotter & Cohen, 2002). An example was given
by Campball (2008) after adopting electronic files in healthcare organisation, and the
employees were pleased with the new technology and its success, then they embraced a new
culture toward it.

Kotter’s model is considered step by step approach and easy to be applied, in contrast it is
found to be a rigid model as manager should follow all the steps and can’t escape any of them
(Appelbaum et al, 2012). Although there is no evidence against Kotter’s model in the literature
and most of the steps in Kotter’s model are supported, further studies needed to test its validity
as a whole (Appelbaum et al, 2012).

Conclusion

Change in an organisation is important for its success and this emphasize on the need for good
management (Senior, 2002). Nowadays Managing change becomes a challenge for the
managers especially with the increased pressure of the environmental factors that influence
the change (Thompson,2010). Managing change is not always succesful, as recent studies
showed that managers believes that only one third of the planned changes succeed (Jarrel,
2017).

for these reasons, the manager should understand his role and his team role precisely during
this process and consider all factors that may affect the change process in order to achieve the
desired goals with the least losses as managing the change in a bad way could cause retreat
in the performance of the organization. Although lot of researches was done to evaluate the
manager role in the change process, more studies needed to focus on his role in a complex
organisation like the healthcare.

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 Appendix 1

Figure 1

The planned change models (Antwi & Kale, 2014)

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 Figure 2

Kotter’s 8-Step Change Model (Webster & Webster, 2017)

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