FOREIGN TRADE UNIVERSITY

CASE REPORT

ORGANIZATIONAL CHANGE IN THE HEALTH CARE SECTOR

Class: QTRE402.1

Instructor: PhD Ngô Quý Nhâm

Group 2: Nguyễn Quang Đức

Nguyễn Thùy Dương
Hồ Lan Phương
Sinda Hung

Hà Nội, 2021
 Tables of contents

Content Page

CASE INTRODUCTION...........................................................................3

ANSWERS TO DISCUSSION QUESTIONS..........................................3

REFERENCE............................................................................................11

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 CASE INTRODUCTION

This case study looks at an attempt to introduce multiskilled, ward-based teams of

support workers in Happy International Hospital (HIH). The change represented part of
a wider, strategic transformation in HIH which focused on human resource issues. The
driving force is an attempt to realise continual improvement in quality and value for
money. However, the initiative was rejected after facing many resistances in the pilot
phase.

ANSWERS TO DISCUSSION QUESTIONS

1. How might the motivation of staff have been affected during the
change process?

Sense of insecurity
"Staff would require additional training then undertake a wider array of tasks and be
required to embrace flexibility and teamwork". The source of insecurity is the feeling
that they are not qualified to be in their current position. This is a result of the
undertaking of new responsibilities thrust upon them that disrupts their usual routine.
They become reluctant to express their useful opinions and ideas or to develop
innovative approaches to their everyday work.

Mood of the organization

"Some managers and staff expressed a strong desire to reduce the level of uncertainty
they faced under the current system". "Some staff would be required to change their
shift pattern and the total hours they worked in any one week". change burnout, impact
on personal lives, and fear of failure were the primary sources of employee emotional
resistance. When emotions become intolerable, productivity and output suffer. As the
attitudes of workers deteriorate, so do their commitment, loyalty and most importantly
their performance.

Job satisfaction

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"Work rotas issues during the pilot scheme". "The porters are understaffed and suffering
from low morale with a poor sickness record". "The gender issue in which male porters
expressed their unwillingness to undertake cleaning duties". More resistance to change
results in less job satisfaction. Job dissatisfaction is a result of different factors such as
company policy, supervision, interpersonal relations, working conditions, job security
and salary. These dissatisfactions can be removed by changing those factors which can
lead to performance improvement.

2. What are the merits and drawbacks of the kind of multi-skilled

teams which this change would have helped to encourage?

The attempted introduction of the generic worker concept had both benefits and
drawbacks.

In terms of the advantages of generic working, the ultimate goal of this organizational
change is to improve patient care and maximize profits:

● First, flexibility and responsiveness to patient needs would be enhanced. All

porters and domestic staff were divided into groups where they were all trained
to perform a wider range of duties This will result in simplification of working
schedule and reduction in waiting time, compliance with government initiatives
and the introduction of new information systems. In other words, the multi-
skilled, flexible workforce would improve both efficiency and effectiveness of
service provision. In managerial perspective, successful implementation of this
policy will lead to competitive advantage as it could save a huge amount of
cost. 
● Second, generic working would formalize control, especially over porters who
are difficult to track down. Additionally, this implementation would make the
tasks clear and members involved could know who they were serving. As a
result, this policy facilitated the provision of an up-to-date service-level
agreement and competitive tendering. Moreover, porters could be motivated as
they can feel part of a team and can take pride in their work and be recognised at
ward level. Thus, job satisfaction among staff has gone up. 

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 ● Third, as staff were required to undertake a wider array of tasks and embrace
flexibility and teamwork, the existing formal status and pay differentials among
members would be removed and highly complex bonus schemes could be
simplified. Porters were understaffed and suffering from low morale with a poor
sickness record, and had a strong desire to reduce the level of uncertainty they
faced under the current system. Staff also had the opportunity to be upgraded
and receive higher salaries which was based on attendance.

This organizational change, however, still has many challenges that make it cannot be
implemented in foreseeable

● First, generic working caused an issue of “ownership” of tasks. In detail, this

change involved reallocation of duties. And the task of dispensing food to
patients was turned from nursing to domestic staff as Hotel Services believed
their staff were better trained to carry out those duties. Therefore, tensions arose
at the interface between Hotel Services and nursing. 
● Second, generic working is also involved in changing work rotas and changing
hours. The rotas were so difficult to follow and staff could struggle with their
job.
● Third, issues related to this change arose among staff. Many posters, especially
males, are unwilling to undertake cleaning duties, which were regarded as
“women’s work”. Moreover, a group of domestics enjoyed a more privileged
position, which is not involved in cleaning or contact with patients and clinical
personnel. It is about the boundaries between groups, which make it impossible
to let them work in one team.
● Fourth, generic working also can be regarded as simply “a cost improvement
exercise”. It changes the terms and conditions of employees and necessitates
contractual changes and facilitates local determination of pays and conditions.
This would contravene national policy and UNISON position about local
bargaining. Therefore, it could be said that staff virtually had no financial
benefit from this change.

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3. What sources of power, or power bases, are threatened by this
change?

Legitimate power was threatened by this change. Legitimate power stems from formal
authority overwork activities and subordinates have to comply with requests. First, as
work rotas changed continually, staff hesitated to accomplish their tasks because they
found it difficult to follow their working schedule. Second, many male posters refused
to undertake cleaning duties because they thought that those duties were exclusively for
women. Third, a group of domestic staff refused to do tasks which related to cleaning or
contact with patients and clinical personnel. Due to the boundaries between groups of
workers, it was impossible to make them work in the same team which was the main
purpose of generic working.

Referent power was also threatened. The referent power is performed when the target
person complies because he or she admires or identifies with the agent and wants to
gain agent’s approvals. UNISON assumed that this policy would alter the terms and
conditions of employees. This change had raised both working hours and salaries.
Therefore, UNISON believed that it was not really beneficial for staff involved and
persuaded them not to approve the implementation. 

4. Why was this change initiative, which held so much promise and
generated such enthusiasm from management, so emphatically
rejected by staff?

According to Oreg’s theory, resistance to change is built up by 2 main factors:

personality and context which include 6 variables: power and prestige, job security,
intrinsic reward, trust in management, information, and social influence. The reasons for
individual resistances vary, for example, failure to recognize and engage in the need for
changes, cognitive dissonance of facing the unknown, feeling of inadequacy, and the
threat of losing the quality of life. 

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 Oreg’s resistane to change model

In this case, the managerial problems that lead to resistance are poor leadership in
groups and teams and lack of communication. 

Consider the contingency perspective of leadership whose idea is that success or failure
of leadership is situational and affected by the task, leadership styles and team
composition. Fiedler’s Contingency Theory emphasizes the importance of leader-
member relations in expanding the performance tuning of team members as well as the
requirement of clear task structure and position power. 

Fiedler’s Contingency Theory

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In the pilot scheme team, managers gather and implement the changes without
discussion with their employees or consultancy of the influenced parties, representing a
negative autocratic leadership style. Despite the fast direction provision, the lack of
involvement, as well as employees-based goals, may discourage their team members,
lower their morale and performances. Especially, without proper communication about
the need for change, making domestic staff change their work pattern and increase extra
35000 working hours will result in dissatisfaction. In addition, the lack of formal
communication channels leads to the risk of information distortion. During the time of
change, rumors and informal information can unconsciously spread negativity,
suspicion and distrust which nurture bigger resistances.

Moreover, the task structure in HIH is highly ambiguous. One porter stated the
understaffed, low morale, and lack of service-level agreement performance evaluation
and feedback; the goals for the pilot scheme are undefined and the working process is
unclear. All of these elements contribute to huge uncertainty for employees; they neither
know what to strive for nor the quality of their performance. 

Ultimately, the position power in HIH is disorientated as several porters are assigned to
the specific department while others are located in the central pool and individually
respond to the demand and the role of the porter-manager is not described. 

An effective team is formed through five stages. In HIH case, cultural and internal
political conflicts have created many obstacles in different development stages and
resulted in adjourning.

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 Foundation of Team Dynamic

Cultural conflicts here include the gender stereotypes which prevent members from
establishing standards and boundaries between the informal group resulting in failure to
conduct norming stage. Internal politics of UNISON and conflicts between clinical and
site service departments are also worth considering. The shifting of resources from
Clinical Directorate to Site service Directorate causes job insecurity for nurses and
tension between two departments. Nevertheless, the urge to protect UNISON’s clear
position and avoid risks of changing terms and conditions of employees has driven the
union to create a coalition and influence its members to go against the change. 

5. What are your recommendations you might propose to make sure

the change initiative could be accepted by staff?

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In this case, I would like to recommend some strategies to minimize resistance to
change and make it easier to be accepted by staff:

Communication:

This strategy is used when employees don’t feel an urgency for change, or don’t know
how the change will affect them.

In this case, the managers relied quite heavily on the informal communication process
as opposed to team briefing. Poor communication led to the staff's lack of understanding
and false feedback.

HIH needs to organize communication activities more carefully and comprehensively,

to make all employees understand their responsibilities, the benefits of the change as
well as to gather information about the mixed reactions in order to improve the process.

Learning:

We need to apply this strategy when employees need to break old routines and adopt
new role patterns.

250 people in HIH had to undertake a wider array of tasks and be required to embrace
flexibility and teamwork. Therefore, learning activity was a must. However, the training
didn’t seem to be very comprehensive. For example, many staff still couldn’t
understand the new work rota. They went up on the board, got confused and then voted
no for taking the task.

The managers need to hold more comprehensive training, focusing not only on guiding
employees to perform their technical tasks, but also on new methods of operation and
coordination so that they are not confused in the change process.

Stress management

This strategy is usually used when communication, training, and involvement do not
sufficiently ease employee worries.

There are many signs of stress in this case, such as: Absenteeism rates increased; some
nurses’ reports, porters’ complaints; men felt frustrated with gender issues and refused
to work,…

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Emotional investment in the change process should be more considerable. Managers
should let employees attend sessions to discuss their worries about the change as well as
hold bonding and rewarding activities to uplift their emotions.

Negotiation

When employees will clearly lose something of value from the change and would not
otherwise support the new conditions, then negotiation should be implemented.

In this case, HIH also faced an open and persistent disapproval of the extent of the
proposed changes from the UNISON. They even advised all its  members not to
facilitate its implementation as such a change would have negative impacts on them.

HIH has to pay more effort to negotiate with not only their staff but also the UNISON
as they have a significant impact on them. Some concessions can be made, such as
adjusting human resource policies, increasing salaries,… Meetings also need to be more
effectively facilitated, to avoid re-debating previously settled issues like HIH
encountered in this case.

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 REFERENCE

Johnson, G., Scholes, K. and WHITTINGTON, R., 2005. “Exploring corporate

strategy”. Harlow: Financial Times/Prentice Hall.

Tuckman, B. C. & Jensen, M. A. C., 1977. “Stages of small group development

revisited”, Group and Organisational Studies, pp 419-27, Vol. 2, no. 4.

Oreg, S., 2006. “Personality, context, and resistance to organizational change”.

European Journal of Work and Organizational Psychology, 15(1), pp.73-101.

McGraw Hill, 2021. “Organizational Behavior and Management”. 10th ed.

J.P. Kotter and L.A. Schlesinger, 1979. “Choosing Strategies for Change,” Harvard
Business Review 57”, pp. 106–14

P.R. Lawrence, “How to Deal With Resistance to Change,” Harvard Business Review,
May–June 1954, pp. 49–57.

UKEssays, 2018. “Concepts and Theories of Organizational Politics.”

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