Title page

Table of contents
Introduction
 Discussion
1. Provide a summary of your understanding of the change management issues
involved in the case.

Change management is described as a technique for leading individuals, teams, or

businesses through an attempt to change the status of the companies’ policies,
supplies, or operations (Cummings & Worley, 2009). The purpose of change
management is to reduce resistance to change and guarantee that the change is
executed effectively and consistently throughout time. Major components of change
management include communication, training, stakeholder participation, as well as
ongoing evaluation and tracking of progress. The study of Integrated Health’s
development of a computerized medication administration record (MAR) at Central
Hospital of Tempe reveals a variety of change management issues. Notwithstanding
implementation challenges, the MIS department at Central Hospital was the project’s
founder and director. It was understood that the MAR would be impossible to
establish and execute in a year, and nurses’ antagonism against the program was
evident when their recommendations and criticisms were dismissed without
explanation. Additionally, the MAR project was affected by a management “shakeup”
that occurred during the project development phase. The MAR system failed
immediately after installation, with customers complaining that it was too
sophisticated and did not operate. The MAR project was suspended when Central
Hospital’s computer system crashed.
In this context, the problems with change management include a lack of stakeholder
involvement and communication, inadequate project planning, and poor testing before
implementation (Ali, & Ivanov, S. 2015). The nurses’ antagonism against the
initiative may have been prevented if their opinions and recommendations had been
considered. The management “shakeup” during the project development stage might
have also delayed project progress, since new management might have been less
acquainted only with the project’s aims and objectives. Since there was insufficient
testing and planning before implementation, the project was cancelled, and the lack of
a contingency option made matters worse (Deming, 1992, 1994).

2. Examine the case using a change management model.

According to (Kritsonis, 2005), Lewin’s study has improved people’s understanding

of organizational change. The three-stage model of change views the situation in its
present form as the status quo and suggests a change process that advances through
three essential parts to the ideal future state: unfreezing, in which a time of thawing or
unfreezing is added to give participants time to adjust to their disposition to resist
change; transition, when the change is implemented and sufficient time is given for all
participants, including leaders, to adjust to the change; and, refreezing, as the change
is appropriately executed, the organization becomes more stable, and people begin to
“refreeze” into their new positions and situations.
 Unfreeze: In the first stage, based on Kate’s argument, the project manager in this
situation needs to analyze and consider where the MAR project went wrong. She
would need to reverse the programming after she has found the source of the problem.

Implement Change: In the second stage, following the undoing of the implementation,
Kate should determine what is truly required to implement MAR correctly. She must
listen to the advice given by the nurses who are working on the ground floor.

Refreeze: In the third stage, Kate needs to rewrite the programming and thoroughly
test it before putting it into use. Once the test has been completed, the full program
should be implemented. In this manner, she would be able to properly execute the
MAR.

3. Evaluate the importance of a change agent.

Change agents are individuals that promote renewal and development by including
people in the process. They assist individuals of a team or organization in analyzing
their circumstances and developing a plan to achieve the expected improvements.
According to (Massey & Willams, 2006) change agents are often disregarded
resources, and their perspectives are frequently overlooked in the study. Although, the
change agent may therefore serve as a data collector, sponsor, instructor, adviser, or
coach. The change agent is in charge of ensuring that the change process is in line
with the objectives and that participants are educated and inspired (Cameron & Green,
2009). The Central Hospital of Tempe’s Chief information Officer chose Kate Cohen
as the project leader for the establishment of Integrated Health’s computerized
Medication Administration Record (MAR). Kate was in charge of organizing and
executing the Central University MAR project. She collaborated with a team
representing Pharmaceutical Services, Nursing Services, and Internal Auditing to
develop a timeframe for implementation, gather opinions on the system, and offer
user training. However, the project encountered several issues despite their efforts.
Nurses’ hostility toward the project became clear after their suggestions and proposals
were unjustifiably rejected. Additionally, the MAR project was affected by a
management “shakeup” that occurred during the project development phase. When
the MAR was ultimately implemented, it immediately failed, leading users to protest
about how difficult the system was and physicians to worry about patient safety. Even
worse, as a result, the computer system crashed, putting an end to the project. In this
case, Kate was the change agent in charge of completing the Central Hospital MAR
project to a successful conclusion. A few traits are necessary for a successful change
agent, including the ability to create connections, communicate effectively, and
negotiate complex organizational structures. They must also be able to deal with
resistance to change and convince important people to approve of it.
In this instance, it seems that Kate may have found it difficult to deal with the nurses’
opposition and adapt to the changes resulting from the management “shakeup”. To
guarantee the success of the change effort, competent change agents should be able to
identify and address any barriers to change.
 In conclusion, the Integrated Health MAR project serves as an illustration of the
necessity of a change agent for an organizational transformation to be successful.
Effective change agents must be equipped with several critical competencies to deal
with resistance to change and convince investors to assist the initiative. Change
initiatives are typically successful or failed based on the change agent’s capacity to
guide and oversee the change process.

4. Discuss the resistance to change in the case and strategies that can be adopted to
reduce the resistance.

The main reason for resistance is a change methodology that excludes essential
stakeholders from the change process (Kilian M, 2003). Resistance to change is one
of the dimensions of an organization’s ability to change if it has followers who can be
trusted. Followers can either accept change or reject it. Successful change
management depends on followers and leaders having mutual respect for one another.
(Clayton, M. 2016).

According to (Olmstead, 2023) the case study of MAR implementation at Integrated

Health demonstrates the organization’s resistance to change. The following points
highlight the case’s resistance to change:

 Resistance to change is a normal reaction that arises when people or

organizations view a new system or process as risky. In the case study, nurses
opposed the MAR project after their ideas and proposals were turned down
without any justification.

 Resistance to change can result in a variety of reasons why people resist

change, including fear of losing their jobs, a lack of confidence in the system,
a lack of knowledge, or a lack of control. In the case study, nurses expressed
their concern that the MAR system’s implementation would result in them
losing control of patient care.

 Resistance to change can be lessened by communicating clearly, by involving

the stakeholders, providing training, and receiving support. In the case study,
it was possible to reduce the nurses’ resistance by including them in the
project development phase and by giving them the necessary support and
training.

 For implementation to be successful, departments must work together. A team

from Nursing services, Pharmacy services, and Internal Auditing came
together to work on the project in the case study, but there was a breakdown in
communication.
  One way to avoid resistance to change would be by involving the members of
staff in decision-making and by promoting participation. Resistance occurred
in the case study because of one of the nurses’ recommendations and
suggestions being disregarded.

 To effectively handle resistance to change, one must be patient, persistent, and

flexible. Change agents must be prepared to adapt to the environment’s
shifting conditions because resistance is not a problem that will go away
overnight. The case study’s project failed because the management and project
team lacked flexibility.

Strategies that can be adopted to reduce the resistance are:

 Communication: Before implementing the MAR system, the MIS division
should have informed the nurses of its advantages. For example, they could
have explained to the nurses how the system would help to minimize errors,
increase productivity, and ultimately improve the safety of their patients.
When speaking with the staff, a mutual decision could have been made
regarding the schedule and general strategy to be utilized for managing and
implementing a new change.

 Participation involvement: Both doctors and nurses should have been

involved in the design and implementation of the MAR system. For example,
the MIS department could have assembled a multidisciplinary team
comprising of nurses, doctors, and other stakeholders to receive their input on
the design of the system. By doing this they would have made the most
essential team members feel like they were a part of the project, by having
them be involved in the change management and implementation process.

 Education and training: Before the MAR system was implemented, the MIS
division should have provided the nurses with training and educated them on
the MAR system. For example, they could have held workshops to teach the
nurses how to use the system properly. The top priority should have been to
inform the teams about how the new change would directly improve their lives
and day-to-day activities. Also, ongoing training should have been offered to
make sure that they felt confident and at ease in navigating the new change.

 Clear communication of expectations: Prior to launching the system, the

MIS division could have given the nurses a clear understanding of what to
expect from it use. Keeping employees informed of status quo changes as soon
as possible promotes communication between management and staff. They
could have, in addition, explained to the nurses what specific tasks they would
need to carry out with the MAR system and what results they could anticipate.
  Feedback mechanism: To get input on the performance of the MAR system
from nurses and doctors, the MIS department could have established a
feedback system. For instance, they could have surveyed the stakeholders or
held focus groups to get their opinions. By finding out how the team felt about
the change by conducting surveys with them and demonstrating to them how
they could have simplified the process.

 Leadership support: The hospital management could have provided

leadership support for the MIS department’s implementation of the MAR
system. For example, the Chief Information Officer could have provided
resources, change management tools, knowledge bases, and training on the
newly implemented procedure or tool to the hospital’s leadership to help them
understand the significance of the system. This would have made it easier for
the staff to quickly see the value in a new system, thereby earning their trust
and gaining their support for its implementation.

5. Evaluate the importance of trustworthy leadership and trusting followers in

managing change in the case.

According to (Judge, 2012) trustworthy leadership is defined as being skilled and kind
in such a way that followers feel secure collaborating with that leader. The capacity of
non-executive individuals to respectfully disagree with and/or voluntarily pursue a
new approach proposed by its top executives is referred to as trustworthy followers
(Judge, W.Q. and Douglas, T., 2009). Trustworthy leadership and trustworthy
followers are designed to create the highest possible level of trust in the organization
and are critical components for effective change management (Ramezan, Ebrahim
Sanjaghi, M., & Rahimian Kalateh Baly, H. 2013).

The following points highlight the importance of trustworthy leadership and trusting
followers:

 Trust in leadership: Leadership requires skill and as such this skill can be
developed over a period of time. It is impossible to develop into a trustworthy
leader without prior experience guiding others through change initiatives
(McCall, Lombardo, & Morrison, 1988). Therefore, anything that an
organization can do to quicken and strengthen the managerial staff’s capacity
for leadership will pay off in the long run by strengthening the organization’s
ability to adapt to change (Tichy and Cohen, 1997). The followers must trust
the leaders for them to successfully implement change. Change may be
resisted by the followers if the leadership is not viewed as trustworthy. Kate
Cohen was chosen to be the project leader in this instance, and the success of
the MAR project depended heavily on her capacity to effectively lead and
manage change.
  Communication and transparency: The goals of leadership and
communication are to make the rest of the organization aware of what the
leader plans to do and to persuade them that resisting change is not a good
idea. Allowing for the expression of concern, doubts, and fears, the discussion
of alternative points of view, and the articulation of challenges to the vision
are all necessary for developing the relationship between a leader and their
followers. Effective communication with followers is a requirement for
trustworthy leadership. Rejection of nurses’ suggestions and recommendations
without justification in the case of Integrated Health resulted in resentment
and opposition to the project MAR. It would have been more effective to
reduce resistance and boost trust in leadership if there had been clear
communication and justification of decisions.

 Active participation and involvement: Trust is critical for effective change

management, as well as active participation. To foster trust between leaders
and followers, leaders must show that they have faith in them. Without trust,
followers might not feel valued or able to fully commit to the change because
they won’t feel empowered. It seems that the management “shakeup” in the
case of Integrated Health resulted in a lack of trust between the leadership and
the followers. The MAR project probably would not have been successful due
to this lack of trust.

 Empowerment and recognition: are also essential for effective change

management. Followers are empowered to be innovative and show initiative in
one’s jobs, and recognition allows them to feel valued and appreciated for
their achievements. In the context of Integrated Health, it seems that Kate
Cohen did not encourage or appreciate her staff members, which likely
resulted in their anger and hostility.

6. Discuss the importance of culture in case.

Culture is defined by (Hofstede, 2011) as the “common mental programming that

separates participants of a group or class of people from others.” Culture has a major
effect on the success or failure of any organizational change program, especially in
healthcare. The culture at Integrated Health was not considered when establishing the
computerized medication administration record (MAR) system in the case study, thus
eventually contributing toward its downfall.

The importance of culture in case shows:

 Organizational culture: highlights the significance of collaboration as a

major sign of a supportive organizational culture and as a significant
component that contributes to the achievement of organizational change
(Braithwaite J, Herkes J, Ludlow K, Testa L, Lamprell G, 2017). By creating a
 culture of teamwork among all members of the hospital staff with shared
beliefs of collaboration and cooperation will affect their levels of engagement
and participation in the collective decision making during a change initiative.
(Hung D, 2017). At Integrated Health, the organizational culture was not one
that was conducive to change. Integrated Health lacked a culture of continuous
improvement, which is critical for any new system or process to be
implemented successfully.

 Communication: This may assist with communication and how informed

staff feels about the change initiative, both of which are important factors in
successful organizational change. When it comes to the distribution of change
information to increase staff awareness and support during organizational
change, change management communication is seen as a key component.
According to (McKay K, Kuntz JR, Näswall K, 2006), good communication
can help staff members feel less anxious and fearful about the change as well
as more confident in their ability to adapt to it. For any organizational change
effort to be successful, effective communication is essential. At Integrated
Health, the nursing staff and the project team were unable to communicate
effectively. The concerns and recommendations of the nurses were not taken
into consideration, and they did not receive sufficient training on the new
system. The nursing staff became frustrated and confused as a result of the
lack of training and communication, which ultimately contributed to the
failure of the MAR system.

 Management style: in a workplace is highly dependent on an individua

leadership skills, which can be influenced by culture. The management
shakeup resulted in a significant impact on the project’s success during the
project development phase. The culture of the organization frequently changes
as a result of management changes, and this can have a significant impact on
whether any change effort is successful or not.

 Resistance to change: is reasonable given that it increases workloads for

workers and requires them to learn something new, which temporarily shakes
their confidence. After their ideas and recommendations were turned down
without justification, nurses’ hostility toward the project became clear. The
nursing staff was excluded from decision-making, and their issues/concerns
were not sufficiently considered. Lack of consultation with employees and
their involvement in the implementation process led to resistance to change.

7. Discuss the importance of assessment tools in the situation presented.

An assessment tool is a technique or instrument used with the intention of collecting
data for numerous reasons such as evaluating and measuring the outcomes in terms of
the learning process, educational needs, and skill acquisition of the students (Kiliç, A.
& Taptik, Ì. Y.,2020). They also help in determining the resources needed for
successful implementation and developing an implementation plan that meets the
needs of all stakeholders.

An assessment tool is a method or device used with the objective of gathering data for
a variety of reasons, such as assessing and measuring the issues in terms of the
learning process, educational needs, and student skill acquisition (Kiliç, A. & Taptik,
Ì. Y.,2020). They assist in creating an implementation plan that satisfies the demands
of stakeholders as well as identifying the resources required for successful
implementation.

The importance of assessment tools in the situation presented are:

 Risk assessment: can significantly lower the likelihood of work-related

incidents. They help employers find options to reduce health and safety risks
by increasing awareness of hazards and the risks they pose. Finding potential
risks connected to the implementation of the MAR system would have
benefited from the use of a risk assessment tool. This would have involved
figuring out the possible effects on patient safety, as stated by doctors, as well
as the dangers connected with a system failure, like the computer system
crash.

 User feedback: this is an essential and fundamental component of any tool for
workplace assessments. User feedback is most effective when it takes the form
of a development discussion where both parties assess performance, pinpoint
emerging needs, consider the best way to meet these needs, and establish
improvement objectives (McKimm & Forrest, 2011). It would have been an
important evaluation tool for the MAR system during its development and
implementation stage. It would have made it easier to pinpoint user issues and
suggestions for system enhancement. The unjustified denial of the nurses’
suggestions highlights how crucial user inputs is to the system’s success.

 Communication and engagement strategies: The organization’s overall

strategy is supported by the communication and engagement strategy, which
outlines the goals and objectives for these two areas. To ensure that all
stakeholders were informed and involved during the implementation process,
communication and engagement strategies could have been developed using
assessment tools.

 Readiness assessment: The readiness assessment can assist in determining

the organization’s ability for change as well as the materials needed for its
implementation. A readiness assessment tool would have aided in establishing
whether the organization was ready to adopt the MAR system (Schibi & Lee,
2015). It could have been used to determine potential obstacles, such as
nurses’ opposition to the project, and to evaluate the technical framework of
the company to make sure it could support the MAR system.
  Stakeholder analysis: Identifies details on key stakeholders who may be
useful in obtaining the necessary data and who may be crucial in formulating
and carrying out the development vision. It helps to locate and involve
stakeholders who will be impacted by the new system. This assessment might
have helped in identifying the needs and concerns of nurses and other
stakeholders, as well as in coming up with solutions to address them.

Conclusion
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