Managing change in healthcare using action research,tibetan buddhism nj,power of purity meditation download - Test Out

18.04.2014
Rob Drewniak is vice president, strategic and advisory services, for Hayes Management Consulting.
Trollbeater: Seriously, 75% adoption of PHRs, patient portal use, whatever you want to call it by 2020? No matter how well designed and planned your change program is, not everyone will be singing its praises. Employees resist change for a wide variety of reasons, ranging from a straightforward intellectual disagreement over facts to deep-seated psychological prejudices.
Typically, they may experience an initial denial, then begin to realize that the change cannot be ignored.
If you identify and manage resistance to change poorly, you can very quickly strangle your change program or, alternatively, slowly and unnoticeably starve it to death. Change recipients who are dead against the change will either resist overtly, voicing their objections loudly and often, or covertly. Followers range from those that are generally compliant, wishing to take the path of least resistance, to those that are initially reticent to adapt, but eventually do so once they accept the inevitability of the change. Change recipients working for the underground have solid motivations for not making their resistance public.
Our comprehensive guide and workbook, Managing Change in the Workplace, will show you how to construct a Force Field analysis diagram and go on to develop a strategy for dealing with resistance. Treating the forces against change is a more productive use of resources than simply reinforcing the forces for change. Think of how you could apply the drivers for change you identified in your analysis to either weakening or eliminating an opposing force. Get customers or suppliers to explain to change resisters face to face how the current situation disadvantages them in concrete terms. Put resisters on teams that allow them to play some decision-making part in the change process, however small. Defuse political power plays amongst managers and other employees by conducting broad-based meetings where goals and tactics are openly discussed and introduce processes that leave little room for individual discretion.
One of the most useful frameworks in this area is the three-stage model of planned change developed in the 1950s by psychologist Kurt Lewin.[327] This model assumes that change will encounter resistance. Do people know what the change entails, or are they hearing about the planned changes through the grapevine or office gossip? Ensuring that top management communicates with employees about the upcoming changes also has symbolic value.[330] When top management and the company CEO discuss the importance of the changes in meetings, employees are provided with a reason to trust that this change is a strategic initiative. To convince people that change is needed, the change leader does not necessarily have to convince every person individually. Studies show that employees who participate in planning change efforts tend to have more positive opinions about the change. During a change effort, if the organization can create a history of small wins, change acceptance will be more likely.[336] If the change is large in scope and the payoff is a long time away, employees may not realize change is occurring during the transformation period. After the change is implemented, the long-term success of a change effort depends on the extent to which the change becomes part of the companya€™s culture. To make change permanent, the organization may benefit from sharing the results of the change effort with employees. To ensure that change becomes permanent, organizations may benefit from rewarding those who embrace the change effort (an aspect of the controlling function). While Lewina€™s three-stage model offers many useful insights into the process of implementing change, it views each organizational change as an episode with a beginning, middle, and end. Effective change effort can be conceptualized as a three-step process in which employees are first prepared for change, then change is implemented, and finally the new behavioral patterns become permanent. Imagine that you are introducing a new system to college students where they would have to use a special ID number you create for them for activities such as logging on to campus computers or using library resources. Health care organization leaders are working hard to create, update and continuously improve on their processes to align with the Triple Aim initiative (see Figure 1. Health care organizations are investing in continuous process improvements to align with the Triple Aim model, so a relevant project management methodology like Agile can potentially maximize new process benefits and return on investment. The framework has proven successful in software development, especially for situations in which a Product Manager and the Agile team use this iterative methodology to discover the solution. Following is a best practice model for prototyping a process improvement project using Agile (see Figure 2.) .
Prototype process engineering paired with Agile helps to quickly confirm incremental requirements, benefits, and deliverables. In summary, health care organizations may want to consider using Agile to organize and control their process re-engineering initiatives.
I have found that there are five areas of focus for successful change management: communication, sponsorship, coaching, education, and understanding resistance. Understanding resistance helps deflect the defensiveness around change, which facilitates moving ahead. These five components should be part of any change and should be an everyday theme for the organization. Kaplan is attorney with more than 25 years experience in commercial litigation, business transactions, and dispute resolution. Kaplan is a Partner in the Pittsburgh firm of DeForest Koscelnik Yokitis Kaplan & Berardinelli and he teaches as a Professorial Lecturer in Law at The George Washington University Law School in Washington, D.C. Kaplan's legal practice focuses on information technology (“IT”), intellectual property licensing, e-commerce, antitrust, competition law, and commercial litigation.
Adding to this complexity is the fact that sometimes the stated reason hides the real, more deeply personal reason. Covert resisters operate from the underground, masking their defiance, but posing you a much more serious challenge. They may agree dispassionately that the change will be of benefit to the organization, or they may stand to receive some personal gain from the change, such as a guarantee of job security, more status or a higher salary. They may disrupt meetings, not attend training, take unapproved leave and refuse to carry out instructions. They may fear direct punishment, such as termination or fines, or more personal costs, such as ridicule or loss of status and authority.
One thing you can do in managing resistance is work with your key employees to construct a Force Field analysis diagram using Kurt Lewin's Force Field Analysis technique.


Choose the most powerful of the restraining forces and devote time and energy to weakening these. Appeal to them either in terms of personal gain (such as status, salary bonus, recognition, and so on) or loss avoided (such as financial loss or job outplacement prevented). Our guide and workbook feature a variety of tools, techniques and tips for ensuring that your change initiative delivers on its promises. When employees are not prepared, they are more likely to resist the change effort and less likely to function effectively under the new system. When employees know what is going to happen, when, and why, they may feel more comfortable. For example, while changing the employee performance appraisal system, the CEO of Kimberly Clark made sure to mention the new system in all meetings with employees, indicating that the change was supported by the CEO. If employees feel their company is doing well, the perceived need for change will be smaller. In fact, peoplea€™s opinions toward change are affected by opinion leaders or those people who have a strong influence over the behaviors and attitudes of others.[332] Instead of trying to get everyone on board at the same time, it may be more useful to convince and prepare the opinion leaders. Therefore, management may prepare employees for change by providing emotional and instrumental support. At this stage, the organization implements the planned changes on technology, structure, culture, or procedures.
They may make mistakes more often or experience uncertainty about their new responsibilities or job descriptions.
However, if people see changes, improvements, and successes along the way, they will be inspired and motivated to continue the change effort. There may be key people who publicly support the change effort while silently undermining the planned changes. If the change has been successful, the revised ways of thinking, behaving, and performing should become routine.
In contrast with this episodic change assumption, some management experts in the 1990s began to propose that change isa€”or ought to bea€”a continuous process.
By setting up a dynamic feedback loop, learning can become a regular part of daily operations.
According to emerging contemporary views, it can also be seen as a continuous process that affirms the organic, ever-evolving nature of an organization. Triple Aim Model). Their top priorities include providing appropriate levels of patient care and patient care quality, as well as learning about patient and health plan member populations and optimizing costs for health care delivery. Agile offers an effective framework to organize and control process improvement projects, especially when paired with a prototype re-engineering approach. Agile’s software industry-based heritage differentiates it from Lean, which originated in the manufacturing industry. Likewise, Agile can be adapted to operational or clinical process improvement projects in health care. We recommend using an impact map to visualize the goal and stakeholders, how stakeholders’ work will be affected by process changes, and what is changing (at least at a high level).
When you believe or suspect there may be a number of scope changes for unknown areas of the solution. The team needs to function at a high level, and thus requires experienced team members with high levels of demonstrated professionalism.
Prototyping a new or significantly altered process is an effective way to discover optimal functions, procedures, and role responsibilities in order to maximize process goal attainment.
Incremental delivery can be an excellent strategy for calibrating and managing the change impact on your organization while effectively managing your project budget. This Agile framework is presented as an adaptive methodology that situates the Product Manager, Sponsor and the team to co-discover and elaborate processes and their requirements in situations where this work has significant ambiguity.
If you use the words “modify,” “improve” or “alter,” it does not create the same stress level.
To communicate well, healthcare leaders and project managers should create a communication plan with milestones and a timeline. If there is not strong leadership behind the change, resistance will keep it from happening. You will also need to recognize that people work through a psychological change process as they give up the old and come to either embrace or reject the new.
Finally, the person accepts the change either negatively, with feelings of resignation and complacency, or positively, with renewed enthusiasm to capitalize on the changes.
Enthusiasts will use opportunities to broadcast approval for the change and will try to convince others of its merits. Objectors will continue to use superseded systems and processes when others are taking up the new ways of doing things. Managers who are against the change but need to be seen to be in support of it are prime candidates for promoting underground resistance.
In these situations, it is important to remain fair and ethical while laying off otherwise exceptional employees. Instead, organizations should start with unfreezingunfreezingMaking sure that organizational members are ready for and receptive to change., or making sure that organizational members are ready for and receptive to change. Those who plan the change will need to make the case that there is an external or internal threat to the organizationa€™s competitiveness, reputation, or sometimes even its survival and that failure to act will have undesirable consequences.
Understanding onea€™s own social networks as well as the networks of others in the organization can help managers identify opinion leaders.
Emotional support may be in the form of frequently discussing the changes, encouraging employees to voice their concerns, and simply expressing confidence in employeesa€™ ability to perform effectively under the new system. Management has an important role in helping employees cope with this stress by displaying support, patience, and continuing to provide support to employees even after the change is complete. For this reason, breaking up the proposed change into phases may be a good idea because it creates smaller targets.
To evaluate and reinforce (a€?refreezea€?) the change, there are a number of things management can do.
The simple act of recognizing those who are giving support to the change effort in front of their peers may encourage others to get on board.
If an employee implements a new method or technology that seems to be successful, a learning organization is in a good position to adopt it.


Since these priorities are so focused on process efficiencies and patient health management outcomes, health care leaders are learning from and implementing Lean methodologies, which focus on understanding and improving customer value.
Thus, agile project management is an approach that leverages this iterative model to define and control the project work.
The process components that the team develops are validated by the sponsor in the end-of-iteration reviews. Since the sponsor defines an iteration’s work, the work is planned within a two- to four-week iteration and subsequent iterations.
Many studies have shown that Agile has the potential to deliver value in conditions of solution uncertainty much faster than traditional project management. Unlike with software development teams, in healthcare there is likely no one who is coaching the team on Agile practices, such as defining work in iterations.
Agile enables the project team to deliver value to the business early in the project’s lifecycle thus increasing the ROI of the project investment.
Many of our clients have been successful using tools such as town hall sessions, newsletters, e-mails, social media, etc. It is effective to have senior leadership coach management, who can then coach their staff members.
While it is important to provide functional knowledge transfer, it is also important to talk about change management coping techniques. People are used to doing their job one way and are concerned about how the change will impact their work and their experience of work. Yet as trust is established and change is experienced as making things better, more people will become change agents. They are not averse to arguing with managers and fellow workers and will try to convince others to continue with the old ways. Once change has occurred, it is vital to take any steps necessary to reinforce the new system.
This is followed by changechangeExecuting the planned changes., or executing the planned changes.
For example, Lou Gerstner, the former CEO of IBM, executed a successful transformation of the company in the early 1990s. Once these individuals agree that the proposed change is needed and will be useful, they will become helpful allies in ensuring that the rest of the organization is ready for change.[333] For example, when Paul Pressler became the CEO of Gap Inc. Instrumental support may be in the form of providing a training program to employees so that they know how to function under the new system.
Small wins are also important for planners of change to make the point that their idea is on the right track. It is the managementa€™s job to identify, understand, and remove these obstacles.[338] Ideally, these obstacles would have been eliminated before implementing the change, but sometimes unexpected roadblocks emerge as change is under way.
By constantly being aware of how employee actions and outcomes affect others as well as overall company productivity, the inevitable small changes throughout organizations can be rapidly absorbed and tailored for daily operations. This is where a subject matter lead role, sponsor, or even project manager will need to lead. It is imperative that as management, we become positive change agents so that our staff members receive the direction that they need. These activities build trust and acceptance of change, predominantly because they facilitate the behavior change. For example, it is important to let staff know the reason that the change is happening and what is in it for them. A healthcare organization’s ability to flex and adapt to change will become a competitive advantage as well.
Kaplan practiced at Reed Smith, LLP, which he joined after serving as the Director of the Trade Remedy Assistance Office of the U.S. These early adopters may also make good choices as trainers and coaches during the implementation process. Finally, refreezingrefreezingEnsuring that change becomes permanent and the new habits, rules, or procedures become the norm. In his biography Elephants Can Dance, Gerstner highlights how he achieved cooperation as follows: a€?Our greatest ally in shaking loose the past was IBMa€™s eminent collapse.
Effective leadership and motivation skills can assist managers to provide support to employees. They will be more knowledgeable about the reasons for change, alternatives to the proposed changes, and why the chosen alternative was better than the others.
When an organization understands that change does indeed occur constantly, it will be in a better position to make use of good changes and intervene if a change seems detrimental. The effects of transformational and change leadership on employeesa€™ commitment to a change: A multilevel study.
When people know ahead of time (again, try to eliminate any surprises), there will be less resistance than if it is forced into place in a hurry. Rather than go with the usual impulse to put on a happy face, I decided to keep the crisis front and center. For this purpose, employees were segmented instead of trying to reach out to all employees at the same time. Finally, they will feel a sense of ownership of the planned change and are more likely to be on board.[335] Participation may be more useful if it starts at earlier stages, preferably while the problem is still being diagnosed. Sharing concrete results with employees increases their confidence that the implemented change was a right decision.
One way of convincing employees that there is a problem that needs to be solved would be to ask them to take customer calls about the product quality. Also, develop appropriate committees and messengers that can communicate to the organization at different and varying levels.
Once employees experience the problem firsthand, they will be more motivated to solve the problem.



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