Chapter 2

THE CHALLENGE OF CHANGE

Objectives 1. Identify the impact of change on organizational

life. 2. Identify the managers role as change agent. 3. Review examples of successful change. 4. Examine a major change having ongoing impact. 5. Describe the organizational change process. 6. Identify specific strategies for dealing with

resistance to change.

The Impact of Change

consumes financial and administrative resources

drains emotional and physical energy away from primary goals

adds a new function to managers role: change agent

Attributes of the Successful Manager

Communication Leadership Adaptability Relationship Building Develops Others Develops Themselves Observation and Awareness

As a Manager: OBSERVE

Successful managers: Are aware of the skills of their employees Know in advance who might resist change Maintain an Open Door policy to the staff

A successful manager observes the team without it being obvious.

Change: Everybody has an opinion..

The Change Curve

The Change Process for the Organization

The Change Process for Managers

The Change Process for Employees

The pyramid components depicted here must be established well in advance of a change project.

Employee Expectations

The Manager as Change Agent mediates imposed change by adjusting patterns of

practice, staffing, and administrative routines monitors horizon events through active

assessment of trends creates a change-ready environment takes the lead in accepting change

Gripes go up the chain of command!

Examples of Successful Change Y2K: change as opportunity Patient Self Determination Act of 1990 (PSDA) HIPAA: extensive change due to legislation Electronic health record: proactive change Economic and market forces: anticipatory

readiness restructuring Disruption in personal circumstances:

revitalization through career development

Change as Opportunity: Y2K

1. Carefully define the characteristics of the anticipated change

2. Compare approaches 3. Use the opportunity to make a major change

(new systems) all at once 4. Use the opportunity to assess and update

related plans

Change as Opportunity: Y2K Characteristics of this event: A definitive event with an exact timetable Given significant time to plan for Some unknowns and uncertainty with clearly

known technical dilemmas Funding for preparation readily available for

organizational survival (not stated in text) Catalyst in overall emergency preparedness and

disaster planning for healthcare institutions

The Routinization of Change: Patient Self Discrimination Act

outreach to educate re: living wills review and update DNR and related protocols review plan of care re: balance of life admission increase emphasis on spiritual and psychological considerations renew involvement of the Ethics Committee augment documentation and related administrative processes to

reflect the details of this sequence of care

**The changes stemming from this law were easily managed through systematic review and adjustment of existing, well established routines.**

HIPAA (1996): Extensive Change via Legislation

Major aspects: employee health insurance portability promote medical savings accounts set standards for covering long-term care administrative simplification, including privacy

** The initial intent of HIPAA was to enable workers to change jobs without fear of losing healthcare coverage.**

Title II of HIPAA: Administrative Simplification

Focus on the Privacy Rule An unanticipated, massive change

new policies and procedures re: patient information

training programs for all employees re: privacy

monitoring programs for compliance

Title II of HIPAA (contd)

maintaining documented proof of compliance setting up trust agreements with suppliers, etc. addressing physical layout to ensure privacy establishing position of Privacy Officer

** The term administrative simplification is misleading because it included several requirements designated for implementation at different times. The effects that HIPAA had on the healthcare industry were much more pronounced than initially anticipated.**

The Electronic Health Record: Proactive Change

a welcome change to enhance existing documentation practices

a change flowing from emerging technology an opportunity to link ongoing vision and

mission to new technology an opportunity for leadership

EHR: Five-Fold Strategy

1. individual initiative within the work place. 2. advocacy in the public arena 3. partnership with key stakeholders 4. outreach to clients/patients 5. continual adjustments to the information

system

Individual Workplace Initiative continual adoption of new technology gradual conversion of workflow and processes internal administrative systems as building

blocks for expansion of computerized systems to include the electronic

health record ** Workflow and processes have been gradually converted over time to automated systems.**

Advocacy in the Public Arena

Contribute professional knowledge to the debate

Assist lawmakers and regulatory agency officials with technical detail

Participate in work groups and task forces re: the issues

Partnership with Key Stakeholders

American Health Information Management Association

American Health Information Community (DHHS)

American Medical Informatics Association Medical Group Management Association National Library of Medicine Corporate Partner Industry Briefing

Outreach to Clients/Patients AHIMAs Community Education Campaign public

awareness AHIMA-created presentations at local level

Consumers are an important partner in the effective use of the electronic health record. Raising public awareness is important in establishing trust in the process of revealing personal information fully and truthfully during healthcare interactions

Health Information Exchanges

LIPIX / Healthix As a Regional Health Information Organization, or RHIO, provide technology and consulting services that connect health care providers and patients. With the patients consent, help medical care teams securely share records across organizations, making patient information available wherever and whenever its needed. https://services.lipixportal.org/HealthixPortal/

Getting back to the Challenge of Change.

Economic and Market Forces (preparing the organization to survive and thrive)

Anticipatory readiness through organizational restructuring emerging from hibernation (restructuring) anticipated changes in state law and

regulation reconfiguration of services being offered

The Individual: Revitalization Through Career Development

example of major change in personal circumstances

assessment of job prospects utilization of resources for career assessment additional formal study additional career experience

** Lifelong Learning**

Sources of Change

Management turnover Product or service lines added, dropped, or

altered Introduction of new technology Job restructuring Methods and procedures updated Organizational policies

Resistance To Change

Change is the only constant in life.- Heraclitus

Resistance To Change

Change is inevitable (for better or worse) Change can be chaotic and painful Change has the power to confuse and frustrate People expect constancy (Human nature) People strive to reach and maintain

equilibrium with their surroundings People equate security with constancy

Resistance to Change

Addressing Resistance with Employees

Tell them what to do (rarely successful) Convince them of what must be done

(always possible) Involve them in determining the nature of

the change (ideal, but not always possible)

Managing Resistance to Change

Five points for managing resistance: Do change management right the first time Expect it Address it formally Identify the root causes Engage the right resistance managers (this is

typically senior leadership of the organization.)

Consider the following change management activities:

Utilize a structured change management approach from the initiation of the project

Active and visible participation by senior leaders Advocacy by management levels including

middle managers and front-line supervisors Communications that describe the need for

change, the impact on employees and the benefits to the employee (answering "What's in it for me?)

Guidelines for Effective Management of Change

Plan thoroughly Communicate fully Convince employees Involve employees when possible Monitor implementation

Guidelines for Effective Management of Change

Plan thoroughly

Fully evaluate the potential change and examine all implications of its potential impact on the department and the organization.

Guidelines for Effective Management of Change

Communicate fully

Completely communicate the change, starting early, ensuring that the employees are not taken by surprise.

Guidelines for Effective Management of Change

Convince employees

Take steps to sell employees on the value and benefits of the proposed change.

This can be a difficult step when personnel downsizing is part of the change plan.

Guidelines for Effective Management of Change

Involve employees when possible

!Be aware of the value of employees as a source of job knowledge, and tap this source not only for the acceptance of change but for the development of improvements.

!Build teams of employees to help plan for change, implement change, and monitor change.

Guidelines for Effective Management of Change

Monitor implementation

!Monitor the implementation of change until it is established as part of the excepted work pattern.

!Initial enthusiasm often wears off and old habits return. New resistance may arise at this point.

A New and Current Challenge

The Patient Protections and Affordable Care Act of 2010

The Patient Protections and Affordable Care Act of 2010

major change affecting all levels of health care

gradual implementation over several years

necessity for having a process to monitor the facts

Tracking Changes Implementing PPACA

impact on the organizational setting patterns of care developments changes in practitioners roles effect on clients needs of employees systems impact

Take a break..

And then it is your turn.

Return in 15 minutes Please sit with your team!

Activity & Class Discussion (a real-world scenario)

You are an administrative staff specialist newly employed by the hospital to act as a management engineer and address a number of issues relating to operating efficiency. Your first assignment is to analyze work methods and staffing in the central sterile supply division of materials management. The department was singled out for study because:

Activity & Class Discussion (a real-world scenario)

The manager, a registered nurse who has held the job for more than 25 years, has requested two more processing aides although her staff is already one person larger than that of another area hospital of equivalent size.

There has been a recent, seemingly unexplainable, upturn in the consumption of disposables.

A number of storage shelves appear to be stocked to overflowing with infrequently used items.

The department issues frequent rush orders to obtain needed items that have completely run out.

Activity & Class Discussion (a real-world scenario)

On your initial visit to the department the first thing the manager says to you is: So youre the one whos going to tell us what were doing wrong? Her tone is none too friendly. Instructions:

Develop a proposed approach to a complete study of the department, including the sales pitch you would use to try winning the managers cooperation and support, specifying what should be done, why it should be done, and how you propose to address the inevitable resistance of both manager and staff.