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Final Paper

Organizational Change: The Deployment of a New Clinical Platform

NGR5720 Organizational Dynamics

Dr. Sandy Swearingen

Katrina General, RN, BSN

Spring 2015

Organizational Change: The Deployment of a New Clinical Platform

. Introduction

According to Nelson & Quick (2013), organizational change is defined as the transformation or modification of an organization and/or its stakeholders. It is stated that change in organizations is inevitable. However, employees often resist change. People resist change for a variety of reasons. Often times, change is resisted because of fear of the unknown or the fear of failure. Recently, a health solutions company underwent organizational change. A new clinical platform was deployed for use by all clinical staff. There has been ongoing resistance to this change by the staff, which has led to job dissatisfaction, poor morale, and loss of staff. The purpose of this paper is to analyze the issues associated with this change, as it pertains to staff attitude and performance, as well as offer recommendations for improvement moving forward.

Background

This organization employs a variety of clinical staff. The staff includes physicians, nurses, and pharmacists. The nurses are employed into different roles and perform a variety of tasks. Some of those tasks are: Pre-Service Medical Review, Post-Service Medical Review, Case Management, Disease Management, Provider Appeals, Member Appeals, etc. It was identified that different organizational systems were being utilized according to the different roles, which caused a disconnect within the organization. The fact that the different staff was using a variety of systems for the same patient also led to inconsistency. Therefore, it was determined that there was a need for a new clinical care platform. The platform was to serve as one organizational system to be used by all clinical staff. The goal of the platform was to be patient-centered, as well as offer a platform where all clinical staff would have access and be able to view patient information consistently across the organization. Ultimately, the platform was to eliminate the numerous systems which were being utilized and basically it was intended to serve as a one-stop shop for all clinical areas.

Description of Issue

Despite the intent, the deployment of the new clinical care platform did not go as planned. Much of the staff proved to not be properly prepared for the change. There were also numerous defects associated with the system. The system did not properly accommodate all of the clinical staff as intended. The system also did not eliminate the need to utilize all of the other systems as promised. It lacked many of the features which were discussed as being needed. It was also difficult to operate. Many staff members complained about the slowness of the system. They stated it would “clock” for extended periods of time. It would not produce reports as needed. Some staff members even complained about being “kicked out of the system” repeatedly.

These factors led to an approximately 30% decrease in productivity. Members and providers were not getting their inquiries answered in a timely manner. There was also a delay in getting authorizations issued for medically necessary healthcare services. This led not only to staff dissatisfaction, but also patient and physician dissatisfaction. The ongoing issues with the new platform have dramatically increased the work inventory. As an attempt to address the backlog, staff has been mandated to work overtime. The majority of the clinical staff are salary-based employees. Therefore, the employees do not receive additional compensation for working overtime hours. All of these factors have led to poor morale, and loss of staff.

Analysis of Issue

In analyzing the issue, there are several factors to consider. First off, who was involved in the choosing of the vendor who would deliver the platform? Ideally, key players from all clinical areas should have been involved to ensure that the system was capable of addressing the diverse needs of the different areas. Next, there is the issue of testing the system. Prior to deployment, vigorous testing was needed to ensure the system was properly working. Adequate testing could have identified some of the defects and performance gaps within the system. Another major issue was training; the staff was trained months before the system was deployed. Many complained of “forgetting” what they learned in training. Other complaints about the training were that: it was unrealistic; it was not tailored to the specific job roles; and the training was conducted by the vendor who did not know the inner-workings of the organization, etc.

As a result of these factors, there has been major resistance to the change. Ultimately, the staff feels left out of the decision-making process, underprepared, and overworked. They feel as if they do not have a voice. Their autonomy has been threatened. As previously mentioned, this change has led to staff dissatisfaction and poor morale. As a way to avoid the change, some staff members even resorted to leaving the organization which has created additional burden and feelings of anger among the remaining staff.

In an article by Bönigk & Steffgen (2013), it is discussed how anger is likely to play an important role in the change process for several reasons: (1) changing tasks and processes frustrate individual goals; (2) lack of support; (3) higher work load; and (4) endangered social relationships. In analyzing the issues associated with the organizational change, all of these reasons appear to be valid. Individual goals have been frustrated. As a result of the defects and work-arounds associated with the new system, many employees are unable to meet their productivity goals. The managers are also under stress. Therefore, there has been a lack of support. Instead of addressing the anger and dissatisfaction, employees are being denied time off and being mandated to work overtime. The associated loss of staff has left the remaining staff with higher workloads and endangered social relationships.

Several staff members have asked to “go back to the old way of doing things.” But because of the financial investment, contractual obligations, etc., not moving forward with the new platform is not an option. So, what now? How to make improvements moving forward?

Recommendations

Armbruster, Moran & Beitsch (2013) stated that “experienced leaders know that organizational change is a traumatic ordeal for any organization and its employees.” Resistance is an integral part of the change process. Therefore, plans for change should anticipate and manage resistance. With that, recommendations must be made for how this organization can move beyond the resistance and successfully adapt to the change.

Identify Change Resistance

Nelson & Quick (2013) states that people show four basic, identifiable reactions to change: disengagement, disidentification, disenchantment, and disorientation. Disengagement is psychological withdrawal from change. With disengagement, the employee may lose interest in the job. They comply, but they lack drive and commitment. They are not invested in the work. Disidentification is a feeling that one’s identity is being threatened by a change. These employees cling to the “old ways” of doing things. Disenchantment is feeling negativity or anger towards a change. These employees realize the past is gone and they are mad about it. Disenchanted employees may try to enlist support of other employees by forming coalitions. They may also resort to sabotage. Lastly, disorientation is a feeling of loss and confusion due to change. The lack of clarity associated with change leaves these employees feeling lost and confused (Nelson & Quick, 2013). Once resistance is identified, management is able to intervene appropriately. The concept of “change management” must be implemented.

Utilize Lewin’s Change Model

A key part of managing change is understanding change. Kurt Lewin’s Change Model is known as a cornerstone model for understanding organizational change (Mind Tools, 2015). According to Nelson & Quick (2013), Lewin’s change model involves a three-step process: unfreezing, moving, and refreezing. Unfreezing is the first step in Lewin’s change model, in which individuals are encouraged to discard old behaviors by shaking up the equilibrium state that maintains the status quo. Moving is the second step in Lewin’s change model. In the moving stage, new attitudes, values, and behaviors are substituted for old ones. Refreezing is the final step in the change process. In this step, new attitudes, values, and behaviors are established as the status quo (Nelson & Quick, 2013).

Implement Interventions

Moving forward, it is clear that additional change need to take place within this organization. Utilizing Lewin’s change model, the three-step process can be used to implement the needed interventions. To “unfreeze”, the organization needs to: (1) Determine what else needs to be changed. This can be accomplished by conducting staff surveys. There needs to be a clear understanding of the issues associated with the new system, as well as what is needed for improvement. (2) Ensure there is strong support from upper management. To do this, the issue must be framed and presented to upper management as one of organization-wide importance. (3) Create the need for additional change. The message must be clear as to why additional change has to occur. (4) Manage and understand the doubts and concerns. There must be ongoing open communication addressing employee’s concerns in terms of the need to change (Mind Tools, 2015).

To “move”, the organization needs to: (1) Communicate often. Employees need to be informed and involved throughout the planning and implementation stages. They need to be informed of the benefits and know exactly how the changes will affect everyone. They must be prepared for what is to come. (2) Dispel rumors. All questions must be answered openly and honestly. System problems and defects must be addressed immediately. The need for change must be related back to operational necessities. (3) Empower action. Provide lots of opportunity for employee involvement. Clearly, additional enhancements will need to be made to the new clinical care platform. End-users should not only be involved in the planning, but also the testing of the system. (4) Involve people in the process. This includes negotiating with external stakeholders, such as the vendor who developed the platform. There must be an agreement made as to how they will re-design the system to accommodate all clinical areas (Mind Tools, 2015).

To “refreeze”, the organization needs to: (1) Anchor the changes into the culture. (2) Develop ways to sustain the change. This can be done by ensuring leadership support, creating a reward system, establishing feedback systems, and adapting the organizational structure as necessary. To address the issue of the backlogged inventory, instead of overworking the current staff and denying employees time off from work, the solution may be to hire on additional staff. Management should also consider adjusting production standards to accurately reflect the time it takes to complete work within the new system. (3) Provide support and training. Adequate training must be provided to all new staff. Refresher training should also be offered to the existing employees who need it. Once the new system is functioning as intended with the majority of staff onboard with the change, the organization should (4) celebrate success (Mind Tools, 2015).

Summary and Conclusion

Organizational change is generally considered to have the strongest potential to trigger emotions compared to other work events (Bönigk & Steffgen, 2013). Bönigk & Steffgen (2013) defines organizational change as a stressful process, which can be perceived as a threat or a challenge by the individual. Allan et al. (2014) states that “organizational change increases pressure and dissatisfaction.” Despite the challenges associated with change, innovative organizations find change is at the core of their culture and values (Staren, 2013).

In summary, this paper discussed an organizational change which took place within a health solutions company. The challenges associated with the deployment of a new clinical care platform led to resistance to change, as well as job dissatisfaction, poor morale, and loss of staff. In analyzing the issue, it was determined that additional change needed to take place. It was discussed how Lewin’s change model could be utilized to understand the change process as well as implement the needed interventions.

In conclusion, the framework provided will allow for continued improvement. Recommendations were made which will allow the organization to: identify and address the issues which led to the unsuccessful deployment of the new clinical care platform, as well as address the factors which have contributed to the resistance to change and job dissatisfaction. As previously stated, change is inevitable and going back to the “old ways” of doing things is not an option. Therefore, it is the goal of the provided recommendations that the organization will be able to effectively utilize the new clinical care platform as intended and that the staff will embrace the change with positivity.

References

Allan, H. T., Brearley, S., Byng, R., Christian, S., Clayton, J., Mackintosh, M., & ... Ross, F.

(2014). People and teams matter in organizational change: professionals' and managers'

experiences of changing governance and incentives in primary care. Health Services

Research, 49(1), 93-112. doi:10.1111/1475-6773.12084

Armbruster, S., Moran, J., & Beitsch, L. (2013). Change resistors: people who block change

initiatives and 5 tips to overcome resistance. Journal of Public Health Management and

Practice: JPHMP, 19(5), 483-484. doi:10.1097/PHH.0b013e3182800173

Bönigk, M., & Steffgen, G. (2013). Effects of habitual anger on employees' behavior during

organizational change. International Journal of Environmental Research and Public Health, 10(12), 6215-6234. doi:10.3390/ijerph10126215

Mind Tools. (2015). Lewin’s change management model: Understanding the three stages of

change. Retrieved from

Nelson, D. L. & Quick, J. C. (2013). Organizational Behavior Science: The Real World and You

(8th ed.). Mason, OH: South-Western Cengage Learning.

Staren, E. D., & Eckes, C. A. (2013). Optimizing organizational change. Physician Executive,

39(3), 58.

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