Leading organizational change in healthcare

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Managing organisational change in the public sector. Int J Public Sector Management ; 14 McCalman J. Medical professionals excel at finding solutions in patient care. Thus, it can be easy to ideate and harder to execute on brilliant ideas in health care—which means, generally, that the industry is constantly at risk of coming up with ideas but not delivering on maximum impact.

The challenges are manifold, but the unique systemic, monetary, and hierarchical challenges in these environments make change particularly thorny. But change management takes into account the various barriers to success. When done properly, it lays out a step-by-step process to identify a challenge, make changes, and execute successfully. As originated by Dr. The first step, for example, poses a particular problem in health care because so much is urgent.

Knowing why a problem needs solving, right now, is essential to change management. The steps that will pose the greatest challenges for leaders will depend on their personality and leadership style. For example, skipping immediately to execution steps 5 and 6 based on an executive decision is another common mistake, since it can come off as superior and patronizing. In the hierarchical, fast-paced world of health care particularly, a leader may feel tempted to gloss over the strategic steps.

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We asked a final open-ended question to capture any other reflections that participants had. In two interviews, we pilot tested the questions to assess their meaningfulness and clarity of concepts. We included the two pilot interviews in the study. Individual interviews were conducted by all the authors except SB, who does not speak Swedish, and were digitally recorded. Before the start of an interview, the participant was asked to re-read the information letter and give written informed consent to participate.

The interviews were transcribed verbatim by a professional transcription agency and were then reviewed by the researcher who conducted the interview. All authors except SB read the transcripts of the interviews individually to create a holistic view of the material. In the next step, each researcher performed a first analysis condensing meaning-bearing units and creating codes and subcategories.

Tentative findings were reported to and discussed with SB. This discussion led to a proposal concerning the categories of analysis, which was then fed back to SB for her comments. Eventually, consensus was reached on the categories and PN suggested labels which were accepted by the whole group.

Finally, SB, whose first language is English, reviewed the English-language quotations for clarity. The findings regarding these characteristics were equally applicable to the physicians, registered nurses and assistant nurses, with few notable differences among the three professional categories. The quotes are attributed to the physicians P , registered nurses RN and assistant nurses AN , who were interviewed, numbered from 1 to The health care professionals emphasized the importance of having the opportunity to influence organizational changes that are implemented.

Changes that were initiated by the professionals themselves were considered the easiest and rarely encountered resistance on the part of health care professionals. It is from there, I think, most often the smartest ideas will emerge, but then it is important to ensure that you are responsive and assess [the ideas]. According to the health care professionals, organizational changes that were clearly communicated to allow for preparation increased the chances for successful changes.

We had two weeks to develop new systems and that results in considerable consequences. We had to solve it anyway. The changes might otherwise be perceived as meaningless and unjustified, which may create change resistance. In particular, health care professionals valued and perceived as successful organizational changes with a patient focus, with clear benefits to patients.

Change is pervasive in modern health care. This study aimed to identify characteristics of successful organizational changes from the perspective of health care professionals at the frontline level of health care. The importance of individual responses to organizational changes has been increasingly emphasized [ 25 ].

Three categories i. Many of the statements by the participants were representative of more than one category, suggesting an interdependency between the three categories of this triad of successful change characteristics. For example, a slower change allows for preparation, which facilitates involvement and influence, thus enabling an appreciation for the change. Alternatively, recognizing the value of a change, e.

This interdependence implies that successful change is more likely if more than one of the three categories is accounted for when planning and implementing changes. The importance of preparation for and involvement in a change has been associated with decisional latitude [ 26 ] and valuing the change in terms of experiencing personal gains has been linked with involvement in the change [ 27 ].

However, we have not been able to find any previous study, either in health care settings or in other environments, which has identified the relevance of this particular triad of characteristics or how they are interlinked.

Although our findings suggest these interdependencies, we did not collect data to specifically investigate the underlying mechanisms; thus, exploring these interdependencies would be an important area for future research.

The health care professionals in our study attached great importance to being able to influence changes that may influence their work. Many of the health care professionals complained about the power differential between those who are affected by the changes and higher management and political levels of the health care system who usually decide on what changes to implement.

Physicians in Sweden have often raised complaints that policy making and decisions concerning the medical profession are made without physicians or their professional organizations being involved in the decision-making process [ 28 ]. These findings underscore the importance of changes having frontline support and being perceived as legitimate among the employees affected by the changes.

Organizational research has shown that participation in changes can yield increased acceptance. Indeed, widespread participation in the change process is perhaps the most frequently cited approach to overcoming resistance to change [ 29 , 30 ]. Even assuming a well-justified and well-planned change initiative, research underscores the importance of managers building internal support for change by means of employee participation in the change process [ 31 ].

These are common findings in organizational research in general, but they seem particularly applicable in health care organizations because of the strong professional discretion in performing the work. Health care professionals emphasized the importance of predictability for them to perceive organizational changes as successful. Individuals are better able to adjust their behaviour accordingly when they are prepared [ 3 ].

However, despite the relevance of predictability, many changes in our study seemed to be characterized by a lack of preparation. When individuals are unprepared, they have difficulties aligning their thoughts, feelings and behaviours with the expectations of those who lead the changes [ 12 , 32 ].

Contextual factors such as resources and culture also influence their preparedness to implement change [ 33 ]. The importance of management communicating the motives for changes was stressed by the health care professionals in our study.

Consistent with our findings, organizational change research has demonstrated that changes have a greater chance of succeeding if employees consider them to be well thought out and respect the managers responsible for the changes, whereas resistance to changes is more likely if employees consider the changes to have little or no value for themselves [ 31 ].

The organizational change literature also stresses the importance of change initiatives resting on coherent and sound causal thinking [ 34 , 35 , 36 ]. The health care professionals in our study argued that the changes must benefit patients to have value. The overall findings of our study may reflect a tension between the traditional logic of professionalism and the managerial logic introduced into health care with the emergence of NPM. Whereas the logic of managerialism assumes that work should be management led to achieve organizational goals, health care professionals tend to be loyal to their profession and their emotional rewards at work are primarily associated with their patients [ 9 ].

NPM has led to an increase in the use of management systems, e. According to professional theory, true professionals such as physicians and lawyers independently treat individual cases e. Research suggests that physicians due to their stronger identification with professional logic are more likely than nurses to be critical of management-initiated changes [ 9 ].

Several studies have shown how physicians respond with scepticism or suspicion to different forms of management-led changes in health care [ 44 , 45 ]. Sweden has seen a lively public debate on NPM in recent years, with many scholars, policy makers and both physicians and registered nurses critiquing core NPM principles and their consequences for health care professionals [ 46 , 47 , 48 , 49 , 50 ].

This initiative is new and we are not aware of any studies of the concept, but research is warranted to investigate how this concept is realized in practice. Future research should assess whether health care professionals perceive changes as more successful under trust-based governance than under NPM principles.

The results of our study should be evaluated in the context of the methods that we chose to address our study question. We chose a qualitative approach because little is known about responses to changes in Swedish health care. For this reason, we considered interviews with physicians, registered nurses, and assistant nurses to gain a deeper understanding of the topic. Participation was voluntary; the interviewees were selected and asked by their respective supervisors about participation in the study, which means that the participants may have been particularly interested in the subject.

The multidisciplinary research team was a strength of the study, because it allowed different perspectives on the issue of changes in health care. Regardless, this enabled us to use quotations from many different participants, adding transparency and trustworthiness to the findings.

While many findings of the study are in line with existing research on organizational changes, no previous study has identified this particular triad of interdependent characteristics. The study provides important knowledge for health care organizations to plan and implement changes with better chances of being successful. In conclusion, organizational changes in health care are more likely to succeed when health care professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the change, including perceiving the benefit of the change for patients.

Although changes in health care organizations are inevitable, there are more or less effective ways to carry out changes. Our results provide important implications for health care organizations concerning how changes in health care can be planned, implemented and managed to increase the chances that they will be supported by health care professionals, which is crucial for successful changes. All interview data analysed during the current study are available from the corresponding author on reasonable request.

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Br J Manage. Weiner BJ. A theory of organizational readiness for change. Background: Understanding change is crucial to implementing quality improvement QI initiatives. Widespread change will be required to correct what many consider to be outmoded and deficient systems of care. This article summarizes the current literature--within both health care and the fields of business and management--regarding how change occurs at the individual and organizational levels.

Part 1 focuses on changing clinician behavior, which is instrumental to any effort directed in the health care setting. Part 2 examines the culture of change.