In every organization there comes a point where change becomes inevitable due to the various dynamic characteristic of the contemporary business world. One of the major factors that prompt change is the need to remain competitive in the market that is already full of players offering the same products and services. Another factor is the need to meet the requirements of clients that seems to change from time to time.
Furthermore every organization needs to evaluate the objectives of the organization putting into consideration aspects such as the practicality and relevance of the objectives to the organization. However much compulsory change can be, it is also important that it is conducted in a constructive way to avoid unnecessary redundancy or recycling of problems. Various methodologies like conducting a SWOT analysis are important to an organization. The contemporary business world always requires that an organization changes from time to time that for competitive organizations change has become a normal business.
Organizations employ both small scale changes and large scale one to avoid being left behind by technological developments. However, one main challenge that may face an organization that is moving towards changes is the how to go about the change itself. There are many theories that have been stipulated to act as guidance towards positive and constructive change but very few have been clearly outlined and clarified such as change initiative by Kotter.
The Kotter initiative takes business administrators through an easy to follow eight steps by which change can be implemented in his book “Leading Change.” This paper will outline a research that can be conducted to evaluate whether the change initiative as developed by John Kotter can save health institutions on the verge of collapse.1
Most hospitals in the UK have established themselves as profitable organizations offering various care based services. The organizations have undergone various developments over the years. Some hospitals have advanced to providing nursing home where they generally care for senior citizens who are incapable of looking after themselves and either did not have any family to care for them or their families were too busy.
Others have developed to a multifaceted businesses with the capacity to offer long term care (LTC) as well as long term and short term therapeutic services and rehabilitation services. However, recent analyses indicate that the organizations’ profits were falling drastically and the number of patients had also significantly reduced. This paper will detail, using Kotter’s (1996) eight step process to detail a major change initiative that has the capacity to resolve the decreasing patient population while simultaneously increasing profits.
For decades, nursing homes and skilled nursing facilities in the UK have functioned, utilizing a hospital or institutional model of care. This model, whether intentionally or not, prevented clients from maintaining individuality, freedom of choice, and a sense of being at home which often resulted in loss of hope and emotional despair.
Statement of the Problem
It is increasingly evident that the numbers of clients leaving against medical advice and requesting transfers to other facilities have increased. Furthermore, the number of physician referrals, patient population, and profits has also decreased. Replacing the executive business directors and the directors of nursing has been helpful but the businesses must urgently begin the transformation from locally oriented businesses organizations to a more global perspective. More importantly, the health institutions must implement a model of care that embraces individualized care, allows for client autonomy, and in respect to LTC, allows the clients to have a true sense of being at home.
Scope of the Research
The changes proposed should be geared towards ensuring that the patients are always in consideration and that they are offered the best health care possible. It is neither acceptable nor ethical for health care providers, licensed nursing assistants, or support staff to force LC residents to adapt to the old, institutional rules. Instead, it is the Hospitals’ employees’ job to provide care in a professional manner, help the residents feels comfortable; continue performing as many activities of daily living as the client’s health permits, and for the LTC clients, help promote a home like environment.
A home environment can be established by assisting the resident in hanging pictures, providing appropriate menu choices for the resident to select for each meal, and ensuring family members are welcomed as well as encouraged to visit. By promoting individuality combined with professional care, the health institutions can improve their reputation, increase the number of patients in each category of care treated per month, and give local citizens an inviting facility to recover after injuries or surgeries or a nice place to call home that also has physicians and nurses on site, providing preventative or tertiary care.
The first step in Kotter’s Model is to establish a sense of urgency among all leaders. The termination of the director of nursing and executive business director has already created a sense of urgency in some employees. However, each department manager and unit supervisor must in agreement with the impending change to be able to persuade subordinates to support the initiative. All have agreed a change in the model of care is necessary.2
It is imperative that change is implemented and nurtured in a visionary and a constructive way. As stipulated by Kotter the first step to achieving positive and constructive change is to create a sense of urgency without any undue pressure.3 The organizations’ business perspective is under threat because they are not getting enough patients and this is being reflected in the profits. Therefore the administration can first begin by informing all the employees that the organization needs to be rescued from apparent collapse in something is not done immediately. This initial step will draw the attention of employees and therefore create a platform for the discussion of various issues.
At this point dialogue, diplomacy and honesty can be the strongest weapons for the organization. It is about spreading the wind of change so that it can have an effect on every employee and clients and would be clients. The organization will then inform the employees of the dangers of losing their jobs in case the company is not rescued. The organization will also come up with a plan to tackle the potential threats and seek for opinions from both employees and clients.
Consequently an honest forum will be created from which every stakeholder will be given the chance to contribute towards the improvement of the organization. After the sense of belonging and urgency has been created implementing the other aspects of change will be much easier and support can be obtained from other stakeholders and players in the industry including professionals.
The vision for the change can be: “Care Towards Comfortable and Quality Life.” The major goal of the organization is the provision of care and ensuring that all the residents experience a life full of value within the organization. The vision in one glance will be able to inform all the stakeholders within the organization that all the services offered by the organization are towards the attainment of this objective. The vision is also brief and concise and can be understood easily since it is self explanatory.
The vision for the change initiative should be directed towards the improvement of customer care for the patients, improvement of working conditions for the employees, improvements on the profits and eventually business success. Most companies that collapse, as it has been observed, implement change without realizing the importance of harmonizing all the mentioned factors in the process. Customer care can be improved by seeking the opinion of various residents via questionnaires and opinion boxes to establish the areas that need adjustments. Furthermore the hospital can seek the services of a professional organization to look into ways that services to the residents can be improved.
Employee satisfaction is also important since the employees act as representatives of the principles held by the company both within and outside of the company. Finally it is important that the organization generates profits to ensure continuity and so that the company can meet its business objectives. All these areas should be addressed in modulation to avoid over concentration in one area and sidelining the other.
There will be no need to change the group since knowledge of company’s goals and objectives is a very important aspect in ensuring that the changes are achieved. The group has immense knowledge concerning the company and it is important to move forward with the group. Change is a movement that cannot be achieved alone or with a few people. In an organization, employees in a particular group show some common behavioral characteristics and patterns defined by the virtue that they belong to that particular group.
The importance of establishing groups cannot be overemphasized because the major aim in the formation of groups is so that the members can work interdependently to arrive at a particular objective or goal. There are many variations that can be observed not in just groups of different organization but also in different groups of the same organization. However there are some common natures and patterns that are characteristics of most groups.
There are some characteristics that all groups should conform to; groups should have a particular goal that should be understood by all the members, members of the group should have the capacity to communicate and interact with each other, members should be able to understand that the group is a collective to which each one of them belongs to, all groups should have norms and rules to which all the members are ready to conform to, members should have a positive impact on one another and finally an individual should be able to benefit from being a member of the group.
Formative research techniques will be carried out to assess the success of the implementation of the change initiative. This will be done using in-depth interviews with staff and the patients.4 The research will also address the use of dialogue as a tool of creating a sense of belonging within the hospital staff and the patient community. Intentional sampling will employed at the hospital to recruit individuals for study participation.
In addition, flyers will be posted at various points within the hospital and the immediate community to encourage people to respond to questionnaires. For quality results, the respondents among the patients will have to be above eighteen years. Development of topic guides in the interviews will also be used because it has proven effective in past studies. The research should have the capacity to require respondents to provide detailed answers, regarding the effects of the change initiative programme on their visits to the hospital. The research will also be geared towards getting response from the physicians, nurses and other employees within the hospital.
This will be important to establish whether the changes have made their working environment more conducive. Furthermore, financial data and patient registry will also be analyzed to determine whether there are significant changes in the business perspective of the hospital. 5
The research should proceed for a whole financial year so that the quarterly financial results can be available for analysis. Furthermore, the implementation of the change initiative will should take around 2 months and one year will be ample time for analysis and presentation of the results.
Table1. Time Scale.
|3 months||Implementation of the change initiative programme|
|6 Months||Data Collection|
|2 Months||Data analysis|
|1 month||Data presentation|
Null Hypothesis: The implementation of the change initiative has led to the improvement of the business aspects of the hospital, the number of patient visits and employee satisfaction
The health care is a sector that still has immense potential and the attainment of these objectives will be the determinant of whether the company will steer forward or wallow slowly in oblivion. Most companies that collapse, as it has been observed, implement change without realizing the importance of harmonizing all the mentioned factors in the process. Customer care can be improved by seeking the opinion of various residents via questionnaires and opinion boxes to establish the areas that need adjustments. Furthermore the company can seek the services of a professional organization to look into ways that services to the residents can be improved.
Employee satisfaction is also important since the employees act as representatives of the principles held by the company both within and outside of the company. Finally it is important that the organization generates profits to ensure continuity and so that the company can meet its business objectives. All these areas should be addressed in modulation to avoid over concentration in one area and sidelining the other. The expected results are that the employees and the managerial will be able to work as a team, and with proper knowledge of the organization’s objectives. Consequently, more patients will be willing to seek medical services in the hospital translating to business success and improved profits.
In most instances, one might argue that hospitals should not concentrate too much on the profits they make, but rather on the overall well being of patients. It is however important to understand that business success and customer satisfaction are two closely aspects that cannot be alienated from each other interrelated. A hospital that is successful businesswise will have enough revenue to drive its operations and pay employees thereby enabling continuity and the provision of quality services.
- Lack of cooperation from the managerial, the staff and employees may undermine the change initiative.
- Undertaking the research requires time and money which may be limited.
- The answers provided in the questionnaires and the interviews may be biased and these may affect the results.
- There is also the risk that certain assumptions taken during the initial stages of the research may change thereby altering the results.
Change requires strong backing from most if not all of the parties concerned. The ownership should ensure that the managerial is strong enough not only to manage but to stand the challenges that come with change. The managerial should therefore identify key figures in the organization, among the patients and other key players in the industry who are influential enough to direct the changes in the organization.
One of the changes required in the organization is that residents should be able to feel comfortable within the environment and it is important that they are involved in coming up with ways to improve in this area. Within the company the managerial can also identify key leadership figures to steer the process of change. All these groups of people need to be organized in a team that will form a formidable force to foster change.
The aspect of urgency building should also be the mandate of this team and building a continuous momentum. The major essence of building a team is identifying the true leaders within an organization who can be used to drive the process. Loyalty should be one of the guiding principles in choosing for these team and they should also have commitment. This will ensure that some members do not quit the team midway. This team will further build other teams within various areas and eventually under the team leaders the whole organization will be working as a team towards a common goal.
The team should also be evaluated from time to time to ensure that any areas of weaknesses are addressed as soon as possible. The team should be as diverse as possible to address and reflect the diversity within the organization so that every individual feels represented. It is therefore important than when choosing a team care should be taken because the team should be able to reflect the company’s goals in achieving the change to avoid conflicts or misinterpretation. Furthermore the vision should be straightforward and concise so that it can be easily placed in a notice board or brochures. 6
In view of the current challenges facing most organizations, it is important that each stakeholder understands that the greatest advantage that the organization has is that it has a big room for change. The change should be viewed from a positive perspective so that it can be done continuously without risking monotony. The change should rather be an interesting undertaking because it is geared towards the development or all areas within the organization. The contemporary business world always requires that an organization changes from time to time that for competitive organizations change has become a normal business.
Organizations employ both small scale changes and large scale one to avoid being left behind by technological developments. However, one main challenge that may face an organization that is moving towards changes is the how to go about the change itself. There are many theories that have been stipulated to act as guidance towards positive and constructive change but very few have been clearly outlined and clarified such as change initiative by Kotter.7
Kotter, John P. (1996) Leading Change. London: Harvard Business Press.
Bryman Allan & Bell Emma. (2003) Business Research Methods. New York: Oxford University Press.
Remenyi Dan & Williams Brian. (1998) Doing Research in Business and Management: An Introduction to Process and Method. London: Sage Publications.
- Kotter, John P. (1996) Leading Change. London: Harvard Business Press.
- Kotter, John P. (1996) Leading Change. London: Harvard Business Press. Pg 18.
- Kotter, John P. (1996) Leading Change. London: Harvard Business Press. Pg 47.
- Remenyi Dan & Williams Brian. (1998) Doing Research in Business and Management: An Introduction to Process and Method. London: Sage Publications. Pg 142.
- Bryman Allan & Bell Emma. (2003) Business Research Methods. New York: Oxford University Press. Pg 38.
- Kotter, John P. (1996) Leading Change. London: Harvard Business Press. Pg 36.
- Kotter, John P. (1996) Leading Change. London: Harvard Business Press. Pg 16.