This report will cover organization change in the Children’s Hospital of Eastern Ontario by specifically covering patient records department. The report will focus on the shift from the manual records system to the electronic management records system and how this process was initiated in the organization, the forces of change and the forces against change to determine how they affected and led to change in the organization.
The report will assist the student in gaining knowledge on change management in organization and how change management theories can be used to understand how change takes place in organizations. This will assist the student to develop critical analysis skills for analyzing organizational issues.
The Canadian government passed a policy that required all healthcare organizations to implement an electronic medical record system (EMR) which was a shift from the manual paper system. This policy meant that all organizations have to switch to electronic management record systems to increase security in records. The Children’s Hospital of Eastern Ontario (CHEO) adopted this organizational change process and began the journey of digitizing its medical records. This organizational change process was involving since it required both financial resource and leadership abilities to achieve the required change.
This question will be addressed through analysis of the change process experienced in The Children’s Hospital of Eastern Ontario’s (CHEO) in its process to switch from the manual system to a new EMR system that entails digitized records for employees. The process will be analyzed using force field analysis through highlighting forces for change and forces against change to determine how they affected the organization. The question will be addressed through force field analysis theory with the assistance of SWOT and PESTEL analysis to determine the internal and external factors in the organizations environment.
Organizational change entails the stages that organizations go through when they revolve or evolve. The business environment that organizations operate in is dynamic thus requires businesses to keep on adjusting to the changing needs in the market. For example, technology can force a business to develop new strategies for doing business which can lead to a total shift in the whole organization or part of the organization. This means that organizational change can be evolutionary due to external market forces or revolutionary due to internal market forces (Northouse 2015, p. 19). Regardless of the nature of change, managers need to put proper strategies for addressing change.
Transformational change mostly affects several areas in the organization. These can include changes in organizational structure or its culture. This can also include business process re-engineering where strategies are developed to change the business process (Parent & King 2015, p. 3). The second type of change is the transitional change that seeks to replace existing organizational processes with the new ones. This process can be planned or unplanned, for example the change witnessed in the process is transitional change since the organization seeks to develop strategies for addressing the challenges that the Canadian government presents through the new policies.
The major difference between transitional and transformational change is that in transitional change the process can be planned by the organization or can be a result of external forces like policies while transformational change entails an overhaul of the whole organization to meet different needs that the organization can be facing.
The purpose of this new change strategy was to improve service delivery to all outpatients by increasing quality access and consistent clinical documentation. When patients are achieving quality services, then efficiency is achieved due to increased service delivery. This process started by scheduling and registering all patients in the Epic system by 2014 thus allowing all laboratory results to be viewed in the system, and also ensuring that all healthcare providers who work with the hospital have access to the Epic system for viewing patient results and any clinical documentation for a particular patient. This process also allows ordering of medications through mobile applications since patients can search within the system to determine what they require and place their request without necessarily visiting the facility.
To achieve this process effectively, the organization used a systematic approach to support its clients through the anticipated change process and applying a culture of continuous improvement from the patient’s feedback. When the system was launched, patients were required to give feedback on the efficiency of the system or the challenges they face when using the system and propose the changes that they felt could correct the system. This system also adopted best practices from other institutions that had implemented the framework and adopting them into the organization (Hayes 2014, p. 12). The hospital developed a change management plan to document all the organizational processes and develop ways of ensuring the process was successful. This was through a document that outlined existing quality management frameworks in the hospital and ensured that they were integrated into the new system while following all government regulations set in the industry.
Further, Kotter (2012, p. 62) suggests that successful change processes in organizations must be managed with a proper strategy that guides the way the process is implemented. Without this, the change process can fail due to system deficiencies that were not corrected and aligned with the new system structure that the organization process creates. Since change creates tension and destabilizes the existing status quo, proper mechanism have to be in place to address such challenges. In this change process, there was need to develop a change management plan detailing how different aspects of the process like transition and adoption will be implemented (Fiorio, Gorli, Verzillo 2018, p. 5). This required the service a project management team charged with the responsibility of initiating the change process and change control. Here the team used a readiness and adoption strategy when dealing with people and change. This allowed activities to take place at multiple levels of project implementation until it was completed.
The Children’s Hospital of Ontario is experiencing planned transitional change due to the need to comply with the requirements of the Canadian policies. This process has led to the transformation of the records department in the whole organization to replace it with the digital system to increase patient data safety.
According to Lewin’s force field analysis is a change management strategy used to understand the change process in organizations. This approach views change as a state of imbalance between the forces of change and the forces that resist change (Jabri 2017, p. 22). In most cases, revolutionary change is difficult since it requires an overhaul of the whole organization which affects the status quo and changes the nature of operations on an organization. This change process takes place in three stages of unfreezing the driving forces, freezing and then the change itself. The model can be used to establish the balance of power in the organization by determining the key stakeholders in the issue, identify opposing forces and allies that form the target group (Loesch 2010, p. 30). Resisting factors can be individuals or organizational factors, while can emanate from both the external and the internal environment. When carrying out force field analysis, SWOT and PESTEL analysis is important in determining the strength of each factor in the change process.
The need for change is driven by the government policy which required organizations to have electronic medical records rather than the use of manual documentation. This push was done by the Canadian government which pushed most hospitals to adopt this new process and put proper strategies in place to replace the existing ones. PESTLE analysis looks at how external forces in an organizations business environment affect processes and decision making (Merchant 2014,). Such factors can be preceptors for change since they create conditions for change. This means that the legal factor of change is the driving force behind the change. To facilitate this process the Canadian government further funded hospitals that were willing to change within four years. Despite this, there was no option in the change process since it was a legal requirement for all hospitals to switch to the use of electronic medical systems. The government is a mediator in the business environment by creating conditions that allow businesses to progress. Since the government is also interested in the quality of care that patients receive, it becomes easy to manage the change process by creating conditions for change. As such, the change process becomes mandatory in all hospitals since the government had set the conditions by providing financial support to all health facilities that were willing to switch within the required period.
The need to increase efficiency in the medical sector through a streamlined medical system is one of the forces that drove the change process in the organization. When the government announced the inception of the electronic medical records system in organizations, the intention was to ensure accuracy in recording and reporting of patient information. According to PWC (2013, p. 3), the EMR system is transformative in nature since it has increased productivity and processes that have led to enhanced care and delivery of services. Manca (2015, p. 846) suggests that the EMR system allows the practitioner to attend to a larger number of patients because since it allows quick access to comprehensive patient history which is important in decision making. From the SWOT analysis of the hospital, technology presents new opportunities for service delivery and increased efficiency in the organization. This is based on the successful implementation of such systems in different institutions. This also allows for benchmarking of business processes against other Canadian hospitals that have implemented the EMR systems and reported better results. Further, Chang & Gupta (2015, p. 1079) add that, patients can interact with practitioners from the comfort of their homes since some conditions do not require testing but only an analysis of signs and symptoms of the patient. This means that the practitioner sees more patients as compared to the manual system where patients have to come in and files need to be moved from one point to another. This systems also increase efficiency since they have system timers that remind patients of the progress that they are making through treatment goals and alerts that provide providers for accurate information on how to intervene in patient situations.
Further, Kamadje, Tapang & Moluh (2005, p. 185), adds that EMR systems offer comprehensive information that is already analyzed thus only allowing the practitioner to make the decision. For example, this information is displayed in graphs with extra values like weight, cholesterol levels, and blood pressure which makes it easy for the practitioner to track these changes over time. From SWOT analysis, the EMR process has strengths that the institution can rely on. The fact that the system offers comprehensive information for the practitioner means that the system carries more strengths than weaknesses. This implies that the institutions stands to benefit more from the implementation of the system (Boonstra, Versilus&Vos 2014, p. 3). In a clinical trial research, it was found that the EMR can reduce disease outcomes due to its ability to provide accurate information and quick access to clinical information. This also culminates to the improved perception of patients on the quality of care that they receive when they feel the medication and care process is meeting their needs.
The changing nature of available technologies for use in the medical sector is one of the forces for change. The rise of the internet and the World Wide Web has completely changed the business environment and the way organizations operate (Saka 2003, p. 485). Today most organizations have been forced to switch to management information systems to compete well with other organizations in the sector. Fraser,Biondich, Moodley Choi Mammlin & Szolovits (2005, p. 89) add that technology allows easy working and improves efficiency. In medical settings practitioners have to coordinate when handling patient situations to ensure that they share information from different points in the facility. This leads to improved patient care since information is shared on time. On the other hand, the rise of mobile applications allows users to access organizational information by creating their profiles within the system. This means that technology is a factor that has pushed for digitizing of medical records to create an electronic medical records system.
Existing organizational structures are the biggest challenge to any change process. The functionalism approach sees the organization as being at an equilibrium stage because all organizational functions are working together to achieve harmony (Stragalas 2010, p. 35). This means that any change in the organization will destabilize the system and lead to conflict. A new digitized system will mean changing from the manual system to a digitized system thus requiring all practitioners to be equipped with relevant skills for meeting the needs of the organization. Training consumes employee time since it requires them to learn how to use the new system when they could not have done the same if the old system was in place. The reason why most people resist change is that it destabilizes the organization culture and creates new conditions in the organization (Parent & King 2015, p. 4). For example, the hospital has to formulate an implementation plan that will ensure the employees shift from the old system to the new system. For the system to work well, people have to be supported through the new system and a proper change management framework to achieve the required goals.
Another force of change is the time taken to construct the new Epicare system by capturing patient data from the manual system to the digital form. This transition takes time and requires patience in management to ensure that the system works (Carberry & Cross 2015, p. 25). For example, the process was to take place in three phases because the project could not be executed once. This means that the change process requires time which may be met with resistance or system setbacks in implementation.
Limited resources are another force against change that the hospital is facing. To implement the new organizational changes, resources are required to create the digital system through the hiring of a consultant for the digitizing process and at the same time the need to purchase computer systems for the program (Ismail, Rose, Uli & Abdula 2012, p. 158). This means that new computer programs that fit the specifications of the new system have to be installed. At the same time, employees have to be properly trained on how to use the new system when accessing it at the level of staff. All these require resources and time before the whole change process can be achieved in the organization (Winter 2003, p. 994). Despite the fact that the government may be willing to fund the digital move, the funds may not meet all the needs of the organization thus requiring management to allocate resources towards this initiative which may compromise other business operations.
Lastly, the need to satisfy customer needs is another force that can lead to resistance to change. Under the new process, efficiency is the factor that led to the initiation of the change since the system will ease communication between different sectors in the organization. However, adoption of change is always slow and any change does not always lead to customer satisfaction. Customer satisfaction is a measure of performance that focusses on how the service surpasses the customer needs (Homburg, Koschate& Hoyer 2006, p. 24). This means that the new changes have to be effected in a way that makes the organization more productive. The intention of the new system is not privacy and security of information but the rather efficient flow of information from one point to another in the facility and improved decision making. John (2003, p. 15) argues that customer satisfaction needs to be adequately analyzed in a new change process to ensure that the needs of the customers are not affected when new changes are initiated in the organization. The Epicare system is comprehensive allowing the practitioner to view data in different forms thus increased decision making. This system allows deeper analysis of patient data through graphs and charts that improve quality of care. However, this is dependent on the level of competence that users have to enable them to analyze the data well.
|
Forces FOR Change |
Change Proposal |
Forces AGAINST Change |
|
government policy |
Implementation of EMR system |
Existing organizational structures |
|
The need to increase efficiency through a streamlined medical system |
time taken to construct the new Epicare system |
|
|
The changing nature of available technologies for use in the medical sector |
Limited resources |
|
|
|
The need to continuously satisfy customer needs |
Force field analysis is an important model for analyzing change in an organization. To understand change the organization needs to analyze the forces of change and those against change to achieve the desired results. In most cases, this change process is a struggle between forces for change and forces against change. For change to be achieved, the forces for change must be more than the forces against change. Through the model, resisting forces in the organization can be determined so that proper strategies are put in place to address them. This means that management has to put proper strategies in place to address the forces of change and determine how these forces will be affected by those against change. This model is effective in change management since it ensures that organizations achieve the intended changes.
3. Conclusion and recommendation
From the analysis, the major force for change is government policy. In the business analysis government policy falls under the macro environment where the PESTEL tool can be used to analyze how it affects the organization. Macro forces exist in the external environment thus the organization has no authority on them. Carr & Nanni (2009, p. 44) suggests that these factors influence decision making in the organization and effect performance since strategies have to be designed to overcome the challenges that the forces bring. This falls under the political forces that limit the operations of the business and the extent to which an organization can go.
For example, when the Canadian government declared that all hospitals must switch to electronic management systems, then it meant that the decision can only be delayed but cannot be avoided. As such every hospital was forced to switch within a given timeline. Despite the availability of technologies for use in the hospitals, some organization like the Children’s Hospital of Eastern Ontario’s had no immediate plans of implementing the system since it requires more resources to put in place. Therefore macro forces push organizations to adapt as the only way since they exist in the external environment where the organization has no control of.
According to Jawhari, Ludwick, Keenan, Zakus & Hayward (2016, p. 116), lack of adequate resources is the major restraining force that was preventing organizational change. The success of electronic management systems in most hospitals in Canada and around the world is the best reason why every facility needs to switch to this system. However, as a new change, it requires a lot of resources that have to be planned for so that the process can be properly implemented. This is the reason why Children’s Hospital of Eastern Ontario’s implemented the change in three phases. The organization had to find ways of raising adequate resources for the new change since the system was an overhaul of the whole organization. to implement this change process, resources had to be allocated to every activity ranging from capacity building to restructuring and installing new computer systems in the organization. Therefore the major reason for resistance is organizational preparedness with enough resources to implement the process. Despite the intended effects of the new change, organizations need to slowly raise the required resources through budget adjustments to meet the needs of the new system. This is the reason why some organizations tool longer to implement the system while others responded immediately.
3.3 Conclusion and recommendation
According to force field analysis, change can only occur when the forces for change overpower the restraining forces. This means that change is created by conditions that lead to dissatisfaction with the present strategies in the organization thus the need for change. If there is continued resistance for change, then management needs to work on reducing the resistance to change through creating the need for change. Through force field analysis, the resisting forces can be identified through force field analysis and measures for tackling them developed. When the change process starts, a vision must be developed on how the organization will look like in the future. For the case of the Children’s Hospital of Eastern Ontario’s, the new vision was a paperless hospital where electronic management records are the order of the day. This requires proper strategies for implementing the change like determining how many phases the change process will take and the key areas that the process will work on.
Therefore, the change process in the Children’s Hospital of Eastern Ontario’s was driven by external factors from the macro environment. The change process in the hospital was easy because there were opportunities that existed within the system thus limiting the resistance to change. However, there is need to put proper measures in place for addressing organizational deficiencies before the change process is initiated. This reduces resistance from the organization due to internal forces that see the change as a threat to the existing status quo.
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