Journal change management pdf

This "warts and all "approach was reliably mentioned in the Practicum response by participants as stimulating, and empowering them to connect more convincingly to their own school.

Thus, organizations are commissioning strategic changes so as to bring into line their business strategies to the environment thus connecting the resources and activities of an organization to that environment. Hill and Jones, on a supplementary consider change management as a transition from a current state to a future state that intensifies competitive advantage.

They further recommend the following in considering the challenges facing change management by establishment of the need for change. The impediment change is not implemented to appraise change. Kanter, on his part asserts that, change management will need aligning it to the environment, provoking assumptions, fashioning a vision, utilizing diplomatic skills to get satisfactory responses this shapes coalitions of backers , keeping actions progressing by handling interventions and resistance, upholding the momentum, integrating ups and coming changes.

The loss of sight for management is on general objectives in the organizations. Scholes affirmed that organization focus of ways to operate with change abilities. The proficiency gains are rapidly evaluated by its change environments. The rising claim for services and the expectation for high-end quality of those services have put real pressure on managers and their companies, portraying change as a nonstop episode in the life-span of organization.

This helps establishments to accomplish the highest power, efficiency and have the least disruption and undesirable consequences.

According to Hardy , handling strategic change is about handling the telling non-linear dynamic processes during strategy application. It comprises of change or configuration in policy, structures, styles, standards, staff and skills of an organization to comprehend a strategy. Armstrong , interprets strategic change management as a method that evaluates the business and the industries in which the corporation is involved; measures its competitors and sets objectives and strategies to meet all prevailing and possible competitors; and then reconsiders each strategy yearly or three-monthly or frequently to establish how it has been implemented and if it has prospered or requires replacement by a fresh strategy to meet altered circumstances, innovative technology, new competitors, a robust economic environment.

Therefore, change management is focused on innovative ways with new changing directions. Change in organizations is still, never attained without resistance to the changes.

Resistance to change is characterized in many forms or features. Resistance to change can also originate from top management or even low unit employees. Forces that arouse resistance to change include habits, self-satisfaction, loss of personal connection or rewards, uncertainty and fear of ineptitude Scott, The management resistance for change requires managing conditions of guaranteed vision and mission accomplished for minimum change.

Research Methodology The study adopted descriptive research design. The study targeted the Nyamira County management staff whose figures according to the staff members report , stands at management staff working at the departments within the Company. The researcher secured a research permit and authorization letter from the university before proceeding to Nyamira County Government for data collection.

Self-administered approach to collect the questionnaire was adopted. The study analyzed the data using descriptive and inferential statistics to address the variables under the study. Data Analysis and Results 6. Descriptive Statistics 6. The findings were presented as table 1. Deviation Management become effective to explain the reasons of 4.

Employees are ready to feel change created by 1. Some employees were not sure that employees are ready to feel changes created by management as well as management are effective with communications of change which was determined by the mean less than 2. This implies that the variances in relations to change management are evenly distributed by challenges emphasized on the assertions on highest means.

The findings were presented in table 2. Those affected by change are rarely involved in change process resulting to 4. Respondents were requested to indicate the views of change process either agreeing or disagreeing using Likert scale.

Descriptive statistics indicated that those affected by change are rarely involved in change process resulting to negative change management had mean of 4. The finding showed that those affected by change are rarely involved in change process resulting to negative change management had the highest mean of 4.

Armstrong interprets that strategic change management as a process that evaluates the business and the industries in which the corporation is involved; measures its competitors and sets objectives and strategies to meet all prevailing and possible competitors. Valuing employees with change process of the firm can generate ideas but change implementation which cannot be emphasized.

Correlation analysis was conducted to establish the relationship between variables where the challenges were correlated with change management. The strength from correlation analysis are based on the results coefficients which was either statistically significant or not statistically significant, all interpretations are made on scale or -1 which indicates negative correlations, In this study Pearson correlations analysis was analyzed on variables under study.

The summative Likert scale was run to correlate values of the variables. Regression analysis was used after correlation analysis. The results were presented in table 1. Table 1 Correlations Analysis Communication of Participation in Management change management change process directions Pearson 1 Communication of correlation change management Sig.

Correlation is significant at the 0. The result from correlation analysis showed that Communication of change management had a positive correlation on change management.

However, Participation in change process had negative correlations of This implied that most of challenges of change are positively significant to correlate with management directions. In this correlation analysis, communication of change management included three variables in change management at statistically significant.

Every variable was correlated with change management where participation in change process in negatively correlated, implied that there is weak correlation between participation in change process and change management. The variables correlations were determine to show how the challenges correlated with change management of organizations. Conclusions and Recommendations From the results, it was concluded that challenges affect change management in organizations.

The results showed that the study clearly analyzed the challenges of change management. It was also concluded that participation in change process is attributable to change management which is indicated with different means and standard deviations under study.

References 1. Ackerman, L. OD Practitioner, December , pp. Armstrong, M. Appelbaum, S. Management Decision, 36 5 , pp. Whilst the accuracy of failure statistics themselves have been questioned by some Burnes, ; Hughes, , there exist a range of themes emanating from the research that characterises change failure through a kaleidoscope of causes, including structure and content of change communication Armenakis and Harris, ; McClellan, ; the role of senior managers and the direction of change from within the organisation Bartunek et al.

As a developmental process, POCM challenges the interplay between organisational inputs, processes, and outputs, with the vagaries of human behaviour, a core variable in the success of organisational change. Therefore, are we in fact moving forward by better understanding and applying the past? This one-dimensional approach fails to recognise the remaining integrated components necessary in understanding all the elements of change.

Within the three-step model is a clear reliance on a range of enablers which he considered as integral to the process. These are presented as criteria related to the creation of permanent changes, of which the three-step model is but one.

Others included the need to identify countervailing forces as part of force field analysis and understanding the characteristics necessary to influence movement within a change process, understanding resistance as an element of habits within groups subjected to change, and the role of group decision making as underpinned by personal and group motivations.

His linkages with action research in the course of his work with certain social groups provided the basis for a more complete picture of change, and underpinned a more iterative approach to change than many writers have since commented on. Method The world of POCM is diverse and complex with a number having resulted from academic- based research, and a number resulting from practice-based application in the hands of management consultants. Given the plethora of options, some of these differing sources have been addressed in the course of this analysis of the prevailing literature.

In the category of academic-based research, the various models can be further categorised into those that are predicated more on the governing approaches to change in that they provide specific approaches or steps that change agents and those who initiate change must address in order to maximise the success of the change programme. A further sub-categorisation points to those models that are more structural in their approach, meaning that they offer more of an overall framework within which change takes place.

Whilst flexibility in both categorisations is necessary, the former approaches tend to be seen by change agents as definitive guides whilst the latter seem more conceptual in nature. In this manner, practice-based models tend to be governance focussed, as they are designed to drive specific client-driven outcomes.

Tables I-III identify the most discussed models within these categories. In the case of each of the research-based POCMs, we have adopted a three-stage evaluative process that first sought to identify the salient features of the model as identified when it was first developed. Second, refinements to the model stemming from any published revisions were highlighted where such refinements changed any components of what was originally published.

Finally, we identified, within each of these models, characteristics that provide fundamental links to the Lewin three-step model, either by direct reference, or by virtue of inherent structure. A non-formulaic approach to understanding change, it focuses on the long-term sustainability issues and the renewal process itself which, at Table II. For one reason or another it seems desirable to reach a certain objective […] The first step then is to examine the idea carefully in the light of the means available.

Provided a dual focus of assessing organisation in current state as well as future state, providing the basis for better understanding the gaps that needed to be filled in order to achieve a desired outcome and change Peters and Waterman, ADKAR Prosci Ltd Results-orientated change management tool that maps a range of enablers of change to a list of management activities that when structured and implemented, respond to those enablers Love and Spencer, Table III.

Emanating from this point is the derivation of the execution phase which, as he identifies for management purposes, requires additional fact-finding processes to be initiated. The iterative process entailed evaluation of the action, assessing initial learning outcomes, laying the foundations for further planning, and finally the remodelling of the plans themselves, in what can clearly be identified as a fluid, non-static process. One of these techniques, force field analysis, became evident in understanding the inhibitors and enhancers of change.

Whilst his mathematical modelling of the impacts makes for interesting reading, it is the practical application in a change strategy that gives credence to its ongoing use.

Further application of group dynamics and resulting group decision-making processes supported the Lewin integrated approach to the management of change, which was also identified in his papers. The project approach recognises the need to drive solutions to the ongoing challenges of change, providing insights into the procedural and process aspects whilst maintaining operational capacity in the short term and expanding it in the long term.

This approach reinforces the procedural aspects embedded within change programs, supported by structured, stepped activities. The resistance approach recognises the difficulties associated with change and focuses on the groundwork necessary to reduce its negative attributes. This approach recognises the need to minimise one of the key inhibitors of change, being the role that individuals play in the change process and the deleterious impact of resistance to change.

Taffinder then moves into an enhanced action list which identifies a range of details actions that are seen as necessary in order to implement the process Planned OCM Table IV. Understanding this from a change one considers the behavioural consideration of management perspective may predict each of these. A common feature in both models is the focus on resistance. No further refinements have been undertaken as of the date of this paper Nadler and As an open systems model that focuses on the Within their open systems model, they identified Tushman congruence of outputs associated with work, key success points for change as 1 developing people, informal, and formal organisational an understanding of the current state 2 elements resulting directly from the interaction articulating a clear vision of the future state, 3 between the external and the internal guiding the organisation through a delicate environment transition period.

In a similar for the various communication elements during approach to Taffinder, identifies specific each of the phases. In , whilst the model did action points that need to be considered for not change, a heavier focus on transitional each of the phases elements was identified Bridges, Carnall Views change from a skills-based perspective Whilst the focus on skills within the suggesting that management must be able to organisation is predominant, the preconditions 1 manage transitions, 2 deal with culture, identified have a correlation with aspects of and 3 manage politics.

In doing so, the Lewin in that building awareness and building approach considers a multiple preconditions the case for change closely align with activities for change success focusing, building that form part of unfreezing, whilst mobilising awareness, building the case for change, support for change has application in both broadening and mobilising support for change, unfreezing and moving.

Crystallising the and crystallising the vision vision reflects attributes of both moving and refreezing. No further refinements have been undertaken as of the date of this paper Senge et al. Consider change by viewing organisations Alignment with Lewin stems more from the more as biological organisms and accordingly consideration of forces and challenges that considers reactions to changes within that may impede progress which underpins the Table V.

The first wave is identified model where in Step 1 opposition and through 1 opposition, and 2 ignorance. The ignorance is addressed during the course of second wave is identified through 3 risk, 4 unfreezing.

Compliance, efficiency and cost, and 5 competitive advantage. Other settings included regional level health organisations health centres or clinics, education centres, community health settings and one in a residential aged care facility. Most studies only involved a single institution, 28 seven studies involved in between 2 and 9 institutions, and three studies involved more than ten institutions with the largest number being 25 institutes.

The impetus for change for the majority of studies came from within the organisation 34 studies. In two further studies, change was due to a directive from the state or national health department. In the final two studies, both conducted in non-OECD countries, the impetus for change was from healthcare professional associations.

Most studies performed strongly in reporting their theoretical and conceptual underpinning, and in reporting of research aims and the involvement of stakeholders in the process of change.

Many studies were case examples of change models and presented in a non-traditional research format. This limited their suitability for quality appraisal regarding the reporting of recruitment methods, data collection and data analyses.

Studies often performed poorly on reporting of sampling to address research aims, description of data collection procedure, recruitment and critical discussion of strength and limitations of the study.

The findings of the quality appraisal may be indicative of the nature of the publications identified but highlight a lack of transparency regarding the quality of the research design and methods used to gather the data, which must be acknowledged in interpreting the review findings.

Thirty-eight of the identified articles described applications of change management models predominantly applied from the discipline of management into healthcare. Applications of the Kotter model were primarily identified in nurse-led, local level, single unit or site quality improvement projects. The Kotter model was also applied in a quality improvement program in head and neck surgery in a Canadian surgical department, with authors concluding the model provided a guiding principle to support the change process.

One physician-led study focused on bringing about change in the management of chest pain in a US emergency department using their locally developed AdventHealth Clinical Transformation method. A key value of taking this planned approach was the ability to maintain clinician engagement in the project and achieving outcomes at a timed accountable follow-up. Twelve institutional-level projects were identified.

Stoller et al reported a teamwork enhancement intervention across four respiratory departments of a US hospital to implement and optimise utilisation of the Respiratory Therapy Consult Service RTCS. However, the application of the model in this context was primarily focused on the moving stage, with few activities that appeared to address the first and third stages of the model and limited data reported of the outcomes of this change project. It was notable that unfreezing activities identified the development of new policies and procedures, with the overall project primarily focused on bringing in the new technology and the moving stage.

Across four medical-surgical units in two Kaiser Permanente hospitals in the US, a Nurse Knowledge Exchange NKE was developed to integrate change management methods into the implantation of practice change. In a larger scale institutional project, Riches 4 Stages Model was applied to transitioning a radiation therapy department to a new hospital site. The authors reported the model as valuable in supporting smooth transition. A final study of a large four-year change project introducing technology upgrades into a healthcare organisation utilised the Change Acceleration Process CAP model.

Six national or system-wide projects were identified. In this study, it should be noted that the model was not applied to explore the role throughout the study. One international multi-system project was identified that reported the management of change in a World Health Organisation WHO project seeking to shift Allergic Rhinitis and its Impact on Asthma ARIA from a guideline to integrated care pathways using mobile technology in patients with allergic rhinitis and asthma multimorbidity.

In maternity services in Uganda and Nepal, change occurred through dissemination workshops, reminders, case reviews, practical workshops and team building guided by AIM methodology. The operationalisation of AIM was not detailed in the studies. Whilst many studies utilised structured change management models reported successful change, it was not possible to detect whether the use of a model, method or process contributed to the success.

Baloh et al followed eight hospitals in the US through a two-year implementation of team huddles TeamSTEPPS to explore, through interviews with 47 leader and change managers or champions, how they performed in relation to the three overarching Kotter phases. Using the Lewin and McKinsey 7S models together, Sokol et al described the application of change management theory to office-wide culture and structural support to meet the twin goals of safe opioid prescribing and treating patients with opioid-use disorder.

Specifically, the programs reported as successful were those introduced in systems that used change management methods aligned more closely with the Kotter model.

Our findings identify multiple change management models that are applied to bring about change in healthcare teams, services and organisations. In the reviewed articles, it was apparent that change management models provided a frame of reference for change agents to support them to consider key elements required for change to occur and be sustained. Key elements include exploring why change is needed and crafting the right messages for stakeholders at every step to bring them along on the change journey.

In the included studies, models that included a series of stages or steps, eg, Lewin or Kotter provided change agents with a series of goal posts to monitor and to create moments of celebration along the change journey.

Notably, there was little emphasis on reliance on the models to overcome resistance or develop specific change activities; their value was consistently in providing a broad guiding framework for clinicians creating change. Drawing upon change management models as a guiding framework rather than as a prescriptive management process is in keeping with contemporary thinking regarding healthcare as a complex adaptive system.

A complex adaptive system seeks to draw out and mobilize the natural creativity of health care professionals to adapt to circumstances and to evolve new and better ways of achieving quality akin to bottom-up change and requires change agents to shift away from the reliance on top-down, highly controlled change processes.

For example, Baloh et al in exploring the introduction and implementation of huddles in rural US hospitals noted the value of integrating broad concepts from change management models, particularly in relation to the earlier model steps, with appropriate implementation scope and strategies.

Methods also emerged from this review that are not as prominent as other change management models and methods but appeared to be used successfully to create and sustain change in healthcare delivery models and services. This review has not determined one change management model as preferred over another. This finding suggests that the guiding framework and flexibility within this to enable a range of activities and actions suited to the particular circumstance is of key value rather than a particular change management approach.

It was notable that in the context of healthcare, change management models were often used by clinicians in local-level projects. The models were rarely used to address issues of resistance and more often used to provide a framework to house a broad and diverse range of activities to facilitate successful sustained change.

Clinician engagement in the change process emerged as a critical factor for change to take hold and be sustained. Change is naturally challenging for humans, particularly when it is rapid and ongoing. The guiding principles of the change management models we identified as commonly used in healthcare seek to create an enabling culture for change; seen through shared ways of thinking, assumptions and visible manifestations.

The reviewed articles suggest an enabling culture for change is central to creating opportunities for and supporting clinician engagement from decision-making about change through to change implementation.

It is well established that implementation research is focused to more than translation of evidence from bench to bedside. As the scientific study of methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice, and hence to improve the quality effectiveness, reliability, safety, appropriateness, equity, efficiency of health care, it is inextricably linked with healthcare change and its management.

One artefact of organisations with cultures supportive of change is the presence of co-design efforts. Such approaches are however contingent on appropriate supports to ensure participants have both the capability and capacity to engage. Our findings must be considered in terms of the limitations of the included studies and the review process.

It is possible that some relevant studies were not captured by the database search or were made available after the search date. The included studies were often case examples of change initiatives with limited breadth of sample and a lack of detail reported about the research methods. The quality of such studies was therefore challenging to appraisal due to the limited reported information.

The ability to generalise findings from such studies was also limited when case examples were utilised. We do note however that the wide range of included studies demonstrated consistent commonalities across change principles and applications of change management models across multiple settings and change projects in health.

Change management models are commonly applied to guide change processes at local, institutional and system-levels in healthcare. Clinician-led change is common, with the value of change management models being primarily to provide a supportive yet flexible framework to direct change processes. The review also highlights the potential opportunities to integrate models for change management with models commonly applied for improvement and implementation to support positive changes in healthcare.

All data included in the review are publicly available research findings. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

National Center for Biotechnology Information , U. Journal List J Healthc Leadersh v. J Healthc Leadersh. Published online Mar Author information Article notes Copyright and License information Disclaimer. Received Oct 28; Accepted Jan This work is published and licensed by Dove Medical Press Limited. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

For permission for commercial use of this work, please see paragraphs 4. This article has been cited by other articles in PMC. Abstract Background The increasing prioritisation of healthcare quality across the six domains of efficiency, safety, patient-centredness, effectiveness, timeliness and accessibility has given rise to accelerated change both in the uptake of initiatives and the realisation of their outcomes to meet external targets.

Methods A systematic review and narrative synthesis was undertaken. Results Thirty-eight studies were included that reported the use of 12 change management methodologies in healthcare contexts across 10 countries. Conclusion Change management methodologies were often used as guiding principle to underpin a change in complex healthcare contexts.

Keywords: healthcare change, change management, transformation, implementation, improvement. Introduction The ability to adapt and change is critical to contemporary health service delivery in order to meet changing population needs, the demands of increasing life expectancy and complex health conditions.

Exclusion Criteria Publications discussing a hypothetical change as a result of a planned intervention were excluded. Study Identification Synonyms and relevant concepts were developed for these two major concepts being evaluated in this review of change management and healthcare delivery.

Data Synthesis A narrative empirical synthesis was undertaken in stages, based on the review objectives. Table 1 Summary of Included Studies. In the other half, success was dependent on the scope of implementation and the strategies utilised.

However, there are still unmet needs for the management of rhinitis and asthma in real life. Presence of a revert back into the handwritten caseload due to a lack in continues driving force thereby making resistance forces increase. Also, the level of patient involvement increased. For a change to be successful, there must be authentic, committed leadership visible to everyone within the organization throughout the duration of an initiative. Leading change activities included having a sponsor or champion and team members who demonstrated visible, active, public commitment and were supportive of the change.

Kotter's principles provided the structure to achieve the necessary changes to attitudes and behaviours. To influence multiple stakeholders to modify their traditional practices and sustain changes. Specialist outpatient appointments given within the timeframe requested by the ED doctor increased from Early discharges increased from Median wait for admission remained unchanged. The initiative is ongoing, but early results indicate that the proportion of radical intent RT courses peer reviewed province wide increased from The four-stage model of change assisted in the smooth implementation of a transition plan for radiation oncology.

Change management theory to support both safe opioid prescribing and treating patients with OUD over the past 5 years resulted in changes to the practices, people, skills, and infrastructure in the clinic. Spira 61 Quantitative Surveillance data and surveys Two hospitals, Uganda Maternity Departments Accelerated Implementation Method To increase the use of intrapartum and postnatal essential interventions EIs in two hospitals in Uganda EIs that were regularly used had no improvement, however, seldom used EIs had a significant improvement in use due to the implementation package of activities developed Spira 62 Quantitative Surveillance data Two tertiary teaching hospitals, Nepal Maternity Departments Accelerated Implementation Method To increase the use of intrapartum and postnatal essential interventions EIs in two hospitals in Nepal Only the timely administration of antibiotics caesarean increased, with all other EIs not showing improvement Stoller 46 Mixed method Randomised control trail, observational and in-person interviews Respiratory therapy department, Cleveland clinic, Cleveland, Ohio RCT on patients, 71 RTCS groups and 74 physicians.

Understanding and embracing change is important. In the second and third quarters of the intervention, the number of falls significantly dropped, with zero falls with injury in the third quarter. Open in a separate window. The purpose of this paper is to examine the influence of high performance work systems HPWSs on employee voice, employee innovation and organization performance in a…. This study investigates the development of absorptive capacity. Using an integrated cognitive learning perspective, this study provides empirical evidence about the….

The interrelationship between organizational learning OL and organizational culture OC is often assumed at an abstract theoretical level, but there is yet no…. The aim of this paper is to analyze the interrelationship between factors conducive to rural tourism development. This touristic segment has enormous potential but still…. It became a fact, and the world's countries went under confinement due to the pandemic of the Covid There are severe impacts on tourism with the supply chain….

This study aims to propose a comprehensive model to help understand factors influencing the intention to participate in a destination management system DMS amongst…. In addition, this study examined the moderating…. This paper aims to present a content analysis of two major constructs among tourism settings, namely involvement and emotions, strictly related to tourist behaviour, due….

This study examines the relationships between structural holes, guanxi and knowledge sharing among groups of stakeholders within a Chinese destination network.

Wine tourism has stood out as a very recognized and valid tourism and marketing segment, growing worldwide and urging the complex needed advances on wine tourism practices…. This study aimed to advance the understanding of employees' individual-level absorptive capacity by examining the mechanisms of three dimensions of their work outcomes….

The purpose of this paper is to investigate the role of empowering leadership in intraorganizational knowledge management practices and to reveal how followers' acceptance…. Report bugs here. Please share your general feedback. You can join in the discussion by joining the community or logging in here. You can also find out more about Emerald Engage. Visit emeraldpublishing. Answers to the most commonly asked questions here. All issues EarlyCite.

Volume 34 Issue 7 Issue 6 Issue 5 Issue 4 Theory are Methods. Or are they?