You have been asked to oversee a major change management process in your organisation (fact or fictional). In your essay you must address the following key points:

• Outline the change that is going to take place;
• What approach you will take in managing the change;
• What are the key elements that you will have to manage during the change process?
• What approaches will you use to measure the success of the change process?
• What will be your approach to incorporating the learnings from the change process into future change management activities?
cribe your assignment





The health service management as a whole is undergoing an inevitable change because of advancing technology, innovation, ageing population and pricing. Unifying sharp business management skills with health service management is the need of the hour as it prepares a health care organization for the changes in order to deliver health care services in the most rational manner against the increasing complexities and competition. It is important to prepare management and the managers to facilitate the change within the organization.


In this article we will explore the change management of the Holy Child Health Care organization. We will discuss various aspects of health changes in the health care to outline the changes that are going to take place. The paper will also sketch the key elements to be managed while the change is being processed. The article proposes a framework or the approach to measure the success of the changes in the manner that its implications are used to manage the changes that may occur in the future activities as well.


Thompson, J.M., (2010, p 167–173) Changing the organization systematically for the purpose of addressing the force of changes and put the organization in dynamism for long term solutions. However, it is a difficult process and the organization will face alarming challenges to be addressed by managers. There will be a need for dynamic leadership to manage the environmental influences in the change process. The article will chart the nature of the changes and find ways to manage them successfully. The main purpose of the article is to establish a change-oriented management for the organization.



Key Elements That Lead to the Need of Change Management


In this section we will identify five key elements to ensure successful change management in the organization. Breaking out the broader change into smaller and more specific categories, we need to measure change in the goal or immediate task; the team to decide the key members to work to address the changes of specific and differentiated nature; the management rules to chart out the major developments and interventions to be introduced to facilitate the change in the organization; and the future to analyze the future potential changes and the control process in advance Scheid, J., (2011). In order to imply these categories into change management and find an approach we need to see them in the light of broader perspective first.


There has been a significant change going in the health services across the world. The key factors driving the changes are technology advancement, increased expectation of public, legislative reforms and the political environment. Furthermore the ageing population and changes in disease patterns are adding to complexities in the health care service management. A health organization is more than just a business organization which increases its challenges of coping with change and transformation. As Drucker, P., (1993) puts a healthcare organization is the most complex form of human organization. In a health organization there is a convergence of very different variety of professions like physicians, pharmacists, administrators and stakeholders comprised of government bodies and patients etc. The interests of these associated bodies are rarely compatible to one another and they characterised with different perspectives and different times, which means it is not necessary all will influence the organization at the same time or for same span of time.


In order to analyze what changes will probably take place in the organization we need to understand that it is constitutes various independent processes, which are called variables. Therefore it is not possible to chart out definite changes that will occur, but it is all about preparing the organization about the anticipated changes. Being a healthcare organization it is important to acknowledge additional challenges which may not be a part of generic management processes. Below are listed the additional variables which are specific to the health organization:


  • Incongruent stakeholders
  • Multiple goals that include, delivering healthcare services to individuals and community, staying profitable and solvent, to grow as a primary employer in the community
  • Acknowledging that professionals like doctors and nurses value professional autonomy and their decisions and work influence a major part of organization’s expenditures.
  • Lack of information about changes

Golden, B., (2006)


All these four will represent the key changes in the broader term to help measure all the aspects of change that will occur in the complex system. As a first step we will analyze the nearest and possible barriers to change within the organizational framework.


Understanding and analysing the types of barriers or challenges to changes is very important for developing strategies to establish change management. We should identify the barriers and influences that are operating in the organization and which may relevant to specific problems. Based on this consideration and analysis we can decide on the approach to develop management strategies to address and facilitate the change. The approach will also have to incorporate management practices to project future changes and their possible treatments.


As also mentioned in the four key variables in the health organization and evidences also support the fact that healthcare professionals have lack of knowledge and awareness of the latest developments in the organization and the environment in which it is operating Golden, B., (2006). We may be aware of the latest guidance but we also need to know how current way of our working is different from it and what the ways to adapt it are. This knowledge is crucial to project what changes are going to take place and how adapting to them can enable us providing the best healthcare services to the community in line with the necessary changes and guidance. We also need analyze if the changes can cause some professionals feel that it will undermine their autonomy, or that it cannot be applied to general population, National Institute for Health and Clinical Excellence, (2007).


Beyond the internal barriers, we need to consider the external barriers as well. Aspects concerning financial environment and political environment constitute external variables, which can impact the organization as well as the healthcare professionals in terms of motivation, practice and ability to adapt with the changes. We need to analyze whether our financial system will accommodate expenditure for changes and new implications or not. We need to assess the resources to see if they are constrained to hamper the change and its management.  Based on these barriers and their analysis we will have to work out incentive regulation and mechanism, which if not in line with the prospective changes will need to be changed.



Based on discussions, questionnaires, and analysis of clinical practices and key individuals say, we could identify the key changes which can be anticipated to be taking place in the coming time or even presently.




Key Changes Anticipated


By now we have understood that the main arrays that are causing changes in the organization are increasing competition, costs, technological advancements, transformed expectations of public, changing social attitude, ageing population and change in the attitude of the stakeholders. These factors lead to changes across the organization, regulation, ownership and delivery of service.



Changes within the organization



Going by various studies, healthcare organizations can undergo changes like shifting to outpatient-visit-based services from hospital-based services alone; moving to nursing homes or towards more managed care, to direct efforts to make it a relatively more profit-based services, developing corporate structure – either horizontal or vertical integration.


Considering the trend and statistics there has been 7.5 percent fall in the number of admissions in community hospitals between 1985 and 1995, AHA,. (1996). However the number of outpatient visits has been on a considerable increase during this period. Therefore, we will target to enhancing our base of outpatient-based healthcare services. Provision of operating in freestanding outpatient centres should also be made as it will add a diversification of the organizational operations to maximize the reach of its services Fennel, M. L. and Jeffrey, A. A. (1993). This step will also reduce the level of organization’s vulnerability and uncertainty to reach and serve the acute care sector.



Changes in care and delivery of healthcare services


Like every industry and organization, a healthcare organization also seek to increase customer or patient satisfaction, increase profitability, expand the operations for growth and increased specialization and efficiency. These motives need to bring change in work culture, organizational framework, and administration in a manner that it breaks down the departmental barriers and increase professional alliances. To enable the shift to out-patient services, the organization will need to acquire reconfigured job profiles and skills Greiner, Ann. 1995.



Health industry changes


Over the years the management of a health organization has brought in factors which are beyond mere doctor-patient relationship, the staffing has been transformed and there have come significant changes in the delivery system and its pattern, and increased focus on quality. There is constant pressures from stakeholders, public and private employers, unions and legislators. Strategies need to be made to respond these pressures to enable collaborative objectives towards best public healthcare, to keep all the stakeholders and public and private bodies satisfied with the organization. These changes will serve as ways measure quality of healthcare. In our organization to enhance specialization we should use these landmark factors to develop formula for creating effective new treatments for specific complicated illnesses Noble, H. B. (1995). Changes in staffing is another inevitable and key change which would take place in the course of time, owing to changed expectations of patients and other outside bodies demanding best care and specialisation. Referring to Wunderlich, G. S.etal. (1996) study, it is concluded that adequate nursing staff is a must to affect the quality of service in the positive way. Any scarcity of nursing staff is proved to be fatal for delivering quality healthcare.



Safety and health change of the workers


Transforming health industry, restructuring healthcare centres and changing pattern of service delivery system are known to eventually affect the work environment. We need to measure to what extent the building pressure from internal and external factors is affecting the quality of healthcare. Key elements to measure the affect will be to observe and measure the change in the attitude, efficiency and health of the workers. It requires a track of work-injuries, work-stress and violence in the workplace, which may be causing staff sacking or increased percentage of switching staff. It may be a cause of increasing substance abuse in a community. This will call for need for changes in health and safety measure of the workers. Quality of health and safety of workers have direct or indirect implication of patient care and organizational costs. Staff turnover and reduction in workdays hamper the flow of care because of unavailability of trained staff. We need serious measures to control these changes and maximize efficiency of workers by taking proper care of workers health and safety.


Change in occupational regulation


This change in itself is a separate category which required extensive change management. It has implications for healthcare, cost and labour. The complex change is largely influenced and driven by professional interests, and is a slow process, which does not quickly adapt to changes in a healthcare organization. Here, regulation basically refers to governmental intervention in market and professional behaviour of an organization Carpenter, E. (1996). Occupational regulation affects an organization with processes and tools like licensing, certification and registration. We need to access knowledge and awareness about latest regulations to run the organizational operations in line with the regulations.


Occupational regulation is important and appropriate for the restructured health care system. It serves a readymade framework for keeping up to adequacy of nursing staff and standard patient care.


Accountability and discipline change is desired so that there are no unethical and unqualified practitioners and service system Carpenter, E. (1996). We need to be part of professional boards to imply remedial education to rehabilitate organization with appropriate professionals and staff. We will refer to list of occupation, which is used by the Bureau of Labor Statistics to classify and track employment in health services. The statistics measured by the bureau predicts that health industry will be one of the fastest growing employment sectors, over the coming decade. Therefore occupational regulation change is certain to affect the workforce and its growth Carpenter, E. (1996).



Change Management Approach



In order to establish organisational structures, process, infrastructure delivery pattern of the services in line with the changes and evidence-based practice, we have to adopt a rational management approach. The purpose of the approach is to enable the organization adapt to changes in its healthcare services and professional behaviour.



In order to cope with change the sense-of-coherence theory should be applied to measure and track how workers address and are affected with the change. Going by the Ambrose, D., (1987) there are five elements applicable to change: vision, skill, incentive, resources and plan of action. Out of these five elements we will put the maximum focus on the plan of action. For the plan to be effective, it will be of utmost importance that the senior management work on sequencing the occurrence of anticipated events of change. It will help us chart out a timeline to divide out focus across the changes which will occur at different time and places considering the complex organizational system of a healthcare organization. Kotter, J. (1996) argues that if management does not consider sequence and completion stage of events bringing change then many additional unanticipated events will encounter them adding to complexities. Therefore, it is essential to make a timeline of events and stick to it.


To allow the time-specific change management it is important to there is least resistance in the organization to the change or the new approach. Evidently, resisting changes will only add to complexities and create more resistance. However, we cannot also ignore the different views, reactions, degree of resistance and potential impacts of change on different wings, bodies, workers, stakeholder and professionals of the organization. If the team is resistant to change, we will have to find ways and measures to manage that resistance. Managing and converting the resistance of team into support should be the core principle of the change management O’Brien, M. 5. (2008). The timeline will guide the management to measure the implication of the changes for the future events as well.




The article analyzed the key changes in the health organization which occur due to definite and structural internal and external environment, which is dynamic. Before anticipating the changes, we analyzed the organization in the light of broader evidence-based changes that have been affecting the health industry. It led us to list key elements that will cause the inevitable change in the organization. The factors thus determined served as basis to identify specific and broad changes, which will occur in the organization and which are even operating under current times. The change management in organization is crucial as it directly or indirectly affects the quality of its health services, its delivery pattern, profits and sustainability in the light of growing competition. Analysing the changes, we found that managing and adapting the workforce to the change is very important to keep up the quality service. In the end we considered Kotter, J. (1996) and Ambrose, D., (1987) change management model to identify key elements of change management process and importance of sequencing the change events presetting a time line for both current and future implications.




Ambrose, D., (1987) . Managing Complex Change . Pittsburgh: The Enterprise Grp Ltd.


American Hospital Association. 1996. Hospital Stats: Emerging Trends in Hospitals. 1995-1996. Chicago: The American Hospital Association.


Carpenter, E. (1996). Licensing and Credentialing in the Health Care Industry. Washington, DC: Department of Professional Employees, AFL-CIO.


Fennel, M. L. and Jeffrey, A. A. (1993). “Perspectives on Organizational Change in the U.S. Medical Care Sector.” Annual Review of Sociology. 19:89-112.


Greiner, Ann. 1995. Cost and Quality Matters: Workplace Innovations in the Health Care Industry. Washington, DC: Economic Policy Institute.


Golden, B., (2006). Change Transforming Healthcare Organizations: Healthcare Quarterly. Vol 10. Special Issue.


Kotter, J. (1996). Leading Change. Boston. Harvard Business School Press.


National Institute for Health and Clinical Excellence, (2007). How to change practice. London


Noble, H. B. (1995). “Quality is Focus for Health Plans.” The New York Times. July 3, 1995.


O’Brien, M. 5. (2008). Approaches to leading successful organizational change: how CFOs handle staff resistance to change is crucial, Heath Financial Management.


Pindus, N.M., and Greiner, A.


Scheid, J., (2011). 5 Key Elements of Effective Change Management. Bright Hub. Available online:


Thompson, J.M., (2010). Understanding and Managing Organizational Change: Implications for Public Health Management. ournal of Public Health Management & Practice: March/April 2010 – Volume 16 – Issue 2 – p 167–173.


Wunderlich, G. S., Frank A. S., and Carolyn K. D., editors. (1996). Nursing Staff in Hospitals and Nursing Homes: Is it Adequate? Institute of Medicine. Washington, DC: National Academy of Sciences.


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