It is important that a project is aligned with the organization’s strategic plan. This project is clearly aligned with the mission and strategic direction for Fraser Health as it will use technology to integrate the respite beds available through Fraser Health thus improving efficient use of staff time and easier access to clients and their caregivers.
Applicable Use Cases
Atkins (2003) states that failure to accurately define requirements can lead to problems in system design and development. She states it is important for the customer and the supplier to spend time on the IT requirements identification process. Inadequate attention to Software Requirements Analysis at the beginning of the project can lead to the end application not performing the intended tasks thus it is important to spend time and resources in identifying how the application will integrate with business processes (outsource2india.com) The list below is based on the writer’s knowledge of the process and therefore may not be complete. The plan would be to meet with stakeholders and identify a complete list of requirements through process mapping.
- System has the capability to add and delete system users
- System has the capability to add, edit, inactivate and delete Facility Respite Providers
- Beds are categorized in the system by geographical area
- Case Manager can check the availability of all beds within Fraser Health for two full calendar years, the current year and the next
- System will not book for less than three days or more than 30 days without supervisor authorization
- A client maybe discharged and another client admitted to a bed on the same day
- Case Managers will access the system using a log in name and password to ensure security
- System does bed booking
- System cancels bed booking
- System makes booking changes in real time
- Bed available, Case Manager enters request into the system
- Bed not available, Caregiver makes a different selection or requests booking to be put on the cancellation list
- Case Manager pulls the client InterRai assessment from the GoldCare database to determine if the assessment is less than six months old, if less than six months old enter the requested dates on the booking calendar, if assessment is older than six months then book an appointment with caregiver and client to reassess and book as hold on the requested dates
- Case Manager forwards the booking request and InterRai assessment to the Respite Facility Provider
- The Respite Provider reviews the InterRai assessment and makes a decision
- Respite Provider sends a denial or confirmation to the Case Manager
- Case Manager informs the caregiver of the denial and the rationale for denial via telephone
- When a booking is confirmed the Case Manager mails the confirmation and pertinent facility information to the Caregiver
- Client arrives at the facility on the confirmed date and the facility completes the admission form and faxes it to the Residential Clerk
- Residential Contracts and Services Clerk enters the admission data into the Provincial database called the Continuing Care Information Management System (CCIMS). This system tracks the clients who use the respite beds. This system is used to reconcile the request for payment invoices received from the Respite Providers. Requirement, system generates an electronic notification to the clerk
- On date of discharge, the Respite Facility completes the discharge form and faxes to the Fraser Health Residential Contracts and Services Clerk who enters the data into CCIMS. Requirement, system generates an electronic notification to the clerk
- The Respite Facility sends an invoice to the client for a daily flat rate set annually by the Ministry of Health. The flat rate multiplied by the number of days of respite stay is the amount the caregiver pays. Requirement, system generates an invoice
- The Respite Facility sends an invoice to Fraser Health Residential Contracts and Services for the pre-agreed to daily rate multiplied by the number of days of respite use. Requirement system generates an invoice
- Respite Facility receives payment from caregiver, closes invoice
- Respite Facility receives payment from Fraser Health, closes invoice
The ideal process would be for caregivers to have direct access to the booking system similar to the hotel booking systems however, policies regarding eligibility requirements and management of confidential client information policies at this time create some barriers therefore, involvement of the Case Manager as the gatekeeper to access to respite services needs to continue.
3.2 Website Enhancement
Current State
Fraser Health has a website available http://www.fraserhealth.ca that includes information on the services available via Fraser Health. Included on the site is information on the residential facilities that are available within the boundaries of Fraser Health. As mentioned above, Fraser Health also offers respite services in residential facilities. Information related to respite services, eligibility, location, and facility specific information in not available on this website. Currently information is being mailed out to caregivers who book a respite bed. When bookings are done on short notice, this information has arrived at the client’s home after the admission to respite has already occurred.
Justification for Selection
Adding information to the current website will allow caregivers timely and accurate information on available respite services. Adding information on respite to the website would allow caregivers the opportunity to gather information and become more knowledgeable which may potentially lead to an increase in the utilization of this resource.
Respite Website Use Case
- Website allows addition, editing, and deletion of respite information
- Pictures can be posted
- Has printer capability to allow users to print material
- Links to Fraser Health’s feedback e-mail
- Consider the target audience (Haag, Cummings, & McCubbrey, 2005) when selecting style, print size, colors and content. Audience will be either an elderly spouse or a client’s child who is over the age of 50 years as the average age of most clients who enter residential services is 75 years (Fraser Health, 2005)
This section has looked at an electronic respite booking system and enhancement of the Fraser Health website as two business requirements that are important for Fraser Health to consider. Initial use cases for each requirement have been outlined but as recommended by Atkins (2003) further work needs to be completed by involving relevant stakeholders to ensure a complete list is compiled and business processes mapped. Process improvements lead to cost savings thus justifying the time spent exploring business requirements.
4.0 Technology Project Plan
This section will identify the hardware and software required for solution designs for the Residential Respite Booking Program and Website Enhancement. How use cases aid in the system analysis and design process will be explained along with how internal and external stakeholders will be affected by the solution. The business risks and security risks of the proposed solution will be evaluated and mitigation plans recommended. A financial plan will be developed and metrics to measure the performance of the technology project plan identified.
4.1 Hardware and Software
The Residential Respite Booking Program and Website enhancement will both require hardware. The hardware required for the solution designs would as Haag, Cummings, and McCubbrey (2005) state include input devices such as keyboards and mice to enter information and commands. Output devices such as a monitor and a storage device to store backup data are required. A central processing unit to interpret and execute software instructions and coordinate the operation of all other hardware is also required. Random access memory (RAM) which is the temporary holding area for the information being worked on as well as the system and application instruction that CPU currently needs is required. Telecommunication devices are other hardware requirements. The Residential Respite Booking Program will require the extranet and wide area network. The Website enhancement will require the internet and wide area network (no author, 2007). The intended users of the Residential Respite Booking Program already have access to the above hardware and the extranet and therefore additional costs for hardware and training on use of the hardware and extranet will not be required. The Web Page will require end users to have access to a PC and Internet connection to view the information.
System, utility and application software will be required (Haag et al., 2005). The Residential Respite Booking Program and the Website enhancement will both require systems software such as Microsoft Windows XP and Microsoft Windows NT. Antivirus software and screensaver software are a couple of the utility software that are required. Fraser Health has systems and utility software. The Website enhancement requires Microsoft FrontPage to create and publish a Website. Fraser Health has this program and thus no added costs are attached. The Respite Booking Program will require a Structured Query Language (SQL) database, File Share and access runtime (Janvrin, 1994).
4.2 Use Cases and Systems Analysis and Design Process
Use Cases are the first step in system analysis and design as Use Cases focus on users and their goals rather than on the product features. Going directly to analysis and design may cause important information to be lost. Use Cases are a way that information can be captured in a non-technical way and thus allow all groups of end users to be involved in the process. Use Cases improve the chances of developing a software package that meets the needs of the customer and end users (Wiegers, 2007). Use Cases assist in building requirements as they “capture the way in which the user uses a system” (Cockburn, 1997). Use cases can decrease the chance that errors in design will occur and thus prevent loss in time and cost involved in redesign.
4.3 Internal and External Stakeholders
Internal and external stakeholder will be affected by both solutions. In the case of the Residential Respite Booking Program work is going from a manual process to an automated process. As part of a change management plan, Case Managers, the primary users of the program, will be involved in all phases of the project. The Case Managers will provide input and will also be involved in the training. The information regarding respite facilities will be available to caregivers in a timely way. Caregivers will not need to wait for the information regarding the respite facility to come via mail but can log onto the internet and view the information on all respite facilities. Stakeholders will be involved in the development of the content. The availability of this information will be communicated to caregivers via Case Managers.
4.4 Business and Security Risks
The website enhancement is low for business risk and security risk as the cost of the enhancement is low and the information to be accessed regarding the facilities is also of a low risk nature. The website can be updated only by Fraser Health communications thus all information is vetted for content to ensure accuracy and is also viewed from a potential liability point of view. The Residential Respite Booking Program has a higher cost risk and has a higher need for security management as confidential information regarding clients will be entered and managed. The business risk will be managed via a clear project charter that will outline expected goals, milestones, deliverables and a financial plan. A contract will be signed with any outside contractor/vendor that clearly outlines requirements, expectations, and penalty clauses for going over budget and being late with deliverables. Security risk will be managed via having only authorized personal having access to the software. A user group will be maintained and authorization for use will be via the home health manager. A specific password will be required to enter the program.
4.5 Financial Plan
Residential Respite Booking Program
The primary projected costs are the cost of labor, the software, and training materials
For the purposes of the project, the assumptions are the cost of the software is negotiated at a set price and clearly defined requirements will be set. Penalty clauses in the vendor contract will cover any problems with the software and delays in delivery time. The labor portion of the budget estimates can be impacted by increases in wages and are calculated based on the assumption the project will be completed within one year during which time there will be no wage increases.
Project Costs:
There are 50 respite beds available within Fraser Health with an occupancy rate of 80%. The loss in dollars of unused resources is 20% of 50 which is 10 beds. At this rate the financial loss is 10 beds times 365 days per year which is a loss of 3650 days per year times the amount paid for each bed which is $130. The total loss per year is $475, 500 in the form of unused resources that are being paid for by Fraser Health. Assuming an occupancy improvement by four beds multiplied by 365 days times $130 the improved flow will equal $189,800. Investment required is $167,200 and will not be discounted as it is an outflow now and not in the future. Assuming a 10% return on investment $189,800 x 0.909 equals $172,528.2. Present value of inflow in year one would be $172,528.2 minus initial investment which is $167,200 which leaves a net present value of investment as $5328.2.
The investment required is $167,200 and cash inflow recouping is sensitive to the rate of occupancy and the rate of cost of the bed. If occupancy rates drop lower than the current 80% even by less than one percent the investment will have been a poor investment as it would not have achieved the goal which is to improve occupancy above 80% (MFEP, 2007). The system will provide reports which will provide utilization of each bed by facility and geographical area thus decisions can be made regarding changes in increasing, decreasing or moving beds based on these reports to further improve occupancy. A change in the rate paid for beds is another variable which could impact cash flow, the assumption is the cost will go up not down.
Website Enhancement
The enhancement of the existing website by adding the respite information can support an improvement in the occupancy rates of the residential respite beds. The site already has the infrastructure in place thus there is no additional cost. The cost of taking photos of the 11 facilities with respite beds at the current rate of $160 per facility is $1760. The cost of staff time involved in the write up, editing and review of content is $95 times 10 hours which equals $950. The total cost of the enhancement would be $2710. The site is already being maintained and thus there will be no additional costs. Due to the limited risk involved in this project a sensitivity analysis and assumptions regarding analysis will not be made. A change management plan is also not required for this change as the site exists and stakeholders are already aware and using the site, this will be an addition. The addition will be communicated via the website itself and via staff newsletters and email.
4.6 Metrics
The quantitative business metric used to measure the performance of the process improvement is the occupancy rates of the respite beds. The benchmark used will be that used for all residential beds which is 99% occupancy. Return on investment will also be considered. Qualitative business indicators of success will also be measured via caregiver and employee satisfaction surveys that will be developed and conducted.
The project metrics used to measure project success will be the time, cost and technical performance. The project will be completed on time. The vendor will deliver the product on or before the target date. The training will be completed on time. Cost will be at or below the estimated cost. The software will meet design and performance specifications. A review of the project will be done with the executive sponsor to determine her satisfaction with the project. A review of the process will also be done with the project team to determine their satisfaction with the process (Bennigson, 1971).
Fraser Health has all of the hardware and most of the software required by both solutions. Use cases aid in system analysis and design processes by involving the end users early on in the process in a non-technical way, thus assuring success. Considering the impact of a solution on all stakeholders, evaluating and mitigating business and security risks are important steps in any project and have been considered in this project. A clear financial plan must be developed to determine the appropriateness of the investment and performance measured by the use of metrics, both have been covered.
5.0 Models and Theories of Change Review
In this section the following five models and theories of change will be discussed for validity and utility: The Generic Change Model; Lewin’s Change Model; Kotter’s Eight-Step Model; Bridges’ Change Model; and Coghlan and McAuliffe’s Model of Large System Change. The human implications of major organizational change, focusing on change that result from the implementation of new technology will be explained. The critical success factors for organizational change from the perspective of managing people will be analyzed. The human implications of the technological changes proposed in the 18 week project will be described, and how the five models and theories selected may be used to address the human implications identified.
5.1 Five Models or Theories of Change: Validity and Utility
The Generic Change Model
The Generic Change Model is proposed by Jay and Smith (1996) state it is vital to focus on change management when implementing a new information system. The model the two authors recommend is mapped onto a typical systems development life-cycle model. Jay and Smith (1996) state this model is the best one to use when change is related to implementing a new information system, as it provides managers with the essential steps required to ensure effective change management throughout the process. The model consists of the following four phases: orientation; preparation; implementation; and support. The orientation stage is where an understanding of the motivation of change is searched for, and a change strategy is developed. The preparation stage involves analyzing the environment, announcing the change direction, developing a change work-plan, ensuring change readiness and providing a common direction. During the implementation phase; the computer system is being designed and developed, system testing occurs, procedures are developed, training takes place, and the system is rolled out. The support phase is the last phase and includes stabilizing or reinforcing the change, evaluating the system’s effectiveness and ensuring the new state remains permanent (Jay & Smith, 1996). This model is valid and useful for use in any technology initiative as it links with the Systems Development Life Cycle and provides change agents clear steps to follow to manage the human aspects of change.
Lewin’s Change Model
Levasseur (2001) recommends using Lewin’s Change Model when introducing new technology. Levasseur (2001) states most failures when introducing new technology occur because of lack of effective communication and failure to involve stakeholders early in the process. He states this failure creates barriers that are difficult to overcome later in the change process. Following the first step of Lewin’s Model helps minimize barriers to change and increase the chance of success (Levasseur, 2001). The second stage, the change stage needs continued support and teamwork to maintain momentum. The third stage is the refreezing stage in which the change agent works with the appropriate stakeholders in the organization to install, test, debug, use, measure, and enhance the new system (Levasseur, 2001). The change agent needs to be involved until old behaviors are replaced with the new ones. The challenge with Lewin’s model does not provide change agents detailed steps to follow however, the model is clear in terms of the major steps that must be followed for change to be successfully implemented (Levasseur, 2001). Lewin’s Model is valid and useful as it takes into account the human implications of a change initiative.
Kotter’s Eight-Step Model
Kotter developed his model as a way of avoiding major errors in the change process after he learned that a majority of change efforts fail (Mento, Jones, & Dirndorfer, 2002). Kotter identified through his study of 100 companies, eight critical stages required for successful change management. The stages are: establishing a sense of urgency; forming a powerful guiding coalition; creating a vision; communicating the vision; empowering others to act on the vision; planning for and creating short-term wins; consolidating improvements and producing still more change; and institutionalizing new approaches (Kotter, 1998). Kotter believes that mismanaging any of the steps can undermine even a well conceived vision. Kotter’s Model is valid and useful as it provides more detail on what steps change agents need to take to successfully manage change.
Bridges’ Change Model
Dulaney and Stanley (2005) used the three phases of the Bridges’ Change Model, the ending, the neutral zone; and the new beginning, to bring about organizational change in their healthcare organization. The goal was to change the way in which addiction services were being provided thus requiring a change in staff behavior. The authors faced a number of challenges through the process but were successful in transitioning the staff to the new processes. Bridges’ Change Model is a popular model when managing an individual’s transitional journey, in this case it was also used successfully in organizational transition (Dulaney & Stanley).
Coghlan and McAuliffe Model of Large System Change
The Coghlan and McAuliffe Model of Large System Change has been used in Ireland for healthcare reorganization (O'Shea, McAuliffe, & Wyness, 2007). Coghlan and McAuliffe according to O'Shea et al. believe health organizations are open systems and therefore, issues, events, forces, and incidents cannot be viewed in isolation but seen as interconnected, interdependent components of a complex entity when making change. The model consists of the following five phases; determine the need for change, define the desired future state, assess the present in terms of the desired future to determine the changes to be made, implement the change and manage the transition, and consolidate and sustain change. O’Shea et al. in a retrospective analysis was able to show that this model was successfully used to re-organize regional orthopedic services in Ireland.
5.2 Human Implications of Major Organizational Change
Change resulting from the implementation of new technology has human implications. A number of critical factors from the perspective of managing people must be taken into account to ensure success (Chrusciel & Field, 2003). Top management must be active and visible champions of the new technology. Communication of the change message must be received by all levels of the organizations. The change message should be delivered verbally and in writing by top management. Direct managers must understand and commit to the change so these managers can deliver a consistent message and vision to the one delivered by top management thus establishing an environment of trust with employees. Involve staff in identifying the gap between where the organization is now and where it would like to be is a must. Support staff in identifying what some personal gains will be to the employee from the change. Involve staff in the development and testing of the technology where possible, this will gain acceptance. Provide mentors or coaches to support any in class type training, again will facilitate acceptance of the technology (Chrusciel & Dr. Field). The above are some of things that must be done to manage people during a technology change to ensure a successful outcome.
5.3 Five Models and Theories: 18 Week Project
The 18 week project is a new technology and will involve a change in how work is completed. The process currently involves three departments and two hundreds plus staff. Staff from all departments will need to recognize the need for change, be willing to participate in the process, and permanently change their behavior. The five models and theories selected above are all similar in that they clearly identify the need to consider the human implications when making any change. Research on the different models has also identified a number of similarities in the recommended steps. The differences appear to be in the level of detail contained within the different models and some models like the Bridges’ Model is more suited to individual change rather than organizational change therefore, all of the models except the Bridges” Model are valid and useful for use for the 18 week initiative. The Generic Change Model was developed to incorporate the human elements when implementing an information system and mirrors the Systems Development Life Cycle Model (Jay & Smith, 1996). As the 18 week project is a new respite bed booking system that will follow the Systems Development Life Cycle, the Generic Change Model would be the most applicable model. The model has clear steps that clearly outline how to involve different levels of staff in the process at different stages of the development of technology.
Considering the human implications of any change it is a must to ensure successful implementation and permanent change in behavior. There are a number of models of change available for use and five of these models have been identified in this section of the paper. All the models can be used successfully for the 18 week Residential Respite Bed Booking System initiative but one model was identified as the most applicable. Regardless of which model is used, organizations cannot lose sight of the need to keep the human implications in the forefront throughout the change process.
6.0 Application of Change Models
There is a continuum on which a project fits in terms of the change scale, where the Residential Respite Bed Booking Project fits on this scale will be explained in this section of the paper. In this section, the rationale for selecting the Generic Change Model as the appropriate change model will be reviewed. A plan to address the human critical success factors of the project and recommended measures to monitor the human change elements of the project will be outlined. Contingency strategies for managing resistance to the proposed changes will also be prepared.
6.1 Change Continuum Scale
Large-scale change is defined by Rouda and Kusy Jr. (1995-96) as change that involves the entire organization and learning is not at an individual or unit level but applies to the entire organization. If this definition is used, the Residential Respite Bed Booking Project is not a large-scale change but a small-scale one as it involves only three of the many departments of Fraser Health. In terms of short-term versus long-term change, the Residential Respite Bed Booking Project is a process improvement initiative that will require a change in behavior on the part of staff thus it is a long-term change.
6.2 Appropriate Change Model
The Generic Change Model is the most applicable change model for this project as it is mapped onto a typical systems development life-cycle model and clearly outlines how to involve the different levels of staff in the process at different stages of the development of technology (Jay & Smith, 1996). The Residential Respite Bed Booking Project will look at the use of technology for process improvement therefore, the Generic Change Model is the most applicable. As explained in the previous paper, the Generic Change Model consists of the following four phases: orientation; preparation; implementation; and support. The orientation stage is where an understanding of the motivation of change is searched for and a change strategy is developed. The preparation stage involves analyzing the environment, announcing the change direction, developing a change work-plan, ensuring change readiness and providing a common direction. During the implementation phase the computer system is being designed and developed, system testing occurs, procedures are developed, training takes place, and the system is rolled out. The support phase is the last phase and includes stabilizing or reinforcing the change, evaluating the system’s effectiveness and ensuring the new state remains permanent (Jay & Smith, 1996). The model provides managers with the essential steps required at each phase of the model to ensure effective change management throughout the process.
6.3 Human Critical Success Factors Plan
Two of the most important human critical success factors in any change initiative are communication and participation (French, Bell Jr., & Zawacki, 2005). Pundziene, Alonderiene, and Buoziute (2007) state, communication is one of the key-elements to the successful implementation of any change and that communication of a technology idea should not be a process of telling or informing stakeholders but a mutual process of an exchange of ideas, thoughts and sharing of fears, anxieties and concerns. The authors go on to say success depends on how well this exchange is done. For the Residential Respite Bed Booking Project a clear communication plan will be developed in consultation with a steering committee that has representation from the stakeholder groups. The plan will outline how, when, where, and what will be communicated and by whom to who.
Participation is another very important human factor. It is imperative to involve stakeholder throughout the process as it builds commitment to the change. The Generic Change Model described earlier clearly outlines who the appropriate stakeholders maybe at each phase of the development of the technology and the change process. For the Residential Respite Bed Booking Project, participation of the different stakeholders will be in the form of a steering committee. Representation will be requested from the Information Technology Department, Home Health Case Management, and Residential Respite Providers to participate in developing the change strategy as per the first phase of the Generic Change Model. The steering committee will then set the direction for analyzing the environment through a change readiness assessment. The steering group will develop a common vision and the strategy for communicating the vision. For the implementation phase where the software is being designed, developed, user tested, procedures developed, and a training manual developed, a task group comprised of appropriate stakeholders will be formed. A representative will be requested from each work group, this person will be responsible for sharing the work of the task group with the group he or she represents. The role of this person will be to collect feedback from his or her work group and bring this feedback to the task group to be incorporated as appropriate. The representatives on the task group can be trained as Super Users and would have responsibility to provide training and mentoring back at their worksites thus providing ongoing support and sustainability. The steering group and task groups would both be involved in the evaluation process.
6.4 Measures to Monitor Human Change Elements
Representatives from the stakeholder groups who are responsible for gathering feedback from their worksites and informing their colleagues about changes are one way of monitoring how change strategies are working and what changes need to be made to these strategies. Additional focus groups to assess the status of change can also be held. A third measure that can be used to monitor is a survey. An anonymous survey can provide an opportunity for individuals to provide feedback and input in a non threatening way. Providing feedback boxes at each worksite is also another method that can be used to monitor how change is going for individuals , again this is an anonymous feedback mechanism for those who would feel uncomfortable sharing their dissatisfaction with the change process in a more direct venue. It is important to have measures to monitor the human change elements at both the group level and individual level.
6.5 Contingency Strategies for Managing Resistance to Change
LaMarsh (2005), states there are a number of different reasons that an individual or group may resist change, the most common ones are: lack of information; fear of lack of ability; and lack of willingness. Banutu-Gomez and Banutu-Gomez (2003) agree with LaMarsh and add selective processing of information as an additional reason for resistance to change. Sherman and Garland (2007) state resistance to change is a defense against fear of loss and a fear that one will not survive the change without losing something familiar. All the authors agree the best strategy for managing resistance is to take steps early on by ensuring a comprehensive communication plan and participation plan are part of the change process. The authors also agree that resistance is part of any change and strategies to deal with resistance are necessary.
If resistance is assessed to be due to a lack of communication around what the change is and how the change is going to be made, then the plan would be to reassess the communication plan in place and communicate in a different way to meet the needs of the individual or group that is resisting. The individual or group can be asked, what information they need, who they would like it delivered by and what method of communication works best. Communication can then be tailored to meet the needs of the individual or group. If the resistance is due to fear of ability to learn the new way or fear of lack of ability to change then the strategy is to provide additional support and training. If the resistance is due to lack of willingness then the right reward needs to be determined and offered to assist the individual or group in accepting the change. Also teaching managers how to coach employees for commitment can be useful when dealing with lack of willingness (LaMarsh, 2005).
Banutu-Gomez and Banutu-Gomez (2003), state the following six tactics can be used in dealing with change resistance: education and communication; participation; facilitation and support; negotiation; manipulation and cooptation; and coercion. Education and communication recommends using multiple ways of communicating such as verbally, in writing, in group setting and one-on-one. Education should also be delivered in a method that is the most beneficial for the learner. Participation refers to involving individuals in the decision-making process to obtain their commitment to the change. Facilitation and support refers to providing opportunity to share fears and work through the fears. Negotiation is similar to LaMarsh’s offering appropriate rewards. The authors’ recommends this is a very appropriate tactic if the resistance comes from a powerful source. Manipulation and cooptation refers to twisting facts to make them appear more attractive to the listener, or withholding undesirable information. Coercion refers to threats of transfer out of the department, loss of promotion, negative performance evaluations. For the purposes of the Residential Respite Bed Booking Project all of the above strategies maybe used except for manipulation, cooptation and coercion.
This section looked at the Residential Respite Bed Booking Project being a small-scale, long-term change that will be moved forward using The Generic Change Model. Communication and participation were identified as the two human critical success factors and a plan to address these factors developed. Measures to monitor the human change elements of the Residential Respite Bed Booking Project have been recommended. Six potential strategies of managing resistance to change have been proposed.
7.0 Recommendations for Leading and Sustaining Change
This section of the paper will recommend leadership behaviors required to keep momentum alive during the implementation of the Respite Bed Booking Project. The elements of Fraser Health’s organizational culture will be evaluated and how these elements may influence successful implementation explained. A strategy to deal effectively with organizational culture issues to ensure success of the implementation plan will be developed. Post implementation management practices necessary for the continued success of the project will also be recommended.
7.1 Recommended Leadership Behaviors
There are a number of leadership behaviors recommended to keep momentum alive during the implementation of the Respite Bed Booking Project; a few of these behaviors will be outlined below. The leader must communicate clearly, often and via multiple routes. The leader must frequently communicate the status of the project. The leader should also thank and acknowledge people who are displaying behaviors that support the values of the project. The leader must also speak positively and enthusiastically about the project at events and walk around. The leader will show team members that she cares about them by showing active interest in the work people perform by visiting the worksite and asking questions and expressing appreciation. The leader will engage team members and ask them what support they feel they need. The leader will provide appropriate resources and tools based on feedback received from staff thus allowing staff to feel confident in the support of the leader. The leader will exhibit behaviors that are consistent with the core values of the organization. For example, respect and trust are two core values that Fraser Health holds (Fraser Health, 2005). To maintain trust the leader will admit mistakes when they are made and without blaming others take steps to correct the mistakes (French, Bell Jr, & Zawacki, 2005). Respect will be shown through the leader following through on what she says she will do. Respect will also be shown through the leader listening to all points of view and answering all questions truthfully. The leader will show respect by communicating all decisions openly and clearly and by explaining the rationale behind the decision. Consistent with Douglas McGregor’s Y Theory, the leader will support the team in setting clear, achievable goals and will assist the team members in recognizing what is in it for the team member to support project goal achievement (Hellriegel, Sloocum, & Woodman, 1998). Following Hershey-Blanchard’s Situational Leadership Theory which is based on the amount of direction and support provided based on a given situation and the maturity level of the follower, the leader will assess the situation and provide the appropriate level of direction, facilitation, and support (French et al.). The leader following Transformational Leadership will instill a feeling of confidence and commitment in team members by creating a vision in collaboration with team members. The leader will provides team members with coaching that will help them see new ways of solving problems and develop new skills to work toward accomplishing the project’s vision and goals (French et al.).
7.2 Evaluation of Elements of Organizational Culture
One definition of organizational culture is, “culture is shared basic assumptions about the correct way to perceive, feel and act” (Goldman, 2006). Based on this definition, the question arises what elements of culture can an organization be evaluated on? Kenny and Reed (2006) state involvement, consistency, adaptability, and a sense of mission are the four traits along with innovation that an organizational culture must reconcile to be effective. Fraser Health’s organizational culture will be assessed using these five elements as these elements may influence successful implementation of the project.
The structure of the organization will determine the level of involvement individuals have or perceive they have. Hellriegel, Sloocum and Woodman (1998) state for individuals to be involved in decisions to help meet organizational goals, a flexible structure which is characterized by “decentralization, shared decision-making, low to moderate us of formal rules and regulations, broadly defined job responsibilities and flexible authority structure with fewer levels in the hierarchy” is necessary. Fraser Health is a large organization with formalized rules and regulations. Job responsibilities are clearly and specifically defined in the very highly unionized environment. There are many levels of hierarchy and a fairly inflexible authority structure. A strategy will be developed to maximize involvement of stakeholders such as the Home Health Case Managers, Respite Service Providers, IT, and vendors to ensure successful implementation of the project.
An organization must have a clear corporate philosophy to enable individuals to coordinate their activities to achieve a common purpose. One effect of a corporate statement of philosophy is the influence it has in creating a strong culture capable of appropriately guiding behaviors and actions; this consistency leads to goal achievement and overall effectiveness of the organization (Hellriegel, Sloocum, & Woodman, 1998). Fraser Health has a strong philosophical statement which is posted throughout the organization, on the website, and reviewed with all new employees. This is an area of strength for the project, as developing a clear mission and goals are things internal stakeholders understand and partners stakeholders expect from Fraser Health.
Adaptability and innovation are closely linked. Martins and Terblanche (2003) state, “for an innovative culture to succeed certain requirements must be met which involves four kinds of attitudes; corporate management is willing to take risks, the participation of all members of the firm is requested, creativity is stimulated and there is shared responsibility.” Martins and Terblanche go on to say “organizational culture affects the extent to which creative solutions are encouraged, supported, and implemented. A culture supportive of creativity encourages innovative ways of representing problems and finding solutions and creativity is regarded as desirable and normal and innovators are rewarded and emulated.” Organizations in which innovation is present managers hold values and beliefs around a free exchange of ideas and information, questions are asked openly, and there is support for change and diversity (Hellriegel et al., 1998). Kenny and Reedy (2006) state the organization’s culture around innovation can be examined based on the company’s innovation strategy, the type of innovation engaged in, and drivers and constraints of innovation. They go on to state investment in training and availability of grants is a suggestion that innovation is considered positively. Fraser Health’s organizational culture is one in which continuous improvement and adaptability are the norm and improvements are considered not just the role of formal leaders but of all staff. Innovation awards are given on a yearly basis to those individuals or groups that put forward innovative ideas that are implemented. Training is made available to interested staff on how to apply for grants, how to do research, and how to manage teams and projects (Fraser Health, 2005).
7.3 Strategy to Deal Effectively with Organizational Culture
The strategy will be to build on the strengths of the culture at Fraser Health and develop ways to manage the challenges the culture presents. Representatives from all stakeholder groups such as Home Health Case Managers, Respite Service Providers, IT, Vendor will be identified and invited to participate in the process. Individuals from these groups with either formal or informal influence will be encouraged to become involved. These individuals will participate on a task group and will gather input from their perspective worksites. They will bring the feedback and input to the task group and will take information back to their worksites on the status of the project. This group will provide feedback on the development of the software and participate in user testing. This task group will also provide feedback on training resources. The Case Manager Representatives will be the super users, meaning they will provide software training back at their worksites. By having this group function as the super users, there will be sustainability for training (Tong, 2002). This collaboration will build strong commitment on the part of task group members and their worksites.
To ensure that all stakeholders understand how the project fits into the overall vision of the organization and what the benefits are to the organization as a whole and to them as individuals a clear project vision and charter will be developed with input from stakeholders using the process outlined above. Through the development of a clear vision and project charter, the project team will have clear goals to meet thus ensuring consistency of behavior that will lead to goal achievement (Ghysels, 2008).
The strong culture of innovation and adaptability will be reinforced with involvement of stakeholders throughout the process. Work processes will be mapped by the task group and the group will be encouraged to problem solve and recommend areas for improvement. Milestones will be mapped out and celebrated as achieved. The process will be streamlined prior to automation. The group will also be encouraged to provide input into the development of the software so the software does what is required (Tong, 2002).
7.4 Post Implementation
Post implementation the task group will continue to be reconvened either in person or by phone or email at pre set times to assess the status of the change both the positives and the challenges. The Super Users will sustain the change through on site problem solving based on the in class training provided and the training materials provided. Super Users will escalate software issues as per training materials. All new staff will be provided software training by the Super User at his or her worksite. Super Users will have two specific program people to bring issues and concerns related to the software and respite process. The project lead will keep management at the stakeholder sites up to date on the project via email, through meetings and through the Super Users. Once the training is complete and go-live date completed, the individuals involved in the project will be invited to a celebration tea as thanks for their involvement.
In this section of the paper, the behaviors leaders must display to keep momentum alive during implementation were recommended. Fraser Health’s organizational culture was evaluated based on five elements and a strategy developed to effectively deal with organizational culture issues to ensure successful implementation. Post implementation management practices necessary for the continued success of the project were recommended.
8.0 Systems Thinking and Change Management Evaluation
This section will evaluate systems thinking and the application of systems logic along with evaluation of various stakeholder interests and resource constraints. The impact of technology on effective managerial decision-making will be assessed and an analysis of the evolving role of ethics and corporate responsibility done.
8.1 Evaluate Systems Thinking and the Application of Systems Logic
Waldman & Schargel (2006) state the reason for resource shortages, errors, and escalating costs in healthcare is linear or silo thinking and the lack of systems thinking. The authors’ further state managers often do not recognize that healthcare organizations are complex, multidimensional systems that demand managers consider the entire system when making decisions. Waldman & Schargel (2006) also state that as healthcare is a complex and multidimensional system a manager cannot get a complete picture of all the interactions leading to system output over a short period of time thus it is imperative to do strategic planning. Werhane (2008) states silo thinking is encouraged as “the culture of healthcare is inflexible and risk-averse and discourages original thinking, risk-taking and entrepreneurial behavior, despite the fact that effective quality improvement efforts require innovation”.
One of the ways systems thinking is incorporated in the project is to involve all appropriate stakeholders in the change planning and look at the entire system rather than only one specific department. The cost and satisfaction benefits are also being viewed over the whole system. It is difficult to measure the impact the change will have on the entire system if utilization rates of respite beds are improved however, one can conclude that improvements in access to services anywhere in the system will impact favorably on the reputation of the organization which is a benefit. If increased utilization of a less expensive resource such as a respite bed leads to a decrease in the use of a more expensive resource such as an acute care bed then the organization, healthcare system, and tax payers all benefit.
8.2 Evaluate Various Stakeholder Interests and Resource Constraints
The stakeholders most directly impacted by the changes related to the systems change are the Case Managers, Respite Service Providers, and Fraser Health. The process for the caregiver does not change as the caregiver will still be calling the Case Manager to book the bed. The constraints for the project is the availability of time the Case Managers have to participate on the project, thus there needs to be efficient use made of all meeting times. Case Managers will be compensated for their time by their regular wages however, they do not get back filling, that is no one does their job while they are at the meeting thus they may be reluctant to attend meetings. Respite service providers are not compensated financially for participating on the project which is a constraint. The strategy used will be to get commitment through clarity on what the long term benefits will be for both these groups in terms of efficient use of their time. There are 200 Case Managers that need to be trained on the use of the software which is a constraint, as is the fact that each employee needs to receive his or her training within three to six week of the go live date. Training provided any earlier than this maybe to soon and learners may not retain the learning. Learners are also spread across a large geographical area which is a constraint. The strategy that will be used to provide just in time training in a suitable geographical location is to provide the in class training to the Case Manager Super Users who in turn will train the other case management staff in their offices two to three weeks prior to go-live. The super users will be provided with a teaching power point presentation and handout materials which provide step by step instructions.
Fraser Health management must also consider the budgetary considerations and constraints. Will the projected lifespan of the software pose a constraint? Most technology changes rapidly and typical lifespan of most technology is about three years thus will upgrades be possible and how much will they cost (Barnes, 2005).
8.3 Assess Impact of Technology on Effective Decision Making
The use of technology is expanding rapidly within healthcare. Technology innovations will help healthcare organizations better identify and track patients, communicate patient information, and provide standardized, quality patient care (Bolster, 2007). Managers need to make decisions based on accurate information. The recommendation is for managers to look outside of healthcare to see how technology is being used effectively and how it has been used ineffectively before making decisions around which technology to consider. Bolster (2007) states decisions should be made on hard trends, things that will happen rather than soft trends which are things that may happen. She states “the ultimate hard trend is a technology-driven trend because technology lets you turn the impossible into the possible”. For example the internet she states is “providing powerful changes in how healthcare is provided as it is leading to wireless telemedicine, changes in procurement services, e-enabled disease management”. She predicts increased processing power, bandwidth, and storage will lead to a move from paper patient charts to electronic charts. It is currently not uncommon for health authorities to have more than 100 databases, with new technology these can be consolidated into only a few (Bolster). The more databases a system has, the more breakdown points there are. Using technology to capture the right information and using it to verify information is accurate needs to be a high priority for healthcare (Bolster).
The technology chosen for the project was selected as part of a process improvement initiative and as such has a great deal of influence on the development of the change plan. In the case of the Residential Respite Bed Booking Program, software must be developed which requires staff input in the development stage to identify the requirements and use cases. Staff also will need to test the software and provide feedback. As 200 staff will be using the technology, a clear training plan along with a sustainability plan needs to be included in the change plan.
8.4 Analyze Evolving Role of Ethics and Corporate Responsibility
Fraser Health contracts respite services for its clients from Health Service Providers who are either for profit or run by non-profit organizations. Historically Fraser Health has had a fairly loose agreement with its Health Service Providers but has recently moved to the development of an agreement which clearly outlines expectations around financial and service expectations. Support is also being provided to Health Service Providers to develop safer environments for employees and clients. Best practices are being shared around infection control practices, disposal of toxic materials, and smoke cession which is showing Fraser Health is taking corporate responsibility not only for itself but also supporting those organizations it collaborates with to do the same. Fraser Health has a code of conduct that all employees must follow. The organization also has an ethics committee and ethicists who are available to consult on complex issues.
9.0 Conclusion
An analysis of business requirements and use cases was done for the Residential Respite Bed Booking System and for an enhancement to the existing website. The decision was made to limit the website work to adding the information about the respite beds and communicate this addition. A project change management plan was not completed on the website. The project change management plan focused on the Residential Respite Bed Booking System. In addition to the work done on the business requirements and use cases, it was noted that identifying and involving the appropriate stakeholders is a must for any change plan to succeed. Mitigating business and security risks would be done through a clear project charter that outlines appropriate the scope, timelines and deliverables. To mitigate risk of working with outside vendors a contract will be signed that and will outlines expectations, timelines, deliverables and penalties. A cost analysis of the cost versus the benefits shows that the project would be positive from a cost point of view. The project itself will be measured using time, cost and technical performance of the software as metrics. The satisfaction of the project’s customer who in this case is the Executive Sponsor will also be used to measure success.
It is important to select an appropriate change theory or model to support the change process to ensure that the human elements are not lost as technology is being developed and implemented. Part of the success of any change plan is the level and quality of the participation of stakeholders and the level of commitment they have towards the project and its outcome. The Generic Change Model was selected as it follows the Systems Development Life Cycle and clearly outlines how to involve different levels of stakeholder in the change process at different stages of the development of technology and supports building stakeholder commitment. The reasons stakeholder may resist change was explored and strategies such as the appropriate use of communication, education, participation, facilitation, and support discussed.
Recommendation for leading and sustaining change looked at evaluating organizational culture and how it influences successful implementation and post implementation. It was identified that leadership behaviors such as communicating via multiple routes, showing an interest in the concerns stakeholder have and engaging people in the process are some of the leadership behaviors that are consistent with Fraser Health’s culture and core values. The importance of systems thinking and using technology for managerial decision making were identified as musts for healthcare organizations because without them costs will continue to escalate.
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