- Want feedback. They want to know how well they are doing on their job.
- They have the capacity to set high personal but obtainable goals.
- They have the concern of personal achievement rather than the rewards for success.
On the other hand, people with low achievement motivation are more concerned about the environment. They want to know how people feel about them, rather than how well they are doing.
So it will become obvious in the analysis section, that the changes proposed were not taking into consideration the high achievement motivated people (Biochemistry Department staff).
In the next session, it will follow the application of those theories to the given case study, with the intention to identify the main reasons of failure of the organisational change programme, conducted in the health care clinic, by introducing modern technology in the department of medical technologists.
- ANALYSIS
The first step is to try to apply Force Field Analysis in order to identify and evaluate in detail the driving and restraining forces of the changes proposed by the clinic’s organisational development staff (OD).
- FORCE FIELD ANALYSIS
Figure 2: Force Field Analysis of the change study given
The Organisational Development staff believed that in order to enhance the job enrichment elements of medical technologists’ jobs, it was necessary to redesign their job, and after series of meetings between them and the lab staff, they decided to administer a pre-fixed questionnaire to all technologists. The questionnaire, allegedly, would enable respondents to express their confidential opinions regarding various aspects of their job.
3.1.1 DIAGNOSING THE PROBLEMS
Although the project team had a general understanding of the concerns facing the laboratory division, the authors view is that they made false assumptions about the results of the changes introduced. The changes introduced failed to be relevant with the causes of dissatisfaction.
3.1.2 THE CHANGE EFFORT
After analysing the data the recommended changes were:
- Creation of dual career paths of permit advancement other than by moving into administrative positions.
- Development of opportunities for job rotation.
- Redesign of the physical environment, to improve working conditions.
- Provision of ways for lab managers to identify and clarify goals more precisely.
As it was reviewed by the OD staff two years later, the results of the change programme were very disappointing, since the dissatisfaction among the lab staff, had grown even more than before, in addition with negative attitudes towards the management team.
3.1.3 EVALUATING THE CHANGE EFFORT
The nature of these changes, showed that the major focus of the OD’s efforts was on driving forces and how they can enhance their power and impact on the employee’s behaviour. The changes had minimal impact on the existing restraining forces (See Figure 1).
- Evidently, by introducing job rotation, the desired outcome expected, was to give the opportunity to medical technologists to have a variety on the job environment, avoid repetition, and keep the job challenging. Although, this change might seem reasonable, it has to be noted that it’s unable to reach the results expected, because it doesn’t have an impact on the actual nature of the job itself, which is what the medical technologists in the biochemistry department would expect.
- The change regarding, redesigning the physical environment of the workplace, again doesn’t address a problem raised by the employees.
- Provision of ways, with which lab managers would be able to identify and clarify goals more precisely, required strong commitment from them, which was definitely lacking throughout the change process, resulting to negative attitudes towards them by the laboratory staff.
In addition to the negative impact that the actual changes brought, there were committed a series of mistakes and omissions that were crucial for the success of the change programme.
- There was no serious effort from the OD staff to include in the change programme other groups of the health care clinic that maybe not directly affected by the introduction of modern technology (e.g doctors), but directly co-operating with the groups affected by it (laboratory division). This could create another restraining force against the change process.
- By administering a questionnaire to the staff, which the purpose of it was to evaluate the current aspects of their job, firstly, transforms them to passive receivers of the change (not asking them for recommendations of how they perceive that their job content could be improved), and secondly, the only outcome that it can have is to look at how the problem created could be minimised, and not to avoid the problem before it appears (reactive and not proactive).
- Management not committed to the change programme.
- HERZBERG’S MOTIVATORS – HYGIENE THEORY & MCCLELLAND’S ACHIEVEMENT MOTIVATION THEORY
As it has been mentioned previously a combination of Herzber’s and McClelland’s theories, shows that employees with high achievement motivation (Lab staff) are mostly motivated with factors that are directly related to the actual job itself (achievement – recognition – challenge) and not by factors (hygiene) and not with factors that are linked to the job environment (salary – interpersonal relationships – job security- working environment).
The changes brought up they influenced just a few aspects of the “motivators” as well as the “hygiene “ factors. But even, if those aspects were successfully handled, the outcome was minimised by the OD’s inefficiency to create a motivational environment starting from the management level of the division.
- CONCLUSIONS
According to Turrill (1986), a number of methods ca be used to understand the issues and identify the work to be done in bringing about change, and he demonstrated two important ideas:
- There is a balance of forces in a change situation and reducing constraints is frequently more effective than increasing pressure. Subsequently, the OD staff should be aware that to move towards a desirable state through change it is sometimes more important trying removing the causes of resistance than generate more forces pushing towards it.
- Change requires a critical mass of supporters and it is important to build this commitment. In contrast, the change programme was proved to be depended too much on the OD’s staff interest and direction and less on the real commitment of the lab management.
As a final remark, it could be supported that the change programme was doomed to fail, since there was not sufficient communication of the desired state wanted to be met, not intense involvement and commitment of the lab management team which should have set the example. Last, but not least important, the evaluation of the change programme by the OD staff was done two years after the changes were introduced, while the review should be a constant element throughout the process in order to correct any mistakes or fill in any omissions.
- RECOMMENDATIONS
As Carnall (1999) clearly underlines, a successful change implementation programme must include plans for dealing constructively with obvious and hidden resistance to change arising from the anxiety of clinicians and supporting staff. Managing change requires that the people affected by change participate significantly in the process by which decisions are made and change is implemented.
That people resist change should come as no surprise. Change management recognises that resistance to fundamental change is a natural, understandable, and expected human reaction that needs to be influenced productively (Clarke, 1994). Managing change requires the people affected by change to play a significant role in the process by which decisions are made and the change is implemented. Their involvement translates into better acceptance of transformational changes, and more willing adoption of new processes and practices.
They need to understand the rationale behind the transformation, how it will benefit them personally, and what it will cost them in terms of effort and commitment. They must be convinced that the disruption to their lives and the effort to learn new processes and technologies will have a tangible and sufficient reward. Viewing noncompliant employees as obstacles to progress is counterproductive. Change management helps channel their expertise and judgement toward the desired future state.
5.1 Change Management Is an Integral Part of the Transformation Initiative
Experience shows that successful transformation initiatives integrate change management techniques throughout the lifecycle of the initiative (Clarke, 1994). So change management is not something that the organisation does as an afterthought (as it appears to happen in the case study); it is as important as system testing and training. As Clarke supports “Change-management activities are directed at identifying and mitigating "people" risks associated with clinical and operational personnel's acceptance of new systems and their ability to use the new processes and technology. In the end when this occurs, the transformation is deemed successful” (Clarke, 1994, p.111).
5.2 Change Management Never Ceases
As noted previously in the conclusions, continuous change requires continuous effort throughout a project's implementation and beyond. Multi-disciplinary work teams are responsible for accomplishing the project's specific initiatives. A communications strategy constantly reminds participants of what they need to accomplish and reports on progress made toward short-term and long-term goals. According to Carnall:
“A training and education strategy provides all participants with the skills they need to design and then use the newly automated processes. It is key to understand that the change-management do not stand alone as isolated operational task groupings. It is only by leveraging all workstreams together that the transformation can achieve its objectives” (Carnall, 1999, p.227).
5.3 Communications
Individuals may not understand the need and business drivers of the solution. They may wonder, "How is this going to impact me?" These are common risks that can be avoided. When delivered in an effective and targeted manner, communications facilitate acceptance of the solution's impact.
Communications should establish a common set of expectations around what the future holds for each impacted discipline. A robust communications plan with specific messages for each department of the clinic must be developed. This plan should include: a statement of the case for change and business benefits; the vision for the future; and the implications for the various disciplines. The communication activities must include opportunities for two-way communications and dialogue with the end users. This results in a better understanding by the various stakeholder groups, such as the medical technologists of the health care clinic.
To keep the organisation current with the progress of the solution, project-related information about issues, challenges, progress, and lessons learned should be communicated in tailored messages to all departments of the health care clinic (Brussee, 1995).
5.4 Training/Education
There is risk to any systems implementation if the end users do not know how to operate the new systems or technology. Education and training help develop effective learning products to support the use of the system and job performance by various disciplines across the organization, during and after implementation.
As specific changes to processes and technology are clarified, it's time to address end-user training and to develop user-specific curriculum and delivery methods based on roles. Creating and delivering role-based training allows for users to attend learning events tailored to what they do and how they will use the new system, rather than one-size-fits-all training courses. Training and education are only effective if they occur before the system is activated, something that was never realised in the health care clinic. The laboratory staff didn’t receive training before changes introduced and that resulted in frustrations when it was time to use the system.
It is important to consider the need for ongoing education, as medical technologists move to different roles and new associates enter the organisation. In order to achieve the desired results, it is necessary to plan for ongoing training support for the new technology.
Training must be customised to meet the specific needs of each user group. It's a good idea to recruit enthusiastic and capable users from each division of the clinic to act as coaches or mentors to their less experienced colleagues.
5.5 Program Management
At the onset of the initiative, the project teams must collaborate on a risk assessment to identify people, process, and technology issues that may affect their organisation's ability to change. As the project begins, the project teams develop an issues database and create a process to manage both expected and unexpected challenges on an ongoing basis.
New objectives need to be decided and agreed upon. Leadership teams need to decide what the desired outcomes for the project should be and how they will be measured. Financial incentives should be built around the new program objectives.
Exceptional contributions should be rewarded. Doing so consistently throughout the implementation helps to integrate change into an organisation's culture (Brussee, 1995), which maybe is the most important reason for the failure of the change programme of the health care clinic. Even if the clinic had everything mentioned above in place before the changes introduced, the implementation wouldn’t be successful if there was not existent the relevant organisational culture to support the change process.
5.6 People Change – The Bottom Line
Throughout a major transformation, individuals will become stressed and demonstrate either overt or covert resistance. Even beneficial changes aren't necessarily greeted with enthusiasm. A transformation plan that expects great benefits from changing clinical processes and technology needs to be accepted by those affected by the changes. The plan must take into account the behaviour of the people who will implement the changes in delivering care to patients. Through an integrated change-management plan, a clear vision of the future is shared throughout the enterprise. Previously unknown plans and processes become familiar. Successes and benefits become common knowledge. Anxiety ease, and the future changes.
BIBLIOGRAPHY
- Lewin, K. (1951) 'Field Theory in Social Science', Harper and Row, New York.
- Maslen, R., Platts, K.W. (1994) 'Force Field Analysis: A Technique to Help SMEs Realise their Intended Manufacturing Strategy', in Operations Strategy and Performance, 1st European Operations Management Association Conference, University of Cambridge, June, pp.587-588.
- Thomas, J. (1985) 'Force Field Analysis: A New Way to Evaluate Your Strategy', Long Range Planning, Vol. 18, No. 6, pp. 54-59.
- Brussee, F.C (Spring, 1995) ‘Managing change in the Health Care Industry’, Sloan Management Review, pp. 97-100.
- Martin, V. & Henderson, E. (2001) ‘ Managing in health and social care’, Routledge, London.
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Carnall, C. (1999) ‘Managing Change in Organisations’, Prentice Hall Europe, 3rd Edition, Hemel Hempstead.
- Clarke, L. (1994) ‘The Essence of Change’, Prentice Hall Europe, Harlow.
- Turrill, T. (1986) ‘Change and Innovation: A Challenge for the NHS’, Institute of Health Services Management.
