The following paper will identify and describe a recent change to work practice in the organisation Nepean Hospital. It will then relate that change primarily to the individual and group, and briefly, the organisation. An analysis of the change in terms of the concept of organisational change will be discussed, focusing primarily on: the type of change, the force driving the change, the resistance to the change, how this was overcome, and, what strategies could be implemented to enable the change to go smoothly next time. Lastly, a change protocol will be suggested for future changes within Nepean Hospital.
Change identified and described
Nepean hospital is a professional bureaucracy, because it relies on the coordination and standardization of skills and its associated design parameter, training and indoctrination. It hires duly trained and indoctrinated specialists and professionals, for the operating core, and then gives them considerable control over their work. For example, the Doctors and Nurses have a reasonable level of autonomy and, while working somewhat independently of their colleagues, work closely with the clients he or she serves (Robbins and Barnwell 2002, p. 487-8).
As part of a day-to-day activity in Nepean Hospital unconscious or immobile patients of all sizes and weights are transferred from their beds to chairs so as they can be sat up for better lung expansion. Until recently, this process has been accomplished primarily by two methods. These methods were: the ‘Top and Tail’ carry, which involved physically carrying the patient from the bed to the chair with two nurses, and the ‘Pat Slide,’ which involves physically sliding them across with a draw sheet. Both of these methods involved considerable strength and carried with them the risk of back injuries.
According to Sanders ‘decision making occurs as a reaction to a problem’ (1999, p. 44); this is where there is a discrepancy between some current state of affairs and some desired state, requiring the consideration of an alternative course of action (change). It can therefore be seen that ‘the awareness that a problem exists and that a decision needs to be made is a perceptual issue’ (Robbins et al 2004, p. 139). At this stage in the development of the organisation, Nepean Hospital, it was determined that there is a problem with the current methodology of moving a patient from a bed to a chair.
As a reaction to this problem, and the fact that considerable workers compensation claims were being made, the invention of the ‘Hover Mat’ occurred, which involves an inflatable sheet that may act as a hover craft ensuring much easier and safer transfers of patients. And in 2001 it was implemented as the only method of transferring immobile patients (who don’t have a spinal injury) from a bed to chair. The change in itself removed the old concept that you must be stronger and tougher if you want to successfully transfer a patient, to the new concept that you must make it safe to do so, regardless of your strength by using a ‘Hover Mat.’
The type of change in this circumstance was both a technological and cultural change. This is because it required the removal of the old knowledge on how to physically transfer a person from a bed to a chair and the indoctrination or education of the new technological way to move a person from a bed to a chair. It also required the cultural change, from the old view that ‘if you’re not tough, you shouldn’t be nursing’ and ‘it’s the nurses job to lift’ to the new view that you must ‘take care of your back, ’and ‘if you can’t easily and safely lift it, use technology that can.’
Change related to the individual, group and organisation
This change affects the individual, group and the organisation in many aspects. However, it most greatly affects the individual and the group. This change affects the individual based on their day to day work protocols and procedures; in doing so, it causes them to forget the old way of completing a task, and develop the new skills involved in performing the new way. It also affects the individual based on their cultural expectations, such as the concept that one must be physically strong in order to be a nurse.
It affects the group based on their work protocols and procedures when transferring a patient, as well as affecting their cultural beliefs regarding what defines a nurse. It affects the decision making process of people within the group, based on what they previously believed to be an okay physical requirement. It affects the group in the way they work together, because there will be some who repudiate the cultural change, and this may affect the group, because others may wish to conform. For example, some individuals within the groups, may wish to boycott the new technology and views associated with it, and because of the minority’s desire to conform to the group, groups of nurse will not utilize the new technology.
Lastly, it affects the organistion in the way it structures protocols. For example, number of staffing required during a transfer may be reduced. Furthermore, due to conflicting views off the change, the introduction of conflict within the organization may develop; and, depending on the outcome of this conflict, it may be either good or bad for the organisation (Capozzoli 1995, p. 2).
Analysis of organisational change in terms of work culture and ethical considerations
According to Robbins et al, work culture may be defined as ‘a system of shared meaning held by members that distinguishes the organization from other organisations’ (2004, p.439). In Nepean Hospital, there are many work cultures that distinguishes the organisation from that of other organisations; however, with reference to this specific change, the most prominent shared meaning is ‘that to be a nurse, you must be physically tough.’ This organsiational change has affected the organisational culture by shifting the old meaning of a nurse as ‘becoming tougher if he or she can’t lift,’ to the new concept of ‘nurses require technologies, not strength.’
According to Preston ethics may defined as ‘doing what is right, fair, just or good; what we should do, not just what is the case or what is the most acceptable or expedient’ (2001 p.18). Although ethics, by their sheer nature, are arguable, and open to the specific perception of the individuals viewing them, many can argue that this change has been ethically right and beneficial. In this case, the change to Nepean Hospital may be considered ethically right, based on the concepts of utilitarianism, which is the ‘goal of providing the greatest good for the greatest number’ (Robbins et al 2004, p.151). This is because it improves the working conditions of all the employees involved or directly affected by the change, as well as making it safer for those patients who require the use of the changed technology as a patient.
The type of change
The type of change was both a technological and a cultural one. Technologically, a means of physically moving a patient from a bed a to a chair had been developed and was now to be utilized, for easier and safer modes of conducting a procedure. This technology consisted of the ability to produce a small hover-craft effectively making it safer to transfer a patient from a bed to a chair and back again. Culturally, the change applied to the concept that as an organisation, for years it had been considered the organisational norm to be tough and physically capable of lifting and moving patients. The words ‘if you can’t lift them, you shouldn’t be nursing.’ were all too common. Where as now, the concept that is trying to be applied is ‘if you can’t lift them get mechanical assistance.’
The driving force of the change
The driving forces of the change includes the introduction of new technologies making it physically easier to utilize the technology of a Hover Mat, the nature of the workforce including the increased professionalism, the change in social trends increasing the amount of obese people in society today, and the economical and political benefits of decreasing the workers compensation claims associated with back injuries caused by poor manual handling methods. The new technology was the invention of the ‘Hover Mat,’ which allowed the safer transfer of a patient from a bed to a chair and back again.
The change in the nature of the workforce included over the years the introduction of degree trained nurses and with it increased professionalism, which pushed the unions to further decrease the amount of back injuries associated with nursing, as nurses were no longer looked upon as labourers.
The change in social trends involved societies developing increasingly sedentary lifestyles, while maintaining high food intakes, leading to increased obesity within society. This causes patients to be heavier and forces the drive for physical change in manual handling methods. Economical restraints have found that it is more viable to ensure a safer working environment than to spend vast amounts of money on workers compensation claims due to back injuries (Sydney Western Area Health Service 2005, p. 4).
Lastly, it was political necessary to show the general public that the health organisations were committed to decreasing the high level of back injuries due to poor manual handling devices and methods, as a failure to do so, would cause more and more persons, as well as those already within the industry to opt towards other career paths.
Describe the resistance to the change
According to Robbins et al ‘one of the most well-documented facts is that organisations and their members resist change’ (2004, p. 570). This was no exception within Nepean Hospital.
The individuals resisted the change by not wanting to put the Hover Mats underneath the patients because they found it a hassle, they forgot, or they thought it could be bad for the patients. Furthermore, they resisted the concept that every patient being physically transferred from a bed to a chair must have a Hover Mat based on their habit of lifting, which had been developed over years of physically lifting patients, when required. The fear of the unknown was another factor of individual resistance. According to Robbins et al, ‘change substitutes ambiguity and uncertainty for the known’ (2004, p.572). In this case, people who had used the equipment before were not only unsure as to how to use it, but feared the concept of using it.
The groups of people resisted the change based on the erroneous cultural belief that ‘if you can’t lift you shouldn’t be a nurse.’ There was the cultural view from the older nurses that the young nurses are weak, and that the use of devices such as hover mats are further proving how weak the next generation of nursing is becoming. This, in turn, caused conflict, and degradation of the organisational team to individual groups. Based on this cultural belief, groups resisted the change, based more on group inertia than individual beliefs. This inertia was further developed by many union norms viewing the product as the organisation’s method of ‘passing the buck’ or putting the onus of a back injury on the individual employee.
The organisation, although promoting the new device, refused to pay for enough Hover Mats to be used by every patient, while putting the blame back on the individuals to ‘use the hover mats where needed or be liable for the injury you sustain.’
How this resistance was overcome
This resistance is being overcome through education, communication, participation, facilitation and support.
Education has been promoted through the use of in-services on the product, its benefits and how to use it. Each unit within the organisation of Nepean Hospital utilized a Hover Mat liaison officer, who assisted with the ongoing education, and promoton of the product/ procedure. Education was further utilized by engaging each employee, who would actively utilize the product, by allowing him or her to experience the patient comfort benefit when being transferred from a bed to a chair by physically having a go of being the ‘pretend’ patient.
Communication was established between the employees and the organisation allowing both parties to discuss their concerns and their views of the new product and the procedures that were being implemented with its use. Some methods of communication included the use of employees filling out specific product questionnaires, and the use of Hover Mat liaison officer who actually participated in the use of Hover Mats within the unit allowing all concerns and viewpoints to be communicated at an informal, as well as formal level.
According to Robbins et al, ‘it is hard for an individual to resist a change decision in which they participated’ (2004, p. 579). In this circumstance, many employees within Nepean Hospital were given the opportunity to participate within the decision making process by trialing the product before it was implemented, writing suggestions for what they would like the organisation to implement, and a problems that they could see with the change.
Facilitation and support were offered to all employees, with specific attention to those who were resisting or opposing the change based on difficulty, or a lack of desire to learn new skills. Methods such as ensuring help was offered to use the new product when required, the use of a paid compulsory in-service, and continual positive reinforcement of the product were developed.
Strategies that could be implemented to make the change go more smoothly
One of the main factors that could have made the change go more smoothly was if
employee participation was better utilized. Robbins et al notes that it is ‘difficult of individuals to resist a change decision in which they participated’ (2004, p.573). Management at SWAHS involved in the decision making process that ultimately decided in the use and implementation of the Hover Mat utilized this concept, by suggesting several means of overcoming the problem and allowing the employees to communicate which ones they would prefer. Other methods of involving individual employees in the change decision, included the use of employees on the Hover Mat Implementation Committee; the downside to involving individuals of all levels within the organisation to participate within the decision making process is that they may not have the expertise required to objectively choose the best product and ultimately, this process will be more time consuming.
A suggested change protocol
As with every faculty of study, there are numerous school’s of thought as to the methodology of change management. In order to determine a successful change protocol one must consider some of these school’s of thought.
Although there can be many goals of a planned change; fundamentally, the goals are: to improve the ability of the organisation by adapting to changes in its environment, and to seek a change in employee behaviour; with the ultimate goal of these changes to improve organisational effectiveness and efficiency (Kotter 1995, p.2-3).
According to Shani and Pasmore, the processes of change management include: ‘diagnosis, analysis, feedback, action and evaluation’ (1985, p. 438). Through the process of diagnosis, an organisation’s change agent, may gather information about the individual and groups perception of the possible change. Through analysis he or she may determine the main problems the individuals and groups within the organisation may focus in on. After this, the feedback stage requires the involvement of the individuals and groups (the employees) to develop a solution. The fourth stage, the action part, requires the change to be set in motion. The final step is evaluation, which determines the actual change’s effectiveness, and ultimately, has it made the organisation more effective and efficient?
At all times, the organisation should involve and gain the support of the people within the system. Management should understand where the organisation is at the moment; where it is desired to be, when, why, and what the measures will be for having got it there. According to Kotter, plans should be in place to ‘develop appropriate, achievable, and measurable stages of the change, while involving, enabling and facilitating the involvement of people, as early and openly as is possible’ (Kotter 1995, p.2-3).
Change must be realistic, achievable and measurable (Kotter 1995, p.6). These aspects are especially relevant to managing individual and group change. Before starting organisational change, an organisation must determine what it wants to achieve with this change; why, and how will it know that the change has been achieved. It then must address who is affected by this change, and how they will react to it. Lastly, how much of this change the organisation is capable of achieving independently, and what aspects of the change does it need specialist or outside help to achieve.
Lewin argued that ‘successful change in organisations should follow three steps: unfreezing from the status quo, movement to a new state, and then refreezing of the new status quo’ (as cited by Robbins et al 2004, p. 575). For example, when applying Lewin’s three step model to the recent change within Nepean Hospital, one may see that the status quo, or equilibrium is the perception that the only way to move a patient from a bed to a chair is to ‘physically lift’ and the cultural belief that ‘nurses are supposed to lift.’ To move from this ‘equilibrium, and overcome the pressures of individual resistance and group conformity requires unfreezing’ (Lewin, as cited by Robbins et al 2004, p. 575).
In order to unfreeze these concepts, the organisation may increase the driving forces that direct organisational behaviour away from the status quo. In this case the driving forces of the change includes the introduction of new technologies making it physically easier to utilize the technology of a Hover Mat, the nature of the workforce including the increased professionalism, the change in social trends increasing the amount of obese people in society today, and the economical and political benefits of decreasing the workers compensation claims associated with back injuries caused by poor manual handling methods. Through education, the organisation may change the perception of individuals and groups to understand the greater need for these changes.
Alternatively, the restraining forces, which decrease the movement from the existing equilibrium, may be decreased. In this circumstance, individual’s who oppose the change on cultural views, may be educated and in doing so, change their perception of the change. According to Kotter, ‘it is often individual’s who oppose change, where groups are merely conforming to individual’s views’ (1995, p.6). By changing the perception of individuals, groups that oppose the change, may dissipate, allowing for the unfreezing process to occur.
Furthermore, an organisation may apply both the previous concepts to promote the unfreezing process, and in doing so, the movement process, from the ‘old’ way of transferring a patient from a bed to a chair to the ‘new’ way is capable.
Lastly, as the movement ceases, equilibrium develops, and the refreezing process begins, and the new organisational cultural norms start to develop.
By considering these concepts, Nepean Hospital may be able to develop a change protocol to be used whenever the organisation intends to implement a change; regardless of whether or not it is going to affect the individual employee, group or organisational structure. By utilizing a change protocol, the organisation, may be able to implement change more successfully, by decreasing the resistance to the change by the individuals and groups and increasing effectiveness and efficiency of the organization. This a suggested change protocol for Nepean Hospital,
1. Determine the need for change
2. Involve all employees in the process
3. Determine possible problems associated with the change by communicating with the individuals and groups (employees of the organization)
4. Determine possible solutions for overcoming the resistance to the change, whether it be by altering the change itself, or the perception of those who ultimately going to be affected by the change
5. Implement the change
6. Evaluate the change, to determine whether or not it has been successful; for example, has the organization become more or less effective as a result?
The following paper has identified and described a recent change to work practice in the organisation Nepean Hospital. In this case, the change has been both technological and cultural through the introduction of a technology and technique (the Hover Mat). It then related that change to the individuals, groups and the organization structure. An analysis of the change in terms of the concept of organisational change was then discussed, focusing primarily on the concepts of: type of change, force driving the change, resistance to change, how this was overcome, and, what strategies could be implemented to enable the change to go smoothly next time. Lastly, a change protocol was suggested for future changes in within Nepean Hospital.
Capozzali, K. 1995, Resolving Conflict Within Teams, Journal for Quality and Participation, Dec Ed
Forrest, L. and Johnstone, L. 2004, Health Services Organisations DE Modules, Charles Sturt University Printing, Bathurst
Kotter, J. 1995, Leading Change, Harvard Business School Press, USA
Preston, N. 2001, Understanding Ethics, 2nd ed, The Federation Press, Annandale, Australia
Robbins, S. Millett, B. Waters-Marsh, T 2004, Organisational Behvaviour, Pearson’s Education Australia, NSW, Australia
Robbins, P. and Barnwell, N. 2002, Orgnaisation theory: concepts and cases, 4th Ed, Prentice Hall, Sydney
Robbins, P. Bergman, R. Stagg, I. and Coulter, M. 2000, Management, Prentice Hall, Sydney
Sanders, R. 1999, The Executive Decision-making Process: Identifying Problems and Assessing Outcomes, CT Quorum, Westport
Shani, A. and Pasmore W. 1985, Contemporary organizational Development: Current Thinking and Applications, Trinity College Printing, Barcelona
Sydney Western Area Health Service 2005, Mission Statement,
http://www.pnc.com.au/~wamhs/whatiswahms.htm, last updated 3/2/2005, viewed on the 12/9/05