Managing Change in Health Care Organisations PU 5004

1
Managing Change in Health Care OrganisationsPU
5004

• Lecture 2
• The Nature of Organisational Change

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Introduction

• Kathryn Charles, University of Aberdeen Business
  School
• e-mail k.charles_at_abdn.ac.uk
• Practitioner
• Researcher
• Teacher

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Objectives

• To define the nature of organisational change
• To provide understanding of diverse the
  theoretical frameworks for managing
  organisational change
• To develop understanding of the practical
  dilemmas for practitioners in designing,
  implementing and sustaining organisational change
  in healthcare organizations

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Organizational Change What is it?

• New ways of organizing and working
• 
  Dawson,1994
• Differences in - how an organization functions,
  who its members and leaders are, what form it
  takes, or how it allocates its resources
• Huber et al, 1993216

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Defining the territory

• Change implies
• Differences between two successive conditions,
  states, or moments in time,
• (Smith,1982)
• Is the term organising more appropriate?
• Organisations are dynamic Chia, 2002
• The co-ordination and standardisation of human
  actions in response to context overtime
• The complexity of context provides the stimulus
  for organisational actors to adjust these
  institutionalised cognitive structures
  organisation is a process!

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Theoretical Perceptions

• Multi-disciplinary Sociology, psychology,
  philosophy.
• Covers individual, group and organisational
  levels
• Useful Resource Review of the theory -National
  Co-ordinating Centre for Service Delivery and
  Organisation Managing Change in the NHS, Iles
  and Sutherland
• Much debate open / closed systems, top down
  imposed change or bottom up participative change
  or umbrella strategies, structural v actor
  perspectives systems v people focus
• http//www.sdo.lshtm.ac.uk/managingchange.html

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Five Dimensions to Change

• Content/ Character of Change of the change TQM,
  Technological change, BPR, Cultural Change
• Temporal Dimension rate or pace of change
• Scale of change incremental or transformational
• Political Dimension Change contested or
  accepted?
• Intentionality

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The Nature of Organisational Change

• Character
• Dominant forms
• TQM
• BPR
• Technological Change
• Culture Change

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The Nature Of Organizational Change

• Defining the territory
• Scale, Scope and Time dimensions
• Episodic Change
• Infrequent, discontinuous and intentional
• Weick and Quinn, 1999
• Transformational / Paradigmatic
• Non routine, non incremental and discontinuous,
• Tichy, 1983

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The Nature of Organisational Change

• Epigenetic change
• Change seeded in the old order
• Which is felt to fall outside some existing
  recipes, but nevertheless finds its genesis
  inside the organisation.
• Burt, 2003

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The Nature of Organisational Change

• Incremental Change
• viewed as a process whereby individual
  elements of the organisation address specific
  internal and external problems, as they arise, in
  a piecemeal fashion, which over time results in
  organisational transformation.
• Hedberge et al,1976 Quinn, 1980b and 1982.

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Integrating Incremental and Transformational
Change

• The Punctuated Equilibrium Model
• Miller and Friesen, 1984 Tushman and
  Romanelli, 1985 Gersick, 1991
• Sets of interdependencies that converge and
  tighten during a period of relative equilibrium,
  often at the expense of continued adaptation to
  environmental changes. As adaptation lags,
  effectiveness decreases, pressures for change
  increase, and a revolutionary period is entered.
  (Weick and Quinn, 1999367)

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Punctuated Equilibrium Model of Change (adapted
from Balogun and Hailey, 2004)
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Change as an evolutionary unplanned Process

• Continuous / Emergent Change
• Absence of explicit prior intentions
• Characterised as being ongoing, evolving and
  emergent where micro-level improvisation,
  translation, reactivity and pro activity can
  cumulatively result in substantial change
• NHS as a Learning Organisation
• Creating Communities of Practice

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A Learning Organisation

• A Learning Organisation is an organisation
  skilled at creating, acquiring and transferring
  knowledge, and at modifying behaviour to reflect
  new knowledge and insights, (Garvin, 199380)
• The learning organization conceives agency as a
  team process, where collaboratively all
  organizational actors use their skills ,
  knowledge to promote and work towards
  organizational success. This occurs via
  cumulative micro-processes of enactment which
  iteratively generate new knowledge, which are
  then transmitted throughout the organisation,
  (Senge, 1990).

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A Learning Organisation

• Senge ,(1990) The Fifth Discipline stresses the
  organisational attributes
• Organisational Learning is a process of improving
  actions through better knowledge
• Organizational learning via such learning
  cultures employs the development of exploitative
  or single loop learning, (Argris and Schon,
  1978), and explorative or double loop learning,
  (March, 1991).

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The Learning Organisation

• Single loop learning adaptive learning
  feedback and monitoring
• Double loop learning Challenging and
  reconstructing basic aspects of an organisations
  operations
• Triple loop learning - questioning the rationale
  for the organisation and radically changing it
• Creation and adaptation of environment
• Communities of practice - acknowledges that
  organizations are emergent and constellations of
  practice, (Wenger 2000). Engagement in practice
  providing the medium by which collaborative
  action produces iterative self organizing
  processes of organizational learning.

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Contemporary Ideas

• Change as the normal condition of organisation,
  whereas organisation is an emergent property
• of change
• Change is not a product of organization, but a
  pre curser to organisation, a condition which
  makes organisation possible.
• The re-weaving of actors webs of beliefs and
  habits of action as a result of new experiences
  obtained through interactions
• Tsoukas and Chia,2002

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Plurality of views of the pace of organisational
change
EPISODIC
PARADIGMATIC
INCREMENTAL
EPIGENETIC
EMERGENT
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Theoretical perceptions of the nature of
organisational Change

• (Source Burnes,2000308)

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Why do we study organisational change processes ?

• Critical issue facing managers employees within
  organisations
• Significant multi-disciplinary topic within
  organisational studies literature economics,
  management, psychology, sociology
• Ongoing debate concerning links between theory
  practice
• Contrast between the rationale for change
  results of change initiatives (70 fail)

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Major Problems Managing Change

• TQM failure rates USA at 90 , (Crosby, 1979)
• BPR failure rates 60 - Bywater, 1997
• 70 of all change efforts fail Beer and Nohria,
  2000
• Common problems associated with change Hamel
  and Prahaled
• Extreme downsizing creates corporate anorexia
• Re-engineering is often catching up with someone
  else's benchmark
• Efficiency driven and short term strategies
• Strategy not just action plan must develop
  behaviour change

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TRIGGERS
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External Triggers

• Drucker (1999) referred to the five certainties
  which are primarily social and political which
  will influence organisational strategy.
• The collapsing birth-rate.
• Shifts in disposable income.
• Defining performance.
• Growth in global competitiveness.
• The growing incongruence between economic
  globalisation and political splintering.

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Internal Triggers

• Leavitt,(1964), identifies
• Technology
• People
• Tasks
• Administrative Structures

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How does it link with other areas of management

• How does it link with other areas of management?
• Central association with strategic management
  (business policy) why an organisation should
  change
• Links with operations management how an
  organisations processes should change
• Key concern with human resource management who
  should be involved in any change initiative how
  to manage that change process

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Why is Organizational Change Important?

• It is generally accepted that managing
  organizational change is inherently difficult and
  represents a key challenge to competitive
  success
• Hanson,1993 Worral and
  Cooper, 1997
• Organizations in transition Drivers both
  internal and external to the organization
• The industrial terrain has been changing so
  quickly or have industry boundaries been so
  malleable. Never before have competitors,
  partners, suppliers and buyers been so
  indistinguishable.
• Hamel and Prahaled,
  1994ix

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Summary

• Defining the nature of organisational change
• Five dimensions to organisational change
• Exploring planned and emergent Change
• Organisational change triggers
• Why is organizational change important

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Group activity

• Exploring organisational change
• Examine the extracts from the NHS Live Annual
  Report (www.dh.gov.uk/Publications) and case
  studies (www.nhslive.nhs.uk)?
• What is the function of NHS Live?
• Identify the character, pace and magnitude of the
  change processes being discussed?
• What are the benefits of this change strategy?
• What are the problems generated by this strategy?

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Next week

• Managing organisational change

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Useful References

• www.cci.scot.nhs.uk
• McDonald.R, (2005), Shifting the balance of
  power? Culture change and identity in an English
  health care setting, Journal of Health
  Organization and Management, Vol.19,i3,pp.189-204.
  
• Burke, R. J,(2004), Implementation of hospital
  restructuring and nursing staff perceptions of
  hospital functioning, Journal of Health
  Organization and Management, Vol.18,i4, pp279.
• NHS Modernisation Agency
• Office for Health Management Learning from NHS
  Change
• Scottish executive Organisational Change in NHS
  Scotland - http//www.healthmanagementonline.co.uk
  /toolkit/toolkit.asp?pdaid19