Organization Development / Change Process

Organizational Development Process

In a bid to achieve desirable change, it is very important that action research is embraced. As such, change is not merely a one-off thingThe change that is required here is an ongoing process that should be implemented in a more systematic fashion. As such, Senior & Swailes OD model is highly desirable for the implementation of the required change. According to Senior and Swailes (2010), organization change should take into consideration four major aspects. These include the organization of the personnel, the organization of tasks, the appropriate technology, the structure of the organization and the organization of the environment. In adopting this change model, the following steps  ought to be followed: diagnosing the current situation, developing a vision for change, ensuring that there is prior commitment to the vision,  developing a comprehensive action plan, implementation of the change, and finally the assessment and reinforcement of the change (Senior et al., 2006). The major aspects of the model that are relevant for this model is that it identifies the need to deal with change over the medium to long term, collaborate and bring the organization on board as a whole as well as its parts, have the support and involvement of the top management and draw upon the behavioral sciences (Senior & Swailes, 2010). The PDSA cycle is very instrumental within this model as it requires a plan to test the change, conducting the test, learning and observing from the consequences and determining the modifications that can be done thereby.

Practices to engage in the organization development process

Diagnosis of the current situation

There are no effective primary control measures because many aspects such as blood lipids, blood pressure, and blood sugar levels are not tracked. Access to primary care has also been problematic as evidenced by the very many complaints from the stakeholders about the same. The extent to which individuals access the organizational services is below the capacity of the organization itself. The providers rarely engage in such initiatives as educating the patients and taking into consideration the medical history of the patients before making prescriptions. This has led into occasional medical errors in the organization (Burke & Noumair, 2015). Educating also assists in the primary prevention of some diseases. There are no data collection mechanisms that can be relied upon since most of the information is only captured at the point which the patients visit the provider. As such, the performance measurement systems is lacking, and this puts the organization in an awkward position whereby efforts are applied in a way that is likely not to be proportionate with the need for such efforts. The patient or customer experience at the facility is not adequately captured because there is no follow-up to ensure that the surveys that are in place are completed. The medical errors and the hygiene compliance levels are poorly traced (Burke & Noumair, 2015).

Developing a vision for change

The change strategy and vision will give the organization an ideal picture of what the future should look like especially after the change has been implemented. The organizational stakeholders will be able to see the need as to why they should forego the past, and sacrifice to work hard at the moment in implementing the change. There will be that appealing and sensible picture of the future, which will be able to guide the health organization decision making. Having a vision in place is one way of evaluating the feasibility of the intended change.  In the absence of the feasibility, it will not be easy for the change to be embraced. It will be the critical responsibility of the leadership to set the direction for the organizational for the future (Anderson, 2013). Safety and quality of the healthcare services are aspects that should not at any time be compromised for a health organization to remain effective. Without the performance indicators in place, quality and safety standards will be compromised. As such, having indicators in place should be viewed as part and parcel of the organization, and should be owned by all the stakeholders. To achieve this, there has to be a change vision that will gradually be imparted and implemented. However, there is a need for some patience in implementing the same because different people may have various perspectives on the best route to take to realize the standard safety and quality levels. Such an appealing and sensible change vision will provide the rationale for the required sacrifice and hard work to create the desirable future state (Cummings & Worley, 2014). Everybody understands that there should be quality and safety measures in place, but the idea here is having these variables leveraged to high standards. It is important that everyone understands the need to adopt performance management processes as well as the measurements that will make it possible to enable change. The vision for change will have to be customized to the health organization and the change initiative. The competencies and the skills of the people will have to be aligned with the vision for them to perform the work in future successfully. As such, training of the staffs is highly recommended.

Vision or strategic direction will give the orientation and meaning to the leaders as well as their teams and is a strong driving force for the systematic and going practice development (Anderson, 2013). People will be better placed to focus their energies and engage in the transformation of practice towards providing standardized care that is aligned with quality and safety measures that have been recommended. It will be the obligation of the leaders of the healthcare organization to ensure that they monitor the energy levels of the organization or the team in an attempt to keep the balance between transformation and recovery (Cummings & Worley, 2014).

Gaining commitment to the vision

The stakeholders will be able to commit to organizational vision because they are gaining something important from their involvement. When they are involved in becoming involved to the vision, they will be able to feel that they are being offered an opportunity is to accomplish something that is significant and meet the high standards of the organization. The employees will have to be prepared for a shift from a traditional to evidence-based as well as standardized care in the clinical practice which will also assist them to be able to speak up and address what appears not to be consistent with the vision. The most important aspect is that the vision will call for the need for continuous development in practice (Burke & Noumair, 2015). Working with the vision will assist the participants to realize that the change is more inherent in the current health organization. Although there might n be acceleration given that members will be very enthusiastic during the initial stages of the change process, a lot of caution will also have to be taken so as to avoid the acceleration trap. This will make the employees start feeling overwhelmed because of the changes and stop feeling engaged with the transformational practice.

In order to sustain the commitment that has already been created in an organization, it will be important to think about every individual as a potential contributor towards this and empower them to channel their efforts towards this. Even though people will have different levels of contribution towards the same, every individual has something positive to contribute. There is also need to listen to what anyone has to say and also get from them some feedback about the progress of the change program that is being initiated (Anderson, 2013).

Developing an action plan

In developing an action plan, the first step will be to create a change team. A team of staff members and leaders with credibility, expertise, and motivation that is needed so as to drive successful team initiative will be it in place. This will entail all the stakeholders that will be at the frontline in the implementation of change. The leaders of the change process will be expected to have some experience in process improvement and relevant skills in such aspects as data analysis, collection, and presentation. The next step will be to identify all the opportunities for improvement that are available. This will entail reviewing all the reports and surveys to identify what the process is, the persons that are involved, when and where it occurs (Anderson, 2013). If possible, a flow chart will be constructed in order identify the critical areas where quality and safety are likely to be compromised in the health organization’s operations. This will identify the loopholes or the major areas that should be monitored. After having identified area where quality and safety are compromised, the next step will be to identify the strategies or how things will be accomplished. This will be done after in-depth consideration and consultation on the appropriateness of these strategies to the situation and their sufficiency in addressing the objectives that have been stipulated. A plan for sustained continuous improvement will also have to be put in place. This will entail plans for the ongoing assessment of the effectiveness of the interventions that are being utilized and the manner in which opportunities for further improvement will be identified. The recommendations will always be tailored towards the continuous improvement of the processes (Anderson, 2013).

Implementation of change

The implementation of change will be an initiative for every stakeholder. Quality and safety sin a healthcare organization is a matter of culture for the entire organization. Since all the employees will be aware of the quality metrics that are being tracked, everyone will have the initiative to report any aspect where they feel that the quality of an organization is being compromised. Enough resources will have to put in place. The resources will entail skilled personnel, adequate stationary, and technologies that will be used in performance management system (Burke & Noumair, 2015).

Assessment and reinforcement of change

Since this is a matter of continuous improvements, assessment and reinforcements are highly recommended. Data will be continuously tracked by the performance management system to gauge the extent to which relevant information is being captured. Questionnaires will be continuously extracted from the suggestion box to assess the level to which the expectations of the patient are being met.

The project is of great significance to the people and systems, especially the patients who are the major clients in this regard (Cummings & Worley, 2014). The change that has to be implemented is tailored towards improving the safety and quality of care in all aspects of operations in the health organization. This is not only going to be done by restricting quality measures to the internal organization, but also considering the general standards that are called for in the external world such as the acceptable standards stipulated by the international health organizations and the accepted quality and safety standards as communicated by the ministry or department of health. As such, there will be a comprehensive and coordinated system-level public reporting on primary levels across all levels (Callara, 2008). Since quality measure and safety measures emanate will emanate from prevention, it will be important that data is captured from the grassroots or homes of the vulnerable groups where various infections or diseases are contracted or infected. There is a likelihood that some deviations will also emerge between observed and anticipated outcomes, and hence negatively impact on the final data that is forwarded. The outcomes of the satisfaction survey are likely to be lower than expected because the quality and safety measures may not be being felt across the board (The deviation between the expected and the actual outcomes). Data captured in the Electronic Health Record (EHS) may also be inconsistent with what is expected due to the systemic failures. However, there is no problem with such deviations because the data that is captured shows the real situation at hand, thus compelling the management to put measures in place so as to attain desirable or expected outcomes (Anderson, 2013). The major limitations are the level of buy-in from all the stakeholders (especially nurses, patients, the management and the families of these patients) and the provisionary budget that may be required for the unanticipated circumstances (Kollberg et al., 2006). Buy-in will be achieved through sensitization of these stakeholders about what the process is all about. Fir effectiveness of the change implantation, it will be important that all the stakeholders own the process (there should be very minimal resistance to change).The outcomes of the project are generalizable to the other health contexts since having the key performance indicators for health safety, and quality is a global requirement. As such, evidence-based practices will be embraced and adopted in the implementation of the quality and safety indicators. The opportunity costs will not manifest because quality and safety indicators affect most aspects of a health organization. As such, there is no missed opportunity that the organization might incur. The major costs will entail investing heavily EHR system, and data collection mechanisms, sensitization of all the stakeholders so that they can support and contribute to the change process and human resource required to ensure that the indicators are consistently functional. There could be other miscellaneous costs that are likely to arise during the change implementation process, hence the need for a provisional budget for the same.

If the change sails through, it will be very useful in enhancing the effectiveness of the provision of services in healthcare. It will assist in gauging and quantifying the tangible improvements in outcomes of patient care, after which the management will be able to draw recommendations from the same, implement them and ensure that the quality and safety of care are standard (Davies, 2012).

Implementation of key performance indicators in the organization will call for buy-in from all the stakeholders. To ensure that the key performance indicators are firmly implemented, such practices as pilot implantation and testing proactive communication, ensuring the alignment of the health system mechanisms, and consistent data-based decision making is highly recommended. All these aspects ought to be aligned with the financial capability of the organization. There is a need for provisional budgetary allocations to cater for rising constraints. However, thorough planning will ensure that everything falls within the norm. Some of the ethical considerations that have to be upheld include such issues as documentations and use of patient information which may raise ethical concerns about patient privacy (Burke & Noumair, 2015).

Reflection using the Gibbs model

This reflective model follows six major steps whereby each step informs the next. The Gibbs’ reflective model encourages one to think systematically about the phases of activity (Johns, 2013). The description takes into consideration the specific and relevant details of the entire experience. The feeling sections take into account one’s thinking during the exercise and prior the experience. In the evaluation, we consider what worked, what did not work, and the resolutions for the same (Davies, 2012). In the analysis, it is important to consider the causes of an action, consequences of an action, what could have done to avoid the negative consequences, and how the positive action could have been improved further (Callara, 2008). One’s contribution to the experience is also considered at large. In conclusion, we sum up what we have learned from the experience. The action plan states the actions that have been designed to improve ability, knowledge, and experience. A committee approach may also be used in testing for change. The committee will have access to all the data and will be responsible for discussing and reviewing changes in details to come up with viable recommendations afore improving safety and quality in the healthcare organization (Johns, 2013).

Description

Considering the description, information was gathered courtesy of a survey on the reasons why the safety and quality of care have been deteriorating in the recent past as unveiled by the audit report.  As such, it was evident that there were no effective key performance indicators for quality and safety of healthcare. Few aspects have already been implemented such as proper documentation of patient data every time they report at the facility. However, quality and safety indicators have been lacking at the very critical points where such information can be captured. There has been a lack of a structure that is elaborate for measurement of performance which can be used in developing and identifying the individual performance measures. There is also no clear framework that can be used in comparison or benchmarking of quality and safety levels within the organization, with the levels of quality and safety in other organizations. Clearly, the organization missed out an ample opportunity in rendering services to the clients. Most of the effort had been concentrated at the point of contact between the medics and patients, and most of the things appeared to stop at this point. This implies that there is very little information or data capturing that was done before and after the patient leaves the facility. Much effort is in the delivery of services, with very little being done to know exactly the level of satisfaction expressed by every patient aftercare, the effectiveness of the treatment,  preventive measures that can be implemented by the organization, ongoing evaluations and timely gathering of data.

Feelings

I felt the organization was lacking something important, a gap that should be filled urgently. In the contemporary world, effectiveness in an organization is best defined by the quality of the services it provides. A healthy organization is not an exceptional to this. Quality is increasingly becoming an important factor for any organization to have a sustainable competitive advantage. Provision of health services can never be effective of utmost safety measures are not observed. The fact that there were no indicators in place implies that the organization had underestimated the need for having them. This was quite disturbing because we are talking about a health organization that is supposed to ensure that people are not only safe but also ensure that preventive diseases do not erupt. The literature reviews gave the same insight over the issue. Performance indicators have assisted many organizations to scale up their quality and safety levels, thus realizing optimum patient satisfaction. As such, no one was very convinced that this was the way forward this organization as well. A lot of sacrifices have to be made to achieve this. Best and evidence-based practices ought to be adopted to increase chances of success. Sacrifice will also be in terms of the resources that have to be put in place to see the project through. This made me feel that there is need fir adequate time to be devoted to planning (that will be done by the change committee), to sail the project through. I was also concerned about how the organization was going to gain a spirited effort from all the stakeholders towards this initiative. Given the need to implement these indicators, I felt this will not go through because of the many stumbling blocks such as budgetary implications, staff culture among others.

At one moment, I also felt that the KPIs had some unintended influences on the behaviors of the people. For instance, the business may set quality and safety targets to encourage employees to conform as much as possible. However, there could be some consequences in the sense that the employees are very much motivated to meet the targets such that any frustration will hinder their zeal, discourage or derail their morale to a greater extent. It will be very important to take into consideration the effect that this move will have on the employees. Another issue of concern is the quality of the KPIs. Having vague targets in place will cost the organization a great deal. As such, there will be a need to have very realistic and quantifiable goals. This can easily be overlooked by the stakeholders implementing the KPIs. Another worrying issue is about trial and error that should sometimes be applied in the process. Sometimes, it is only possible to get things right by trial and error. An expert may recommend some changes to be done on the performance indicators that are in place, while another one expert may recommend an entirely different set of changes. Neither of t6he recommendations may be right or wrong. All of them could be having their advantages and disadvantages. As such, the organization might be obliged to filter, brainstorm and seek agreement. The need to measure the level of organizational success will always be called for to monitor the level of progress that is always made by the changes.

Evaluation

As for evaluation, it greatly enhanced my experience in planning change in a healthcare organization. The ultimate goal of the key performance indicators is to promote the achievement of the health system objectives. However, one thing that was not going so well was about monitoring of the investment itself. Before an organization engages in this type of activity cycles, there is need to consider the investments as well as the inputs that are required to launch and sustain the change process. Considering the complexity of implementing functional performance indicators across various dimensions of the health organization, is expected that there will be multiple investments of resources, effort and time. As such, there is a need for extensive mechanisms that will ensure that there are inputs and efforts applied appropriately when needed. So far, nothing much has been done with regard. Having resources and management of the same is something that will lead to the success or downfall of the change process. When the change process has been launched, there is need to check as to whether the activity is being taken up according to the plan or not. In that case, there will be a need to focus on the level of activity evidence, and also examining the trends as to whether they are increasing or not. Evidence-based practices should be embraced in an attempt to do this. This aspect has also not been explored widely in light to the implementation of key performance indicators in the healthcare organization. The idea of tracking progress ought to be addressed optimally. The slightest change in the trends has to be noted (Davies, 2012).

The project also gave us a golden chance to explore various works of literature about the implementation of key performance literature on safety and quality of healthcare. The literature reviews done in advance were very enriching as they gave more insight on the need for performance metrics in healthcare organizations. This is the reality that dawned on me in the course of the project. The search strategy that was used brought out the best of the books and articles that could be used in the project. However, the literature reviews bring out a range of issues concerning performance indicators, most of which will not have been relevant in this context. The writer had some hard time trying to sieve information that will have some implications for the particular change project. Finally, there were 15 (both articles and books) that addressed quality and safety performance indicators which were more relevant to the study aims and could be reviewed perfectly. This made it possible for the writer to gain more insight into the change process, and the various technicalities that should be observed when trying to bring such organization-wide changes in a health organization. Issues were optimally explored, starting from the necessity of targets in the healthcare system, scope of performance indicators, quality and safety indicators themselves, the necessity of safety and quality indicators, limitations of these quality and safety indicators and methods used in developing quality and safety Indicators in healthcare. Each of these themes was individually examined (Kolb, 2015). There has been a successful attempt to explore the implications of these issues to the change implementation in the organization.

Analysis

Considering the analysis, quality and safety of a healthcare organization are the major aspects that define the effectiveness of the healthcare services. As such, matters like patient satisfaction, tracking such aspects as blood sugar, blood pressure, and blood lipids to provide as more comprehensive primary control measures among had to be reflected with the intention of aligning the objectives of the project with these needs. Notably, these are the things that cut across the board and do not only affect the organization at hand. Without having the key performance indicators, an organization is likely to lose touch regarding safety and quality of healthcare. When considering the organizational development model that could be adopted, Senior & Swailes OD model was found more appropriate courtesy of its emphasis on such aspects as collaboration and support from the top management. The model is also more compatible with the PDSA cycle. The PDSA cycle is very instrumental within this model as it requires a plan to test the change, conducting the test, learning and observing from the consequences and determining the modifications that can be done thereby. Since this is a continuous improvement process, the PDSA cycle becomes essential in ensuring that changes are effected systematically and thoroughly without committing a lot of errors that may cost the health organization in the long run. Mistakes in the change implementation can be very costly for the organization, hence the need to take all the appropriate measures in ensuring that errors are minimized (Davies, 2012).

Conclusion

I learned from the project that the safety and quality of healthcare are guaranteed when performance metrics are firmly in place because this is the major source for discovering the discrepancies in place. However, implementing such a massive change in a health organization is not something that can be done haphazardly. There is need to conform with evidence-based practices at the stages of change implementation. Implementation of such a change is quite demanding for a health organization and calls for a hands-on approach in terms of engaging the stakeholders that will make the change process a success. It was also evident that this is a continuous improvement process, and it should embrace the evidence-based practice. Challenges such as the availability of resources are something that has to be immensely addressed before the implementation of the change process. There was a need to address such schedules immensely i.e. how resource constraints or budget deficits will be met (Jasper, 2013).

Action plan

As for the action plan, there is need to take into consideration sensitization of all the stakeholders to ensure that the staffs are all well prepared for the changes and that they can also participate. They have to be familiarized on the need to have performance metrics in place (as well as their roles). This should be a priority in such as endeavor. The next thing is ensuring that the required resources are firmly in place. There is a need to stipulate how deficits will be met. Afterward, the changes are effected systematically, with tests for modifications at every stage.

 

References

Anderson, D. L. 2013. Organization development: The process of leading organizational change. Sage Publications.

Burke, W. W., & Noumair, D. A. 2015. Organization development: A process of learning and changing. FT Press.

Callara, L. R. 2008. Nursing education challenges in the 21st century. New York: Nova Science Pub.

Cummings, T. G., & Worley, C.G. 2014. Organization development and change. Cengage learning.

Davies, S. 2012. Embracing reflective practice. Education for Primary Care, 23(1), 9-12.

Jasper, M. 2013. Beginning reflective practice. Andover: Cengage Learning.

Johns, C. 2013. Becoming a Reflective Practitioner. Chichester: Wiley.

Kolb, D. A. 2015. Experiential learning: Experience as the source of learning and development.

Kollberg, B., Dahlgaard, J.J., & Brehmer, P.O. 2006. Measuring lean initiatives in health care services: issues and findings. International Journal of Productivity and Performance Management, 56(1), 7-24.

Senior, B., & Swailes, S. 2010. Organizational change. Harlow, Essex, England: Pearson Education.

Senior, B., Swailes, S., London, O. C., Times, P. H. F., Hardy, B., & Student, M. S. 2010. Managing Organisational Change. SOAS, University of London, London.

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