Making a Difference to Service Delivery
Introduction
Introducing extensive organizational change is necessary to achieve effective and efficient services at a hospital. Across the entire healthcare, there is growing realization of the need for system changes that would result in effective and efficient delivery of safe, quality care. This reflection paper discusses my experience as a hospital administrator in implementing change to improve service delivery, with specific focus on improving patient safety. It is been my experience as head of the hospital that the challenge of patient safety is intimately linked with the challenge of organizational change. This implies that the challenge of patient safety is not only clinical, but also organizational. As such, patient safety initiatives need to be designed and implemented following such effective change management principles as harmonious changes targeting a number of components, particular change management roles for the different participants in the whole care-delivery process, execution through dedicated support systems and multiple techniques, as well as institutionalization by enhanced workforce capabilities and chances for continuous learning.
The reflection includes organizational change literature pertaining to critical issues in managing such change including definition of the change, the roles of different players in the change process, as well as how organization is implemented and made to be self-sustaining. As this paper would espouse, it is not enough to put into place tools and strategies designed to bring about effectiveness and efficiency in service delivery at a hospital – there is need to be aware of the challenges and opportunities to be expected when introducing organizational change, how best to engage staff as well as how to make change sustainable.
Organizational change for improved patient safety
One of the major responsibilities of a hospital is to ensure patient safety at all times – a challenge that is both clinical and organizational. Like any other major health institution, my hospital has faced increasing challenges in its patient safety efforts i.e. avoiding, preventing, and mitigating patient harm resulting from deficiencies in the whole process of patient care delivery (Youngberg, 2003). These adverse events at the hospital were mainly errors resulting from flaws in equipment design; communication failure among different departments, the staff and other hospitals; staff shortages causing stress and fatigue resulting into lapses in performance; error-prone environments due to complex health care system; and punitive organizational culture discouraging staff from notifying senior management about errors and learning from experience (ASHRM, 2011). Patient safety was also found to be significantly compromised by the evolving process of care delivery that entails multiple interfaces and patient handoffs among numerous health care professionals with varying educational levels as well as occupational training.
Prior to implementing organizational change at my hospital, these complex processes which are highly susceptible to errors, were exacerbated by a traditional health care culture typified by individual accountability, professional silos, and non-collaboration. To achieve effectiveness and efficiency in service delivery at the hospital, therefore, there was need for widespread organizational change particularly at the point of care (ASHRM, 2011). It was clear to me and the hospital staff that to implement successful patient safety initiatives, we had to appreciate the need for and devise the means to undertake organizational changes that were long overdue. As a result, we employed an organizational model identifying essential choices and principles meant to realize long-lasting organization-wide upgrades in patient safety at the hospital.
The organizational change that we pursued entailed four different components: work; people; informal structures and processes; and formal structures and processes. Being a hospital, our strategy was influenced by the external environment, availability of resources, and history (Youngberg, 2003). Consequently, we developed a strategy designed to attain such specific outcomes as improved quality of care, lower costs, and increased revenues. We had specific outcomes for different levels i.e. for the entire organization, for individual departments, and for specific processes. As would be expected, implementing such a complex organizational change required that we adopt a radical redefinition of the hospital’s mission, culture, and competencies (Institute of Medicine, 2003). Such reorientation or transformational change meant changes in various organizational elements along with their congruence.
It was clear that achieving system-wide enhancements in patient safety at our hospital depended on our ability to coordinate changes several components i.e. clinical procedures, coordination structures and processes, behaviors and attitudes of our care providers, patterns of engagement among care providers, our incentive programs, as well as organizational culture. This was pursued on the understanding that change efforts targeting a handful of organizational components would not be sufficient, as would be the case of unrelated multiple changes (Institute of Medicine, 2003).
As stated above, successful implementation of the organizational change required the input of organizational groups, with each undertaking specific responsibilities in the entire change management process. Studies attest to the fact that improving patient safety is indeed a multi-faceted undertaking requiring involvement of everyone in the health care system (Mazur, 2008). As the hospital administrator, I had to lead from the front by playing an active, visible role towards initiating organizational change, by clearly articulating a vision pertaining to what the hospital needed to be in terms of delivering effective and efficient services for patient safety. It was the role of senior management to energize the entire change process and launch a guiding coalition for organizational change consisting of senior administrators, clinicians, along with opinion leaders drawn from across the organization (Mazur, 2008). In conjunction with the guiding coalition, the administrator made a convincing case against the status quo in favor of urgent organizational change at the hospital. The implementation of change also significantly involved the practitioners involved directly in the health care delivery process at our hospital.
The implementation of the proposed organizational change faced a number of major challenges. Probably, the major challenge was entrenched organizational culture, where the staff were resistant to change due to their comfort of doing “business as usual” (Wong & Beglaryan, 2004). This was especially the case because most senior physicians were far removed from the everyday processes of patient care delivery besides being unaware of how much patients were exposed to medical errors. Similarly, most clinicians were initially unappreciative of the need to have transformational change because their concern for those errors with serious implications to patient safety only. In addition, some medical staff members regarded some proposed changes, such the suggestion for increased engagements with nurses, as both inappropriate and unnecessary for improving patient safety at the hospital.
It took joint effort from myself as hospital administrator and the guiding coalition to overcome the challenges by diffusing the assumptions informing these viewpoints. For instance, we had to actively participate in the change process so as to send a message across the organization that the exercise was crucial and was being monitored daily (Wong & Beglaryan, 2004). Our active, visible engagement also served to inspired desired changes in behaviors such as senior medical staff opening up about their own errors.
Beneficial Results of Organizational Change
Implementing organizational change at the hospital was beneficial in many significant ways as relates to patient safety. The initiative was a major source of positive safety culture, which an essential factor in attaining safer care for patients at the hospital (McCarthy & Staton, 2006). The positive gains pertained to improved human resource management practices and procedures in terms of supervision and discipline of the caregivers reporting adverse events to the hospital management. By undertaking organizational change management, this hospital – like many other hospitals before – has encourage reporting of medical errors by doing away with the blame and shame culture (Hughes, 2013). A adopting a new culture in this regard contributes significantly to increased reporting rates as employees have the confidence that they would not backlash for reporting medical errors, harm or no harm, as well as near miss events.
The organizational change has also resulted in more and beneficial active involvement of key leaders at the hospital, who were initially far removed from the process of patient safety (Hughes, 2013). The active involvement hospital organizational leadership – both administrative and clinical – in patient safety improvement has had remarkably beneficial effect on all members of staff. For instance, the hospital’s senior leaders routinely visit clinical units to discuss patient safety issues. The increased senior management involvement in promoting safety helps greatly in figuring out the risks and hazards facing patients, and appropriate course of action taken (McCarthy & Staton, 2006).
The organizational change has also improved the knowhow of care providers in relation to aspects of patient safety and how to identify errors. More learning reinforces the understanding of health professionals in addition to introducing them to new concepts relevant to patient safety, resulting in minimized or eliminated harm to patients (Omachonu, 2010). More skills in identifying and analyzing medical errors on the part of health practitioners also significantly contributes to improved patient safety.
As a result of implementing organizational change at the hospital, it was able to establish patient safety committees that help in identify more effective corrective actions as well as implement safe procedures. The safety committees constitute of physicians, pharmacists, nurses, among other health care providers. The interdisciplinary safety committees significantly helps to draw attention to patient safety issues in addition to facilitating adoption of safe practices (Omachonu, 2010).
In addition, implementation of organizational change management at the hospital also resulted into development and adoption of more safe protocols and procedures and procedures. Research findings have demonstrated that hospitals have been able to develop and adopt safe mechanisms towards effective reduction of medical errors after implementing organizational change (Krause & Hidley, 2009). For instance, they develop manuals and guides for safe medication use and use of standard abbreviations.
Finally, implementing organizational culture enable the hospital to take advantage of technology as an effective tool for reducing errors and improving overall patient safety. Technology contributes significantly to reduced errors through such capabilities as using computerized physician order entry. It is usually beneficial where there are excellent system designs and well-trained users of technology to stress and error.
Knowledge from the Program and the change process
It must be admitted that achieving total patient safety at such a multi-disciplinary hospital is no mean fete, if not farfetched. Many other hospitals before have undertaken such an overhaul of the organization management in order to achieve effectiveness and efficiency in delivery of services as relates to patient safety, but failed to realize their organizational change objectives (Hughes, 2013). Overall, the model we adopted has been seen to have high propensity of producing grave mismatches especially between the organizational objective of improving patient safety on the one hand, and the change strategies that a hospital pursues in achieving this objective on the other. Such mismatch often result in a series of unintended consequences, which often impact negatively on the ability of the hospital to achieve continuous improvements (Krause & Hidley, 2009). While a hospital is targeting to have organization-wide improvements, there is always greater possibly of ending up with local and temporary achievements.
The model is criticized for being characterized by disconnect between discussion of the change and the definition of the change itself. Many hospitals approach organizational change following recognition for the need of multifaceted change so as to improve patient safety (Savage & Ford, 2008). Internal discussions to this effect often correctly identify different requirements such as need for greater physician involvement, better-integrated information technology, no-blame culture, among other needs. However, during implementation, most of the actions of many hospitals in the effort to develop and execute specific patient safety interventions are often out of touch with the discussed change (Myers, 2012).
Another commonly identified problem is the limiting of participation to a few people when implementing new patient safety initiatives. These are usually individuals with formal responsibilities in patient safety-related matters and informal safety champions. Usually this group has insufficient capability to deal with issues cutting across departmental boundaries (Myers, 2012). While senior leader often voice their support for such efforts, they are usually far removed from the entire change management process, leaving decision on definition and implementation of change to mid-level administrators. In many hospitals, there is often little cooperation between senior, influential representatives from nursing, medical staff, pharmacy, and legal counsel (Savage & Ford, 2008).
The success of the organizational change may also be hampered by the lack of dedicated support structures to facilitate implementation of change at hospital and attain desired effectiveness and efficiency (Schulz & Johnson, 2003). This because most hospitals often continue to depend on existing structures and mechanisms in implementing patient safety initiatives even after it has been identified that the hospital needs greater organization-wide changes. In such instances, hospitals usually make few attempts to redefine the current roles of people engaged in the patient safety initiatives or make available extra resources to facilitate the implementation process. In an effort to encourage workers to report medical errors, many hospitals also implement such insufficient narrow-focused tactics as presentations at meetings, memos and newsletters, signs and notices – which are usually disconnected from each other (Hughes, 2013).
Failure of organizational change in hospitals striving to improve patient safety is also more probable as a result of inability to sustain change. Research into this issue has indicated that many hospitals experience increased error reporting with the first 12 months of the program (Myers, 2012). This is especially the case because these initiatives often continue to largely depend on few people to sustain its momentum, who are overwhelmed when additional work demands arise e.g. preparation for licensure as well as accreditation reviews. It is therefore very crucial to have knowledge on these pitfalls so as to undertake successful organizational change in a hospital.
This program and change process has contributed immensely to my professional development as a person who will be leading change in the future. The greatest takeaway has been in relation to the challenges and opportunities that exist in undertaking organizational change at a hospital. Overall, it has come out very clear to me that the healthcare industry today is increasingly facing new realities that are presenting both challenges and opportunities for change. Hospitals are experiencing a multitude of challenges such as rising management cost, shortage of healthcare workers, an aging population, challenges in accessing challenges, issues of safety and quality, timely availability of information, rising consumerism among others (Hughes, 2013). A major hospital is grappling with how to have efficient management and offer enhanced services without necessary placing extra strain on a system already overstretched; how to offer cost-effective care at a time of rising healthcare spending; and how to utilize resources most efficiently and support front-line staff so as to realize reduced medical error and enhanced quality of care. Implementing change in management has therefore become inevitable as hospitals are forced to pursue more efficient and effective ways of delivering services at relatively reduced costs, improved quality, and extended reach.
Managing a hospital today, as I have learned, is challenging as a result of increasing societal and political forces which require increased quality and service, which must be delivered at reduced cost. The main sources of challenges in delivering effective and efficient services relate to ineffective service, medical errors, and soaring costs (Omachonu, 2010). Therefore, the hospital faces inherent difficulties in delivering services in an efficient and effective manner. Attaining effectiveness and efficiency in service delivery is largely hampered by a largely uncoordinated, archaic model made up of disparate providers offering health care on a disjointed basis. The shift to a more comprehensive, coordinated care model that would ensure effective and efficient delivery of services at the hospital faces an obstacle of entrenched hierarchical management structure characterized by complexity, professional fragmentation, as well as a culture of individualism.
Another great lesson has been that culture change at a hospital is major challenge for the leadership. As administrator, therefore, undertaking change had always to start with engaging in a multi-disciplinary dialogue, discussion and debate pertaining to efficiency and effectiveness and thus moving away from segmented discussions.
The change process has also underscored another major challenge for the hospital and health system when pursuing organizational change to improve effectiveness and efficiency of delivery of services – reduced funding. This has particularly been occasioned by the decision of both the federal government and private sponsors to cut reimbursement of most services to levels equal to those paid by Medicare and Medicaid. As a result, hospitals have to deal with the challenge of eking out sustainable margins from the programs, which necessitated re-examination of every aspect of heal care operations so as to optimize performance. In other words, effectiveness and efficiency in health care services cannot be achieved until the management figure out how to permanently reduce cost from their systems (Schulz & Johnson, 2003). Finally, there has been learning that implementing effectiveness and efficiency require greater degree of collaboration as working in concert is necessary so as to maximize the available resources and talents.
Notwithstanding the challenges, there exist lots of opportunities for hospitals to build on in implementing change. These include new information technologies in the healthcare industry which management can use. By using new information technologies, a hospital has a chance to achieve immediate, information-rich communications (Omachonu, 2010). In addition, the technologies serve as user-friendly collaborative tools which are increasingly become crucial elements of today’s healthcare. In general, implementing change renders the hospital ready to meet future challenges, secure its attractiveness to patients, staff, and referral sources by means of long-term models (ASHRM, 2011).
Conclusion
This reflection has given my experience as hospital administrator in managing organization change to achieve effectiveness and efficiency in delivering services towards patient safety. The paper has discussed the issue of error that occurred at the hospital prior to the adoption of the new organizational change at the hospital. The reflection has appreciated the challenges and opportunities that the hospital faced in implementing change include organizational culture, funding problems and issues relating to technology. As the hospital administrator, I have a greater role in proving efficient and effective services. It is my responsibility as administrator of the hospital to provide vision and supply it with state-of-the-art technology. I have to push for necessary change at the hospital for the greater good of patients, the staff, and the community at large.
I also have obligation to serve as a catalyst for positive relationship building my staff and patients, the hospital and the government and private sector, as well as good working relations between our hospital and other hospitals.
As hospital administrator, also, I have to play the role of a business practitioner to bring about effectiveness and efficiency in our delivery of healthcare services. As such, I must have greater input in executive communication, management, problem solving, budgeting,
References:
American Society for Healthcare Risk Management (ASHRM). (2011). Risk Management Handbook for Health Care Organizations, 3 Volume Set. New York: John Wiley & Sons.
Hughes, G. R. (2013). Chapter 44Tools and Strategies for Quality Improvement and Patient Safety. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK2682/
Institute of Medicine (U.S.). (2003). Crossing the quality chasm. Washington, D.C: National Academy Press.
Krause, T. R., & Hidley, J. H. (2009). Taking the lead in patient safety: How healthcare leaders influence behavior and create culture. Hoboken, N.J: John Wiley & Sons.
Mazur, M., L. (2008). The Study of Errors, Expectations and Skills for Medication Delivery Systems Improvement. Michigan: ProQuest.
McCarthy, D., & Staton, E. (2006). Case Study: A Transformational Change Process to Improve Patient Safety at Ascension Health. Retrieved from: http://www.commonwealthfund.org/Newsletters/Quality-Matters/2006/January/Case-Study-A-Transformational-Change-Process-to-Improve-Patient-Safety.aspx
Myers, S. (2012). Patient safety and hospital accreditation: A model for ensuring success. New York: Springer Pub. Co.
Omachonu, K., V. (2010). Innovation in Healthcare Delivery Systems: A Conceptual Framework. Retrieved from: http://www.innovation.cc/scholarly-style/omachonu_healthcare_3innovate2.pdf
Savage, G. T., & Ford, E. W. (2008). Patient safety and health care management. Bingley, UK: Emerald JAI.
Schulz, R., & Johnson, A. C. (2003). Management of hospitals and health services: Strategic issues and performance. Washington, D.C: Beard Books.
Wong, J., & Beglaryan, H. (2004). Strategies for Hospitals to Improve Patient Safety: A Review of the Research. Retrieved from: http://www.providence.on.ca/wp-content/uploads/2012/05/Change-Foundation-Improve-Patient-Safety.pdf
Youngberg, B. (2003). Patient safety handbook. Jones & Bartlett.
