Organizational change concepts and applications

Organizational Change

Brief Summary of Prior Work

At IHRC there have been two elopement breaches, and this has resulted in a change in the elopement policy. Although the incidents were reported to the authorities in a timely manner, at issue is how IHRC can prevent another elopement incident from occurring in the future. There are currently two issues to be addressed in the organization's plan. The first is to prevent elopements and the second is to improve the speed at which we find the person.

It was previously noted that there might be some organizational barriers to implementing the proposed changes. For example, some of the changes involve increasing security barriers that restrict freedom of movement within the facility, and in/out of the facility. There is also a high level of employee burnout and the changes might add to their work load, causing resistance. Nurses will be more accountable for patient whereabouts, and they might resist taking on this added responsibility. Lewin's theory has been applied in this case to implement the decision, and it is therefore recommended that there needs to be some employee engagement in this process. Further, leadership needs to handle this crisis well, because of the current challenging internal climate at the facility.

Effectiveness

The new plan is expected to reduce the risk of elopement dramatically. While IHRC has experienced two elopements in the past two weeks, the rate over the long run is lower. With the new plans, however, the objective is to lower the rate of elopement to zero. This is the final output measure that will be used to ensure the success of our new strategies. Furthermore, there are a series of small measures to evaluate different aspects of this plan.

The reason that IHRC wants to measure its change plan is that measuring change allows the organization to monitor the implementation process, to understand how the organization reached its goals, to learn from the process and to identify where the organization is in the process of this change (Bond, 2013). Measuring organizational change can be

challenging, especially where the measure is for non-numeric variables. The change must therefore be operationalized (Mullaly, 2014). One of the ways that this is done is to evaluate employee knowledge about the change. For example, right now the with the lapses it can safely be assumed that there is a low level of organizational knowledge about the proper procedures. We seek to have our staff members with 100% knowledge. Furthermore, the change can also be measured by how well the nurses implement the system of tracking and signing off for patients. Spot checks by managers can ensure that nurses are legitimately signing off every two hours on each patient, as instructed. This is likely to raise the overall standard of care that the facility is going to deliver as well, since the nurses will see patients more frequently.

The organization will need to measure, periodically, the outcomes that it desires. The minor outcome measures can be done systematically, or with random spot checks for things like the nurse sign-off sheets. Major outcomes like the number of elopements are obviously something that need to be addressed immediately after they occur. There are substantial consequences for not doing so, but such immediate reporting will also allow the organization to conduct investigations as quickly as possible to understand why the change has not been successful at reducing elopements to zero.

One of the things that we want to achieve is a high level of buy-in from the staff members, because they are integral to the success of this initiative, as with any organizational change initiative. People within the organization need to feel the problem, and in one case the person who eloped died in the woods, so it is critical that they are made to understand the consequences of not doing their jobs -- somebody needs to get fired for that one. This will instil some motivation for performance (Kotter, 2011). Leadership also needs to be involved, and overall measurement is going to be done in part on the basis of seeing the different changes put into action. Each change is going to be listed, with a time frame and outcome measures, and management will be charged with the task of ensuring that each task is completed on time.

Cost outcomes are a little bit easier to measure. The big concern is that some of the proposed solutions, in particular the physical barriers, are going to be very expensive. A cost-benefit analysis tells us that there are usually limited costs to elopements, and even when someone dies the costs are not as high as some of the physical barriers. So a full cost-benefit analysis has to be done with respect to some of the proposals before there is full management buy-in. Importantly, the cost outcomes of the proposals that are adopted are of interest as well, and there will be a project budget that reflects these things. The project will be continually evaluated to ensure that it remains on budget, using time honored and established budget control techniques (FAO, 2014).

Satisfaction measures are also worth taking into a consideration. It is not a big mystery that satisfaction of staff, patients and patient families decreases when patients elope, and especially where that elopement leads to patient death. The satisfaction level of the relevant stakeholders is already gathered in surveys, and the response here needs to be to include elopement protections as a specific question or set of questions in the surveys. The result of this is that the organization will then be able to gather the information needed to evaluate the satisfaction of the different stakeholders.