Leadership and Change Management in Healthcare - Essay Example

Leadership and Change Management in Healthcare Introduction Change is one of the attributes of organizations that must occur in the day to day operations of the organizations. Change can bring benefits to the organizations or cause their downfall (Jones 2006). It is therefore imperative that any type of change brought into any organization be evaluated studiously first. According to Yoder-Wise (2003), organizations submit to change and they no longer rely on rules, policies and pecking orders to have work accomplished in nonflexible ways (p. 128). In view of the above standpoint, healthcare organizations are unable to control most long term outcomes in regard to the chaos theory viewpoints because of the rapidly changing characteristics of humanity and world factors (Yoder-Wise 2003). In addition, organizations are open systems that operate in intricate fast changing environments (Jones 2006). This makes the conception that “organizations are potentially chaotic” true according to the principle of the chaos theory (Carpenito-Moyet 2008). The richness of various factors surrounding an organization (in terms of the various parts acting between the system and the prevailing environment) usually makes the entire system of an organization to undergo rapid self evaluation. Thus, it is common for organizations to undergo alternating periods of stability that is interrupted by times of intense transformation (Yoder-Wise 2003). Healthcare is a sensitive area in society. It is notable that in spite of the increasing level of medical advancement, the field is not becoming any safer (Kenny & Duckett 2003). Adverse aspects of change within healthcare organizations are the second highest cause of deaths in Australian hospitals (Kenny & Duckett 2003). It is for this reason that most organizations are opting to adopt lean thinking as a strategy to increase efficiency in management (Jones 2006). In view of this, the paper will present a problem faced in the management of healthcare systems and address the issue by applying the appropriate management strategies. The paper is divided into sections: the first section will entail identification of the problem and a review of literature about the problem from various authors’ perspectives. The next part will be a highlight of various change management strategies to tackle the problem. The last section of the paper is a conclusion that summarizes the main ideas addressed in the paper. Identification and review of the problem One major problem facing the Australian healthcare system is the dominance of doctors. The problem presents challenges in multiple dimensions ranging from how doctors are perceived by the public to how the government supports the healthcare system as well as how most healthcare organizations are run (Kenny & Duckett 2003). Australia, like many other nations, is characterized by a health sector environment in which the medicine fraternity, the government and communities have maintained a symbiotic relationship that is based on mutual dependence and reciprocity of resources (Kenny & Duckett 2003; Jasper & Jumaa 2005). In particular, the department of medicine has become indispensable to both the communities and the government, a factor that has made it achieve absolute power making it more selective and willing to seek more financial gain rather than achieve its core function of providing essential healthcare services (Kenny & Duckett 2003). Kenny and Duckett (2003) note further that doctors have managed and directed medical knowledge in a totalitarian manner that has been instrumental in increasing their dominance and power. As a result of doctors’ dominance and possession of absolute power, doctors have greatly been portrayed negatively in the society (Jasper & Jumaa 2005; Kenny & Duckett 2003; Hough 2008). In essence, there are many reported cases of medical negligence, sexual harassment of patients, and a variety of greedy practices by doctors (Kenny & Duckett 2003; Hough 2008). These practices are essentially pegged upon aspects of poor leadership within the healthcare sector in Australia. It is for this reason that there has been a significant decline in cases of medical success in the country (Jasper & Jumaa 2005). The state of affairs in the healthcare sector of Australia is however opposed by emerging trends in leadership such as corporatization of medicine, proletarianization (a situation whereby people shift from being either employers or in self employment to become employed as paid workers), and managerialism (Kenny & Duckett 2003). These trends seek to clip the immense powers that people in the medical fraternity seek to possess (Kenny & Duckett 2003). The dominance of the medical fraternity in Australia is amplified by the fact that most doctors in the county are in private practice where they charge clients for the services they offer (Australian Government Department of the Aging, 2009), and enjoy better terms than their counterparts in the public healthcare institutions. As a result, public health institutions are characterized by staff who are not only poorly remunerated but also poorly managed (Lewis 2003). According to Pairman, Pincombe & Thorogood (2006), Australia’s health sector is characterized by too much government intervention that limits and constrains the healthcare sector by regulating the behavior of the market as well as limiting the size of the market. Thus, most transactions within the healthcare system are characterized by asymmetrical power and asymmetrical information (Pincombe & Thorogood 2006; Kenny & Duckett 2003). Pairman, Pincombe & Thorogood (2006) also evaluate the subject of doctors in private practice in Australia by noting that service delivery is largely influenced by politically effective individuals and organizations. The result of this is that various aspects of healthcare such as health insurance are bizarre (Pairman, Pincombe & Thorogood 2006; Hardie & Critchley 2008). In addition, most healthcare institutions have failed to implement effective policies and strategies as a consequence of ineffective leadership and management. In view of this, the following section presents ideas that are vital for effective management and which are vital in eliminating the leadership problems in healthcare as so far discussed. Medical dominance, change and practice application “Medical dominance” is a term that is used quite frequently in literature and is also commonly used interchangeably with “professional dominance” (Collyer 1994). The term refers to the stance by the medical profession to control many divisions of labour, which translates to a form of authoritarian leadership with regard to the society at large. The medical profession has immense power as a result of the alliance between the profession and the structure of power existing in Australia at the macro economic level (Kenny & Duckett 2003). For this reason, medical practitioners in various organizations act from a “business level of medicine” rather than from the perspective of good leadership and efficient service delivery. Leadership in the field of medicine is controlled by factors that act within four levels. The initial point and which is the most influential is industrial and financial capital. The second one is the capitalist (as shown by the tendency of the sector to control the resources in healthcare). The third one is medicine itself. The fourth factor is the public (Collyer 1994). In view of this, the field of medicine is subjugated by capital as well as the capitalist state, and is challenged, although not dominated by the public sector (Collyer 1994; Kenny & Duckett 2003). Medicine is important as it determines the success of various branches of nursing such as midwifery and patient care. However, the capitalistic development of the profession makes it individualistic and objective rather than being person centered interventionist and curative. According to Collyer (1994) the capitalistic nature of medicine makes service delivery not only ineffective but also mind-numbing from the public’s perspective. Yet this is an attribute that is very common among many healthcare organizations in Australia (Pairman, Pincombe & Thorogood 2006; Jasper & Jumaa 2005; Kenny & Duckett 2003). From the above perspective, there is need for change in the in the medical aspects of healthcare in order to ensure that service delivery improved simultaneously with a change from current perceptions about medicine where it is considered to be ineffective. The change should however progressive as opposed to spontaneous in order to facilitate proper implementation of the strategies and policies. Theories for planned change According to Yoder-Wise (2003), there are various aspects of change that can make organizations effective. Quoting Havelock in the Six Phases of Planned Change, Yoder-Wise (2003) notes that change can be planned, implemented and evaluated in six chronological stages. The six stage model is highly advocated for in developing an effective system of change agents and their application in a rational problem solving process. The first point involves building a relationship (Yoder-Wise 2003, p. 127). Healthcare organizations must develop good relationships among their members of staff and between the staff and the public who need medical care (Yoder-Wise 2003, p. 127; Kenny & Duckett 2003). The problem within the healthcare system is multifaceted in that although some medical personnel are not liked by the public, the views of the public are divergent with various care givers. For instance, Hardie and Critchley (2008) note that although the public has a low opinion of most medical service providers, their research statistics show that Australians regard doctors highly (particularly practitioners as opposed to specialists). The findings of a research carried out by Hardie and Critchley (2008) also reveal that there is low trust in alternative practitioners and moderate trust in hospitals (although private hospitals are trusted more than public hospitals). The root of this variation takes an analyst to the point mentioned earlier that private hospitals have better leadership and management because they tend to have better facilities (Pairman, Pincombe & Thorogood 2006; Jasper & Jumaa 2005; Kenny & Duckett 2003). And this forms the basis of the problem to be solved be solved in discussion. The second approach to change management is diagnosing the problem (Yoder-Wise 2003). This involves evaluating the various aspects from many dimensions. In this case the perceptible problem is the disconnect between medical nursing. Doctors seem to dominate the healthcare industry at the expense of other sectors such as midwifery and nursing, which are equally important for achieving a balanced scorecard in provision of medical care (Yoder-Wise 2003). The third approach to change management in healthcare is acquiring the relevant resources (Yoder-Wise 2003). For effective change management in healthcare, there is need to spread resources within the various departments of the healthcare organizations. This strategy is the essence of good leadership and management since it means that there is equal satisfaction among various staff with no tendency for doctors to dominate over other members of staff within the healthcare organizations. A fair distribution of resources is also important for ensuring that there are no negative consequences whenever minor changes are implemented within the organizations that provide health care (Yoder-Wise 2003; Pairman, Pincombe & Thorogood 2006; Jasper & Jumaa 2005; Kenny & Duckett 2003). The fourth approach to managing change is choosing the solution (Yoder-Wise 2003). It is evident that the solution to implementing good leadership and management practices within healthcare organizations is to create a balance between medicine and the other sectors or departments of healthcare (Hardie & Critchley 2008). While it may appear that that the medicine department is more powerful among the various departments of healthcare, there is no need to show favouritism towards the other departments as this sounds bad in the public domain. The fifth point about managing change is gaining acceptance of any particular change (Yoder-Wise 2003; Jones 2006). It is obvious that change within healthcare organizations will be significant if it is not accepted. Various members of staff can be trained adequately, resources can be distributed evenly within various departments of the organization- but all these may not be successful or may not bear the anticipated results if they are not complimented with concomitant acceptance (Collyer 1994; Hardie & Critchley 2008). After carrying out all the four aforementioned points, there is need to sensitize the various members of staff on the need and importance of the changes that are implemented (Jones 2006). Without acceptance by the affected staff, any change in healthcare organization will be a futile attempt to make the institutions of providing health care better (Kenny & Duckett 2003; Yoder-Wise 2003; Pairman, Pincombe & Thorogood 2006; Hardie & Critchley 2008; Collyer 1994). The sixth point stated by Yoder-Wise (2003) about managing change is stabilizing the innovation and generating self renewal. The changes so far discussed must actually be implemented in order to complete the cycle and realize the benefits. Again, if the change is not stabilised, it is likely to be a cause of resentment among various members of a healthcare organization who are not content with the changes implemented. Thus the staff of healthcare organizations have to be reminded constantly about the need for stabilizing the benefits arising from it from it. Change theory A key aspect of leadership is the capacity of leaders to manage change so that people will embrace it and move towards a new vision (Finkelman 2006). There is no absolute way to facilitate change but as shown and as will be shown further, some common rules apply. The fundamental aspect of change is that there is no single way to manage it. Finkelman (2006) describes a simple change that involves improving nurses’ or doctors’ hand washing or a more complex one that involves redistribution and relocation of healthcare services. According to Finkelman (2006), the elements of change shown in table 1 are vital for management of healthcare organizations. Step Change Element Example 1. Create a sense of urgency Doctors and nurses should take the shortest possible time to adjust to changes in healthcare systems (Huber 2006, 816). Doing so is the best way to avoid the inconveniences that commonly arise when serving patients. 2. Create a guiding coalition and mobilize commitment Doctors and nurses should work hand in hand with each other since the success of one side is dependent on the success of the other. Working together will ensure that the tendency by doctors to dominate healthcare systems is eliminated. This can be achieved by having clearly defined roles on the side of doctors as well as nurses. 3. Develop and communicate a shared vision Doctors and nurses should develop strategy that focuses on giving patients first hand attention that is not only interventionist but also curative. 4. Empower employees to make the change Empowering employees to play their role is very important in view of better healthcare management. For example, every department should be empowered by way of provisions in resources to ensure that long patient queues are eliminated. 5. Generate short-term wins The healthcare providers can focus on generating short terms wins by ensuring that their short-term services are perfect. For instance, outpatients should take the least possible time in processes such as diagnosis, laboratory analysis and prescription. The success of such services is one of the best short-term wins that can change the shape of healthcare systems. 6. Consolidate and produce more change The short-term wins should slowly be improved and sustained as long-term measures that will completely change the management of healthcare. 7. Anchor into organizational culture It is possible to build an organizational culture that is pegged on effective leadership and management of healthcare. Once short-term and long-term services become routinely effective, this becomes embedded in the organizational culture. 8. Monitor progress and adjust vision as required Short time efficiency is not meaningful if it is not evaluated. The progress of changes in management and leadership should be assessed routinely to guarantee consistency. The efficiency of every department should be monitored in order to facilitate success at every level of management. Source: Adapted from Finkelman (2006), p. 44. Concept of leaning healthcare Having discussed various aspects of change in the previous sections, this section will focus on leaning health care, a utility that is being applied by many health organizations to increase their efficiency in service delivery. Lean is a mechanism that has been used in the field of manufacturing for a period of over 50 years now (Jones 2006; Yoder-Wise 2003). Giant companies like Toyota have implemented the strategy by using a variety of tools, principle, as well as practices to reach new levels of quality and improve their service delivery (Jones 2006). The lean or leaning strategy is focused on improving service delivery by eliminating activities that have no significant value; identifying exactly what customers want and what the customers perceive as being of true value, and according respect to people in the society. The lean strategy has been used with success in many sectors, particularly healthcare (Jones 2006). Lean healthcare sets a foundation for ensuring that the safety and quality of healthcare is improved by integrating various activities involved in providing healthcare to ensure that they are focused on the patients, thus making the mission of healthcare to be providing curative and interventionist attention rather than focused on money making as has been the common trend. The principles of the lean strategy are thus aimed at the patient as discussed in the following section. The first principle is that the patients are allowed to define value (Jones 2006). Under this, anything that benefits the patients has value; anything else is a waste (Jones 2006). The cumulative resources that are freed by eliminating wasteful processes can be used to create value for other patients (Jones 2006). In the Australian healthcare setting, many resources are wasted though bureaucracy particularly in public hospitals. This can be eliminated by streamlining service delivery processes. The second principle of lean healthcare refers to the pull systems (Jones 2006). Under this principle, healthcare organizations have to provide services in accordance with demand (Jones 2006). Service delivery based on demand means that only the required practices and services are delivered. Any other practices by healthcare providers which do not contribute to the patients’ recovery are considered to be merely a waste of time (Yoder-Wise 2003). The third principle is flow (Jones 2006). The pull systems described above must be organised in a manner such that there is flow of services to the patient. For instance, the patient should be able to move from one point to another in a healthcare institution without necessarily having to follow long queues. This can be eliminated by centralizing the services of registration, diagnosis, and laboratory analysis in a clear area in order to ensure that patients do not move from one point to another carrying various documents and then line to be served. By ensuring a good flow of pull systems, healthcare providers are likely to increase the quality of services they provide and therefore make patients and the public in general have a better perception of them. The fourth principle is concerned with value streams (Jones 2006). This pertains to the to order of steps that increase the value of services delivered to patients right from the point where patients start seeking medical help to the point when they live the health facility (Yoder-Wise 2003; Jones 2006). The goal under the lean strategy is to ensure that all services are streamlined and processes shortened to enhance faster delivery of services to patients. The fifth principle of the lean strategy is perfection (Jones 2006). Under this, healthcare providers should be sensitised to be never satisfied with the presence of non-value addition activities or steps in their profession (Yoder-Wise 2003; Jones 2006). This should always used as the basis for ensuring high quality service delivery in order to guarantee that the quality of various processes is continually improved (Yoder-Wise 2003). In summary, change involving the lean strategy is aimed at creating a product or service that is largely free of defects. In healthcare provision, this ensures that patients are subjected only to processes which are beneficial to their health. Secondly, the lean strategy eliminates wasteful processes and activities and increases efficiency. As a result, if the strategy is fully implemented, it is likely to increase both patient and healthcare staff satisfaction. Most importantly, the lean strategy is the essence of good leadership and management in healthcare institutions. Conclusion In recognition of the fact that change is inevitable in organizations, the paper has discussed various aspects of change that must be implemented within healthcare organizations in order to achieve high levels of service delivery. In particular, the healthcare sector is faced with the problem of dominance by the medical fraternity, which makes delivery of services inefficient. As it has been discussed in the paper, the dominance by the fraternity makes provision of services to be curtailed by a lot of bureaucracies, which ultimately lowers the quality of services delivered to patients. This needs to be corrected by implementing a series of six steps which have been discussed. The implementation must be strengthened by sensitization and stabilization of the measures that are implemented so as to achieve acceptance by the various players. Good leadership and management in healthcare must be supported by the lean strategy. This involves elimination of wasteful processes and paying attention only to factors that contribute to the success of services offered to patients. References Australian Government Department of the Aging 2009, Working in Private Practice, viewed 12 September 2009, from http://www.health.gov.au/internet/otd/publishing.nsf/Content/work-Working-in-private-practice. Carpenito-Moyet, L J 2008, Nursing Care Plans and Documentation: Nursing Diagnosis and Collaborative Problems: Nursing Care Plans and Documentation (5th ed.), Lippincott Williams & Wilkins, Philadelphia. Collyer, F 1994, Medical dominance in the Australian Health System: The case of bionic ear, Explorations in knowledge, 11(1): 1-12. Finkelman, AW 2006, Leadership and management in nursing, Pearson, New Jersey. References and further reading may be available for this article. To view references and further reading you must purchase this article.Hardie, EA & Critchley, CR 2008, Public perceptions of Australia’s doctors, hospitals and health care systems, MJA; 189 (4): 210-214 Hough, D E 2008, The Business of Healthcare, Greenwood Publishing Group, Santa Barbara. Huber, D 2006, Leadership and nursing care management, Elsevier Health Sciences, New York. Jasper, M & Jumaa, M 2005, Effective healthcare leadership, Wiley-Blackwell, London. Jones, DT 2006, Leaning healthcare, Management services, 50(2): 16-17 Kenny, A & Duckett, S 2003, A question of place: medical power in rural Australia, Social Science & Medicine, 58 (6): 1059-1073 Lewis, MJ 2003, The People's Health: Public health in Australia, 1950 to the present: Volume 2 of The People's Health: Public Health in Australia, Greenwood Publishing Group, Santa Barbara. Pairman, S; Pincombe, J & Thorogood, C 2006, Midwifery: preparation for practice, Elsevier Australia, Melbourne. Yoder-Wise, PS 2003, Leading and managing in nursing, Elsevier Health Sciences, New York. Read More