Changing to improve? Organizational change and change-oriented leadership in hospitals

Øygarden, Olaug; Olsen, Espen; Mikkelsen, Aslaug

doi:10.1108/jhom-09-2019-0280

Cited by 25 publications

(32 citation statements)

References 65 publications

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“…The apparent simplicity of this process to reduce a waitlist belies the conflicts that require acknowledgement when implementing any organisational change, even one which has a relatively small and local impact (Matland, 1995). Improvement initiatives are often instigated from hospital executive managers, driven by health department policy, but change activity can be experienced by ground-level staff as additional work demands in an environment which is already at capacity (Øygarden et al , 2020). In the current study there was “bottom-up” implementation (Matland, 1995) where the instigator of the project was the senior neurologist who identified a mismatch between both policy objectives and aspirations of access and quality of care and the performance of his clinic.…”

Section: Discussionmentioning

confidence: 99%

Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study

Lewis

Taylor

Carney

et al. 2020

JHOM

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PurposeLong waitlists in outpatient clinics are a widely recognised problem. The purpose of this paper is to describe and report the impact of a waitlist reduction strategy for an epilepsy clinic.Design/methodology/approachThis observational study described the local impact of a methodical approach to tackling a long waiting list, using targeted strategies supported by a modest additional budget. The interventions were described using the template for intervention description and replication (TIDieR).FindingsOver an eight-month period, the waitlist for the epilepsy clinic was reduced from 599 to 24 patients without increasing the number of days until the next available appointment. Most referrals were removed from the waitlist without an appointment. Auditing revealed a high proportion of patients no longer required the service or referrals remained on the waitlist due to administration error. A short-term increase in clinic capacity of 51 extra appointments met the needs of the remaining waiting patients. The additional project funding invested in this process was AUD $10,500 and a time-limited amount of extra work was absorbed by using existing clinic resources.Practical implicationsThis waitlist reduction strategy resulted in a very small waitlist for the epilepsy clinic, which is now well placed to trial further interventions with the aim of sustaining the service with minimal waiting times. Not every referral on the waitlist, particularly the very long waiters, required an appointment. Other outpatient clinics may be able to apply this process to reduce their waitlists using a modest budget.Originality/valueAlthough there are reports of successful waitlist reduction, few report the intervention in detail. Use of the TIDieR in reporting enables the intervention to be appraised or adapted to other settings where long waitlists are problematic. Considerations related to implementation of policy are discussed and in this case, a locally led and executed change management strategy was a key to achieving the result.

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Section: Discussionmentioning

confidence: 99%

Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study

Lewis

Taylor

Carney

et al. 2020

JHOM

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“…They concluded that "it is more reasonable to interpret our finding as an indication that organizational changes which in the current health policy climate are often motivated by cutting costs and increasing control and efficiency may indeed create more work system performance obstacles" (11), adding that "participation in decisionmaking is an aspect of such engagement and should be encouraged and safeguarded by hospital leadership in change processes as well as in day-to-day operations" (11). There is literature that examines organizational change in hospitals in terms of change tactics and methods suggesting that those at lower levels should be given as much autonomy and flexibility as possible to implement change at their levels (12,13).…”

Section: Introductionmentioning

confidence: 94%

Rethinking organizational change in the COVID-19 era

Choflet¹,

Packard²,

Stashower³

2021

J Hosp Manag Health Policy

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Planned organizational change has a long history in formal organizations of all types. A model of planned organizational change from the existing literature can be used to identify a set of principles which can be offered for use during the current COVID-19 crisis, but this traditional model may not be fully adequate during this especially challenging period. A relatively new model from the field of complexity theory for organizations, Complex Adaptive Systems (CAS), offers promise for addressing the unique crisis conditions facing hospitals in the COVID-19 era. These conditions require constant assessment; ongoing high levels of communication; and iterative cycles of experimentation, reflection and learning, which can be better addressed in a CAS framework. Healthcare providers are experiencing periods of relative calm and interspersed crisis, which need to be proactively recognized and managed through sustained, "big picture" changes using timely combinations of traditional methods, complexity approaches, with the flexibility and ethical considerations of crisis management strategies built in. Successful crisis management requires leadership skills of those involved in decision-making at the local level, with a preference for the use of inclusive and adaptive leadership styles. Innovative strategies, teamwork, and crisis management models that have recently emerged may enable deeper systemic change in the long term. Any hospital or program in a healthcare system should be able to use this material to address a significant organizational change need.

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“…The main responsibility of Middle Managers is to keep the organization running, moving forward and making profit so that top management members can focus on bigger decisions about budgets, goals, and vision (Kahm and Ingelsson 2020 ; Øygarden et al 2020 ). Maintaining worker productivity is a major responsibility for Middle Managers, and the top management often sets productivity standards.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Middle Management is the backbone that all organizations have relied upon. The distinction in this level of management depends on the extent of its proximity to the theater of the lower levels in the organization, which make it obvious for all work processes, areas of improvement, shortcomings and development, (Kahm and Ingelsson 2020 ; Øygarden et al 2020 ).…”

Section: Literature Reviewmentioning

confidence: 99%

“…Øygarden et al ( 2020 ) study to fill gaps when their impact of organizational change on two outputs related to hospital service quality and when the role of Middle Manager change-oriented leadership style in relation to the same outputs. Additionally, the researchers aim to identify how Middle Managers’ participation in decision-making impacted by organizational change and change-oriented leadership, in addition to how it arbitrates the relationships between these two hospital service quality variables, performance obstacles and job satisfaction.…”

Section: Literature Reviewmentioning

confidence: 99%

See 1 more Smart Citation

The Contribution of Healthcare Middle Managers as Change Agents in the Era of Covid-19: Critical Review

Ahmed

Hamdan

Alareeni

2021

The Importance of New Technologies and Entrepreneurship in Business Development: In the Context of Economic Diversity in Develo

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This paper critically investigates the contribution of effective Healthcare Middle Management as change agents based on recent studies, and argues that management change in a crisis such as the COVID-19 pandemic can be well-handled by Healthcare Middle Managers, who are critical components in the stability and success of organizational transformation in a turbulent economy. With the emergence of the COVID-19 pandemic, organizations around the world have struggled to adapt effectively to change, and healthcare organization have especially suffered through subjective responses. However, these methods have been proven ineffective by recent studies. This paper critically discusses the recent literature on the contribution of Healthcare Middle Managers as change agents in organizational change during cases of crisis and uncertainty. The results have shown that supporting Middle Managers in Healthcare is crucial for creating a sense of change to other immediate and relevant parties within the organization, while minimizing unnecessary costs and losses. Consequently, this paper contributes to clarifying the problem of not engaging the Middle Managers sufficiently with Healthcare owners and directors, and addresses the problem of disregarding Middle Managers as change agents. Thereby, the paper develops management knowledge, and it creates an opportunity for researchers to test this study on quantitative and qualitative methods in any population.

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Changing to improve? Organizational change and change-oriented leadership in hospitals

Cited by 25 publications

References 65 publications

Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study

Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study

Rethinking organizational change in the COVID-19 era

The Contribution of Healthcare Middle Managers as Change Agents in the Era of Covid-19: Critical Review

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