Building Organizational Capacity in Health Care

This paper discusses the importance of leadership in healthcare, leadership styles, change management models, and the role of vision, mission, and strategic goals in workplace change. It identifies the roles of leaders in bringing about change, discusses leadership styles and implementation of change using change management models, and mentions the barriers and facilitators of change. The paper also emphasizes the importance of an organization's vision, mission, and strategic goals when considering workplace change.

Running head: BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
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1BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
Introduction
There is an increasing amount of awareness in the importance of leadership in the
field of healthcare. Most theories of leadership were generally formed for the setting of the
business and then were applied to the field of healthcare. However with increasing complex
situations, the health care organizations are starting to recognize the importance of leadership
practices. This paper aims to identify the roles of the leaders in bringing about the change in
the workplace environment. It further discusses about the leadership styles and
implementation of the change using the change management models. Additionally the
barriers of change that is faced is mentioned in the paper along with the facilitators of change,
and what the leaders are to do for proper flow of the change.
The behaviour of any person which includes directing activities in order to move
forward towards a goal is called leadership (Al-Sawai, 2013).The major aspects of leadership
includes influencing the activities that requires to be conducted in a group and coping with
any kind of change that is required in the workplace. When considering the case of health
care professionals it is seen that the concept of leadership is both that well developed among
the healthcare setting. Even studies show that very little evidence exists for the leadership
initiatives taken for the improvement of the patients or the organizational developments
(Aarons, 2015). Within large organizations such as the medical organizations, the need of
leadership is desired which requires to capitalize on the notion of diversity in the organization
as a whole. The emergence of leadership will also help in efficiently utilizing the resources
while designing the processes of management along with encouraging individuals to target
towards some common goals.

2BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
Leadership in the health care
There lie various leadership approaches that can be adapted to the settings of the
health care in order to effectively optimize the system of management in an environment
which is largely complex. The approaches of leadership include collaborative leadership,
transformational leadership, shared leadership, conflict management, ethical leadership,
distributed leadership, and healthcare leadership whose results is functional oriented (Carter,
2013). The theory of transformational leadership puts emphasis over the working of the
people more efficiently with an established sense of mission. It is required for the leaders to
initiate communication of their vision in such a way that is, exciting, meaningful and
develops unity and a nature of collective purpose within the community of individuals. The
context of collaborative leadership plays role when a cooperative procedure occurs and each
and every individuals try to work collaboratively for their mutual benefit. It involves
information for the communicating with the co-workers and associated organizations, so that
they can initiate in making their own decisions that are informed. This joint strategies of
communication elevate and facilitate the healthcare management by initiating encouragement
of conversation among multiple stakeholders; knowledge sharing and experiences; and
furthermore decrease in the level of complexity that is present among healthcare settings
(Ginter, Duncan & Swayne, 2018). Conflict is seen as a persuasive force that exists among
the organizations of healthcare and as gaps in the development of communication, there exist
higher probability of failure in the practices at the workplace. The leader of healthcare must
thrive to implement some of the suitable approach for initiating handling of conflict in all the
stages in order to create a positive outcome for all who are involved. Shared leadership
reflects a system of management which is of team-level or the leadership that enables to give
power to the staff in the processes of decision-making. Shared leadership generally results in
the adoption of leadership behaviours of individual staff members, greater autonomy, and

3BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
improved outcomes of patient care (Marquis & Huston, 2015). According to distributed
leadership theory, the goal of the leader is to initiate formation of an ethos whereby the
individuals are enabled to complement towards individual’s strengths and offset towards one
another's weakness, with the quality of leadership distributed throughout the environment or
the field of organization. Practicing effective leadership tends to have significant effect on the
healthcare staff regarding their employment life, outcomes of the patient, and an
organizational fate. A good and an efficient leader must therefore have goals, behaviours and
values that will not bring any harm and will always tend to respect the rights of all the parties.
This concept is included on the notion of ethical leadership.
Some of the categories of challenges which clinicians face while dealing with the
complex setting of the services of modern health care include: requirement of diverse
changes, rising expectations of the patients, and accelerating cost of treatments and new
interventions. The main focus by the functional results-oriented leadership style on the
organizational process imply specific role of the concept of leadership and required skills that
is necessary for the effective delivery of the targeted results of the group on the basis of
fulfilling the requirements of the three areas that includes individuals, tasks and the team
(Mosadeghrad & Ferdosi, 2013).
Role of leadership in the Organizational change
For the proper workplace functioning and performance of an organization effective
leadership has become very important. Leaders who are intelligent enough show skills and
knowledge for effective and efficient management of the tasks required on a daily basis in the
workplace environment. In order to bring about effective changes, efficient leadership skills
is of prime importance. This requires competent leadership that can be put to use for handling

4BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
and managing problems arising in a workplace (Seo et al., 2012). A competent leadership has
the ability to manage the knowledge and other skills and capabilities.
For the development and managing a change, it is very important for the leader to create a
favourable atmosphere within the workplace. A suitable atmosphere is also required in order
to adopt the change within the organization. In the development of change in any workplace,
the workplace culture also has a role to play (Thomas, 2015). It is the leader who becomes
responsible for bringing in new strategies for the effective development and management of
the culture. Strategies can be implemented to interconnect the people involved in an
organization. The workplace culture includes several values and beliefs that is may change
the organization from being conservative to innovative. For effectively managing
technologies, two dimensions of leadership skills should be accessed namely transactional
and transformational leadership (Taplin, Foster & Shortell2013). The focus of transactional
relationship is on managing the technological changes that needs to be brought about.
Transformational leadership on the other hand mainly focuses on the need of technological
changes along with the consideration of the human relation factors. This form of leadership
helps the leader in portraying the role of a pathfinder and communicating the visions through
proper exercising of skills. According to some studies, transformational leadership is more
effective for the organizations to develop a change in the workplace environment and
implementing innovations (Carter et al., 2013).
Importance of an organisation’s vision, mission and strategic goals when
considering workplace change
To understand the importance of leadership and the need of workplace change, it
becomes very important to understand the essential concepts of mission, vision and the
strategic goals of the organization. The mission of the organisation is the prime reason of its

5BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
existence. In case of a health care organization, the mission should be provision of high
quality care to the patients or the consumers. Existence of a clear mission is required for the
proper guidance of the leaders to take major decisions and choose between alternatives
(Goodwin, 2013).
The conceptualization of the future is referred to as vision. The vision helps to
navigate the organization towards a better future. A systemic formulation of the vision is
essential based on the terms of scientific advances, demographic trends and technological
innovations in the respective fields. For example considering the field of cardiology, it can be
seen that with increasing of the age of the population there is a prevalence of more calcific
aortic stenosis. Along with this the innovations are implemented of trans-catheter aortic valve
replacement (TAVR), which are able to motivate the leader to arrange the implementation of
this new technology into practice. This should be done in consideration of the consequences
on surgical volumes, staffing needs, and organization finances and facilities (Hayes, 2018).
The concept of strategy puts forward the plans that the organization tends to follow
for becoming successful and providing competition to other organisations in the similar field.
The strategy that it being followed for the achievement of this vision include the development
of a team of physicians who are nationally renowned and work in a multidisciplinary manner.
Furthermore emphasis is also given on broadly developing their reputation (Greenfield,
2007).
In order to bring out changes with maximum effectiveness, it is desirable that the
leaders understand the workplace culture. Good leaders are able to provide an impact on the
long-term culture and values of the workplace by implementation of self-modelling of
behaviors. Additionally creation of cultural expectations and communication of the cultural
expectations formally is also required. For example in case of maintenance of expectations

6BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
and showing mutual respect, a demonstration can be professed by the leaders even in times of
complex situations (Marquis & Huston, 2015). It is required of the leaders that they show
mutual respect in such times, instead of letting the situations go unaddressed. This helps in
providing a positive workplace culture.
Leadership styles
As discussed by several theorists, there are different styles of leadership and each of
this style has an impact on the change management. According to Aarons et al., (2015), in the
Leadership Model for Change Management, the Transformational leadership aims in
promoting the organizational development. The leaders can be visionary change agents who
needs to be more skilful and motivational. Such leaders are able to sustain the operations
within an organizational by which specific personal actions combined with perceived
personal characteristics can be implemented (Andrews, Cameron& Harris, 2008). It is the
duty of the leaders in the change management model to lead to bringing out of change by
helping to develop the skills that help in facilitating to accustom with the changes. Leaders in
order to become successful in bringing about change have to focus on the launch, ways of
implementation and sustenance of the particular change effort.
The process of change management needs to consist of various skills like leadership
development and communication skills. In case these are lacking then it will have a negative
impact on the effectiveness of change management process in the workplace. The leaders
needs to possess the factors such as strong determination to make the change happen,
perseverance, stamina and first-hand intelligence. In absence of a strong leadership,
implementation of organizational change is not possible. It is desired of the leaders that they
should be able to lead the team for managing the change and making the team adapt to the
changes that is brought into the existing system. Due to change there is a transformation in

7BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
the environment or the culture of a workplace therefore the leaders, being the agents of
change have to oversee the process so that they can provide a supportive response towards
the change. The visionary leaders are expected to bring about quality-led strategic change
(Cameron & Green, 2015).
Change theory models in health care
Several models of change management have been developed recently from the
context of healthcare. ‘Lewin’s Change Management Model’ is the example of one such
model that includes the elements such as the field theory, action research, group dynamics
and the three major procedure of change (Hayes, 2018). The concept of field theory projects
the idea that maintenance of the current situation is carried out by a full set of the symbolic
forces which has an effect on the group structures. This in turn can influence the behaviour of
the individuals. According to Lewin’s theory, change is considered to be the consequences in
the forces among the respective field of symbols. Therefore, recognition of those forces
enables the understanding of the motives of the people and helps initiating influence of the
behaviour of the people. For the identification the forces of field of a given situation, the
theory proposed looking to the subjective (cognitive) and the objective (behavioral) aspects
of the life’s group. The circumstances would involve the groups and subgroups that are
included, their targeted relationships with one other and their system of values together with
their social habits (Mosadeghrad & Ferdosi, 2013).
The individual behaviour is generally constrained by group pressure, as claimed by
the concept of group dynamics. Thus, the focus should therefore be given at the group level
instead of the individual level. The research of actions illustrates two aspects as the
following. Firstly, it is required for the individuals to feel the requirement for change, that
involves the capability to understand the momentary status quo of one and the gap compared

8BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
to the desired status quo of the future. Next, one of the most appropriate solutions at hand
should be implemented and chosen. This scenario consists of the evaluation and continuous
analysis of all the possible measures (Son et al., 2011). Finally, according to Lewin, in the
context of complete change management, the procedures can be differentiated among three
steps namely ‘Unfreeze, Move, and Refreeze’.
One of the familiar procedures was to be “unfrozen” by the act of sensitizing the
participants of the process towards the requirements of change and by overcoming and
evaluating their defence mechanisms. The next or the second step that is the (Move) targets
towards effectively strengthening all the required changing forces. This is because of the
change to actually take place. The final step that is the (Refreeze), that initiates reinforcement
on the maintenance of the acquired status quo which is newly acquired for deterring the
participants. This causes initiating reversion towards their initial state (Taplin, Foster&
Shortell, 2013).In accordance to the above discussion, Lewin’s model of change management
can be capable of structuring a workplace change project in the health care setting.
Implementation of the change theory
In a study conducted by Tannenbaum, Weschler& Massarik, (2013), the author
illustrated the ‘Lewin’s change management models’ namely, group dynamics, the field
theory, action research , the 3-step model, in the context of the health care setting for
initiating changes in the cost unit accounting system at a teaching hospital in German.
The main aim of this study was to highlight and analyse the documentation of the
accurate costs which are associated with the periods of patient care system. In the light of the
Lewin’s field theory, the change initiators were recognised with the aspects of the
environment related to health institution This represents the forces and the driving attire for
initiating change that are restraining in nature. For the identification of the necessary actions

9BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
for obtaining support of the senior hospital officials, group dynamics were analysed. Some of
the examples include administrators, board of directors, medical and directors of nursing.
Furthermore staff and workers might act as alteration opponents. Effective understanding of
the dynamics of the group initiates the allowance of change initiators for hosting the
workshops that targets for informing all stakeholders for the change requirements. Example
includes formation the feeling of requirements and to give them an opportunity for effective
contribution towards the change and the planning initiative.
Finally, the ‘3-step model’ was utilised to effectively implement the initiatives of the
change. This resulted in the formation of an ‘unfreezing stage’ in which workshops were
carried out for informing the staff of the nursing regarding the need for approach of new
documentation. Next, the move stage, in which the concept of new documentation was set in
for production and all the teams were initiated the extra support for accommodating the
changes. Lastly step, the ‘refreezing stage’, in which feedback opportunities were initiated for
ensuring that the required and the targeted concerns were addressed efficiently (Thomas,
2015). The case study described in this assignment highlights a well-structured and a
comprehensive example of the theories of Lewin’s change management and highlights their
capability to usher for the alteration within the healthcare organizations.
Barriers to change management
Change taking place in the workplace may be a planned change or an emergent one.
Most of the times the organizations opt for the changes of the incremental type as it is better
suited for minor modifications or improvements. The organizational change tends to involve
everyone involved in the organization, therefore there is a requirement for the alignment of
the individual goal along with the organizational goal. Although the organizations emphasis
more on the controlled factors while bringing about change like resources and technologies,

10BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
sometimes the human part of the change is ignored. These leads to the cause of barriers. The
barriers of change tend to come from these major sources: the organization that is targeted for
change, the change that needs to be initiated and the lastly the employees who are affected by
the change (Parris & Peachey, 2013).
Some of the barriers that is faced by the leaders who are the agent of the changes are
lack of clear understanding of the change that needs to be brought about. Often people also
fail to understand what change is with respect to their workplace. To overcome this the
leaders from the starting should make the definition of change clear and compelling.
Sometimes there is an issue of insufficient Active Change Leadership. It is critical for
stakeholders to be expressing, modelling, and reinforcing consistently their personal and
collective commitment to the change (Martin & Waring, 2013). This includes Executive
leaders down through the middle layers of the organization. There is also a problem of
resistance to change. In such cases the agent should try to use the opportunity of resistance to
try and gather project feedback instead of training and communicating the way out of the
resistance.
Poor communications is one of the major factors of change barriers. There is a general
belief that getting a mere message towards the audience can be more than enough for buy-in,
eliminating resistance and the drive of the behavioural changes. The lenders should centre
their efforts on the communication of the right message towards the audience which will
include the feedback loop so the t the reactions are gathered properly (Al-Sawai, 2013).
Lastly there is the problem of lack of Rigorous Governance for Transformational Changes.
The structure of the governance should be able to provide a sight of clear line from the
strategy to the portfolio and then the programs, projects, and sub-projects. If the stakeholders
don't have this sight line then there are high chances of the lack disciplined management by

11BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
the transformational change project. The leader should oversee that there is a consistent
process for implementing change in order to facilitate the flow of change.
Conclusion
Many theories and models that have initiated influences on the strategies of leadership
are applicable currently in the setting of healthcare management. In case of effective
leadership settings, the guidance should target or aim over the connection and the
relationships among the values of leadership, capabilities, culture and the context of the
organization, which should be dynamic in nature. Development of leadership has reached a
critical point and thus the most essential role of a leader that could be described is the proper
ensuring of a ready supply of the replacement leaders for the maintenance of the
organizational procedure and the progress within the ever-changing environment of
healthcare.

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13BUILDING ORGANIZATIONAL CAPACITY IN HEALTH CARE
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