Implementing Quality Improvement in Healthcare

This assignment delves into the implementation of quality improvement strategies within the healthcare sector. It emphasizes the application of Lewin's change model as a framework for driving successful organizational transformations. The focus also extends to critical aspects of patient safety, highlighting near-miss reporting and the integration of high reliability organization principles into healthcare settings.

Running head: CHANGE MANAGEMENT
Change Management
Name of the Student
Name of the University
Author’s Note

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1 Given this review will affect all Victorian hospital and health services:
 What are the major health care deficiencies addressed by the review?
 Which of the National Safety and Quality Health Service Standards (2012) do these
deficiencies relate to?
Introduction
Duckett report 2016 was commissioned in the response to a review of the role of
Department of Health and Human Service in detecting and managing critical safety risks and
clinical governance in the hospital system. It was due to the occurrence of a cluster of perinatal
deaths at Djerriwarrh Health Service in between 2013 to 2014. Duckett in his report clarifies the
misconception held by the Victorian population about the high quality healthcare across the
system. He highlighted the significant deficiencies in Victorian healthcare system and health care
system’s defences against the avoidable patient injury. Duckett’s work is a review of the hospital
acquired diagnoses in the Victorian healthcare system that concludes the existence of
complications in the hospital. The report states that around 300,000 patients suffer a
complication in the Victorian hospital while receiving healthcare every year and at least 70,000
of them were potentially preventable. He also identifies a lack in monitoring process of the
outcome data and it circulation in the hospitals to efficiently deal with similar situations that
might occur in the future. Duckett suggested a series of modification in the Victorian Health
Service in achieving the high level of clinical governance on safety and quality, monitor and
circulate the outcome data and increase the efficiency of response when things go wrong. This
essay will primarily identify the healthcare deficiencies mentioned by Duckett and his team in

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the review and relate them with the standards of National Safety and Quality Health Service
2012.
Major Health care Deficiencies Identified in the Duckett’s Review
Duckett and his team have identified several issues that need attention to eradicate the
health care deficiencies prevailing among the Victorian hospitals. The review addresses some of
the major deficiencies that are discussed in the following.
Isolation in Governance
Many of the hospitals in Victoria achieved success in innovation, accountabilities to local
communities and even reflect exceptional leadership. However, these successes are limited to the
particular hospital. Duckett’s (2016) report identifies the principle of devolution and local
autonomy among for justifying the inadequacy and inefficiency of the healthcare system in
disseminating the innovations achieved by individual hospitals. Implementation of strategies,
incentives and cultural development are the keys to achieve the standard quality and safety as
identified by Bismark, Walter and Studdert in their work in 2013. Duckett’s report (2016) finds
significant gap in the legislative requirements for big and small and the private hospitals. This
contributes to the variation in adequate skills in both financial and legal sector (Bismark &
Studdert, 2014). Lack of proper justification leads the community to formulate the idea that these
deficiencies are the medical issues that are resulting into the low quality of health service and
safety. Implementation of strategies and specifying the roles and responsibilities of the board can
help the hospitals increasing the quality.
Complication of Health Care

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According to Duckett (2016), the complications that exist in the Victorian hospitals are a
frequent case. The total number of the patients suffering from a complication in Victorian
hospitals is above 300,000 out of which, around 70,000 were preventable. Moreover, Ducketts
calculated a total number of 250 surgical deaths in Victorian Hospitals. The report made from
Australian research identifies that one out of ten patients undergo a complication of health care
during their treatment that can easily be avoided. The maximum numbers of the complications
only have minor impact on the patients; however, some of the affected patients faces permanent
disability and death. On the other end, these complications have devastating effect for the
patients their families and healthcare system as it significantly increases the cost of the care
across the system. Furthermore, these complications arise within the complex, high-pressure
environments where mistakes are likely to occur. The hospitals need process of minimising the
risk and consequences of human error. These complications results into failure of the system.
The hospitals definitely need efficient management support that is support from the department
to address the health care deficiencies. It might also facilitate the hospitals in taking swift and
appropriate decisions during the strenuous situation by releasing the steam. The implementation
of efficient manager can also result in strengthening the safety and quality of their care by using
their vantage point and economies of scale to coordinate, facilitate and encourage improvement
in efforts across the system.
Lack of Transparency in Health care System
Lee et al. (2015) pointed out the importance of transparency in the health care system is
essential for maintaining high quality care. The patients and his family must know all the details
related to the patient’s care and the charges (Christensen, Floyd & Maffett, 2016). The lack of
transparency and accountability in the health care deliverance is present in the system (Lee et al.,

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2015). The various events of death at Djerriwarrh Health Services highlighted the deficiency.
Duckett (2016) argued for the transparency in the healthcare where the hospital is accountable
for investigating the cases, and engage in an open disclosure with the effected families. The
health care lack transparency as the process of treatment, chances and other important factors are
not properly communicated with the patients. Hence, the patients and their family and friends
find it difficult to make decision best suited for their situation. This reduces the efficiency, safety
and the overall quality of the process of health care in the Victorian hospitals (Hor et al., 2013;
Ledema et al., 2012). The family members and friends of the patients should be informed about
the identified risk of the procedure to take proper decision where both the public and private
hospitals fail. Not only this Victorian public has no information about the safety standard or the
record of the hospital and even if there is any information available it gives public false
impression about safety.
Flow of information and Data Sharing Issues
The department should take responsibility for monitoring the safety and quality in
Victoria’s hospital sector. The essential data are rarely collected or used or made available in an
accessible form that limits the clinicians’ ability to use information to identify opportunities for
improvement and strengthen safety and Quality of the care. Sometimes, routine is maintained for
data collection on preventable surgical and perinatal deaths; however, it is rarely accessed by the
hospital in future cases. Anderson and Kodate (2015) find importance of information in the
continuously improving system and related it to the reporting system which can play the role of a
useful resource for providing the critical data required for continuous improvement and risk
management. Their view was supported by Van Spall, Kassam and Tollefson (2015). The report
from the Department of Health (2017) also states about the limitations in monitoring and flow of

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data in Victorian health sectors. It evidences that only one percent of the total of 300,000 adverse
cases are properly reported which can be used to support Duckett’s findings. The administrative
department fails to follow a standard for monitoring and data collection on the patient outcomes.
Moreover, the administrative department does not have any idea of the number of complaints
against individual practitioners. This disrupted information flow is a result of fragmented
custodianship of data across the system combined with underuse of existing data. The data on
clinical governance and safety issue is not shared by the department to the AHPRA on a routine
basis. It results into failure of AHPRA in risk assessment. It means that the information on the
cases related to unsafe and low quality service is not circulated to AHPRA. It reflects significant
consequences that can mean that a lack of broader context about a health service can hinder
investigation of individual practitioners, which otherwise be warranted. No amount of
investigation and intervention can speed up the process until the data is flows between the
hospitals and AHPRA. The issue could only be eradicate if is flows from both sides. Moreover,
the report presents the need of increased data collection and analysis and calculation of combined
prone score using the pooled data from AHPRA and HCEs.
Cultural Issue
The workplace culture is one of the essential factors in the health care sector for
providing quality care and maintaining safety of the care (Holland, 2017; Jeffreys, 2015). The
review evidenced a number of unsafe health care practices that were deliberately continued over
years. Duckett evidenced that a number of staff complaints were ignored, discouraged or even
dismissed. The internal management did not detect the problem and failed to address the issues.
This is the result of a weaker culture of reporting the cases of unsafe and low quality service that
took place in the Victorian hospitals.

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Independent Clinical Expertise
The independent incompetence or malice is another complication faced by the healthcare
service of Victoria. A number of complex, high-pressure cases arrive where the patients are
already frail and at risk of deteriorating. The mistakes easily arise in these types of cases. The
hospitals require stronger process for minimising the risk and consequences of human error. The
administration also needs to ensure the process of monitoring, reporting, reviewing and
addressing these cases to ensure the avoidance of such incidents in the future time. This in turn
demands for a strong system manager who can protect the patients from serious failures in the
safety and quality. The role of the manager would be to oversee the quality and safety and ensure
to take swift and appropriate decisions to address the deficiencies (Buchbinder & Shanks, 2016).
Relating the issues with National Safety and Quality Health Service Standards (2012)
The Australian Commission on Safety and Quality in Health Care (ACSQHC) after
consulting with the technical experts, jurisdiction and a wide range of stakeholders including the
health professional and patients proposed ten National Safety and Quality Health Service
Standards for the hospitals. Maintaining these standards can potentially increase the safety and
quality of the health care service provided. The Standards are as follows:
Standard 1 – Governance for Safety and Quality in Health Service Organization that marks the
standard of the quality framework required for health service organizations to implement safe
system.
Standard 2 – Partnering with Customers that narrates the strategies and systems to create a
patient-centred health system by including patient in the development and design of quality
health care.

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Standard 3 – Preventing and Controlling Healthcare Associated Infections that suggests the way
of preventing the infection of the patients within the health care system and to control the
infection effectively when they occur to minimise the consequences.
Standard 4 – Medication Safety highlights the strategies and systems that ensures the clinicians
safely prescribe, dispense and administer proper medicines to informed patient.
Standard 5 – Patient Identification and Procedure Matching defines the process of identification
of patients and properly matching their identity with the correct treatment.
Standard 6 – Clinical Handover states the strategies of effective clinical communication that
needs implementation in accountability and responsibility for a patient’s care.
Standard 7 – Blood and Blood Products process of strategic management of blood and blood
products to ensure the safety and quality of the blood that the patients are receiving.
Standard 8 – Preventing and Managing Pressure Injuries describes the guideline of preventing
the patients from developing the pressure injuries and provide knowledge of the best practice
management when pressure injuries occur.
Standard 9 – Recognising and Responding to Clinical Deterioration in Acute Health Care
explains the process of implementation of required health care effectively by the organization
during the deterioration of the patient’s clinical condition.
Standard 10 – Preventing Falls and Harm from Falls that marks the strategies to minimise the
occasions of patient falls ill and the best practice management if they do fall ill.
The identified issues from the review of Victorian health services by Duckett fall under the
Governance for Safety and Quality Health Service Organizations standard. It is possible to

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address the issues with this standard proposed by ACSQHC that describes the quality framework
required for health service organizations to implement safe system. However, the issues
identified require multilevel attention as they are related to each other. Hence, procedure
implemented for the complexity issue might also be useful in addressing the information flow
and service monitoring. On the other hand, a single issue might require assistance from a number
of actions proposed in the governance standard.
Clinical Governance
Bringing improvement in the clinical governance requires to setting a governance system
in the organization. The role of the system will be to set out policies procedures and protocols
achieving the standardized safety and quality. This seeks for a clinical governance framework,
identification of risks, collection and reviewing of performance data, implementation of
prevention strategies, and analysis of incidents. Following these suggestions will help the
organization to address the following issues that falls under clinical governance and increasing
the quality and safety of the service.
Complication of Health Care
This particular deficiency identified in the review needs attention in the managerial
ground and also the staff level training. The process of simplifying the complexity in the health
care service needs a proper management. Hence, implementation of an appropriate leader for the
task is necessary. A multiple level assistance required in resolving the issue.
Lack of Transparency in Health care System
The issue in the transparency in health care system identified from the report is possible
to address with the standard 2 in the NSQHSS that calls for a customer centred health system. It

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asks the hospitals to include the patients in the development and designing process of quality
healthcare. The hospitals needs to implement systems to support partnering with patients, carers
and other consumers, clinicians and other family stakeholders in order to improve the safety and
quality of care. The guideline 2.2 of the second standard of NSQHSS points out the requirement
of forming policies, procedures and protocols for successfully partnering with the above
mentioned parties. The hospital needs strategic and operational planning, decision making about
safety and quality initiatives and quality improvement activities (safetyandquality.gov.au. 2017;
Heyland et al., 2013).
Flow of information and Data Sharing Issues
The monitoring and data sharing issue faced by the Victorian health care service can be
managed using the guidelines proposed under the Governance for Safety and Quality in health
Service Organization Standard. Standard 1 make suggestion for establishing an organization with
quality management system that monitors and reports on the safety and quality of patient care. It
means that the health care organizations with the issue in information collection and data sharing
needs to use a management system that will actively monitor the quality and safety standards of
the health care being provided to the student. This will help the organizations to track the
deficiency in the quality and safeties of the health care provided to the patient and formulate the
necessary planning for addressing the particular deficiency. Moreover, it can ensure the flow and
accessibility of the data when it is required. These proposed actions have the potential in
improving the patient quality.
The standard also proposes the hospitals to include the patients in the decision making
process about their care including informed consent to treatment. This will enable the patient to
make proper decision regarding the service they require.

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Cultural Issue
A separate system is required in the hospitals to manage the complaints both from the
staffs and patients as proposed by the Standard 1 of the guideline. This is due to the corrupted
culture of the workforce in the Victorian hospital sector. Wachter (2015) calls for a just culture
that will balance between the extremes of punishment and no blame for achieving goal for a
improved healthcare system. It allows the workforce to recognize and report complaints
regarding the quality maintenance in service. The patients will also be allowed to lodge a
complaint if they find any complications in understanding or some unsatisfactory service is
provided to them. The system will then analyse and implement the improvements required in
response to the complaints. This feedbacks and complaints will be reviewed at the highest level
of priority. The process must be made transparent to all the stakeholders of the health care
service and the feedback will be communicated to them. Last but not the least, the patients
feedback will be viewed with the highest priority.
Independent Clinical Expertise
The governance standard identifies the requirement of a training program for
implementing the safe and quality health care protocol in the healthcare system. Implementation
of this training program will increase the skills of the workforce and develop their information
base that is required to fulfil the safety and quality roles and responsibilities (Nelson & Staggers,
2016). The standard proposes for an annual mandatory training program that will help meeting
these required standards. The training will be competency based training that will ensure the
improvement and safety and quality service in the health care system.
Conclusion

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The review conducted by Duckett and his team on the range of Victorian health care
organizations has successfully identified several issues in health care quality and safety
prevailing in the organizations. The issue is visible in both the private and public organizations
of Victoria that needs consideration. The deficiencies that are identified in this essay are clinical
governance, flow of information and data sharing issues, independent clinical expertise, lack of
transparency, cultural issues and complication of health care. These are the primary reasons
working against the Victorian health care organizations in providing high quality health care to
their patients, though they are associated with good clinical outcomes. The change in the
administration and workplace culture is required ensuring patient safety across the Victorian
hospitals. The blaming needs to be changed into learning. The patients still do not receive the
safest and high quality health care recommended for them. The workers need to be properly
trained and they must have a proper understanding of their roles and responsibilities. It we help
them to work accordingly that will lead to real and perceived changes in patient safety. The
standards set in National Safety and Quality Health Service Standards (2012) proposes
guidelines for managing and performing the operations that are necessary in health care
organizing to function properly without disruption. Implementation of these standard guidelines
can help Victorian Healthcare Organizations to overcome these issues.
Introduction
Change is inevitable in the present business scenario for the contemporary business
organizations. This is due to the reason that, the current business scenario is much more
challenging for the operating organizations than ever (Grant et al., 2014). Moreover, for the
health care sectors, the rapid change in the technology and patient service is making more
difficult for the health care organizations to operate. Hence, to effectively cope up with the

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change in the market and business scenario, it is important for the health care organizations to
implement the process of change management in their internal management (Hayes, 2014).
Moreover, the current business scenario is more oriented towards the customers compared to the
organizations.
Thus, effective determination of the requirement of the customers and identifying the
grievances of the customers is important for enhancing the level of satisfaction and loyalty of the
customers (Agrawal, Gaur & Narayanan, 2012). In this case, also initiation of the change
management will be beneficial for the business organizations. Effective implementation of the
change management process will help the organization to offer effective customer service along
with considering other aspects of the organizational effectiveness (By, Burnes & Oswick, 2012).
This essay will discuss about the initiation of different theories of change management and
power in improving the internal culture of the organization.
Stakeholders involved in the initiation of change management
To initiate an effective management of change in the health care organization, it is
necessary to indentify the stakeholders who can be involved in the change management. The key
stakeholders in the change management will be the upper level management, employees and the
patients (Bradley, 2016). Upper level management and the employees will form the internal
organization in implementing the change. However, patients will be involved in the process due
to the fact that the change management will be designed according to the requirement of them
and thus it is important to effectively determine their requirement.
Implementation of the change in the existing process

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It is been previously discussed and observed that, there is an urgent need of initiation of
effective communication process in the organization (Shockley-Zalabak, 2014). This is due to
the reason that, the existing communication channel is not effective in garnering the feedback
from the patients and transmitting it to the upper level management. Thus, it is being
recommended that an effective mechanism of communication system should be implemented in
the hospital (Sorensen et al., 2012). Moreover, the employees have to be trained in reporting the
patient safety issues to their manager. Thus, in initiation of the change management in the
communication channel in the hospital, theories of change management will be used in order to
create and design an effective plan to improve the internal organizational culture.
Initiation of theories of change management
Lewin model of change
Various authors have given different theories of change management in the business
organization. One of the most prominent theories of change management is being stated by Kurt
Lewin. According to him, three steps should be maintained by the business organizations in
implementing the change in the internal management effectively.
Unfreezing
The first step is unfreezing the resisting force in the organization (Manchester et al.,
2014). This is due to the reason that in initiating change in any existing organizational
procedures, resistance will emerge from the side of the employees and other stakeholders along
with various infrastructural barriers. Thus, the process of unfreezing will help to resolve the
barriers of implementing change. It makes the employees comfortable and aware about the

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potential benefits of the change. Moreover, the organizational structure is being modified
according to the requirement of the change.
In the case of this hospital, the upper level management should first aware the employees
and other internal stakeholders about the implementation of the new communication channel and
methods in the organization. They should be well aware about the benefits of having updated
channel of communication. This will help to reduce the influence of the resisting forces.
Change
The next step in the Lewin model of change management is the implementation of the
change. The updated technologies and other required infrastructure will be employed and the
change will be effectively implemented (Shirey, 2013). The training process should be initiated
and provided to the employees in order to equip them in handling the latest technologies in the
communication channel. Moreover, training should also be given in enhancing their skills
regarding the handling of patient security and welfare.
Refreezing
The last step will be the refreezing. In this step, the organizational procedures and
structure will be taken back to their existing place after the implementation of the change. The
more effective will be the process of refreezing, the more will be success rate of the change.
McKinsey’s 7s model

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This model is also helpful in designing the organizational structure and other procedures
in implementing the change in the internal management. The key advantage of this model is its
holistic approach with having covered all the required aspects of change management (Singh,
2013). In the case of the discussed hospital here in this essay, this model will help to design the
plan of the change management with considering all the required aspects and stakeholders of the
organization. The above-discussed hospital can implement the change management in their
management with the help of this model.
Strategy
According to this model, the first aspects to be considered are the strategy. To implement
the change management in the organization, a specific strategy is required, which will act as
vision for them in future implementation of the change (Cummings & Worley, 2014). Thus, an
effective strategy should be initiated in order to implement the culture of reporting the patient
safety effectively. The next step in this model is the structure. Having an effective organizational
structure is important due to the reason that the more effective will be organizational structure,
the more effective will be the mechanism of the reporting in the organization. If the
organizational structure can be effectively maintained, then it will be easy for the patient to
report their safety issue to the employees and it can be effectively transmitted to the upper level
management. Adhering with the health reforms should also be considered during the
determination of the strategy.
Systems and cultures
The next step is the effective initiation of the systems and procedures. The more will be
the effective system in the organization, the more will be the engagement level of the employees.

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Thus, in order to enhance the process of reporting in the hospitals in the Victorian regions, the
internal systems of the hospitals should be effectively managed. This will help in increasing the
engagement of the employees in the workplace. Thus, the increased level of engagement of the
employees will help to effective transmission of the safety report from the patient to the upper
level management. Organizational culture also holds an important part in enhancing the
effectiveness of the change in the organization (Alvesson & Sveningsson, 2015). This is due to
the reason that, the effectiveness and flexibility of the organizational culture will determine the
extent to which the employees can adhere with the implementation of the change. Thus, in
implementing the plan of change the internal culture of the hospitals of Victorian region,
organizational culture should be made flexible and effective.
Leadership roles
In the process of initiation of implementing change in the organization, role of leadership
also plays an important part. Thus, the leadership role in these hospitals should be effective and
efficient in order to motivate and create effective vision for the employees. The level of
motivation of the employees and their engagement in the workplace is being determined by the
effectiveness of the leadership. In the case of the change management, the initiatives should start
from the upper level management (Northouse, 2015). The leaders should convey and
communicate the effectiveness and benefits of the change to be initiated to the employees.
Moreover, the effectiveness of the working environment in the organization is being determined
by the effectiveness of the leadership. Thus, in the case of the hospitals in the Victorian region,
the style of the leadership should be changed first and transformational along with situational
style of leadership should be adopted. It will help the hospitals to enhance the level of motivation
of the employees.

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In addition, initiation of transformational leadership will help to effectively communicate
the organizational vision to the employees. Thus, the change in the taste and preference pattern
of the customers will be effectively determined and situational leadership help to train the
employees accordingly (Avolio & Yammarino, 2013). In the case of the hospitals in the
Victorian regions, initiation of effective leadership will help to enhance the level of motivation
and job engagement of the employees, which will in turn help to create the suitable
organizational culture for reporting the safety concern of the patient. Human resources along
with the upper level management also play an important role in effective initiation of the change
management. In the case of the hospitals in the Victorian regions, right employees for the right
job should be employed. It will help the organizations in having the right expertise for the right
job. In the change of the internal culture of the hospitals, having the right employees in the
organizations will help to enhance the effectiveness in reporting the patient safety. Moreover,
having the right employees for the right job will also help in effectively determining the issues in
the reporting and resolving accordingly.
Skill set of the employees
The last step of this model is the skills that are being possessed by the employees in the
organization. If the employees do not possess the right kind and amount of skills for their
respective job roles, then the accomplishment of the organizational task will not be possible.
Thus, it is required for the organizations and especially the hospitals in the Victorian regions to
recruit the employees for the certain job role with having the needed expertise. The more
diversified and effective skills being possessed by the employees, the more will be the
competencies of the organization in the market (Gallie et al., 2012). Thus, in the case of the

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hospitals in the Victorian region, existing employees should be provided proper training and skill
development courses in order to enhance their skill sets. On the other hand, newly employed
employees should also be recruited according to the required skills in the organization along with
providing them proper and suitable induction-training program (Breaugh, 2012). This will help
them in enhancing their existing skill sets. This will help in enhancing their capability in
adhering with the change being implemented in the organization. Moreover, the reporting of the
safety concern of the patient will also be more effective due to the enhanced expertise and skills
of the employees. The employees with their diversified skill sets will effectively solve the safety
concern of the patient.
Initiation of theories of power
Along with adhering with various theories of change management implementing the
change in the internal culture of the hospitals in the Victorian regions, adhering with the theories
of power will be also be beneficial for them. This is due to the reason that according to theory
being given by French and Raven, without influence or power, the procedures in the
organizations will cannot be effectively managed (Lunenburg, 2012). According to them, the
effectiveness of the role of the leadership will only be proven if they can effectively utilize
power, authority or influence in managing the internal organization. Thus, in the case of the
organizations in the Victorian regions, the upper level management should the power according
to the situation in order to effectively lead the organization.
Power is of five types, which should be initiated according to the generated situation and
external environment. However, it should be considered that, initiation of power is not only
about negatively managing the employees rather than rewarding and recognizing the effort of the
employees are also being included in the theories (De Gieter & Hofmans, 2015). Among the

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various types of power, expert power and reward power will be the most effective for the
Victorian hospitals. This is due to the reason that, there are no employees’ issues that are being
generated from these hospitals and thus there is no need of exercising the coercive power. This is
in turn will create negativity and lower the morale of the employees. On the other hand, initiation
of reward power and expertise power will help the upper level management to motivate the
employees along with guiding them in determining the change in the market scenario and work
accordingly.
With the effective initiation of power by the upper level management in the
organizations, the implementation of the change will be more efficient. The leadership qualities
will get enhanced further along with effectively controlling the internal management of the
organization. In reporting of the patient safety in the hospitals, the initiation of the use of power
will motivate the employees in reporting the safety in timely manner and to the responsible
stakeholders. Initiation of power will act as the complementary to the initiation of the change
management in the organization. Thus, the more effective will be the initiation of the power, the
more effective will be the implementation of the change in the organizations.
Challenges to change in health care
Resistance from the side of the employees is one of the key challenges being faced by the
organizations. This is due to the reason that employees will have the fear about the change to be
implemented in the health care organization (Payne & Askeland, 2016). This is due to the fact
that, employees will have the fear of the uncertainty associated with the implementation of the
change. Another challenge that may get aroused is the fact that the implemented change may not
adhere to the existing culture of the health care organizations, which will further reduce the
efficiency of the health care (Mclnnes et al., 2012). Aligning the implemented change may also

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not adhere with the health reforms. This, it will also difficult task for the health care
organizations to effectively adhere to the various health reforms.
Planning process
Thus, after evaluating the various theories related to change and power, it can be
concluded that an effective planning process will be required to counter the safety issues in the
ward. In this case, Kotter’s eight stage model will be the most effective model in designing an
effective planning process (Appelbaum et al., 2012). The first step is establishing the sense of
urgency in the health care organization. It is being expected that the prime motive if the health
care organizations will be to ensure the safety and health of the patients. Thus, the first step is the
identification of the crisis or gaps in the existing process. This will help all the internal
stakeholders to act accordingly. As discussed earlier, leadership plays an important role in the
managing the safety concerns. Thus, leadership role should be played in every organizational
structure. For instance, in nursing, leaders should be made, who will provide guidance to others.
This will enable more sharing of knowledge among the peers, which further resolve the issues.
Creating and communicating the vision to the subordinates is also important. According to the
Ducket (2016), creation of the vision to the employees will help them to adhere to the health
standards. As discussed earlier, effective channel of communication is important to communicate
the vision to the employees.
However, it should be considered that, the communication process should be both ways,
which will enable the employees to gain the visionary ideas as well as providing effective
feedback. Thus, any type of safety concern will be effectively identified and solved. For ensuring
the patient safety, employee empowerment is also important (Guffey & Loewy, 2012). This is
due to the reason that, if the employees will be provided with enough resources and equipment,

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then they will effectively meet the safety standards. Rewarding the employees will also be
beneficial to ensure the patient safety. This is due to the reason that, employees will be more
motivated if they are being rewarded and recognized. Thus, short term targets should be made
for the employees, which will be easy for them to accomplish. Continuous process of monitoring
and evaluating the change process is important due to the reason that, it will help to determine
the effectiveness of the change process in solving the patient safety concern (Moore et al., 2015).
Accordingly, the strategies should be rectified and modified to enhance their effectiveness. As
discussed earlier, shared leadership and visionary leadership will be beneficial for the change
process. It will help in continual development of the change process according to the change in
the safety concern in the health care organization.
Conclusion
Thus, in order to implement an effective plan of change in the internal culture of the
hospitals in the Victorian regions, an effective initiation of the change theories and power
theories should be considered. This will help the hospitals in motivating and engaging their
employees in order to implement the change in the organization without having any resistance
from their side. Moreover, the initiation of the theories of the change management will help to
consider the various aspects of the change management, which will help them to initiate a
holistic approach in the change management. On the other hand, the initiation of the theories of
the power will help to enhance the leadership qualities in these hospitals. This will in turn will
help the hospitals to lead and motivate the employees in effective plan of safety reporting of the

22CHANGE MANAGEMENT
patients. Thus, it can be concluded that, effective implementation of these theories in initiating
the change in the hospitals will help to create an ideal culture of safety reporting in the hospitals.

23CHANGE MANAGEMENT
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