Healthcare System Change Management

This assignment delves into the complexities of managing change within healthcare systems. You are tasked with analyzing various challenges faced by healthcare organizations, examining proposed solutions and successful implementation strategies. The analysis should draw upon relevant change management theories, such as Lewin's model, and explore key factors influencing healthcare service quality. Additionally, the assignment requires an evaluation of the impact of technological advancements on healthcare systems and a critical assessment of Singapore's healthcare system profile.

Running head: CHANGE MANAGEMENT IN HEALTHCARE
CHANGE MANAGEMENT IN HEALTHCARE
Name of the Student
Name of the University
Author Note

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Introduction:
Healthcare in Singapore is considered by the World Health Organization as the sixth
ranking in the providence of affordable healthcare to the citizens (Frakt & Carroll, 2017).
This has been achieved even with governmental investment on healthcare (as a percent of its
GDP), that is lower in comparison to United States or Canada, which suggests the efficiency
of Singapore’s Healthcare systems. However, the prevalence of health conditions like
Diabetes and Hypertension and health risks like low birth weight are still high in Singapore,
which highlights the necessity to address such conditions, and the requirement of change in
the healthcare system to reduce such health burden in Singapore. Abri (2018) suggested that
the obligation of healthcare professionals towards the maintenance of expertise on
professional tasks and selective commissioning of tasks based on the expertise held by the
professionals as being a key concern in healthcare management as well as for the
management of change in healthcare. Change is a continuous and dynamic process, and its
pace has increased significantly in healthcare over the years (Huber, 2017).
Management of change involves handling of the factors driving the change. Umiker
identified the steps leading to change as evaluation, planning, implementation, as well as
tactics, strategies involved, while ensuring the relevancy and the importance of the change
(McConnell, 2016).
Change:
Effective change can be brought about by the modification or even removal of old
practices and behaviors to allow the introduction of new ones, and then followed by the
solidification of the new practices or behavior. Such changes can be continuous, non-
continuous or sporadic, frequent or non-frequent (Abri, 2018). When the changes are
predictable, it allows scope for preparation for the change, while unpredictable changes do

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not allow such scope. In healthcare, change is a rapid and frequent process, which reduces the
predictability for the change (Cummings & Worley, 2014). The phenomenal growth in
healthcare can be attributed to technological breakthroughs in genetic and genomic studies
and gene based therapies, bioengineering as well as economic and competitive stress, and the
utilization of technologies in healthcare. In Addition, change has also been caused by an
evolution in the financing and financing systems in healthcare, involves different type’s
organizations and services (Ginter, Duncan & Swayne, 2018).
Change is also understood in an evolutionary and life cycle perspective as a
predetermined process occurring over time, and at a pre specified direction, while in
teleological and dialectical context, change trajectory can be understood as a construct in
which changes can be made at will on the goals or the steps used to attain the goals (Hayes,
2014). Considering that change is a dynamic process, and improvement in healthcare
requires change, it becomes pertinent to manage the process of change in order to have
favorable outcome. Davidson (2015) pointed out that the importance of change management
in healthcare is more now than ever before, as is hence is essential management practice, and
undermining its importance can have serious consequences or even failure in the
implementation and sustenance of change.
Hayes (2014) conceptualizes change management as purposeful processes that
revolve around seven core activities:
1. Identification of the need for change, and initiating the process of change.
2. Identification of the different areas of change and creating an idea of goals to be
achieved.
3. Planning interventions to reach the desired goals.
4. Implementation of the intervention plans, and progress review.

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5. Change sustenance.
6. Leadership and management of human issues.
7. Learning process.
A significant change in Singapore’s healthcare is reflected by the long life expectancy
and low infant mortality rates in the country. The first restructuring of public hospitals, in the
1980’s resulted in the commissioning of autonomous boards who can decide how to reward
the employees, and manage their own affairs within parameters, while they received
continued funding from the government in order to subsidize healthcare to patients. Another
aspect of change in healthcare happened due to the grouping of healthcare assets into two
clusters, namely SingHealth and National Healthcare Group, each cluster comprising of acute
hospitals, specialist centers and polyclinics. Each of the clusters will also include medical
school that will help to develop and improve professional training and research. This will also
allow scope for healthcare professionals to switch between clusters, thereby improving access
to patients (Khalik, 2018).
Collaborated 5 parts of change:
Tushman (1997) pointed out that the evolution of change in an organization is not constant
process, and there are variations in the rate and repetition of the cycle of change. While
Meyer & Stensaker (2006) defines the ability for change as the providence and improvement
of alterations in operational capabilities that can maintain performance in the long run. Both
short term and long term capabilities for change and maintain ace of daily operations are
necessary to ascertain change without the destruction of the well functioning aspects in the
organization.
Different blocks to change can be categorized as emotional, perceptual, cultural,
environmental and cognitive. Perceptual blocks include: stereotyping, difficulty in isolating

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problems, focusing on wrong problems, defining problems incorrectly, lack of adjectivity
towards problems, saturation, and failure to identify resources available. Emotional Blocks
include fear of taking risks, or failing, inability to deal with ambiguity, being judgmental and
inability to defer judgment on situations. Cultural blocks include taboos, ignorance,
seriousness, reason and intuition, and tradition. Environmental blocks include lack of support,
not able to accept criticism, and overconfidence of bosses.
The PESTEL model is a tool that can be used to analyze and monitor the macro environment
that impacts the functioning of an organization. It involves 6 factors, namely: Political,
Economic, Social, Technological, Environmental and Legal. Yüksel (2012) further divided
each of these factors into sub factors in a hierarchical process, with each factor interacting
with each other.
Figure 1: Pestel model
The five why’s technique can also be a powerful tool to troubleshoot problems and explore
cause-effect relationships of different organizational problems. Serrat (2017) suggests that

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asking ‘why’ 5 times can be useful for systematic problem solving, and must include an
accurate and complete identification or outlining of problems, honest answering to the
questions asked and a determination to get to the root of the problem. This can be utilized in
5 basic steps:
1. Gathering a team to design the problem statement to which everyone is in agreement
with. Once this is done, the requirement of additional members needed to address the
problem, can be ascertained.
2. The first why of the team, that questions the reason of the problem taking place. It is
important to record all the identified answers and index them.
3. Asking successive why’s, associated with the parent question, and following up on the
plausible responses.
4. Identification of systematic causes of the problems. This will allow addressing the
problems identified by the questions.
5. Development of proper correctional measures to eliminate the main reason of the
problems.
Figure 1:Five Why’s Worksheet; source: (Serrat, 2017).

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Lewin’s Model
Kurt Lewin’s 3 step model for change involves three processes: Unfreezing, changing
and refreezing, also known as changing as three steps (CATS). This has been considered as a
classic or fundamental approach in change management, and also is criticized for it’s over
simplistic approach. CATS had significant influence on almost every western theories of
change in the last five decades (Kassean & Jagoo, 2005). The Unfreezing step includes the
pointing out of the need to change, Changing is an attempt to set up a new state of affairs,
while refreezing involves incorporating the changes, and creating or maintaining the new
system put in place.
Southerland (2013) pointed out in the Unfreezing stage, round table discussions to
point out different challenges and driving forces in healthcare, to identify any barriers that
need to be addressed. This action engages all parties to work together to drive development
and reduce the challenges. In the moving stage, real change happens which can involve
planning and implementation of the projects. Aspects like timeline for implementation,
reliability of equipments, training and education, workflow management, organizational
nature and leadership are important considerations at this stage. In the refreezing stage,
stability is brought to the changes, and evaluated thereafter. Once the change is fully
implemented, the evaluation process will summarize the problems encountered during the
change, and the success attained from it, which can be utilized for future research.(Spetz,
Burgess & Phibbs, 2012).
The need for change can be at seggregated levels, the patient level, the team level and
the system level. At the patient level, the change considers the centrality of patient’s
experience and well being. At the team level, the change emphasizes the dynamics of team
work, in the optimization of performance and improvement of care, and in the innovation and

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creation of novel ideas to usher transformational change. At the system level, a change
implies an organization wide approach.
One aspect of change on a systems level is the percent of GDP funded for healthcare
in Singapore. At 4.7%, Singapore’s funding is lesser than US or Canada, while still providing
affordable care. Improving funding, can further enhance the healthcare system and increase
coverage to citizens. Additionally, it would also reduce the expense from the side of the
patients, especially those who are unable to cover their medical expenses. At team level,
change can involve improved transitions between healthcare professionals, ensuring
minimum encumbrance for the patient. While at patient level, change can be aimed to ensure
the best healthcare delivery, and improved accessibility to healthcare by the citizen.
Sutherland (2013), also suggested the importance of bar coding and change management in
the improvement of healthcare in Canada. She pointed out that technologies can be used in
hralthcare to reduce medical errors and thereby improve health outcomes. Suchan aspect can
be recommended in Singapore’s Healthcare system.
Figure 2: Lewin’s Model for Change.

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Factors that affects the leadership and culture
Bolman & Deal (2017) points out effective leadership skills as analytical skills,
design skills, support, empowerment, coalition building, inspiration, advocacy and making
meaning of situations. Mosadeghrad (2014) proposed that poor leadership can affect
employee satisfaction, while supportive leadership can improve the quality of healthcare, and
foster proper planning, education and training, and optimal utilization of resources,
employees and processes. It has also been added that leadership capital is vital to direct a
positive development within the organization. Different aspects that influence leadership and
culture, extends its effect on the performance of the organization. Yeung, Ong, Davies, Gao
& Perkins (2012) argues the importance of team leadership in the providence of effective
healthcare. The Tannenbaum and Schimt Model proposes that leadership are effected by
elements like leader’s personality, impact of the team members on the leader, environmental
aspects of the organization such as the team or organizational spirit, tem performance,
challenges faced by the team, deadlines, and social influences.
Factors affecting leadership: The different factors affecting leadership can include
organizational environment, organizational resources, and roles of employees, culture of the
organization, sociological aspects, economic and political aspects, and technology. Cote,
(2017) supports the significance of organizational environment in the emergence of
leadership, suggesting that effective leadership can be developed through motivating
employees to accomplish tasks and achieve goals. Tsai (2011) mentions that culture is a
socially acquired phenomenon that is transferred by its members, and it develops the ground
rules for behavior in the organization. Organizational culture sets up beliefs which then act as
guidance as to the code of conduct of the employees, including the practice, values and
assumptions. Similarly, effective leaders depend on the performance of staffs, technologies
and the presence of financial and physical resources of the organization. Presence of adequate

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resources is necessary for the development of strong leader’s hip skills. Roles undertaken by
the employees, as well as their code of conduct also effects leadership, through its effect on
organizational environment. The work ethic and personal values are precursors of human
behavior, and hence affect leadership in an organization. Survey done on 1,400 CEO’s and
professionals in human resources management, by Right Management and Chally Group
highlighted4 factors that enables effective leadership as: strategic vision, inspiring others
while maintaining leadership and responsibilities, developing an correct and comprehensive
idea on the organizational operation, and decision making capabilities. While characteristics
that can negatively affect leadership include: failure to build team culture and relationships,
mismatch in team culture, unable to provide results, unable to obtain support, improper
training, ego and a lack of vision (Editor, 2011). Additional factors can include experiences
of the person, characteristics, economics and support.
Similarly, culture within an organization can be affected by good leadership principles
that are set up by policies, procedures and rules of the organization. The nature of the
business also significantly affects the culture. The values, policies and ambience of the
organization form the foundations of the behavior of the employees in the organization, and
hence form bedrock to the culture. Even the processes of recruitment and selection plays an
integral role, by is selection and filtering processes.
Conclusion
Thus with an overview of the different factors driving change in an organization, it
can be concluded that effective change can be brought about my change management and
good leadership qualities. A change that is directed towards a positive approach can foster
development and ensure growth of organization. In healthcare services, such can ensure
better health outcome among citizens. Improvement of the status quo would be made possible

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only by the inclusion of effective changes that is based upon a thorough analysis, and which
is able t address the various challenges that affect healthcare of citizens. The different aspects
that needs to be changed and the reasons for including such changes can be highlighted by the
five why model, while the change in itself can be implemented using the Lewin’s Model.
Additionally PESTEL analysis can help to identify the different domains where changes can
be implemented, or status quo changed. Considering that healthcare is a constantly evolving,
dynamic process, it is pertinent that healthcare professionals be adept with the changing
environment of healthcare systems to be able to provide care in adherence to the various
healthcare policies and ethical principles.

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