Organizational Change Management: A Case Study of Tufts NEMC

This assignment attempts to incorporate Change management theories and framework on a hospital, NEMC. Among the theories, Ducks five stage change curve seems appropriate. This is in terms of upgrading the standards and quality of the healthcare services from an ambience of financial losses.

Running head- MANAGEMENT
Organizational change management
Name of the student
Name of the university
Author note

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Executive summary
Preserving the traditional values helps the companies and organizations to gain trust, loyalty
and dependence from the customers. However, change is needed in terms of attracting more
and more customers. For bringing the change, systematic planning is needed. Typical
example of this is frameworks and theories, which helps in managing and measuring the
effectiveness of the implemented changes. This assignment attempts to incorporate Change
management theories and framework on a hospital, NEMC. Among the theories, Ducks five
stage change curve seems appropriate. This is in terms of upgrading the standards and quality
of the healthcare services from an ambience of financial losses. Partnership and strategic
alliance with Tufts University is a planned and reasoned approach in terms of acquiring
innovative medical treatments for the patients.

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Table of contents
Introduction................................................................................................................................3
Overview of the company..........................................................................................................3
An insight into the change management situation.....................................................................3
Discussion..................................................................................................................................5
Theoretical consideration towards change.............................................................................5
Ducks five stage change curve...............................................................................................6
Management of the proposed change...................................................................................10
The Change Path Model.......................................................................................................11
Recommendations....................................................................................................................12
Conclusion................................................................................................................................15
References................................................................................................................................16
Bibliography.............................................................................................................................18
Appendix..................................................................................................................................19

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Introduction
Managing the operations is one of the crucial activities of the companies and
organizations. This is in terms of estimating the future progress, on which the business would
flow. One of the major forms of management is altering the workplace terms and conditions.
Theoretical considerations like Lewin’s change management model, Kotter’s eight step
change management model develops relevancy into the strategies and the plans. Adopting
these theories, for bringing the change, is considered as intentional and planned approach in
terms of improving the organizational effectiveness (Kirkland et al., 2017). This report
attempts to peek into the change management strategies adopted by Tufts NEMC.
Overview of the company
New England Medical Centre (NEMC) is originally known as the Boston Dispensary.
Founded in 1976, it has achieved accolades and glory as one of the oldest hospitals in United
States. The hospital provides permanent medical facilities to the poor and community people.
Presence of skilled and qualified nurses addresses the concerns of the patients regarding
dental, rehabilitation, venereal diseases, lung, food and nutrition. The popular services
include employee paid clinic treatment, well child services and moving x-rays
(Tuftsmedicalcenter.org, 2019). Innovation was reflected from the programs in cancer
treatment, transplants and neurosurgery. 1992 was the era when maternity services initiated.
Financials constraints acted as an obstacle in meeting the targets. Negative market forces
adversely affected the performance of the hospitals, which did not possess affiliation.
An insight into the change management situation
In order to upgrade the situation, the hospital looked for partners in the mid-1990s.
Referrals from the community plans were adopted for stabilizing the healthcare plans.

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Among the partners selected, mention can be made of CareGroup. Estimation was made that
if the merger seemed productive, the hospital would be one of the first AMC owned
companies operating on a non-profit basis. 2004 seemed to be a critical phase, as the hospital
encountered an estimated loss of $3 million every month. However, this was not the actual
story. The size was one of the other challenges for the hospital. In the markets of Boston, the
hospital faced tough competition from Partners, CareGroup and Caritas. With the advent of
Zane, the situation compromised of inadequate cash along with the time limit of 10 months
(Tuftsmedicalcenter.org, 2019). In spite of the strategies, there were concerns regarding the
payrolls. These situations hampered the performance of many employees, which compelled
Zane to think of the ways and means to achieve stability in the operations.
Conducting rapid diagnosis helped Zane to detect the methods for mapping the losses.
In this, mention can be made of the reviews on accounts, average lengths of stay, profit
functionality, cash and the savings in the supply chain. Examination of the managed care
contracts resulted in the discovery of the underpayments. As a result of this, evaluation was
conducted on the current management team. Cost cutting initiatives developed best practices
for the hospital. Financial investments were made in terms of the establishing the brand
image. This was in terms of restoring networks and the productive talents
(Tuftsmedicalcenter.org, 2019). These aspects can be related with the analysis of knowing-
doing gap for gaining an insight into the competencies and capabilities towards adopting the
changes in staffs, communication and outreach, length of stay in case of the patients,
contracts, network building and strategic partnership with Tufts University.
Second round planning for reducing the operational costs and efficiency plans were
the main components of the agenda for change. The main activity in this stage was
upgrading the reimbursement through restructuring. The parameters covered in this aspect
were- managed care contracts, accounts, FTEs, supply chain, real estate, ambulatory clinics

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and expenses behind research. Along with this, restructuring plans were made on the product
lines on cardiac, cancer, surgery, general medicine, transplant, OB or GYN, paediatrics and
psychiatric or neurosciences. Each of these product lines was included in the operations of
the departmental units (Tuftsmedicalcenter.org, 2019).
Discussion
Theoretical consideration towards change
Prior to bringing the change, the mindset needs to be proper. This includes the
components of what is the change and what are the ways in which the change can be
achieved. Within this, mention can be made of Sigmoid Curve, which projects the
relationship between the time and the outcome of the proposed changes. As per the
arguments of Bradley, (2016), strategic approach and rational planning helps in the
achievement of positive outcomes. In case of the NEMC, agenda for change is a wise
approach, which proves beneficial in terms of mapping the product lines on which the change
is to be achieved. Along with this, reference can be cited of Lewin’s change management
model, which comprises of the steps of unfreeze, change and refreeze. NEMC revised the
recruitment and selection policies for increasing the number of nursing staffs. Refreeze was
conducted through the establishment of contracts, negotiations, mergers, which expanded the
network and the supply chain.
Bartunek, (2018) is of the view that Kotter’s eight stage change process is productive
in terms of exposing the appropriate approach towards the change. For this, developing a
vision and strategy is crucial in terms of adding focus into the operations. Short and long term
goals help in mapping the plans and assessing its feasibility and appropriateness in terms of
the identified and the specified requirements. Within this, resistance towards change is vital
in terms of catering to the needs, demands and requirements of the employees. Herein lays

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the appropriateness of the role of managers and leaders like Zane in terms of moulding them
according to the organizational requirements.
Along with this, Steigenberger, (2015) makes mention of the concept, “Gentile in
voice” in terms of providing a flexible platform to the employees regarding voicing out the
opinions regarding preservation of the core values. Conscious approach towards enhancement
of traditionalism, in an ambience of change is beneficial in terms of retaining the clients and
the customers. Articulation of the feedbacks and peers in the post decision making process is
effective in terms of gaining the trust, loyalty and dependence from the stakeholders and
shareholders. In case of NEMC, Zane needs to be praised for assessing the mission statement
before evaluating the senior staffs for change. She exposed leadership approach in
appreciating the efforts of the physicians. However, Harrison and Lock, (2017) opine that
feedbacks from the peers compelled Zane to make changes in the senior management team.
She faced many criticisms from the others, while making the changes. However, her selective
and rational approach towards hiring the people is praiseworthy in terms of altering the
workforce diversity. .
Ducks five stage change curve
Changes within the workplace need to be systematic for achieving positive outcomes.
Proper planning proves fruitful in terms of the averting the delays at the time of executing the
operations. Here, mention can be made of Duck’s five stage change curve, which attaches
proper shape to the approach towards change and its management. As per the opinions of
Anderson, (2016), adopting this curve proves beneficial in terms of convincing the employees
towards the proposed change. Applying the curve on NEMC, application of the model would
have been beneficial in terms of generating practical ideas for moulding the employees
according to the organizational environment. In this case, the main emphasis lies on the

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connection between the employees and the managers. Typical evidence of this lies in Zane’s
alteration of the workforce.
Tackling the emotional responses of the people is accounted as the main responsibility
of the managers. This is not only when the change needs to be brought into the workplace
instead it is applicable in all of the business processes (Basile & Faraci, 2015). As a matter of
specification, the change curve consists of five stages- stagnation, preparation,
implementation, determination and fruition.
Figure 1- Duck’s five stage change curve
(Source: Heckmann, Steger & Dowling, 2016)
Moulding the operations into these stages enhance the experience of the employees
and the managers in terms of approaching the activities. This model is effective towards
governing the emotions, thoughts and ideas towards accepting the change. On the contrary,
negating the change adds an interrogative parameter to the role of the managers. Within this,
mergers and acquisitions attains an important position in terms of altering the workplace

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terms and conditions. In view of these aspects, NEMC can be placed in this category, as it
indulged in joint venture with CareGroup, Partners and Caritas for upgrading the standards
and quality of the healthcare products and services. These aspects can be related with the
“preparation stage”, as mentioned by Duck in his change management curve. As per the
assumptions of Holloway, Romme and Demerouti, (2018), incorporating latest technologies
in the business operations is beneficial in terms of adding automation into the services like
dental, rehabilitation, venereal diseases, lung, food and nutrition. The popular services
include clinic treatment, well child services, moving x-rays, cancer treatment, transplants and
neurosurgery.
Stagnation phase related to the tough competition, which NEMC received from the
brands in the foreign markets. The financial losses in 2004 are the typical evidence behind
this. As a result of this, assessing the mission statement for making changes in the senior
management team is a wise and planned approach of leaders like Zane. Considering of the
external environment helped Zane to map the turbulence in the market, which can act as an
obstacle in the process of altering the scenario of the workplace. Size is one of the challenges
for NEMC (Tuftsmedicalcenter.org, 2019). In this context, it can be said that large firms like
Partners, CareGroup, and Caritas, enriched in the network and supply chain leads to
dislocated teams and intense global rivalries.
In the implementation stage, the actual processes initiate. Typical components of this
stage are designing the organizational structures, job descriptions, and plans and most
importantly, regulating the mindset of the employees. Faster decision making, learning and
innovation are the typical components for adopting the changes. However, selective and
rational approach of leaders like Zane needs to be applauded in terms of making systematic
progress to the proposed changes in staffs, communication outreach and strategic alliance
with Tufts University (Tuftsmedicalcenter.org, 2019).

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Determination phase relates to the preparedness of the companies and organizations
for embracing the change. Diversity, synchronized requirements, industry life cycles,
knowledge management and assessment of the risks involved in the competencies are the
components are the challenges, which need to be dealt with for reaching to this phase of
determination. These activities can be accounted as the steps of the Causal Model Driving
Change. O'Donovan, (2017) argues that mapping the impact of the micro changes on the
business environment helps in management of the challenges within a new environment.
Typical reference can be cited of the initiatives towards expanding the parameter of
communication and outreach. Within this, the activities of the presenting the financial facts
and the revised targets reflects the components of the preparation stage. This is actually
effective in terms of evaluating the exposed performance towards reaching closer to the
targets to some extent.
Fruition is the stage when the companies and organization seems new with the
implemented changes. Major drive behind this is the hard efforts of the employees,
employers and the managers in terms of executing the tasks according to the identified and
specified requirements (Al-Ali et al. 2017). At this stage, the personnel feel confident
regarding the practical application of the learnt skills into the workplace operations. In this
stage, it is important for leaders like Zane to maintain consistency in evaluating the achieved
results. This is in terms of averting the instances of stagnation, which can add vulnerability
into the market position amidst the competitive ambience.
Maintaining consistency in evaluation is effective in terms of preserving the balance
between the stages for adopting the changes. For this, developing short and long term goals is
a wise and planned approach towards adding focus into the business. Referring to the
Elizabeth Kubler Ross’ predictable emotional stages, Duck is of the view that individuals go
through different emotional phases while adopting the changes (Kovač, 2017). These are

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denial, anger, bargaining, depression and acceptance. However, it is the duty of the
managers like Zane to control their own emotions while providing the response to change.
Management of the proposed change
Mere implementation of the change is not enough. Management of the change is
needed in terms of achieving the estimated outcomes. Even in this aspect, theoretical
considerations are vital in terms of averting discrepancies. Here, mention can be made of the
Beckhard and Harris’ Change Process Model. According to this model, at the first stage,
analysis is conducted on the current status of the companies and organizations. In relation to
NEMC, taking into consideration the financial losses and the tough competition from the
contemporaries develops relevancy in this context (Tuftsmedicalcenter.org, 2019). The
second stage is identifying the reasons for adopting the change. Herein comparison can be
developed with the unfreezing stage, as proposed by Lewin in his change management
model. In case of NEMC, underfunding from federal and state government was the major
cause for altering the workplace scenario. In the process of identifying the factors,
determination of the degree to which the change is needed is one of the important
components. Cummings, Bridgman and Brown, (2016) states that re-structuring the mission
and vision statements helps managers like Zane in mapping the areas on which the change is
needed.
In this journey mapping, managers detect the gaps, which obstruct the process of
acquiring changes. Based on these gaps, action plans are created for improving the focus of
the business operations. Zane needs to be praised for revising the structure of the senior
management level through the consideration of NEMC’s mission statement. On the contrary,
Holten and Brenner, (2015), involvement of the stakeholders and shareholders in the planning
process upgraded the standards and quality of healthcare services and recruitment and
selection. Here, communication was an important means for conveying the message to the

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audience. Developing the “agenda for change” added value and weightage to the process for
acquiring the changes. This agenda somewhat reflects the altered dynamics of the workplace.
The Change Path Model
Figure- The Change Path Model
(Source- Krantz, 2018)
The main components of the model are awakening, mobilization, acceleration and
institutionalization. Awakening relates with the unfreezing stage of Lewin’s change
management model. Herein lays the appropriateness of the role of managers like Zane in
terms of convincing the employees towards acquiring the changes in staffs, communication
and outreach of NEMC. In this, the dimension of indulgence vs restraint, as proposed by
Hofstede can be infused into the discussion. The next component of the model is
mobilization, which involves the activity of detecting the potential gaps within the business
operations (Doppelt, 2017). Considering the mission statement assisted Zane to discover the

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financial gaps, which acted as a compromise for the patients regarding the necessary
treatment.
Acceleration can be related to the norming and performing stages of Tuckman’s
stages of team development. At this stage, Zane made plans for strengthening the scope and
arena of the supply chain network. This was through contracts and negotiations, which added
flexibility to the customer base. Meetings were held with the stakeholders and shareholders,
which proved beneficial for Zane in terms of implementing the proposed plans and strategies.
After implementing the plans, evaluating the exposed performance assisted in conducting
journey mapping from the financial crisis to the altering the scenario of the workplace.
Typical evidence of this lies in partnership with New England Baptist Hospital, which
increased the number of beds for the patients in NEMC (Tuftsmedicalcenter.org, 2019).
Institutionalization relates to the activity of monitoring and measuring the changes.
Reviewing the progress with the implemented changes resulted in alteration of the goal,
which was to introduce separate operations for the Academic Medical Centre. This was
through the provision of sub specialities. Meanwhile, the planning was also done for selling
the building to Tufts University. However, this required $28 million along with additional
capital, cost savings, managed care contracts. Presence of 3% market share in comparison to
the 25% market share for Partners was a matter of concern for Zane. Monitoring was needed
also in terms of ensuring the maintenance of proper ratio for the number of bed per patients
(Tuftsmedicalcenter.org, 2019).
Recommendations
 For adopting the change, managers and leaders like Zane needs to ensure the type of
change, which would alter the workplace dynamics. Within this, execution of gap

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analysis would be effective in terms of detecting the areas, which needs to be
modified before acquiring the change.
 Theoretical consideration is always beneficial in terms of adopting the planned
changes. Within this, mention can be made of Nadler and Tushman’s Organizational
Congruence Model. Adopting this model would act assistance for Zane in terms of
assessing the transformation from input and output. In this, the main focus needs to be
on the systems and resources, which would contribute in promoting the workplace
culture of NEMC. The collaborative approach of the employees would add value to
the strategies. Using this model would enhance the awareness of managers like Zane
regarding the extent of the external challenges and pressures from the contemporary
brands like Partners, CareGroup, and Caritas.
 Collaborative view of the goal and situation would enable Zane to undertake
appropriate decision for achieving the results of upgrading accommodation facilities
and equipment for the patients. Consideration of the gaps would seem fruitful in terms
of preparing the action plans for stabilizing the future courses of action. In this,
conducting journey mapping with situational analysis would be beneficial in terms of
assessing the need for additional resources.
 Applying linear view on the current status of the healthcare services would help Zane
in searching for the ways for reducing the intensity of the errors, delays and lags in
inventory stocks, information flows related to cancer treatment, transplants, and
neurosurgery cases. Irrational and careless approach towards this direction would
aggravate the complexities in the causal effects.
 Surveys and feedback from the clients would help managers like Zane to evaluate the
effectiveness, appropriates and feasibility of the proposed strategies. Here, adoption
of Feedback Model would be helpful in terms of exposing systematic progress

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towards the adoption of change. Experimenting with the opinions of the clients and
the customers would act as a cornerstone in terms of reaching to the appropriate
decision for the betterment of the patients. Consideration of the internal and external
environment in this experimentation would be beneficial in terms of making rational
approach towards the execution of the marketing activities. Rationality is needed in
the process of handling the responses of the clients and the customers. This
rationality, in turn, would help in gaining trust, loyalty and dependence from the
clients and the customers.
 Frameworks are crucial in terms of providing the healthcare services according the
NHS standards. Within this, reference can be cited of Quinn’s Competing Values
framework, which would be effective for NEMC in terms of assessing their flexibility
and competency towards controlling the operations in the markets of Boston.
Focusing on the increasing the sales revenue and profit margin through increasing the
trafficking of the audience would be beneficial in terms of gaining control over the
external challenges and pressures.
 Evaluation of the exposed performance is needed in terms of assessing whether the
activities are on the right track. In this, considering Greneir’s phases of organizational
growth would be fruitful for NEMC in terms of expanding the scope and arena.
Collaborating with the personnel of the contemporaries would be effective in terms of
delving deeper in the root causes of the financial crisis. Implementing creativity in the
strategies for providing the healthcare services would result in something different
from the traditional marketing. Experimenting with the available and collected ideas
would result in evolution of innovate ideas for altering the dynamics of the workplace.
 Conscious approach is needed in terms of dealing with the complexities. Typical
example can be non-linear feedback loops. These loops would disrupt the stability in

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the relationship between the patients and healthcare institutions and hospitals. This
disruption, in turn, would possess dire consequences in terms of ensuring the
wellbeing of the patients. The channels and systems for providing the feedbacks needs
to flexible enough, so that the message of the customers reaches to the respective unit
of the hospital. Operating in an unstable environment of equilibrium adds an
interrogative parameter to the feedback systems. This unstability would be assistance
in terms of assessing the chaos.
 Training the staffs would be beneficial in making them aware of the recent trends in
healthcare. Practical demonstration of system usage would help in reducing the errors
and mistakes in providing the services. Appointing one two staffs for the patients
would be helpful in catering to their specific needs, demands and requirements.
Flexible shifts within the duties would result in productive output.
Conclusion
Healthcare is one such parameter, which relates to the wellbeing of the individuals. In
this, ethical approach is needed for achieving positive outcomes. This can be done through
the development of frameworks, policies and programs on healthcare. Situational analysis
helps the managers and leaders like Zane to detect the gaps like the financial crisis, which
hampered the operations towards providing the healthcare services. Analysing the situation
through different perspectives is effective in terms of checking the current situation in terms
of the external pressures and challenges. Maintaining consistency in evaluation is assistance
for achieving infrastructural development, which would lure the foreign investors and clients.
Rationality in this approach is flexible enough for expanding the scope and arena of the
healthcare institutions and hospitals.

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Appendix
Figure 2: Healthcare Analytical Transformation Model
(Source: Petrou, Demerouti & Schaufeli, 2018)