1BSc Leadership and Innovation Module 2018 Table of Contents Introduction..........................................................................................................................2 Discussion............................................................................................................................3 Leadership........................................................................................................................3 Behavioral leadership theory...........................................................................................3 Strengths and limitation...............................................................................................4 The situational or contingency theory.............................................................................5 Strengths and weaknesses............................................................................................5 Innovation in healthcare..................................................................................................7 Strength........................................................................................................................7 Weakness.....................................................................................................................8 Opportunities...............................................................................................................8 Threats.........................................................................................................................8 Change and change management theory.........................................................................9 Rodgers model.............................................................................................................9 Kurt Lewin model......................................................................................................10 Discussion..................................................................................................................12 Conclusion.........................................................................................................................12 References..........................................................................................................................14
2BSc Leadership and Innovation Module 2018 Introduction Regulatory systems, increased market competition and fixed targets are unable to bring the necessary fundamental changes required to face the challenges of the healthcare system. Therefore, there are changes in each aspect such as cultural, operational and service should be brought about so that improvement in the continuous delivery, quality and patient concerned care (Burke, 2017). Hence, leadership is an important aspect that helps to drive the organization and associated professionals to bring the necessary changes within the organization and maintain stability and sustainability while thechange management is implemented (Fullan, 2014). Leadership is always associated to innovation as while setting direction for the growth of organization, they implement several innovative ideas that inspire associated professionals to achieve the prime goal. Innovation bears supreme importance, as in the phase of globalization, where each industry including healthcare sector is shattering boundaries, innovative skills, ides and processes has become prime driver of value, growth and performance of the employees (Burke, 2017). This process of improvement and development is known as change management and the strategies of change management is implemented to effective, controlled and easily adaptive change. Medication error is one of the biggest shortcoming of the modern medication system as increased patients, variety of diseases and preventive measures lead the healthcare professionals to commit mistakes unintendedly (Bonkowski et al., 2013). Therefore, this assignment is proposing usage of Barcode Medication Administration (BCMA) in one of the busiest unit of hospital, the renal unit. In this assignment, the two leadership theory needed for implementation
3BSc Leadership and Innovation Module 2018 of change in healthcare facility will be discussed with their strength and weakness. Further, the importance of innovation in health sector will be described with SWOT model. Finally, the changemanagementwill be discussed and two change theorieswillbe included in the assignment and evidences will be used to link theory with the practical practice. Discussion Leadership For a successful change management process, there are six steps that need to be followed so that compliance to the new process can be achieved. These steps are managing support for introducing change to the employees as well as customers, deciding the primary target for change and seek employee assistance for implementation and finally taking follow-ups after implementationofthechangeintheprocess(García-Morales,Jiménez-Barrionuevo& Gutiérrez-Gutiérrez,2012).Hence,leadersarealsoatpressurewhileconductingchange management as while going through change process, employees seek assistance, accountability, clarityandconnectionfromtheirleaders.Therefore,itisimportantforthehealthcare organization leaders to implement leadership theories so that the change management process becomes easier and convenient for the healthcare professionals (Carter et al., 2013). There are two leadership theories that the leaders should implement while implementing change in the process, such as thebehavioral theoryandthe situational or contingency theory. Behavioral leadership theory Human behavior is an important aspect that is reflected while the person goes through pressure or implements any change in his/her personal or professional life. This change in behavior is influenced by persuasions, hypnosis, culture, attitude and coercion (Dinh et al.,
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4BSc Leadership and Innovation Module 2018 2014). The person who is able to control all these aspects of behavior while going through pressure has the traits of leadership.Behavioral theory of leadershipis defined as the process, in which the observable actions and respective reactions of the leaders as well as their followers or employees are assessed for a specific situation. This theory believes that every person can learn skills and attitudes that can make them leaders and it is the learning capacity of the leaders that decides their efficiency while introducing change in the organization (Parris & Peachy, 2013). Strengths and limitation Thestrengthof this leadership theory is associated to its value that enhances the people collaboration and has an emphasis on relation between leaders and its followers, which is an important aspect while going through change management process. Further, as the leaders are open for learning and gaining knowledge from everywhere, they let employees to participate in the decision-making processes and put forward their views regarding the implementing change in the process (Dinh et al., 2014). This made them more flexible towards their employees and understand the situations that can hamper the relationship between leadership and employees. Further this behavioral theory let leaders to understand the concerns of each stakeholders associated to it (such as in the proposed change, implementation of barcode can affect patients and healthcare professionals) for increased productivity (Parris & Peachy, 2013). The primelimitationof this process is associated with the acquired attitude and behavior of the leaders. As the leader acquired the attitude and behavior from different situational pressure it might possible that he or she is unable to take appropriate step in each situation and enact according to the theory properly (Dinh et al., 2014). This is more challenging as adapting to the
5BSc Leadership and Innovation Module 2018 acquired behavioral change correctly each time, is psychologically not possible. The second limitationis related to the adaptability of the leader to the given situation, cultural situation and organizational aspects. There is a less amount of theory present that demonstrate the appropriate behavioral trait that the leader should acquire while going through cultural conflicts, and problematic situations in change management process. The prime reason behind this can be the subjective nature of behaviors as one person’s behavior to one situation can differ from someone else’s reaction (Parris & Peachy, 2013). The situational or contingency theory The management style of leaders has direct and proportional effect on the failure and success of the organization or the employees, who struggle to achieve success for the company. This theory determines that the leadership is the personal trait of people, and does not change with every coming challenges (McCleskey, 2014). According to this theory, dominant nature of leaders are help them to achieve task-related and human-relation related tasks and the followers also feel influenced and inspired to achieve the target for the company. These leadership theory is beneficial in extreme situation, when sudden change management related to an important process of the company is implemented (Van de Ven, Ganco & Hinings, 2013). Strengths and weaknesses As the leadership style focuses on domination of the leader while going through change management, the most importantstrengthof this leadership style is that it makes the employees responsible for their own decisions and actions. Further, as the leadership style focuses on discussionwithexperiencedandtenuredemployeesregardingtheirviews,asenseof accomplishment will be created in the tenured employees of the organization, which will lead
6BSc Leadership and Innovation Module 2018 them deliver their tasks honestly and eventually achieve the goal for the organization (Hanisch & Wald, 2012). However, this dominant trait is the weakness in few situations. Job readiness and ability to adapt to the change is different for different people, hence, dominance can lead them to break down and their entire work performance can collapse. Further, wrongly applied pressure can let employees to leave the organization which eventually harms the organization as fresher or new worker will not be able to produce the desired productivity while going throughthechange managementprocess(McCleskey,2014). Further,asthisleadershipskillisabusive, the followers may willingly quit working and performing tasks that affects the change management by delaying the process, as well as affecting the accountability, productivity and efficiency of the associated employees. Furthermore, according to Wright, Moynihan& Pandey (2012), while working in a healthcare organization going through change management process, it is quite impossible to apply one style of leadership skills as each situation brought different difficulty for whichdifferentleadershiptraitsandsolutionsarerequired. Thesearethestrengths and weaknesses of this leadership theory (Van de Ven, Ganco & Hinings, 2013). Within these two leadership theories, to implement the change related to usage of Barcode Medication Administration in the renal department of healthcare organization, the situational or contingency theory of the leadership has been chosen. The reason for choosing this leadership theory for the implementation of change management related to process is associated with the personal trait of the leader (Carter et al., 2013). As the behavioral theory described that leaders acquire attitudes towards issues while suffering from similar situations. However it is possible that similar situations require different reactions in two different situations, hence, in
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7BSc Leadership and Innovation Module 2018 such situation, a strong and dominant leadership is required who can lead the followers through tough situations. Further, as the contingency theory, focuses on boardroom discussions with employees, and creating a roadmap for implemented change, its efficiency increases compared to the behavioral theory (García-Morales, Jiménez-Barrionuevo & Gutiérrez-Gutiérrez, 2012). Hence, for the proposed change management, the contingency or situational theory will be applied. Innovation in healthcare Innovation is a critical aspect for organizations, as it helps to increase the business related productivity and enhance the chances of survival in the competitive culture (Weber & Rohracher, 2012). Especially in healthcare system, innovation increases the quality of the process and enhances the reliability of patients and service users within the process. There are two types of innovations related to different aspects of healthcare process such as product innovation and process innovation (Bock et al., 2012). Product innovation in healthcare is related to new medication and instruments that helps to easily diagnose and provide faster recovery from the disease,whereastheprocessinnovationenhancesthecapabilityofassociatedhealthcare professionals so that they can utilize the newly innovated products for the betterment of the patients (Weber & Rohracher, 2012). The role of working environment also determines the level of compliance of the employees towards the proposed change as it can increase or decrease the capability of people to combatthedifficultieswhilechangemanagement.TheSWOTanalysisofthisworking environment is mentioned below.
8BSc Leadership and Innovation Module 2018 Strength While change management process, the strength of the working environment is regarding the competitive and adjustable nature of the employees. These two aspects help the organization to take necessary steps while implementing change. Further, fixed target of the working force, local support and presence of professional employees are strengths of working environment (Opsahl, George & Gann, 2012). Weakness Excess workload, leader’s pressure and unsupportive working environment are the primary weakness that affects the change management process by delaying its speed. Further, as the entire process related to the tasks are changed, employees take time to acquire the knowledge regarding the new process prior to speed up their production (Somech & Drach-Zahavy, 2913). Opportunities The most important opportunity that the working environment in the midst of change management the organization has regarding the relation between leader and its followers. It helps to enhance the effective communication skills, enhance the employee’s ability to withstand pressure with training and development programs (Bock et al., 2012). Threats As the working environment in change management process is full of domination and work pressure, the chances of resignations from the employees’ increases and new or fresh workforce may take time to understand the process and implement change, creating a lag in the change management plan (Opsahl, George & Gann, 2012).
9BSc Leadership and Innovation Module 2018 The prime implication of change regarding usage of barcodes instead of paper works regarding the medication administration of patient is decreases amount of medication errors, which usually causes more than 65% of patient worldwide (Weber & Rohracher, 2012). Further, as the nursing and healthcare professional will be using barcode and associated electronic medication administration record system, it will be easier for the patient and the healthcare facility to keep the patient data securely. The staff interpersonal communication also increases (Bock et al., 2012). For example, while implementing Barcode medical administration in the renal unit of the healthcare facility, if the healthcare professionals and staff support the hospital authority, the authorities will be able to take further harsh steps for the overall growth of the organization (Weber & Rohracher, 2012). Change and change management theory Change is a specific idea or notion that helps to improve the condition of organizations and combining with different theories it helps to create new concepts of change, implementing which can help the leaders to transform the process completely (Burke, 2017). On the other hand, change agents are people who help the organization by transforming or improving the process and the effective communication within the system. The change agent can be anyone who helps to drive or influence people to accept the new system or program inside the process and helps to develop or improve the process effectiveness (Fullan, 2014). For better management of the change applied in the healthcare organization, different change management models are present, within which, two has been presented in this study.
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10BSc Leadership and Innovation Module 2018 Rodgers model According to Cameron and Green (2015), Rodger’s described four elements as driving forcetodiffusenewerideasandinspirationwhileimplementingchangeandtheseare Innovations related to new ideas, project, object and practice, effective communication, time to determine accurate decision-making and solving problems in groups so that goals can be achieved with cumulated force (Cameron & Green, 2015).In the Rodger’s model of change, there are five kinds of people in every organization, and depending on their level of adaptations, the change can be implemented within the organization. The categories are innovators, early adaptors, early majority, late majority and laggards. The innovators are the one who primarily adapts the change and willing to take risk for the benefit of the company, early adaptors are the group of people who based on evidence, join the change management willingly (Benn, Dunphy & Griffiths, 2014). Early and late majorities are in neutral position in case of joining change management whereas the laggards are people who join the change process at last, unwillingly. Hence, this model believes that each employee will take their own time to implement change and organization should provide them time to adjust to the new process (Cameron & Green, 2015). Kurt Lewin model This model of change is comprised of three steps such as unfreezing, change and refreezing, which makes it easy to apply and implement in any organization irrespective of its complexity (Burnes & Cooke, 2013). Unfreezing determines the preparation stage of change management by informing the employees regarding change and seeking their valuable feedback so that their complete support can be achieved. This step challenges the belief, values, attitude and behavior of the employees, current practices so that newer model and process can be implemented (Shirey, 2013). The second step, which is change and in this, people set their minds
11BSc Leadership and Innovation Module 2018 and try their best accept to the change and implement newer process in their work system. In this step the leaders of the organization try to solve all the issues of employees while adapting to the change. Finally, the third step refreezing is applies to organization, as this determine that all the employees are accustomed to the new process and are ready to perform for the betterment of the organization (Burnes & Cooke, 2013). To implement the proposed change in the desired healthcare organization, the Kurt Lewin model of change has been selected. According to Cummings, Bridgman and Brown (2016), change is a process that should be done with the consent of the involved people so that resistance can be minimized. The Lewin change management model’s first step, Unfreezing is about informing the associated people about the change in the process so that they can prepare themselves for the newer challenges mentally (Burke, 2017). Further, as the nurses are the change agents in this model of change, their adaptation to newer changed process is necessary and Lewin model provides them with numerous support from the administration and senior healthcare professionals to understand the new process (Fullan, 2014). Therefore, to implement barcode medical administration process in the renal unit of the hospital, the Kurt Lewin model of change has been implemented. For example, providing nurses with training related to BCMA while implementing change and undertaking several assessments related to the practice will help them to acquire the process completely and the chances of medication errors will be minimized (Cummings, Bridgman & Brown, 2016). Further, for the management of change, the hospital authorities should assess the state of the renal department and the rate of medication related error in the unit. This will help them to identify the problems and convince the agent of change that is the nurses to adapt to the newer
12BSc Leadership and Innovation Module 2018 practice (Appelbaum et al., 2012). Authorities or leader of the healthcare organization should envision the process and effect of implemented change so that the loopholes and resistance of employee can be minimized on priority basis. Finally, the authorities should implement the change in orderly manner so that management and transition to the newer process can be done effectively. Further for the enthusiasm of the change agents, the management should arrange rewardsandrecognitionsothatoutstandingeffortsofthenursesandotherhealthcare professional to adapt to the change can be recognized (Cummings, Bridgman & Brown, 2016). Discussion Medication error is an important aspect in this evolving healthcare system, and according to the Journal of Nursing Administration, this leads to unavoidable situations, if not avoided and replacedwithsomeotherprocess.Toidentifythereplacingprocessandminimizethe medicational errors, Oshashi et al. (2014) conducted a systematic review and searched 32 articles and found that barcode medication administration has been used to effectively minimize the risk of medication error in all those research articles. The prime reason of errors identified in those articles was impaired cognitive skills of nursing professional because they had to handle more than 50 patients’ every day (Bonkowski et al., 2013). Therefore, implementing barcodes in the administration process will help them to remind the last dose of drug administration to a specific patient. Further, as per Rack, Dudjak & EWolf (2012), as the shift of a specific nurse is fixed, the other nurse who replaces the first one is unable to understand the drug administration process and leads to medication error. Therefore, to restrict the medication error, usage of barcode medication administration system should be implemented as a changed process in the healthcare organization in discussion.
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13BSc Leadership and Innovation Module 2018 Conclusion While concluding the assignment it should be mentioned that change is spontaneous and to attain a sustainable development in every aspect, each organization should undergo change management process. While, unable to change with the advanced system, the organization, its employees are unable to provide its customers with effective and quality service. The role of leaders and innovative ideas are important in this case as leaders holdingthe hand of employees and direct them to the desired success determined by them for the organization. Further, innovation is the process through which, newer ideas and substances are introduced in the company that helps in expansion or improvement of the process. In combination, leaders with their innovative ideas implement change in the organization, and the change agents’ helps to drive the change in the desired direction. In this assignment, the proposed change was the implementation of Barcode Medication Administration (BCMA) in the renal department of the healthcare organization, the situational or contingency theory of leadership was implemented and Kurt Lewin change management theory was implemented in the process. Furthermore, in the assignment, the SWOT analysis of the working environment in driving the process was carried out and the benefit of the Lewin change management in driving the change was described in the process with a proper discussion about the proposed change and its benefit in lowering the error related to medication.
14BSc Leadership and Innovation Module 2018 References Appelbaum, S. H., Habashy, S., Malo, J. L., & Shafiq, H. (2012). Back to the future: revisiting Kotter's 1996 change model.Journal of Management Development,Vol.31, issue. 8, pp. 764-782.DOI: https://doi.org/10.1108/02621711211253231 Benn,S.,Dunphy,D.,&Griffiths,A.(2014).Organizationalchangeforcorporate sustainability, 2ndedn, pp. 45-98, Routledge. Bock, A. J.Vaccaro, I. G., Jansen, J. J., Van Den Bosch, F. A., & Volberda, H. W. (2012). Managementinnovationandleadership:Themoderatingroleoforganizational size.Journal of Management Studies,Vol.49, issue 1, pp. 28-51. DOI:10.1111/j.1467- 6486.2011.01030.x Bonkowski, J., Carnes, C., Melucci, J., Mirtallo, J., Prier, B., Reichert, E., ... & Weber, R. (2013). Effect of barcode‐assisted medication administration on emergency department medication errors.Academic Emergency Medicine,Vol20, issue 8, pp. 801-806. DOI: 10.1111/acem.12189 Burke, W. W. (2017).Organization change: Theory and practice, 5thEdn, pp. 123-145, Sage Publications. Burnes,B.,&Cooke,B.(2013).KurtLewin'sFieldTheory:AReviewandRe‐ evaluation.International journal of management reviews,Volume15, issue. 4, pp. 408- 425.DOI:10.1111/j.1468-2370.2012.00348.x
15BSc Leadership and Innovation Module 2018 Cameron, E., & Green, M. (2015).Making sense of change management: A complete guide to the models, tools and techniques of organizational change, 1stedn, pp. 34-68, Kogan Page Publishers. Carter, M. Z., Armenakis, A. A., Feild, H. S., & Mossholder, K. W. (2013). Transformational leadership,relationshipquality,andemployeeperformanceduringcontinuous incremental organizational change.Journal of Organizational Behavior,Vol.34, issue 7, pp. 942-958.DOI:10.1002/job.1824 Cummings, S., Bridgman, T., & Brown, K. G. (2016). Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management.human relations,Vol.69, issue. 1, pp. 33-60. DOI: https://doi.org/10.1177/0018726715577707 Dinh, J. E., Lord, R. G., Gardner, W. L., Meuser, J. D., Liden, R. C., & Hu, J. (2014). Leadership theory and research in the new millennium: Current theoretical trends and changing perspectives.TheLeadershipQuarterly,Vol.25,issue1,pp.36-62.DOI: https://doi.org/10.1016/j.leaqua.2013.11.005 Fullan, M. (2014).Leading in a culture of change personal action guide and workbook, 1stEdn, Pp. 12-67, John Wiley & Sons. García-Morales,V.J.,Jiménez-Barrionuevo,M.M.,&Gutiérrez-Gutiérrez,L.(2012). Transformationalleadershipinfluenceonorganizationalperformancethrough organizational learning and innovation.Journal of business research,Vol.65, issue. 7, pp. 1040-1050. DOI: https://doi.org/10.1016/j.jbusres.2011.03.005
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16BSc Leadership and Innovation Module 2018 Hanisch, B., & Wald, A. (2012). A bibliometric view on the use of contingency theory in project management research.Project Management Journal,Vol.43, issue 3, pp. 4-23. Langley, A. N. N., Smallman, C., Tsoukas, H., & Van de Ven, A. H. (2013). Process studies of changeinorganizationandmanagement:Unveilingtemporality,activity,and flow.AcademyofManagementJournal,Vol.56,Issue.1,pp.1-13. doi:10.5465/amj.2013.4001 McCleskey,J.A.(2014).Situational,transformational,andtransactionalleadershipand leadership development.Journal of Business Studies Quarterly,Vol.5, issue 4, pp. 117. DOI: https://doi.org/10.1080/19416520.2013.774983 Ohashi, K., Dalleur, O., Dykes, P. C., & Bates, D. W. (2014). Benefits and risks of using smart pumps to reduce medication error rates: a systematic review.Drug safety,Vol.37, issue 12, pp. 1011-1020. DOI: https://doi.org/10.1007/s40264-014-0232-1 Opsahl, T., George, G., & Gann, D. M. (2012). The effects of culture and structure on strategic flexibility during business model innovation.Journal of Management Studies,Vol.49, issue 2, pp. 279-305. DOI: https://doi.org/10.1016/j.respol.2011.10.015 Parris, D. L., & Peachey, J. W. (2013). A systematic literature review of servant leadership theory in organizational contexts.Journal of business ethics,Vol.113, issue 3, pp. 377- 393. DOI:https://doi.org/10.1007/s10551-012-1322-6
17BSc Leadership and Innovation Module 2018 Rack, L. L., Dudjak, L. A., & Wolf, G. A. (2012). Study of nurse workarounds in a hospital using bar code medication administration system.Journal of nursing care quality,Vol. 27, issue 3, pp. 232-239. DOI: 10.1097/NCQ.0b013e318240a854 Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., ... & Dawson, G. (2012). Effects of a brief Early Start Denver Model (ESDM)–based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial.Journal of the American Academy of Child & Adolescent Psychiatry,Volume.51, issue. 10, 1052-1065. DOI:https://doi.org/10.1016/j.jaac.2012.08.003 Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource.Journal of NursingAdministration,Volume43,issue2,pp.69-72.doi: 10.1097/NNA.0b013e31827f20a9 Somech,A.,&Drach-Zahavy,A.(2013).Translatingteamcreativitytoinnovation implementation: The role of team composition and climate for innovation.Journal of management,Vol.39,issue3,pp.684-708.DOI: https://doi.org/10.1177/0149206310394187 Van de Ven, A. H., Ganco, M., & Hinings, C. B. (2013). Returning to the frontier of contingency theory of organizational and institutional designs.Academy of Management Annals,Vol. 7, issue 1, pp. 393-440.DOI: https://doi.org/10.1080/19416520.2013.774981 Weber, K. M., & Rohracher, H. (2012). Legitimizing research, technology and innovation policies for transformative change: Combining insights from innovation systems and
18BSc Leadership and Innovation Module 2018 multi-level perspective in a comprehensive ‘failures’ framework.Research Policy,Vol. 41, issue 6, pp. 1037-1047. DOI: https://doi.org/10.1016/j.respol.2011.10.015 Wright, B. E., Moynihan, D. P., & Pandey, S. K. (2012). Pulling the levers: Transformational leadership,publicservicemotivation,andmissionvalence.PublicAdministration Review,Vol.72, issue 2, pp. 206-215. DOI: 10.1111/j.1540-6210.2011.02496.x
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