Organisation Development Process in Healthcare: Addressing No-Show Rates and Implementing Change

This document focuses on the organizational development (OD) process in the healthcare sector, specifically addressing the issue of high no-show rates in clinic appointments. The chapter discusses different approaches to OD, including Kurt Lewin's change model and the Kotter change model. The rationale for selecting the HSE Change Model is provided, highlighting its relevance and alignment with current practices in the Health Service Executive. The chosen model aims to improve appointment attendance through the implementation of an appointment reminder system.

Running head: ORGANISATION DEVELOPMENT PROCESS
1
Organisation development process
Name:
Institution:

ORGANISATION DEVELOPMENT PROCESS 2
3.0 Organisational Development Process........................................................................................3
3.1 Introduction............................................................................................................................3
3.2 Critical Review of Approaches to Organisational Development...........................................5
3.3 Rationale for OD Model Selected..........................................................................................6
3.4Organisation Development Model..........................................................................................8
3.4 The Change Process...............................................................................................................9
3.4. 1 Initiation.........................................................................................................................9
3.4.2 Planning.........................................................................................................................10
3.4.3 Implementation..............................................................................................................14
3.4.4 Mainstreaming...............................................................................................................15
3.5 Ethical consideration............................................................................................................15
3.6 Summary and Conclusion....................................................................................................16
References......................................................................................................................................17

ORGANISATION DEVELOPMENT PROCESS 3
3.0 Organizational Development Process
3.1 Introduction
The healthcare sector is one of the world’s most multifaceted, prevalent and fast developing
businesses. The health care structure in United Arab Emirates (UAE) is a mixed private-public
system. There is a public system for Emiratis with centralised control and financing frameworks
and there is a huge and developing private sector in the key metropolitan parts. Private health
care services are growing at swift rate each day in the UAE through the medical cities, clinical
and private hospitals. The number of private hospitals exceeds the number of the public health
care centres. This growth has been reinforced by a huge number of expatriates and foreign
personnel who normally incur a high cost compared to local individuals in the Ministry of health
amenities. Therefore, it causes a lot of attendance of private hospitals. No-shows are schedules
missed by patients, either non-attendance or failure to terminate in a suitable period for another
patient to be reserved as a replacement. Rates for missed appointments (no-shows) are especially
high in Internal Medicine Department of ABC clinic. No shows adversely affect the efficacy of
healthcare structures and also influence patient care. Patients who do not show up to their
planned clinic appointments can considerably interrupt productivity further upsetting cost-
effective healthcare, patient quality and well-being. The present no-show rates for the ABC
clinic are greater than anticipated. Therefore, appointment reminder systems are an effective
method for increasing appointment attendance and cancellations.
In the health and social care service, change has been argued as a constant feature, which has a
significant impact on the culture as a whole i.e. the way people work within the organisation, the
way they communicate with each other, the way in which services are scheduled to safeguard

ORGANISATION DEVELOPMENT PROCESS 4
optimum level of paybacks to service consumers, local populations, and patients (Waibel, Henao,
Aller, Vargas & Vázquez, 2011). Considering this, transformation has been argued as an
adaptive and incessant process, where all the elements are interrelated and have influence on
each other. More importantly, it has been indicated that organizational change focuses
extensively upon the change in people, as they are the most important resource of the
organisation that helps in the achievement of desired goals and objectives. Therefore, it has been
revealed that change cannot be easily predicted and it emerges over time (McCance, McCormack
& Dewing, 2011).
The business dictionary describes Organisational Development (OD) as a routine and framework
of intended, systematic transformation in the philosophies, attitudes and values of the workers
through the reinforcement and generation of long-term training packages (Bartle & Leuenberger,
2014). OD is action oriented. It begins with a suitable organisation wide evaluation of the present
conditions and of the forthcoming needs, and uses approaches of behavioral knowledge such as
modeling behaviour, transition assessment and sensitivity training (Burgess & Radnor, 2013).
The OD aim is to help the organisation to appropriately adapt to the quick-transforming external
surrounding of novel markets, technologies and regulations. Change is unending feature for the
organisation both at the strategic and functional level (Lanzarone, Matta & Sahin, 2012). This
chapter will plan a proposal for an Organisation Development process within the ABC clinic in
the Health Service Executive to enable a more efficient and effective means of decreasing ‘No-
Show’ Rates by Implementation of the Appointment Reminder System in an Internal Medicine
Department.
3.2 Critical Review of Approaches to Organisational Development

ORGANISATION DEVELOPMENT PROCESS 5
Kurt Lewin change model
Kurt Lewin is a German psychologist and the author of the model of planned change (TPC) in
the 1950s (Stivers & Wheelan, 2012; Patnoe, 2013), presently well-known as a change
management theory. Lewin coined the phrase “there is nothing as practical as a good theory”
(Hamel & Zanini, 2014, pp.21) and also invented the word “group dynamics” (Stivers &
Wheelan, 2012, pp.44). He proposed that the group dynamic had robust effects on the single
person, and the essential change at the group level needs a change at the team level and not on
the personal level (Stivers & Wheelan, 2012).
Change management model begun as early as 1945 when Grabbe and Kurt published Conduct,
Knowledge, and Acceptable of New value (1945) on the culture modification and divergence.
The change management theory stated is vital before transformation can happen (Stivers &
Wheelan, 2012).
The Lewin change model comprises three steps namely; the initial stage in the change
management model is the unfreezing point where undesired behaviours are ceased (Stivers &
Wheelan, 2012; Patnoe, 2013). The second stage is transition which joins the wanted traits. The
third stage is the refreezing, which denotes to the change stabilization. Workers in this phase will
continue to model novel and wanted behaviour (Stivers & Wheelan, 2012; Patnoe, 2013).
The Kurt Lewin’s work controlled the model and routine of change management for over five
decades. But, in the last two decades, Kurt’s strategy to change, specifically, the three-phase
theory has attracted key criticisms because is it regarded as management-driven and favours top-
down leadership style. Additionally, the health system is in another time of major transformation

ORGANISATION DEVELOPMENT PROCESS 6
and re-organisation. Therefore, find that this framework could be deemed inappropriate for this
transformation initiative (Rowbottom, Jones & Cobb, 2015).
Nevertheless, Lewin’s model has attracted major criticism as it postulates that the firm work with
stable surrounding and fails to offer deliberations to the concerns around the organisation’s
politics and power. It is also alleged that the model is simply relevant to isolated and
incremental change projects which thus makes it unable to tackle transformation change
(Rowbottom, Jones & Cobb, 2015)..
Figure 1: (Stivers & Wheelan, 2012).
Kotter Change Model
The Kotter model is subdivided into eight sequential phases; building a sense of urgency,
creation of coalition rules, generating a transformation vision, vision communication to the
workers, empowering personnel to take actions on the vision, forming a short term objectives,
consolidating paybacks and generating more transformation, and employing novel cultural
techniques to sustain change (McAllister, Dunn, Payne, Davies & Todd, 2012). Kotter pinpoint

ORGANISATION DEVELOPMENT PROCESS 7
the most regular faults managers make while trying to create change and provides an eight-step
process to overcome the blockades and carry out the organisation transformation routine
(Donnelly & Kirk, 2015). While important in specific situations, this change framework is not
chosen as the author feels that it is does not take into the account the transformation that has
happened in change management zones (Adler, 2011).
The major critics of Kotter is that the approaches is centred on an unfounded assumptions that
people will resist change and when resistance happens, there is inadequate explanation of the
reason why.Both Lewin’s and Kotter’s framework concentrate particularly on planned
transformation and it is this element becomes the target of major critics. It is assumed that their
models are insufficient in a scope of circumstances, specifically where the given transformation
is merely one of a multiplicity of change occurring within the firm (Adler, 2011).
Figure 2: (Adler, 2011).

ORGANISATION DEVELOPMENT PROCESS 8
3.3 Rationale for OD Model Selected
Senior and Swailes (2010)
The Senior and Swailes change model successfully explores modification and how it relates to
the difficulties of organisational existence and puts an emphasis on using the theory into practice.
The model reflects a rapidly changing biosphere and deliberates in what way change has
transformed. The Senior and Swailes model considers the roots and nature of change; it expands
on matters of structuring for modification, the cultural and political contexts for transformation
and by what means to lead transformation. In addition, it addresses the more practical
considerations of designing, planning and implementing change. Even though this framework
was not chosen for this proposal it is recognised that it is very analogous to the HSE change
classical and would be very valued to use in executing change within organisations.
HSE Change Model 2008
The HSE Change Management Assets have been initiated to back all the personnel working in
the health service to have the skills, confidence and knowledge to tackle change in a direction
that advances the likelihood of a good result for the service users, patients, communities and
staff. The HSE Change Model is centred on experience of what functions in practice and place a
specific focus on the necessity of engaging individuals in the change process. The HSE change
model is the technique agreed by the HSE management group and the Joint Information &
Consultation Forum (Rowbottom, Jones & Cobb, 2015). This method to modification sets out
how to improve services as is specified in the Public Sector. The writer has decided to select this
classical as the literature study on this framework is up to date. In addition, because this model is
being developed and implemented within the HSE and agreed by HSE Management, the author
is of the opinion that it will be the best model to use.

ORGANISATION DEVELOPMENT PROCESS 9
There are many change frameworks to select from currently. In this chapter, the writer has
evaluated HSE change model both 2008 and 2018, Senior & Swailes (2010), Lewin’s change
model and the Kotter model. When selecting a change classical to start change, routine for the
selection ought to comprise that is quick to comprehend and feasible to function with, it should
adjust to the organisation as near as possible and should be adequately comprehensive to assist
the data collection without omitting crucial bits of info. Rather than articulating a model to
ensemble all situations, it is better to consent to the fact that there is a degree of disorder during
the transformation process and that managers should focus in connection and identities in the
organisation that will assist them to function with chaotic change (Haggerty, 2012). As indicated
above, the HSE change model (HSE, 2008) has been chosen for this proposal as it thoroughly fits
the organisation.
Figure 3: HSE change model (HSE, 2008)

ORGANISATION DEVELOPMENT PROCESS 10
HSE change model 2018
HSE change model 2018 is a framework that locates on one place all of the crucial elements that
need to be emphasized on to provide change properly. These include the team’s definition of
change. This means working with individuals to comprehend their support in an ongoing
engagement. Leaders should also create culture of people and change platform, where the
change priorities that require to be worked on together build a heath environmental and culture
of transformation. The framework defines, design and deliver the change. In implementation
stage, the leader ought to measure results and support sustainability. Change outcomes should be
accountable for performance and the provision of safer healthcare and services that are worth to
the staff and public.

ORGANISATION DEVELOPMENT PROCESS 11
Figure 4: (HSE, 2018)
3.4Organisation Development Model
The HSE change framework has four main stages which comprises initiation, planning,
mainstreaming and implementation. Initiation comprises preparing to lead the transformation.
Planning is subdivided into three classes i.e. building commitment, determining the detail of
change and developing the implementation plan. The third phase is execution of the change and
the last step is mainstreaming which entails of making the change the novel way of functioning
and assessing and learning from know-hows.
3.4 The Change Process
3.4. 1 Initiation
Preparing to lead the change

ORGANISATION DEVELOPMENT PROCESS 12
Change resistance has been long been well-known as vital and essential elements that can impact
the victory of an organisation development routine. Resistance is frequently taken by managers
as an enemy of transformation. The vigor ought to be overcome if change assertions are to be
effective. Leadership is an action of pinpointing an objective, encouraging other individuals to
act and offer support and motivates to realise mutually negotiated objective (Davidson, 2010).
Leading a change such as this proposal will need the manager to engage in diverse leadership
approaches to comprehensively execute all the transformations. This is essential in order to
create crucial commitment as there are a number of diverse expertises involved in this change
routine. When dealing with over twelve thousand employees, doctors, nurses, paramedic and
administrators, a situational style of leadership will be needed. The sheer numbers of individuals
comprised in the change will definitely means that there will unmistakably be in states that will
arise that cannot be scheduled for and the manager will require taking chance of these situations
for those involved. Situational leadership is effectiveness coming from a behavioral style that is
suitable to the requirement of the surroundings and secondly on the learning to analyse that
environment (Grimm, 2010).
In order to efficiently encourage personnel and control variances, the managers need aspects of
transformational leadership as the manager ought to have competencies and qualities in the
management of self. Transformational leadership happens when managers rise and widen the
staffs’ interest by creating awareness of the team’s mission and encouraging staff to concentrate
on the good of the group as opposed to their individuals self-gain (Kelloway, Turner, Barling &
Loughlin, 2012). This type of style will be mainly prevalent when dealing with health care
professional such as paramedics, doctors and nurses. By supporting no show initiative it will

ORGANISATION DEVELOPMENT PROCESS 13
eventually lead to a higher excellence and it will mean less input from health nurses (Cheng,
Chen & Hou, 2010).
3.4.2 Planning
The three phases in the HSE Change Model for planning transformation is building commitment,
determining the detail of transformation and developing the execution plan.
Building commitment
Fish-bone analysis
A fish-bone analysis pinpoints the root causes for patient missing appointment. The patients,
heath care professionals, materials and routine sum up the primary motives for patient missing
appointment (Gallagher et al., 2013). Every class ought to be further assessed to reach the root-
cause, which will assist exact change interventions. The management has assessed the complete
non-shows rates in the outpatient ABC clinic and they are high than the universal benchmark
which ranges from 5-10% in primary health care facilities and slightly greater in specialty
amenities. The wanted conditions are the execution of a reminder system within the present
appointment scheduling structure which will offer patient with two sorts of reminder before to
the actual appointment. A reminder system has been acknowledged to drop no-show rates in
clinics and will furthermore lead to reduction wait time for new patients, thus decreasing waste
possessions and growing clinic output (Berwick & Hackbarth, 2012).
Stakeholder analysis
The literature review carried out for this proposal supports this change initiative and this
information would be used to influence all those involved. By reducing no show rates will
potentially reduce wastage of resources and it will also ensure every new patient is attended

ORGANISATION DEVELOPMENT PROCESS 14
without delay. Through reducing staff number, the organisation would also be reducing the
processes involved by engaging with the principles of lean so that the organisation can add value,
continuously improve and reduce waste (Bhasin, 2012). By use of appointment reminder system,
it would improve the working environment and lead to better job satisfaction thus an improved
quality of care that would be delivered (Berwick & Hackbarth, 2012).
It is of great importance that workplaces have strategies in place to increase the well-being of the
workforce. It is important that these strategies take into account that successful implementation
of any organisation development process involves staff engagement so that the culture is
changed (Hill, Twiddy, Hewison & House, 2014). The workforce engagement would gain
commitment from other ABC clinic professionals and encourage a change in the cultural norm.
The nurses said that communication with workers in relation to patient updates had greatly
reduced and in their opinion, the staff and patients were delighted with the change. This feedback
from employees already working on the decreasing ‘No-Show’ Rates by Implementation of the
Appointment Reminder Systems will ultimately assist in gaining commitment from all involved
in the change.
The author is using PDSA cycle analysis to identify the key stakeholders where commitment
required so as to have payback for the entire process.
The Plan-Do-Study-Act (PDSA) model is portion of the institute for health improvement, a
simple yet a robust tool for accelerating quality progression. Once a team has set an objective,
initiated its membership and developed measures to assess whether a change result to an
improvement, the next phase is to test a change in the real working environment. Therefore,

ORGANISATION DEVELOPMENT PROCESS 15
PDSA model is a scientific technique utilised for action-oriented learning (Donnelly & Kirk,
2015).
The plan stage will include the medical director, change consultant (author), quality team,
administration, and IM head of department. The phase will entail staff training, patient and staff
feedback, reminder system and periodical assessment which happen after every three months.
The planning process will takes place through departmental meeting, training session and
assessment, process mapping, PDSA cycles and value stream mapping (Donnelly & Kirk, 2015).
IT teams who are admin, change consultant and quality team will be involved in the
implementation of reminder system, data collection and giving the reason for cancelation of
appointment which should happen monthly. At this stage, it will be evaluated by the patient
satisfaction survey and departmental no-show rates.
Study phase will involves the same personnel as in the Do stage that will do data collection and
reason for appointment cancellation, which should occur on monthly basis. The process will
performed through process mapping and value stream mapping. Finally, the Act stage will
comprise administration, change consultant and quality team doing 100% reminder system
compliance, giving recommendations and limitations for every 3 months. The process will be
carried out through data comparison of no-show rates and mystery calls.
Determining the detail of the change
As already stated earlier, this proposal has already been implemented on a small scale in the
department of health nursing areas which is significant in determining the detail for change. This

ORGANISATION DEVELOPMENT PROCESS 16
area consisted of twenty five clients and twelve ABC clinic staffs. There were three meetings
with ABC staff prior to implementation which lasted approximately one hour each. Prior to these
meetings, appointment Reminder System was drawn up to present to the group for their feedback
and the necessary adjustments in relation to patient times, staff allocations were made after the
first meeting. The second meeting consisted of verifying changes and agreeing the planned date
for implementation. At the final meeting, the new appointment Reminder System was distributed
for final confirmation and reassurance to all the ABC staffs.
Developing the implementation plan
Organise a meeting with key stakeholders i.e. General Manager, Service Managers and ABC
administrators to give feedback on the pilot area and advice of proposal to gain commitment and
additional resources in the management.
When commitment from the meeting above has been agreed, the ABC Coordinator supported by
Senior Management will arrange meetings with stakeholders per area i.e. patients, staff, nurses,
doctors, paramedics and clerical administrators to establish feedback on current situation and
proposed system.
The ABC clinic Coordinator and the clerical staff supported with additional resources will devise
reminder System for the area taking into account patient needs, geographical area and ABC
clinic contracted hours.
Meetings should then be arranged with ABC clinic staff to discuss drafts and make any
necessary adjustments and agree implementation date

ORGANISATION DEVELOPMENT PROCESS 17
On final agreement with the stakeholders, clerical staff will issue documentation about changes
to staff and service users
The ABC clinic coordinator will induct system to patients and arrange training with nurses,
paramedics, administrators and doctors if necessary.
Then, commence appointment reminder system for six weeks pilot period
Plan reviews with staff and service users after six week period to gain feedback through phone
call and text messages reviews.
The appropriate direction an employer can communicate transformation is to openly tell workers
what is happening. Employing a blend of informal and formal communication permits one to
make sure that all workers get the messages about the transformation in certain means or another.
With all communication channels the ABC clinic have such as emails, texts and phone calls, and
face to face meetings, the message is going to go across the health care facility. Using diverse
ways to communicate change assists defines the goals, vision and expectations for what require
to occur and why.
Irrespective of how well the organisation manages change, there is always goings to occur some
resistance in one way or another. Organisation should engage individuals who are opposed to
change. By doing the above, this can appropriately see what their issues are and possibly
alleviate the concerns in a timely manner. By permitting personnel’s time to offer their input, it
warrants them that they are part and parcel of a group that focuses on its employees.
Communicating often and early is important when attempting to convey something to workforce.
There should be steady conversation between the various organs of the clinic on what is

ORGANISATION DEVELOPMENT PROCESS 18
occurring in daily basis and what is expected to come in future. By assisting the employees to
better comprehend why a change is crucial for the organisation, it is simple to get them on board
with the change, and it can motivate them to become an advocate for change.
3.4.3 Implementation
The plan outlined above should be done in every department as re-organisation of one section
may have a direct knock on effect on the next area (Van Dyke, McHugh, Yonek & Moss, 2011).
The implementation of this plan would need to be closely supported by the Service Manager or
equivalent to support the ABC clinic coordinator in the areas. Additional clerical administration
in each ABC clinic office to manage the paper work and communication for an initial period of
time would also be necessary. It is envisaged that this surge of system would reduce the rate of
no show and so, resources could then be used for further service development and quality
improvement initiatives.
3.4.4 Mainstreaming
Mainstreaming is used to focus attention on successful change initiatives and to sustain new
ways of working (HSE, 2008). This initiative when standardised across the county could be
managed mainly at local level but could be supported from a central function. On successful
implementation of this proposal, many more initiatives could be implemented, for instance,
travel auditing and potentially could be used to pay the salaries to ABC staffs which is currently
another labour intensive for four weekly administration process in the department.
Naturally, momentum also affects the business outcomes. Initiating change and creating
momentum is way to having the transformation stick to the workers. Momentum keeps the
change from “petering out” and from wearing people down. When executing change, it is
important to communicate a short-term wins to encourage individuals to stick with channel. It is

ORGANISATION DEVELOPMENT PROCESS 19
important also to clearly and broadly communicate the “why” by defining how this change will
be important to people, the organisation and the patients. Painting a compelling image of what
individuals are moving from and towards is also of essence. Workers need to know the managers
have a plan for this journey of transformation. Leaders should plan and project for ways to work
though the inevitable and natural inertial and resistance along the way. Reinforcement is
important to creating and upholding momentum. No employer wants to trusts a guide that is
overburdened, tired or stressed.
Many options exist for motivating employers to perform well in an organisation when
implementing change such as job enrichments and rotation. Managers can motivate employees
by providing training programme that improves their knowledge and skills. It is worth noting
also the leadership style can encourage the employees to perform better. Organizations can
operate such a package for their workers, mainly mid-tier management workforces, where teams
get a percentage of their yearly wages as a bonus. The physiological and mental wants and
wishes of staffs must be met and upheld to keep them inspired. Core physiognomies of a
vigorous reward scheme comprise both intrinsic and extrinsic promoters.
The following are the main evaluation measure put in place to assess the successful progress and
implementation of the change; Individual and team progress tracking. Support requests,
Employee feedback and behavioural shifts, Job performance improvement, employee
engagement/satisfaction/attrition.
Advancing a change management approaches offers purpose and direction for all other change
changes management actions. By outlining the distinct traits of the change and its risks and
potential resistance, change practitioners set themselves and their project group partners up for

ORGANISATION DEVELOPMENT PROCESS 20
the victory. All of the succeeding change management strategies and actions are guided by an
active change management plan.
3.5 Ethical consideration
Components of ethical will require to be combined when dealing with all staff and patients
involved in this change by permitting staff already working in the appointment reminder system
to be involved as they will gain the reliance of their coworkers (Haggerty, Roberge, Freeman &
Beaulieu, 2013). Therefore, the identified ethical principles with respect to this paper is informed
consent, voluntary participation and no coercion, respects for members, data collection, ethical
governance, no harm to participants, circumvention of undue intrusion, no use of dishonesty, the
presumption and preservation of anonymity, privacy of individual matters, data protection,
permitting participation, provision of criticism procedures, suitability of research methodology,
and comprehensive reporting of techniques.
Recommendations
The author strongly recommends that this project is supported and implemented in the ABC
clinic as soon as possible. Studies commend that mainstream patient no-show is perhaps due to
missing out on planned schedules out of absent-mindedness, and this can be regulated by
safeguarding well-timed reminders which are sent through emails, text messages and phone calls
(Radnor, Holweg & Waring, 2012). The author would recommend that all the cases be examined
for potential delivery by HSE again and recommend that the HSE use their ABC helps to provide
these services so that only one provider delivers the ABC service and it is managed under one
structure. As stated earlier, this proposal on full implementation could be used a means of
enabling systematic reviews, used as an audit for travel and certainly has potential to be used as a
means of remunerating ABC clinic on a four weekly basis.

ORGANISATION DEVELOPMENT PROCESS 21
3.6 Summary and Conclusion
At the heart of the capacity to study, is the philosophy and leadership within an organisation that
vigorously seeks out means to constantly advance the quality and safety of facilities for its
populace. This procedure should be lead in an open and clear manner with flawless responsibility
and accountability arrangements. Leadership is a course of finding a goal, inspiring other
individuals to act and provide care and drive to realise an equally discussed goals but it is a
complex task comprising of many definitions and qualities (BWaibel et al., 2011). Change
programme are frequently highly advanced, noticeable, and costly practices that regularly do not
result in fruitful transformation. This proposal is very apparent and joins the opinions of all
participants at every phase of the course. In addition, if executed it has evidently well-defined
paybacks for patients and employees. And so, the change from the present state to the projected
state ought to be accomplished.

ORGANISATION DEVELOPMENT PROCESS 22
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