A Personal Framework for Leading, Managing and Promoting Sustainable Change in Health Care

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A personal framework for leading, managing and
promoting sustainable change in Health Care
Introduction and Background
Healthcare organisations are some of the most complex
institutions partly because of the confluence of different healthcare
practitioners since they bring on board competing viewpoints, interests,
and time horizons in the management of different healthcare policies
and strategies (Mitchell, 2013). Instituting changes to address various
healthcare concerns in such a complex and multifaceted environment
can indeed be a daunting task but possible (Ham, Kipping, and
McLeod, 2003). It requires grounded leadership from the government
and healthcare institutions as well as tighter cooperation amongst
healthcare practitioners. Healthcare stakeholders must articulate a
firm and common understanding of what leading, managing and
promoting sustainable change is as well as its implications (Parkin,
2009)
This paper focuses on how change implementation can be lead,
managed and sustained over time in an ever dynamic healthcare
environment. In doing so, a critical review of the literature on
sustainable change will be examined. This literature review will then
inform the description of my personal framework for leading, managing
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and promoting sustainable change in my future role as a nurse leader-
manager in a theatre environment.
Literature Review
To successfully facilitate change in the healthcare industry,
healthcare stakeholders must be well acquainted with how change
happens in order to come up with a conducive environment for leading,
managing sustainable change (Barr, 2016). Van de Van and Poole,
(2000) assert that the change management process is not only complex
but also very non-sequential. Healthcare providers are bound to
experience change either as change agents or change targets (Grenny,
et al., 2013). The change agents are the stakeholders bestowed with the
authority and powers necessary to effect change policies in practice
while change targets are those stakeholders the organization
recognises as being part and parcel of the change itself. Change agents
include policy makers, consultants, and managers while change targets
include ordinary employees but some stakeholders may be both change
agents as well as change targets (Varkey, & Antonio, 2010).
Cultivating a healthcare environment that supports and
promotes sustainable change by and large demands the attainment of
commitment of both of these stakeholders. Gaining commitment plays
a big role in overcoming resistance to change from stakeholders who
may feel left out in the planning, formulation, and implementation of
change initiatives (Bridges, 2009). Commitment can be achieved by
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first assessing the motives of all stakeholders bound to be affected by
change besides finding out if they perceive change as positive or
negative for the healthcare organisation. Individuals must be in a
position to perceive that eminent changes are for the good of the
organisation and that the benefits of the changes proposed far outweigh
the disadvantages (Battilana, et al., 2010).
Leading, managing and promoting sustainable change in the
healthcare industry is extensively underpinned by certain critical
elements central to the healthcare sector as was aforementioned.
These are; strength based approaches, appreciative inquiry,
interpersonal and intrapersonal stakeholder relationships, and
engagements, governance and leadership, communications, obtaining
and maintaining key stakeholder buy in, and measurement, monitoring
and evaluation (Antwi & Kale, 2014).
Strength-based Approaches
Strength-based approaches tap on the strengths persons,
organisations, relatives, and teams exhibit and by extension
positioning these assets to facilitate change and empowerment
(Hammond, 2010). Essentially, strength-based approaches to sustained
change exploit the assets different people hold to influence their own
betterment. Strengths that individuals, groups and organisations
exhibit include skills, experiences, connections, and knowledge.
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Healthcare practitioners should identify these strengths and mobilise
them to effect necessary sustained changes.
Focussing on strengths does not necessarily insinuate assuming
the presence of challenges or trying to sway them into strengths but it
means finding opportunities within one’s capacities significant at
solving these challenges. As a change strategy, strength-based
approach calls upon healthcare practitioners to work in collaboration
with those seeking support by assisting them to carry out things by
themselves. (Hughes, 2008). As such, individuals cease from being just
consumers of support to become co-producers of the very support
(Morgan & Ziglio, 2007). However, McMillen, Morris, and Sherraden,
(2004); Staudt, Howard and Drake, (2001) have openly criticised
strength-based approaches by advancing that these approaches are no
different from most traditional approaches besides not being evidence
by research. To salvage this strategy from condemnation as an
important change strategy, different disciplines have used various
terms to define it. In mental health, positive psychology and recovery
are perceived as efficient describers of strength-based approaches.
Community development uses the term "asset-based" while
practitioners in prevention are inclined to use the term “resilience”
(Petersen and Seligman, 2004).
In efforts of leading and managing sustainable change in
healthcare, these varying terms can be pretty confusing. To this end,
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Rapp, Saleebey, and Sullivan (2008) advanced six standards that
practitioners can employ in determining what exactly constitutes a
strength-based approach. First, the strength-based approach is goal
oriented meaning it is aimed at achieving specific set goals. Secondly,
the approach is aimed at assessing the strength of those seeking
support since individuals are embodied with recourses that can enable
them to overcome their adversities. Thirdly, the environment has
resources that individuals can exploit to ease any difficulties at their
disposal.
It is the role of practitioners to identify the environmental
resources that can lead and sustain change in the health status of their
patients. Fourthly, strength-based approaches exploit explicit methods
for determining both patient and environmental strengths to achieve
set objectives. Fifthly, relationships built by strength-based approaches
are meant to elevate the hopefulness of patients as well as affirming
relationships with people and communities. Lastly, strength-based
approaches capacitate people to make informed decisions and choices.
Appreciative inquiry
Appreciative inquiry (AI) as a change management strategy is
concerned with determining what strategy works best for an
institution, finding out why the strategy works well and moving ahead
to implement it more in future endeavours (Lewis, Passmore, &
Cantore, 2016). The leading principle underpinning the appreciative
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inquiry change strategy is that an organisation will always grow in
whatever orientation the stakeholders in the organisation adopts
(Messerschmidt, 2008). To this end, if a healthcare organisation decides
to focus more with challenges and problems, then determining
problems and challenges likely to impact the organisation and finding
solutions to them is what the institution will do best. On the contrary,
if the healthcare organisation instead focuses attention on
organisational strengths, then the focus is laid at identifying strengths
and developing those strengths and this consequently becomes what an
organisation can do best (Bushe, 2013).
In leading and managing change for sustainability purposes,
appreciative inquiry demands that change agents ask change targets
specific guided questions in a way that promotes positive thinking as
well as an employee to employee communication (Cooperrider, 2013).
The questions lay emphasis on four critical areas; discover, imagine,
design and deliver (DIDD). Discover questions are aimed at facilitating
the determination of change cues that are beneficial and work
efficiently for the organisation. Imagine questions are instrumental in
analysing why specific processes work well besides helping in
brainstorming strategies of replicating them elsewhere in the future.
Design questions are inclined at creating an action plan while deliver
questions are concerned with the creation of a criterion for evaluating
success.
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