Planning and Implementation of Change at the World Health Organization

This report provides a comprehensive analysis of the change process implemented at the World Health Organization (WHO), focusing on the strategies employed by Dr. Lee. The report examines the necessary changes, including decentralization, human resource reforms, administrative efficiency, IT investments, and the promotion of accountability and transparency. It delves into the change process management, highlighting external consultations, listening and learning phases, strategic planning, delegation of responsibilities, and the crystallization of changes. The report also discusses Dr. Brundtland's previous attempts at change, including the challenges faced, such as employee resistance and poor leadership. Furthermore, it addresses the future challenges facing Dr. Lee's transition team, including organizational culture, the utilization of virtual teams, and employee motivation. The analysis provides insights into the successes and failures of the change management initiatives, offering a valuable case study for understanding organizational transformation within a global health context.

PLANNING AND IMPLEMENTATION OF A CHANGE PROCESS
WORLD HEALTH ORGANIZATION CASE STUDY
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Table of Contents
1.0 Introduction................................................................................................................................4
2.0 Change path required by WHO.................................................................................................5
2.1 Organization level changes/ Decentralization.......................................................................6
2.2 Human resource reforms........................................................................................................7
2.3 Administrative efficiency and competency...........................................................................8
2.3 Information Technology (IT) investment..............................................................................8
2.4 Accountability and transparency...........................................................................................9
3.0 Change process management at WHO......................................................................................9
3.1 External Consultations...........................................................................................................9
3.2 Listening and learning phase.................................................................................................9
3.3 Strategic planning................................................................................................................10
3.4 Delegation of responsibilities..............................................................................................11
3.5 Crystallization of changes....................................................................................................11
3.6 Change management model implementation.......................................................................11
4.0 Dr. Brundtland changes at WHO.............................................................................................12
4.1 Dr. Brundtland first unsuccessful attempt...........................................................................13
4.1.1 Resistance from the employees....................................................................................13
4.1.2 Poor Leadership skills...................................................................................................14
4.1.3 Poor managerial change................................................................................................15
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5.0 Future challenges facing Dr. Lee and his transition team.......................................................15
5.1 Organization culture............................................................................................................15
5.2 Virtual teams’ utilization.....................................................................................................16
5.3 Employees motivation and satisfaction...............................................................................16
6.0 Conclusion...............................................................................................................................17
References......................................................................................................................................18
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1.0 Introduction
Health problems have increasingly become a major concern globally. Numerous people in the
world are suffering from various diseases that need immediate attention. Both communicable and
non-communicable diseases affect both young children and adults alike. Due to these concerns,
World Health Organization (WHO), was established with a goal of improving health conditions
in the whole world (Petersen 2003). Additionally, WHO aims in promoting healthy lifestyles,
reducing health risks as well as responding to various underlying factors and the determinants of
health. WHO operates under several objectives; It aims in developing and implementing various
multi-sectoral healthy policies for the general public. It also applies integrated approaches which
are age- and gender-sensitive for community empowerment hence improving self-care, health
promotion, and health protection.
WHO was established in the year 1948 on April 7. It’s one of the specialized agencies of United
Nations (UN) and is headquartered in Geneva, Switzerland. WHO consists of three major bodies;
the Executive Board, the Secretariat and the World Health Assembly (WHA). WHA is usually
concerned with the decision-making process of the entire organization.
Figure 1: Structure of WHO
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World Health Organization
The Executive
Board
World Health
Assembly
The Secretariat

Due to the rapidly changing world especially in the health sector, it is crucial for WHO and other
organizations concerned with health to adapt to these changes by implementing sustainable
strategies. As such directors of the WHO have a mandate of ensuring the organization adapts to
the rapid health changes experienced globally (Jong-Wook 2003). This paper, therefore,
discusses change process and the planning and implementation strategies that can be adopted.
Special focus will be on the case study involving Dr. Lee who was appointed the Director-
General (DG) of WHO in 2003.
2.0 Change path required by WHO
The world is rapidly changing with the emergence of new diseases every day. Diseases such as
HIV/AIDS, Ebola, Malaria, Tuberculosis and other communicable diseases and viruses pose a
significant threat to the wellbeing of individuals (Heymann et al. 2015). WHO is, therefore,
faced with a challenge of ensuring the changes occurring in the health sector are contained. Other
difficulties experienced by WHO include; decreased governmental financial support, lack of
interest by the society on health issues, competition for the limited funds and resources, and
poverty especially in the developing countries. Due to these challenges, every Director General
(DG) of WHO has a huge role to play in ensuring the prevailing situation is contained. Dr. Lee
Jong-Wook was one director who brought such significant changes in the organization during his
era (Lidén 2014). His main agenda during his term was to develop a sustainable approach to the
ever-changing world of public health. To effect this, he first brought together a core change team
that was to analyze the changes and determine the way forward. It was, therefore, crucial for the
organization to undergo various changes to gain back their power in improving the health sector
throughout the world. Change path which is taken by WHO include;
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2.1 Organization level changes/ Decentralization
Dr. Lee mission was to bring WHO back to its roots by making it a result-oriented and flexible
organization. Before Dr. Lee was elected as the DG of WHO, the WHO headquarters had the
mandate of overseeing all the operations of the organization. It used to set targets, goals, and
priorities for the organization, distribute human, and financial resources as well as determine the
overall organization in both county and regional offices. Due to this, WHO was therefore known
as a hierarchic, top-down organization (Cassels et al. 2014). The lack of confidence in these
county and regional offices made it difficult for the organization to perform their work
effectively. Dr. Lee believed that the skepticism shown by the management that the county and
regional offices could not deliver on their own brought about the centralization of the finances
and resources. Therefore, this made the organization to underperform since only the headquarters
had the mandate of overseeing the entire operations of the organization.
Organization structure can either be centralized or decentralized. In a centralized organization,
the decisions of the entire union, as well as the power and authority, are in the hands of the top
management (Goldthau 2014). It means that only the top management can control the operations
of the organization since the lower levels cannot decide on their own. On the other hand, all the
levels of the organization are given powers and authority to effect any changes they deem fit in a
decentralized structure. Dr. Lee understood the demerits of centralization, and that’s why he
pushed for decentralization of the WHO. The disadvantages are; loss of agility, organization size
involvement, lack of personal involvement by the junior employees, and lack of ownership.
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Figure 2: Centralized and decentralized structure
Reorganization of WHO into a decentralized structure consequently, involved reallocation of
finances and resources to places where they were needed most (Graham 2014). For instance, the
weak regional and county offices like in Africa they were deployed with greater resources that
helped them to focus more on country’s needs. Certain technology programs were also deployed
in various regional offices that amplified the effect while reducing the costs. The accountability,
authority, power, and responsibilities of these agencies were also increased.
2.2 Human resource reforms
Human resource (HR) plays a crucial role in the performance of an organization. Dr. Brundtland
proposed some of the changes impacted on HR department by Dr. Lee during his term in 2000.
Building a competency framework was one of the major reform which was implemented. The
structure was meant to lay out the job profile for each category (Gautier et al. 2014). It involved
having certain competencies such as writing and communication skills, leadership and
management experience. Implementation of appraisal system was also essential in improving the
performance of the organization. Evaluation and assessment of the employees allow the
organization to understand their strengths and weaknesses. Consequently, you can employ
strategies that can enhance their performance. To improve the performance of the employees, it
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is crucial to keep on motivating them. Motivation can be achieved through incentives, rewards,
and promotions (Zeb et al. 2014). Through this, the employees are committed to the organization
operations, and the overall performance is increased.
Other HR reforms that were implemented involved a voluntary and mandatory mobility
programs and rotation programs. The aim was to break the cultural barriers that were there for a
long time. The employees were now able to move from one position to another across the
organization offices which gave them mobility and new experiences (Lerer and Matzopoulos
2001).
2.3 Administrative efficiency and competency
The administration of WHO was undergoing through a critical process. It was known to suffer
from inertia and bureaucracy (Unit 2001). It was necessary, therefore, to change the common
culture of the organization and at the same time reduce the costs as well as maintain the
operations at high standards. Although it was a difficult task, the transition team together with
the cross-functional team implemented the proposed cultural adaptations effortlessly. All the
initiatives created strengthened the organization while promoting collaboration.
2.3 Information Technology (IT) investment
Before Dr. Lee’s period, IT infrastructure at WHO was poor. In the IT department, there was no
proper leadership as well as IT support. As such, the change path required was to develop IT
infrastructure to enable the free flow of information throughout the organization offices.
Therefore, a new director in the year 2004 was appointed to head the IT department. His primary
assignment was to use an Enterprise Resource Planning (ERP) tool to develop a new system
encompassing a Global Management System (GMS). Also, they also initiated training programs
for the staff to understand how to use the new software as well as appreciate its usefulness
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(Yamey & Abbasi 2003). The team went further in introducing a Strategic Health Operations
Centre (SHOC) that enhanced connectivity between the regional and county offices. It became
the WHO global hub that nowadays is used to provide response operations and alert system.
2.4 Accountability and transparency
WHO activities usually involve a cooperative system with other United Nations Agencies and
other governmental and international institutions. Thus, it is always important for their results to
be in line with their objectives. Otherwise, there is a high chance of losing trust and financial aid
from their donors. Accountability was thereby increased through decentralization of the
resources to various levels (Eccleston-Turner & McArdle 2017). Implementation of performance
auditing system further enhanced transparency and improved the overall performance of the
organization.
3.0 Change process management at WHO
Dr. Lee and his transition team brought significant changes at the WHO. The transition process
was not easy, but he promised to bring the organization to greater heights. Therefore, Dr. Lee
and his team applied some reforms that enabled them to manage the transition process.
3.1 External Consultations
Dr. Lee and his transition team worked so hard in ensuring the implementation of changes they
had introduced. Dr. Lee decided to engage external McKinsey consultants to help them achieve
their goals (Kumaresan et al. 2004). Despite the fact that they still had their in-house resources,
the team needed an external group that would introduce new ideas. It was vital to introduce new
ideas since innovation is key to the success of any company.
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3.2 Listening and learning phase
The ‘listening and learning’ phase was launched in March 2003. This phase aimed to perform
internal consultations within the organization to determine the cause of the challenges facing
WHO. All the senior advisors of WHO were interviewed where they gave their views on various
problems affecting the organization. The transition team went a step further by traveling to
different member states of WHO where they also listened to their concerns. Stakeholders as well
took part in giving their views especially on the state of health and development all over the
world. Getting in touch with the concerned parties played a vital role in transition process
implementation and management. These are people who are in close contact with what is
happening in the society and hence have knowledge on how to manage or contain the situation.
3.3 Strategic planning
The team developed a strategic plan which ensured all the changes they raised were
implemented. It was crucial to ensure all the changes made in the structure organization at WHO
were adapted quickly and did not affect the normal operations (Klarner et al. 2008). The plan
was to analyze critically the situation the organization was and the future direction. It helped
them to achieve their targets and initiatives they had set. Through this, Dr. Lee re-organized the
office of Director General by bringing inboard a new leadership team.
Figure 3: Dr. Lee’s DG office
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Leadership Team
DG Office
Transition Team
Planning
Teams
Senior
Management
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3.4 Delegation of responsibilities
Dr. Lee did not achieve the results of the changes he implemented in the organization alone. He
delegated responsibilities to various senior officials heading various offices who in turn
delegated to their managers and junior staff. The process was as well termed as Rollout phase 1.
By giving managers and other official power and authority to carry out organizations mandate, it
enhanced the performance of the organization significantly. The managers had the duty of
motivating their employees who in turn produced work of high quality. Motivated workers are
enthusiastic and are known to work so hard and as well remain committed to their jobs.
3.5 Crystallization of changes
The implementation of changes started in July 2003, during the period of roll-out phase I. With
time there was progress in the operations of the organization. During roll-out phase II, all the
planned changes by the team were executed (Klarner et al. 2008). Despite the fact that the
changes took time to be implemented, at the long run the team and Dr. Lee succeeded in
achieving their objectives.
3.6 Change management model implementation
Change is very vital in every organization or business. Many organizations are failing today not
because the managers do not know that change is required but because they do not know who to
consult or how to effect the change. Change management is crucial for the survival of an
organization. Dr. Lee knew this so well and that why he applied the Unfreeze-Change-Refreeze
model in this process change.
Figure 4: Lewis change model
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RefreezeChangeUnfreeze

He used the Lewis Change Management model in bringing WHO back to its feet. The process
starts by preparing the employees to be ready for the change, and then the involved parties start
to resolve the uncertainty created in the unfreeze stage. Here, the teams start to implement the
planned change in achieving their objectives. In the refreezing stage, the organization now is
ready to institutionalize the changes to be used in day to day operations. Dr. Lee and his
transition team applied this model appropriately that saw the performance of WHO improved.
4.0 Dr. Brundtland changes at WHO
Dr. Brundtland was the 5th Director General of WHO before being succeeded by Dr. Lee. She
was elected to head WHO in 1998. After being elected many people had hope in her that she
would strengthen the reputation and position of WHO by implementing the necessary reports.
Given that she was the former Prime Minister of Norway; it gave her many opportunities to get
funding from various donors who would invest in the health sector (Gwatkin 2000). However,
contrary to the expectations of many, she did not meet their expectations. She did not seek for
the second term in office, and as such, she served for only one term. Dr. Brundtland was not able
to effectively lead the organization in curbing the spread of various diseases as well as in
improving the health conditions worldwide. Nevertheless, she was able to come up with some
reforms that saw the organization perform on some sectors. For instance, she initiated the
establishment of the Commission on Macroeconomics and Health, launched new partnerships for
health, started the Framework Convention on Tobacco Control which aimed at reducing tobacco
usage and sensitizing people on the risks associated with tobacco smoking (Horton 2002). She as
well was among the people who initiated various focus programs in different countries.
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4.1 Dr. Brundtland first unsuccessful attempt
Dr. Brundtland tried to improve the performance of WHO by forming a team of external experts
who helped her to make critical decisions on mental health and health system as a whole.
However, despite her effort, WHO still faced severe structural problems. These challenges had to
be addressed immediately for the survival of the organization. During her time WHO was termed
as a compartmentalized, top-down and bureaucratic organization. Lack of success by Dr.
Brundtland during his era is attributed to various factors.
4.1.1 Resistance from the employees
Due to the crisis that Dr. Brundtland found WHO in, she tried to propose some reforms with the
objective of improving the overall operations as well as the performance of the organization.
However, since she was only nominated and not fully elected at the time, she started
experiencing resistance from the staff members. Some of her actions were considered immature,
and therefore, her reforms were not implemented successfully. Some employees felt threated and
thereby started being so defensive, and as a result, they did not participate fully in the change
process implementation. When she started questioning the employees more on their work
pattern, she further faced greater resistance. Due to the resistance she encountered, she could not
bring a significant change at WHO (Godlee 1998). When a company is changing, normally there
is resistance either from the individuals or the whole organization at large. Organization
resistance can be attributed to factors such as organizational culture, need to maintain stability,
and authority threats. Individual resistance mostly is due to fear of the unknown, freedom loss,
and job insecurity.
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4.1.2 Poor Leadership skills
Leadership skills are crucial for the success of a business or any organization. The leader should
focus on the important aspects that determine the success of business. Creating teamwork
ensures cooperation amongst the employees and as well between the top management and the
juniors. Various models have been proposed which try to explain proper leadership skills
especially for managers, senior staff, directors and other leaders in managerial positions. Adair’s
model, in particular, gives the three areas that every leader should employ to avoid chances of
failure (Adair 1973). The model focuses on the task, team, and individual. These three factors
when implemented correctly they lead to efficient performance.
Figure 5: Adair’s model
Dr. Brundtland specifically concentrated on the task more forgetting the importance of teamwork
and the role played by single individuals. She aimed to develop various reforms, but she couldn’t
implement them alone. She needed the employees and therefore, what she could have done was
to consider the employees and motivate them. The employees were afraid they could lose their
jobs. But if she explained to them that the reforms were for the good of the company as well as
for them as individuals, she could have avoided the resistance.
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Task
Team
Individual

4.1.3 Poor managerial change
Dr. Brundtland administrative changes were not received so well by the WHO staff. She tried to
centralize WHO by ensuring all the resources were concentrated at the WHO headquarters in
Geneva. Comparing Dr. Brundtland and Dr. Lee, Lee scores highly due to his managerial skills
and change process management and implementation. As much as she tried to centralize all
resources at the headquarters, she was not able to extend her reforms to other offices. For Dr. Lee
he decentralized the organization allowing resources to be distributed to county and regional
offices. There are basic managerial philosophies that have proposed by various scholars. It
contains several elements such as recognition, trust, satisfaction, involvement (Meyers & van
Woerkom 2014), and availability of the employees as well as the emphasis on the end-results.
5.0 Future challenges facing Dr. Lee and his transition team
One of the greatest DG of the WHO was Dr. Lee, who together with his team did excellent work
in transforming WHO in both structure and performance. Nevertheless, there are always
challenges that face one during their progress (Chow 2005). Dr. Lee was not an exemption, and
therefore, he experienced various problems during the implementation of the change process. For
instance, when they proposed for voluntary mobility programs, 180 people registered to change
positions, but only 20 were given an okay to change. However, at the end of it all, no one moved.
5.1 Organization culture
WHO was known for a long time as a centralized organization. It is always difficult to change
the culture of an organization completely. It’s a process that takes time before the people,
society, and stakeholders accept the real difference (Gagliardi 1986). For Dr. Lee, it is important
to consider the culture and traditions of the WHO before implementing the changes. If people are
not ready to leave their traditions, then it becomes difficult to apply any change since it will not
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be accepted. It is crucial, therefore, for the team and Dr. Lee to put into consideration the WHO
cultures and traditions for effective implementation of changes.
5.2 Virtual teams’ utilization
It is also known as a geographically dispersed team. Virtual team use involves the process of
people working from different geographical locations but working together. The process is
mediated by communication technology such as voice and video conferencing, FAX, and emails.
The process of a virtual team is very critical for WHO due to the various members they have.
Due to the difference in geographical location, WHO needs virtual teams in the various
geographical locations where their county and regional offices are located. It’s through this that
the organization can be able to run their operations smoothly in all the regions. Despite the fact
that Dr. Lee has upgraded information technology systems, challenges remain that need to be
overcome (Daim et al. 2012). Cohesion and trust are the major issues facing the team together
with lack of face-to-face communication and meetings. To avoid project failures and minimize
the probable risks, the team together with Dr. Lee need to ensure proper facilitation of the virtual
team projects.
5.3 Employees motivation and satisfaction
For employees to perform well, they need to be motivated and satisfied. Fulfilling the
employee’s needs and expectations is a difficult task for an employer. And this is the challenge
that is facing the transition team and Dr. Lee. Getting the junior staff motivated and accepting the
changes made is very difficult. However, this is the ultimate challenge that the team needs to
undertake to ensure the changes are implemented without any resistance. Expectations and needs
of workers can be categorized into three aspects; intrinsic satisfaction, economic rewards and
social relationship. Fulfillment of these three elements determines the extent to which the
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employees are motivated and in turn the final results. Motivated employees produce quality
work, and their performance is greater as compared to less motivated employees (Ali & Ahmed
2009). Job fulfillment is also vital and this one of the reasons that the voluntary rotation program
that Dr. Lee introduced did not become successful.
6.0 Conclusion
World Health Organization has a significant role to play in the health sector worldwide. Every
Director General of WHO usually has a big mandate to perform in ensuring smooth operations of
the organization. Dr. Brandtland together with Dr. Lee transformed the organization by
implementing various reforms. Changing an organization nevertheless, takes time and hard work
and requires patience. During change process implementation, an organization might experience
challenges, but with good strategies, teamwork, and collaboration with the stakeholders, it is
possible to have a smooth transition process.
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