Abstract
This issue of Healthcare Management Forum is devoted to case studies of managing change within healthcare services and small scale systems. Why? Because these indirect examinations of leadership may be the most direct way of examining the essence of what the work of health leaders produces. Simply defined, leadership is the art of achieving common goals through the actions of others. Leadership is not, as W. C. H. Prentice noted in a seminal publication in 1961, goal achievement through the exercise of power and force over others. Leaders set direction, align people, motivate and inspire individuals, groups, and communities. But how do we recognize and measure the outcomes of leadership? How is the worth of leaders identified?
Studies of leadership tend to examine attributes that leaders possess and use but do not always help us understand leadership in a way that we can hold it in our hands, the way that we can hold financial spreadsheets and deeds of asset ownership. What do leaders lead others to? Once an individual or group arrives at a destination—a goal—and that goal is beneficial to them, evidence and our own tacit experience tell us that these same individuals and groups will return to that destination again and again. They do not need leaders and leadership to take them there. They know the way and use it. Leaders are the ones who step off the beaten path, who look beyond the benefits of current ways and means to recognize different destinations, with different (hopefully better) benefits. They set these different destinations as new goals and turn their focus toward management of the means to have others adopt and achieve these new goals. In this sense, change management is a process used to accomplish new achievements.
To pull this issue together, we posed a framework for authors to work within: Describe a change management project that you led. What did you do? What worked and did not work? Why? What would you do differently if you had a chance for a re-do? The challenge was accepted and seven case studies are presented, not only as the interesting and necessary projects that they are—but as leadership and change management learning opportunities for readers.
Balcom and Reyes present a project that produced a 50% improvement in door-to-needle administration time using LEAN methodology demonstrating the value of engaging content experts and explicit cues to achieve efficiency improvements in team performance. A lesson exposed in this project is the adoption of a “no excuses” culture within the management and celebration of goal achievement.
Participatory action methodology underlies the implementation of intentional rounding as a nursing intervention to improve responsiveness to inpatient needs in the case study by Maddigan and her co-authors. This brave depiction demonstrates the necessity of identifying and using not just a change management framework for a project but selecting and using the “right” change management framework—one that resonates with the intent of the project and the culture and setting in which the project is carried out.
Much of the successful management of a change project lies in the pre-work of leaders in motivating and inducing commitment to and connection between a new practice and desired outcomes. Heenan and co-authors dug behind the scenes to examine the understanding by non-clinical staff of core clinical care procedures and their influence in building commitment for clinical quality improvement developments across organizational departments and functions. This case demonstrates the nuance that changes must be understood and accepted, not only by the individual or team adopting a new process or action, but by those whose work supports, but are physically removed from, the “frontline” of the change.
Three articles examine change management cases that extend beyond a single organization to networks and health authorities. Our French language article by Dubois describes change within the governance model of a health and social service network. Dubois goes on to describe the new partnership that emerged and the joint vision which will contribute to the definition and determination of the nursing workforce in Quebec. This project demonstrates the confluence between internal and external environments. As a result of this change management project, political actions have been taken to change the legislation governing the practice of nursing in Quebec and broaden collaboration between the associations and the universities in the province.
Drebit and her co-authors describe the change management process underlying the development of a multi-organizational emergency medicine network. Change management lessons learned include the requirement for the change design and implementation to be responsive in real time to more or different needs that emerge during implementation of a planned project. Simply put, leading and managing change requires flexibility and nimbleness as much as accepting and implementing change does.
Within a project designed to bring new capacities into a health authority, Trytten and her co-authors highlight the criticality of aligning planned changes with organizational vision, values, priorities, and interestingly, key partnerships. They warn against allowing time pressures to rush implementation of planned changes. They also suggest that simplifying complex processes into linear segments may be counterproductive to the achievement of a large-scale change project. Their advice, “embrace complexity and work with it.” Perhaps we should listen.
However, leading change happens not only at the tangible frontline. Brave souls tackle culture change, as in the article by Forster and co-authors who describe and analyze a hospital’s determination to adopt a culture of patient, visitor, and staff safety—termed a “Just Culture.” Cultural change may be the epitome of leading and managing change. It takes years to achieve and is susceptible to outside influences such as external societal forces such that it requires consistency in values and communication. Overall, this penultimate case provides us with a profound leadership and change management lesson—the balancing of adaptability with resiliency.
So, by examining or measuring the management of new achievements, leadership can be grasped, its outcomes and worth identified. Static, closed-system services and organizations need neither leadership nor management. They will exist and self-perpetuate. Dynamic, open systems and services need both. If your organization is in the latter category, you will benefit from reading this issue of Forum.
