Two reviewers independently screened the titles and abstracts followed by the full-text articles that were potentially relevant against the inclusion criteria. An appraisal of methodological and reporting quality of the included studies was also conducted by two further reviewers. Thirty-eight studies were included that reported the use of 12 change management methodologies in healthcare contexts across 10 countries. Change management methodologies were applied in projects at local ward or unit level 14 , institutional level 12 and system or multi-system 6 levels.
The remainder of the studies provided commentary on the success of change efforts that had not utilised a change methodology with reference to change management approaches.
Change management methodologies were often used as guiding principle to underpin a change in complex healthcare contexts. The lack of prescription application of the change management methodologies was identified.
Change management methodologies were valued for providing guiding principles for change that are well suited to enable methodologies to be applied in the context of complex and unique healthcare contexts, and to be used in synergy with implementation and improvement methodologies. The ability to adapt and change is critical to contemporary health service delivery in order to meet changing population needs, the demands of increasing life expectancy and complex health conditions.
With high volume, rapid change required as a central and enduring feature, the healthcare sector has recognised change management as a core competency for healthcare leaders and managers; reflected in professional registration requirements internationally. The Institute for Healthcare Improvement highlights that the Model for Improvement is not intended to replace change models but rather to accelerate improvement.
When integrated with improvement and implementation methodologies, change management models may support increased clinician and patient engagement with change initiatives in healthcare and their success. The contemporary application of change management models in healthcare and their potential value towards enabling change in the context of a complex adaptive system remains unclear.
A systematic review was completed to establish the evidence regarding defined change management models currently adopted in healthcare and the implications of their use to support implementation and improvement methodologies. In this review, change management models are defined as a structured overall process for change from the inception of change to benefits realisation.
The evidence base identified through this review is critical to inform health systems about how change management models currently support healthcare change and to consider the opportunities to integrate change management models with improvement and implementation science methods.
Primary data that demonstrated the application of an identified change management process, defined as a structured overall process for change from the inception of change to benefits realisation eg, PROCSI, ADKAR, AIM , towards healthcare delivery published in English between 1 st January —31 st August were included in the review.
No restrictions were placed on the health system, service setting or the study design for inclusion in the review. Publications discussing a hypothetical change as a result of a planned intervention were excluded. Additionally, non-primary sources such as editorials, opinion pieces or letters were excluded. Review articles were excluded but their reference lists searched to identify additional relevant material. The expansive literature utilising the Model for Improvement was not included in this review given the definition by the IHI as a model to accelerate improvement models rather than as a change model in itself.
Furthermore, an aim of this review was to explore how change management models may support the use of improvement models such as the Model for Improvement. Synonyms and relevant concepts were developed for these two major concepts being evaluated in this review of change management and healthcare delivery. Results were merged using reference-management software Endnote X9. The review process utilised the Covidence systematic review software Veritas Health Innovation, Melbourne, Australia for screening and extraction.
Two reviewers TB, RH screened the titles and abstracts against the eligibility criteria. Full-text documents were obtained for all potentially relevant articles. The eligibility criteria were then applied to the articles by two reviewers TB, RH. Two further reviewers conducted a face validity check on the final set of articles for inclusion HLD, RW , with disagreements resolved via consultation. A narrative empirical synthesis was undertaken in stages, based on the review objectives.
Initial descriptions of eligible studies and results were tabulated Table 1. Common concepts were discussed between the review team members and patterns in the data explored to identify consistent findings in relation to the study objectives. In this process, interrogation of the findings explored relationships between study characteristics and their findings; the findings of different studies; and the influence of the use of different outcome measures, methods and settings on the resulting data.
The literature was then subjected to a quality appraisal process before a narrative synthesis of the findings was produced. Due to heterogeneity of the study types selected, appraisal of methodological and reporting quality of the included studies and overall body of evidence was carried out using the revised version of the Quality Assessment for Diverse Studies tool QuADS , which has demonstrated reliability and validity.
After duplicates were removed, papers were extracted from Endnote into Covidence. After title and abstract screening, papers fulfilled the inclusion criteria and copies of full texts were obtained. Full-text screening led to a total of 38 papers included in the review. Figure 1 demonstrates the screening and selection process. The most common reasons for excluding papers at full-text review were because they did not discuss a formal change management method explicitly , were not in a healthcare setting, 16 were commentary, protocol or editorial pieces, 11 or were not in health service delivery.
The distinct and expansive literature employing the Model for Improvement as a methodology was excluded because, whilst the model intersects with change management methodologies, the focus is determining the nature of changes and adaptations to introduce through incremental introduction and analysis of changes rather than the process of managing the change. This body of work was therefore beyond the scope of the present review. Two articles emerged from non-OECD countries: Nepal 1 study and Uganda 1 study ; and one study did not specify the country.
Most studies were conducted in hospital settings 29 studies , with more than half of these at a department or unit level 17 studies. Other settings included regional level health organisations health centres or clinics, education centres, community health settings and one in a residential aged care facility. Most studies only involved a single institution, 28 seven studies involved in between 2 and 9 institutions, and three studies involved more than ten institutions with the largest number being 25 institutes.
The impetus for change for the majority of studies came from within the organisation 34 studies. In two further studies, change was due to a directive from the state or national health department. In the final two studies, both conducted in non-OECD countries, the impetus for change was from healthcare professional associations.
Most studies performed strongly in reporting their theoretical and conceptual underpinning, and in reporting of research aims and the involvement of stakeholders in the process of change.
Many studies were case examples of change models and presented in a non-traditional research format. This limited their suitability for quality appraisal regarding the reporting of recruitment methods, data collection and data analyses.
Studies often performed poorly on reporting of sampling to address research aims, description of data collection procedure, recruitment and critical discussion of strength and limitations of the study. The findings of the quality appraisal may be indicative of the nature of the publications identified but highlight a lack of transparency regarding the quality of the research design and methods used to gather the data, which must be acknowledged in interpreting the review findings.
Thirty-eight of the identified articles described applications of change management models predominantly applied from the discipline of management into healthcare.
Applications of the Kotter model were primarily identified in nurse-led, local level, single unit or site quality improvement projects. The Kotter model was also applied in a quality improvement program in head and neck surgery in a Canadian surgical department, with authors concluding the model provided a guiding principle to support the change process.
One physician-led study focused on bringing about change in the management of chest pain in a US emergency department using their locally developed AdventHealth Clinical Transformation method. A key value of taking this planned approach was the ability to maintain clinician engagement in the project and achieving outcomes at a timed accountable follow-up.
Twelve institutional-level projects were identified. Stoller et al reported a teamwork enhancement intervention across four respiratory departments of a US hospital to implement and optimise utilisation of the Respiratory Therapy Consult Service RTCS.
However, the application of the model in this context was primarily focused on the moving stage, with few activities that appeared to address the first and third stages of the model and limited data reported of the outcomes of this change project. It was notable that unfreezing activities identified the development of new policies and procedures, with the overall project primarily focused on bringing in the new technology and the moving stage.
Across four medical-surgical units in two Kaiser Permanente hospitals in the US, a Nurse Knowledge Exchange NKE was developed to integrate change management methods into the implantation of practice change. In a larger scale institutional project, Riches 4 Stages Model was applied to transitioning a radiation therapy department to a new hospital site.
The authors reported the model as valuable in supporting smooth transition. A final study of a large four-year change project introducing technology upgrades into a healthcare organisation utilised the Change Acceleration Process CAP model. Six national or system-wide projects were identified. In this study, it should be noted that the model was not applied to explore the role throughout the study.
One international multi-system project was identified that reported the management of change in a World Health Organisation WHO project seeking to shift Allergic Rhinitis and its Impact on Asthma ARIA from a guideline to integrated care pathways using mobile technology in patients with allergic rhinitis and asthma multimorbidity. In maternity services in Uganda and Nepal, change occurred through dissemination workshops, reminders, case reviews, practical workshops and team building guided by AIM methodology.
The operationalisation of AIM was not detailed in the studies. Whilst many studies utilised structured change management models reported successful change, it was not possible to detect whether the use of a model, method or process contributed to the success. Baloh et al followed eight hospitals in the US through a two-year implementation of team huddles TeamSTEPPS to explore, through interviews with 47 leader and change managers or champions, how they performed in relation to the three overarching Kotter phases.
Using the Lewin and McKinsey 7S models together, Sokol et al described the application of change management theory to office-wide culture and structural support to meet the twin goals of safe opioid prescribing and treating patients with opioid-use disorder. Specifically, the programs reported as successful were those introduced in systems that used change management methods aligned more closely with the Kotter model. Our findings identify multiple change management models that are applied to bring about change in healthcare teams, services and organisations.
In the reviewed articles, it was apparent that change management models provided a frame of reference for change agents to support them to consider key elements required for change to occur and be sustained. Key elements include exploring why change is needed and crafting the right messages for stakeholders at every step to bring them along on the change journey.
In the included studies, models that included a series of stages or steps, eg, Lewin or Kotter provided change agents with a series of goal posts to monitor and to create moments of celebration along the change journey. Notably, there was little emphasis on reliance on the models to overcome resistance or develop specific change activities; their value was consistently in providing a broad guiding framework for clinicians creating change.
Drawing upon change management models as a guiding framework rather than as a prescriptive management process is in keeping with contemporary thinking regarding healthcare as a complex adaptive system.
A complex adaptive system seeks to draw out and mobilize the natural creativity of health care professionals to adapt to circumstances and to evolve new and better ways of achieving quality akin to bottom-up change and requires change agents to shift away from the reliance on top-down, highly controlled change processes.
For example, Baloh et al in exploring the introduction and implementation of huddles in rural US hospitals noted the value of integrating broad concepts from change management models, particularly in relation to the earlier model steps, with appropriate implementation scope and strategies.
Methods also emerged from this review that are not as prominent as other change management models and methods but appeared to be used successfully to create and sustain change in healthcare delivery models and services. This review has not determined one change management model as preferred over another. This finding suggests that the guiding framework and flexibility within this to enable a range of activities and actions suited to the particular circumstance is of key value rather than a particular change management approach.
It was notable that in the context of healthcare, change management models were often used by clinicians in local-level projects. The models were rarely used to address issues of resistance and more often used to provide a framework to house a broad and diverse range of activities to facilitate successful sustained change.
Clinician engagement in the change process emerged as a critical factor for change to take hold and be sustained. Change is naturally challenging for humans, particularly when it is rapid and ongoing. The guiding principles of the change management models we identified as commonly used in healthcare seek to create an enabling culture for change; seen through shared ways of thinking, assumptions and visible manifestations. The reviewed articles suggest an enabling culture for change is central to creating opportunities for and supporting clinician engagement from decision-making about change through to change implementation.
It is well established that implementation research is focused to more than translation of evidence from bench to bedside. As the scientific study of methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice, and hence to improve the quality effectiveness, reliability, safety, appropriateness, equity, efficiency of health care, it is inextricably linked with healthcare change and its management.
One artefact of organisations with cultures supportive of change is the presence of co-design efforts. Such approaches are however contingent on appropriate supports to ensure participants have both the capability and capacity to engage. Our findings must be considered in terms of the limitations of the included studies and the review process. It is possible that some relevant studies were not captured by the database search or were made available after the search date.
The included studies were often case examples of change initiatives with limited breadth of sample and a lack of detail reported about the research methods. The quality of such studies was therefore challenging to appraisal due to the limited reported information.
The ability to generalise findings from such studies was also limited when case examples were utilised. According to Wischnevsky , organizational leaders are more likely to act if they perceive a gap between the actual level of performance compared to an internal or external benchmark or if there are changes that require their action. Research has shown that certain circumstances tend to increase the likelihood that leaders will engage in major organizational change initiatives.
These circumstances include top management changes, environmental shifts and a decline in performance. All of the models incorporate the development of a vision or desired business result and movement from the status quo to a future state.
Visioning is one of the most important steps of a change process. A good vision helps people in the organization know where they are going. Many organizations have written visions that are published, distributed to employees and hung prominently on the walls.
Having a published vision is not enough to direct people to a future state or assist them in getting there. The leaders have to communicate the vision to the people within the organization and they have to lead by example to make the vision real. When there is a difference in what leaders say and what leaders do, this leads to a loss of trust and faith among the leaders and their people.
If the vision of a company is to have the best workforce in the industry and the leaders disregard employee opinions, hire inappropriate candidates and spend little in the way of employee training and education, it sends a message that the vision is not really worth the paper on which it is written Simonson, Some of the models address the concept of changing processes to empower people in the organization to change.
This step includes evaluating the current systems, processes and capabilities to facilitate change. Organizational learning and the ability of a company to create and exploit knowledge and information leads to successful organizational performance Farrell, Flood,Curtain, Hannigan, Dawson and West According to Herrick , leaders should be involved in stewardship. This involves the transformational process of involving others in solutions and actions.
Leaders need to create a healthy work environment to provide the framework for a positive and professional practice environment. All of the models incorporate the idea of reinforcing and creating small improvements to encourage additional change. Most organizations have a model for improvement. Employees need to understand that every process can be improved and when leadership focuses on continuous improvement and reinforces the small successes, it encourages people to seek more opportunities for improvement Pryor, White and Toombs, People respond differently to change.
Some people find it exciting and enjoy change, while others vehemently resist it. Resistance is a normal reaction to change and should be expected. This is especially true during the development stages of groups undergoing change and working on improvement projects. Leaders need to understand this reaction and support the teams as they go through these phases of change. Transformational organizations recognize normal resistance and plan strategies to enable people to work through their resistance Kohles, Baker and Donaho, There are some significant differences in the models as well.
All change models, except Shields , identified a step where the support for the change is completed as well as developing the team which will make the changes.
The change plan should not be created in some high level office and then forced upon the staff who will implement the changes. Instead, the planning should involve a vertical and horizontal microcosm of an organization.
It is empowering when people are involved in the planning and change management process Collins, Each model except Shields addresses the importance of communication in order to gain support for the change and to encourage buy in. Although she does not discuss communication in the steps of her change model, Sheilds does discuss them in the cultural model or levers which lead up to change.
Successful organizations have to acquire, integrate and use new knowledge to be successful. They have to be able to combine and exchange information in order to enhance their processes to guard against failure.
Understanding where an organization is and where they should be is part of this process. Successful implementation of change involves discipline. Collins in his book, Good to Great, indicates that the most successful organizations should have disciplined people, disciplined thought and disciplined actions.
People should be held accountable for their actions and this can not occur unless measurements are in place. Newcomb suggests that leaders have to be accountable to the organization for the results of their plans and the outcomes of the organization. Accountability requires a master plan which can be segmented into smaller projects, assigned to teams and monitored by team leaders. This plan can be tracked with target dates for completion and evaluation Newcomb, Kotter and Shields focus more on the cultivation of the team members implementing the change.
Transformational leadership has four dimensions: 1 charisma, 2 inspiration to gain support for their vision, 3 individual consideration and 4 intellectual stimulation. He indicates that there are specific requirements for successful leaders: 1 Leaders must have the ability to assess the environment on a continuous basis: 2 Leaders must know what their visions are and be able to gain support for them; and 3 Leaders must have the ability to execute the plan in order to achieve the vision that they have established.
Carly Fiorina achieved significant, meaningful change at Hewlett Packard HP as she fought board members and acquired Compaq. However, they differed in terms of speed of execution. La Monica, According to Carless , there are common themes seen in transformational leaders. These leaders can clearly articulate a vision, use nontraditional thinking, encourage individual feedback, promote a trusting environment and promote cooperation among the team.
Transformational leadership has become a popular model of leadership in business organization. According to her study, there are few gender differences in transformational leadership behaviors. What is important to transformational leadership is the emphasis on vision, development of individuals and empowerment Carless, Preparation for the Abnormal Mitroff says that organizational leaders have no other alternative — they must think about and prepare for the abnormal.
He states that nations as well as organizations and institutions have become breeding grounds for crises of all kinds.
He feels that conventional management is of little use in either coping with or preventing major crises.
In fact, he feels that conventional methods are largely responsible for causing major crises. Organizational leaders must think about and prepare for the abnormal because in the last few years, a new and ominous category of crises abnormal, intentional accidents has emerged. These intentional accidents are the result of deliberate acts of evil. Abnormal, intentional accidents are bad enough, but the character of normal accidents has also changed dramatically.
Therefore, organizational leaders should adopt a dynamic strategic management model that enables their respective organizations to be in a state of continuous entrepreneurial reinvention. They can only do this if their strategic management model is a systems model and all elements in the system are continuously re- aligned as reinvention occurs.
This is a systems model and all five elements of the model must be aligned for the model to be most effective. If these elements are in place and in a state of continuous re-alignment, an organization can become transformed and transforming. Its organizational leaders can invent its future and it can positively impact its domestic and international environments.
The Purpose strategic thrust , Principles, Processes, People and Performance systems should be in place so that the organization can operate at the highest possible levels of efficiency and effectiveness. Toombs, and John H. This era is one of rapid change, sophisticated communication and technological systems and variables that make preparation for the future complex and fast-paced. In order to be able to be a winner in this type of environment, processes and relationships must be streamlined, non- value-added activities must be eliminated and people at all levels in organizations must be empowered to rapidly make decisions and held accountable for those decisions.
The organizational leaders who anticipate and invent the future are even more successful because they are the leaders in their organizations and their industries. The organizations that do not survive are those that are led by people who fail to invent the future or even adapt to change.
Empirical research should be conducted assessing the extent to which organizations have developed an agile system that can continuously reinvent itself.
This research should investigate what parts of the system are missing or inadequately aligned in order to predict how capable the organizations are in terms of organizational transformation. Organizations need more than a model that simply helps an organization move from the current state to a future state.
What is needed is a comprehensive, systems model that is strategic, yet also has elements that are executable at the tactical level. References Armenakis, A. Argyris, C. Arnetz, B. Advantages of conducting a crosswalk are that it elucidates key connections and critical opportunities for growth and knowledge expansion, equitable resource allocation, and inquiry; and it depicts a large amount of information in a clear and concise manner. However, since the goals of qualitative methods are not causal links or generalizability, crosswalks can offer an intentional, systematic method to consider complex information in a meaningful way.
To conduct a gap analysis between required skills for nurse executives and competency assessment. To compare the findings of two mental state exams in the African Americans for accurate interpretation. To link unique physician identifiers from two national directories so that Medicare data can be used for research.
For this case, the crosswalk was used to visually examine the relationships, concepts, and language used within two approaches to change and quality improvement. Team members visualized the similarities and dissimilarities and adopted the teacher and learner role necessary to move the BSR project forward.
Our Team Initially, an interprofessional team of six consisting of executives; mid-level and staff nurses; performance improvement professionals; the patient-family education and resource center; and director of ethics convened through semi-monthly work sessions from early spring to early fall for the purpose of BSR. During interprofessional work sessions, the language used among team members when discussing the improvement process differed, which resulted in confusion among members and became a barrier to collaboration.
What the team experienced was similar to what Andersen and Rovik described as the many interpretations of lean thinking. Different definitions or interpretations of concepts were being made, prolonging the improvement and sustaining process. D'Andreamatteo et al. The team wanted all participants of the various disciplines to see the commonalities of approach, to create a better known definition of each concept, and to continue to build collaboration and understanding for better outcomes.
Visually showing theoretical connections helped improve the understanding of all team members and thus our process became more adoptable to the group. This crosswalk, demonstrated in Table 2, launched the connection to understand improvement theory and techniques. Our Process and Crosswalk Once we determined a topic of interest bedside reporting our interprofessional team used the following process to problem solve:.
Our Outcomes This case review illustrates two outcomes. To browse Academia. Skip to main content. By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy.
Log In Sign Up. Download Free PDF. It cannot be changed without changing our thinking. Not long ago, Amazon was simply a source to purchase books online.
Fast forward 20 years. So, why is it that businesses like Amazon possess the uncanny ability to adapt and reinvent themselves ahead of shifting consumer preferences or industry trends, while once formidable and ubiquitous businesses like Kmart and Sears become casualties in the retail landscape? Yet, no matter how logical or well planned the new course of action might be, buy-in from employees is crucial.
The lack of cooperation between employees, a general distrust of unproven processes, or the fear of turning away from what has worked in the past are just some of the common barriers to implementing change. One of the constants in any business is the need to regularly evolve — to change. This may be due to advances in technology, the growth of a company, or the changing demands of consumers. Home Explore Login Signup. Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime. Next SlideShares. You are reading a preview. Create your free account to continue reading.
Sign Up. Upcoming SlideShare. Managing change theories. Embed Size px. Start on. Show related SlideShares at end. WordPress Shortcode. Share Email. Top clipped slide. Download Now Download Download to read offline. Change management theories Aug. Education Business.
Management Engineering. Jo Balucanag - Bitonio Follow. Change Management Models- a comparison. Organization change mgmt models.
Change management strategy ppt. Change management. Change Management In Organisations. Change Management. Change Management - Leading Organizational Change. Related Books Free with a 30 day trial from Scribd. Related Audiobooks Free with a 30 day trial from Scribd. Change management theories 1. Stella M. Change management theories and how well they are implemented can be the ultimate driving factor of success in the organizational change.
There are many models and theories, and each one has potential benefits or weaknesses for each organization.
0コメント