Current Events and Planning
You are a manager in a public health agency. in reading the morning paper before going to work today, you peruse an article about the influx of hispanic families in your county. there has been an increase of 10% in this population in the last year, and it is expected to continue to rise. You ponder how this will affect your client population and your agency.
You decide to gather your staff together and develop a strategic plan for dealing with the problems and opportunities that this change in client demographics presents.
Assignment: in examining the 10 steps listed in development of strategic plans, what are the things that you can personally influence, and what other individuals in the organization should be involved with the strategic plan? Make a list of 10 to 12 strategies that will assist you in planning for this new client population. What other statistics will you need to help you plan?
What are some other future developments in your county that could have a positive or negative influence on your plan?
Curran, C., & Totten, M. (2010). Mission, strategy, and stakeholders. Nursing Economics, 28(2), 116–118.
Huston, C. (2014). Technology in the health care workplace:
Benefits, limitations, and challenges. In C. J. Huston (Ed.), Professional issues in nursing (3rd ed.).
Philadelphia, PA: Lippincott Williams & Wilkins 214–227.
JaxWorks. (2012). The balanced scorecard concept.
Retrieved April 22, 2013, from http://www.jaxworks .com/thebalancedscorecardconcept.htm
Marketing Teacher. (2000–2013). SWOT analysis: Lesson.
Retrieved April 22, 2013, from http://www .marketingteacher.com/wordpress/swot-analysis/
McNally, M. (1980). Values. As individual experience broadens, realistic value systems must be flexible enough to grow... part 1. Supervisor Nurse, 11, 27–30.
Operational Assessment in Strategic Planning. (2012).
H&HN: Hospitals & Health Networks, 86(11), 39–41.
Saint-Amand, A. (2008, February 6). Building an expert exchange. Networks in decision-making. O’Reilly Media, Inc. Retrieved April 22, 2013, from http://
en.oreilly.com/money2008/public/schedule/
detail/2187
Voges, N. (2012). The ethics of mission and margin.
Healthcare Executive, 27(5), 30–32, 34, 36.
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8
Planned Change
… managing and innovation did not always fit comfortably together. That’s not surprising. Managers are people who like order. They like forecasts to come out as planned. In fact, managers are often judged on how much order they produce. Innovation, on the other hand, is often a disorderly process. Many times, perhaps most times, innovation does not turn out as planned. As a result, there is tension between managers and innovation.
—Lewis Lehro (about the first years at Minnesota Mining and Manufacturing)
… I can’t understand why people are frightened of new ideas. I’m frightened of old ones.
—John Cage
CROSSWALK
this Chapter addresses:BSN Essential II: Basic organizational and systems leadership for quality care and patient safety BSN Essential III: scholarship for evidence-based practice
BSN Essential VI: interprofessional communication and collaboration for improving patient health outcomes
MSN Essential II: Organizational and systems leadership
MSN Essential IV: translating and integrating scholarship into practice
MSN Essential VII: interprofessional collaboration for improving patient and population health outcomes
MSN Essential IX: advanced generalist nursing practice
AONE Nurse Executive Competency I: Communication and relationship building AONE Nurse Executive Competency II: a knowledge of the health-care environment AONE Nurse Executive Competency III: Leadership
AONE Nurse Executive Competency V: Business skills QSEN Competency: teamwork and collaboration
LEARNING OBJECTIVES
The learner will:l differentiate between planned change and change by drift
l identify the responsibilities of a change agent
l develop strategies for unfreezing, movement, and refreezing a specific planned change
l assess driving and restraining forces for change in given situations
l apply rational–empirical, normative–reeducative, and power–coercive strategies for effecting change
l describe resistance as a natural and expected response to change
l identify and implement strategies to manage resistance to change
l involve all those who may be affected by a change in planning for that change whenever possible
l identify characteristics of aged organizations as well as strategies to keep them ever-renewing
l identify critical features of complex adaptive systems change theory
l describe the impact of chaos and the butterfly effect on both short- and long-term planning
l plan at least one desired personal change
Many forces are driving change in contemporary health care, including rising health-care costs, declining reimbursement, workforce shortages, increasing technology, the dynamic nature of knowledge, and a growing elderly population. Contemporary health-care agencies then must continually institute change to upgrade their structure, promote greater quality, and keep their workers. In fact, most health-care organizations find themselves undergoing continual change directed at organizational restructuring, quality improvement, and employee retention.
In most cases, these changes are planned. Planned change, in contrast to accidental change or change by drift, results from a well thought-out and deliberate effort to make something happen. Planned change is the deliberate application of knowledge and skills by a leader to bring about a change. Successful leader-managers must be well grounded in change theories and be able to apply such theories appropriately.
Today, most health-care organizations find themselves undergoing continual change directed at organizational restructuring, quality improvement, and employee retention.
Many change attempts fail because the individual undertaking the change uses an unstructured approach to implementation (Mitchell, 2013). Indeed, what often differentiates a successful change effort from an unsuccessful one is the ability of the change agent—a person skilled in the theory and implementation of planned change—to deal appropriately with conflicted human emotions and to connect and balance all aspects of the organization that will be affected by that change. In organizational planned change, the manager is often the change agent.
In some large organizations today, however, multidisciplinary teams of individuals, representing all key stakeholders in the organization, are assigned the responsibility for managing the change process. In such organizations, this team manages the communication between the people leading the change effort and those who are expected to implement the new strategies. In addition, this team manages the organizational context in which change occurs and the emotional connections essential for any transformation.
But having a skilled change agent alone is not enough. Change is never easy, and regardless of the type of change, all major change brings feelings of achievement and pride as well as loss and stress. The leader then must use developmental, political, and relational expertise to ensure that needed change is not sabotaged.
In addition, many good ideas are never realized because of poor timing or a lack of power on the part of the change agent. For example, both organizations and individuals tend to reject outsiders as change agents because they are perceived as having inadequate knowledge or expertise about the current status, and their motives often are not trusted. Therefore, there is more widespread resistance if the change agent is an outsider. The outside change agent, however, tends to be more objective in his or her assessment, whereas the inside change agent is often influenced by a personal bias regarding how the organization functions.
Likewise, some greatly needed changes are never implemented because the change agent lacks sensitivity to timing. If the organization or the people within that organization have recently undergone a great deal of change or stress, any other change should wait until group resistance decreases.
It becomes clear that initiating and coordinating change requires well-developed leadership and management skills. It also requires vision and expert planning skills because a vision is not the same as a plan. The failure to reassess goals proactively and to initiate these changes results in misdirected and poorly used fiscal and human resources. Leader-managers must be visionary in identifying where change is needed in the organization and they must be flexible in adapting to change they directly initiated as well as change that has indirectly affected them. Display 8.1 delineates selected leadership roles and management functions necessary for leader-managers acting either in the change agent role or as a coordinator of the planned change team.