How to Enact Change Dissertation Defense


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The people and organizational side of change management

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How to Enact Change Dissertation Defense

  1. 1. Leadership Action Required to Enact Change By: Barbara Julian Garner July 12, 2013 Barbara Julian Garner 1
  2. 2. Nature and Background of Issues • Chapter 1: Barbara Julian Garner 2
  3. 3. Nature and Background of Issues • Introduction – Interest in topic – Definition of terms • Nature of the Issue: – Many changes being implemented at Preston Memorial for all employees – Non-Clinical employees were being asked to interact with patients within the clinical setting Barbara Julian Garner 3
  4. 4. Nature and Background of Issues • Internal Stakeholders: – – – – Non-Clinical employees Clinical employees Hospital leadership Staff physicians • External Stakeholders – – – – Patients Patients’ family members Community at large Accrediting Boards • The Joint Commission • Medicare Barbara Julian Garner 4
  5. 5. Nature and Background of Issues • Issue Background & Context: Examination of the Beginning of a Cultural Change – Patient-Centered Care Model – Six Pillars of Excellence & the No Pass Zone (Studer 2003) Barbara Julian Garner 5
  6. 6. Pupose of the Study – Identify challenges to hospital leadership during a change process at Preston Memorial Hospital Barbara Julian Garner 6
  7. 7. Research Questions 1. If there were leadership challenges in executing this cultural change, especially in regards to nonclinical employees, what were they and why did these challenges arise? 2. If there were issues with the implementation of this cultural change, especially in regards to nonclinical employees, what were the leader lessons learned? Barbara Julian Garner 7
  8. 8. Literature Review • Chapter 2: Barbara Julian Garner 8
  9. 9. Literature Review • Chapter 2: • Leadership Role in Change Management – – – – Kotter (2007) Hiatt (2006) Luecke (2003) Randall (2004) • Leadership & Employees Shared Role: Teaming – Edmondson (2012) – Ul-Bien & Ospina (2012) Barbara Julian Garner 9
  10. 10. Literature Review • Chapter 2: • Preparation for Change:     Dudink & Berge (2006) Duncan, R.D. (2012) Hiatt, J.M. (2012) Kotter, J. (2012) • Importance of Teamwork  Edmondson, A. (2012) • Engagement of Employees  Galunic & Hermreck (2012) • Barriers to Change  Shaller (2007) Barbara Julian Garner 10
  11. 11. Methodology • Chapter 3: Barbara Julian Garner 11
  12. 12. Research Desgin Research Design: Single Case Embedded Design (Based on Yin 2009) Context of Single Case: The Change Process Related to Implementing a Patient-Centered Care Model Embedded Case Analysis 1 Embedded Case Analysis 2 Embedded Case Analysis 3 • Non-Clinical Employees • Clinical Employees • Hospital Leadership The Three Embedded Areas of Analysis Reviewed for the Change Process Barbara Julian Garner 12
  13. 13. Single Case Study with Embedded Design • Case Study: – – – – – Allowed the use of varied methods and dives into people’s behaviors The interest in the process—How things work and why Provided understanding of a program or event of an organization Provided understanding to a complex issue Added breadth and depth to data collection and assisted in bringing data together from multiple sources (Yin, 2009) • Embedded Design: – Allowed for the investigation into non-clinical, clinical, and leadership employees in the changes related to implementing a patient-centered care model Barbara Julian Garner 13
  14. 14. Method • Explanatory Mixed Method – Quantitative/Qualitative • Surveys: Quantitative • Open ended interviews: Qualitative • In what ways do the qualitative data help explain the quantitative method? Barbara Julian Garner 14
  15. 15. Validity & Reliability The following procedure was recommended by Creswell (2009) – 3 peers reviewed inputted data for accuracy – 2 doctorally prepared professionals were consulted to expand or deny themes – Validity was achieved by sending the interviews back to the interviewees for verification – Average length of the interviews were 45 minutes Barbara Julian Garner 15
  16. 16. Data Collection • Surveys were distributed by the Community Development Director • Surveys returned in sealed envelopes without any personal identification. Colored coded for either Non-Clinical, Clinical, or Leadership • Interviews were conducted in the researcher’s office • All questions were answered and interviewees were at ease • Consent form was explained to and signed by participants • Audiotaped • Transcribed • Transcripts verified by participant • Themes analysis verified by 3 other reseachers Barbara Julian Garner 16
  17. 17. Data Processing & Analysis – – – – – Survey data were calculated and bar graphs were used to present data Data were used to provide focus for interviews Individual verified transcript was read In the analysis themes were identified Themes were then re-examined for patterns common to all 3 groups Barbara Julian Garner 17
  18. 18. Data Processing & Analysis • Rigor • Ethics • Limitations • Delimitations Barbara Julian Garner 18
  19. 19. Results • Chapter 4: Barbara Julian Garner 19
  20. 20. Survey Distribution & Returns • Total Surveys Distributed – 105 Non-Clinical Surveys – 141 Clinical Surveys – 6 Leadership Surveys • Total Surveys Returned – 49 Non-Clinical Surveys – 60 Clinical Surveys – 3 Leadership Surveys • A Likert Scale was used for each question with room for comments at the end of the survey Barbara Julian Garner 20
  21. 21. Survey Analysis • Survey Analysis – A simple percentage was used – If a 50% or higher of respondents disagreed or strongly disagreed with the question, that topic was expanded on in the interview questions. – Each group’s survey contained a comment section • Some survey questions did not add to the understanding of the issues and were not used in the interviews. These can be found in Appendix F • The data collected were used to answer research questions Barbara Julian Garner 21
  22. 22. Survey Results I Understand the Need for the Six Pillars of Excellence 100% 95% Percentage 91% 90% 86% 85% 80% 75% Non-Clinical Clinical N=109 Respondents Agree or Strongly Agree Barbara Julian Garner 22
  23. 23. Survey Results I Support the No Pass Zone 90 82% 80 Percentage 70 60 50 40 30 20 10 0 N=49 Non-Clinical Agree or Strongly Agree Barbara Julian Garner 23
  24. 24. Survey Results Non-Clinical Employees Feel Comfortable Entering a Patient's Room 120% 100% PERCENTAGE 100% 80% 68% 60% 40% 20% 0% Non-Clinical Staff Leadership N=52 RESPONSES OF DISAGREE & STRONGLY DISAGREE Barbara Julian Garner 24
  25. 25. Survey Results Barbara Julian Garner 25
  26. 26. Survey Comments • Constant Positive Themes – PMH Employees supported the changes that were implemented – PMH Employees understood the changes • Constant Negative Themes – Preparing employees for the changes – Addressing the fear of employees with the changes Barbara Julian Garner 26
  27. 27. Interview Information • Interviews were voluntary and offered to all employees • Interview Participants: – 6 Non-Clinical Employees – 5 Clinical Employees – 3 Leadership Barbara Julian Garner 27
  28. 28. Research Questions & Discoveries 1. Part A: If there were leadership challenges in executing this cultural change, especially in regards to non-clinical employees, what were they? – – – – – Preparation for changes Feeling a part of the change Lack of engagement Communication about the changes Fear of the unknown Barbara Julian Garner 28
  29. 29. Common Themes Coded Interviews - Common Themes Fear of the Unknown - 9 Communication on changes being implemented - 10 Explanation for the Lack of Engagement - 11 1 Inclusiveness in the Change Process 12 Preparation for the Changes 13 0 2 4 6 8 Barbara Julian Garner 10 12 14 29
  30. 30. Other Issues Coded Interviews - Other Issues Improved Employee Identification 1 Patient Acceptance and Training - 2 Employee/Patient Safety 2 0 0.5 1 1.5 Employee Identification Patient Acceptance Barbara Julian Garner 2 2.5 Patient Safety 30
  31. 31. Interview Findings • Fear of the Unknown: NC1 explored the idea that the fear for the non-clinical employee was how that patient feels about a non-clinical employee coming into his/her room: NC1 imagined wondering “What are you [non-clinical employee] doing in my room if you can’t help me and why are you in my room?” C5 stated: “It is kind of the fear of the unknown…I think that the non-clinical staff does have some issues with the No Pass Zone because they don’t know and they are scared.” Barbara Julian Garner 31
  32. 32. Interview Findings • Communication About The Changes: NC6 explained the idea of a breakdown in communication as follows: “There was not only a breakdown in communication between leadership and nonclinical employees, but there was also a breakdown in communication within the leadership team. The leadership team was not on the same page and there was a conflict between them on how all the changes were presented… I was in the room when this was all presented and you could feel the tension in the room… There is a communication breakdown that we continue to have problems with. It is the expectations of people, and again I have said since the day I got here; the expectations for clinical and non-clinical need to be clearly defined and they are not. They are blurred and merged.” Barbara Julian Garner 32
  33. 33. Interview Findings Avoidance of the No Pass Zone: 11 of the 14 interviewees admitted to avoiding the patient care area so as not to engage in the process. Barbara Julian Garner 33
  34. 34. Interview Findings • Lack of Inclusiveness: NC3 stated: “I haven’t really been invited to give input or anything. That [being asked] would be nice. ” C4 stated: “I feel there is a separation of how much clinical and non-clinical employees have been involved. Clinical, especially nursing, have been involved more than nonclinical, and that is what I mean by a separation. ” Barbara Julian Garner 34
  35. 35. Interview Findings • Preparedness NC3 stated: “It is intimidating if you are non-clinical because you don’t know what to do… I wouldn’t know where to go to look for a nurse… Are they at the nurse’s station?” C1explained that clinical employees who are not on the patient care floor also need training: “We could have done a better job preparing our people. I couldn’t tell you where the call light is…I know how to do a certain procedure, but I just don’t know how to get in and out of the room.” HL1 felt more training needed to be done with both clinical and non-clinical employees: “I think they [all employees] know bits and pieces, but I am not sure they know how to put it all together. They can regurgitate the information but they can’t connect the dots. I think both clinical and non-clinical employees need more training on all the changes we are asking them to make.” Barbara Julian Garner 35
  36. 36. Research Questions & Discoveries 1. Part B: Why did these challenges arise? - Failure to communicate the changes being implemented - Lack of preparation of employees for the changes HL3 commented on the survey: “I don’t think we did a very good job with many things in [with] the No Pass Zone…We did not explain the importance of non-clinical staff in answering a patient call light…We did not prepare or train them[non-clinical employees] on what to do. We just told them what to do and to do it.” Although leadership realized they did not communicate or prepare the non-clinical employees they did not identify a reason why. Barbara Julian Garner 36
  37. 37. Research Question & Discoveries 2. If there were issues with the implementation of this cultural change especially in regards to non-clinical employees, what were the lessons learned? - Lack of preparedness of the employees for the changes - Inclusivity of employees in the change process - Communication of the change process - Better framing of the Six Pillars of Excellence as an over arching theme NC 32: “ There should be more information given to non-clinical employees about A-I-D-E-T and the 6 Pillars [of Excellence].” From Survey C15: “I feel that managers need to review A-I-D-E-T with employees and potentially do some role playing to help non-clinical employees feel comfortable using it.” NC4: “Maybe we could have been given examples or scenarios that would have helped us to understand what we need to do.” Barbara Julian Garner 37
  38. 38. Conclusions & Recommendations • Chapter 5: Barbara Julian Garner 38
  39. 39. Results & Findings Summary • Non-clinical employees supported the No Pass Zone in theory but not practice. • Non-clinical and clinical employees understood the need for the Six Pillars of Excellence. • Non-clinical employees did not feel prepared for the No Pass Zone. • Non-clinical employees stated they were afraid to enter a patient’s room. • Non-clinical employees felt a lack of inclusiveness with the changes. Barbara Julian Garner 39
  40. 40. Recommendations for PMH Leadership • Overall Plan for PMH for Future Change – Understand the rationale for preparedness of those involved in a change process – Create a clear vision and common direction – Provide the preparedness needed for employees to make the change – Communicate the change and involve people in the process – Assign or hire a change agent to oversee any profound change projects • Example New Hospital Building Project Barbara Julian Garner 40
  41. 41. Leadership Actions Arose During this Study – Implementation of a pilot hospital wide shadowing program. – Internal electronic employee engagement survey distributed to all PMH employees on the changes being asked of them. Survey data is still being gathered. – Hospital leadership have started to visit NEO to explain the 6 Pillars of Excellence. – A LEAN Project is being developed for identification of infectious rooms: This training will be for all employees. This researcher has been asked to be a member of the LEAN Project Team. Barbara Julian Garner 41
  42. 42. Recommendations for Future Studies – Do patients want non-clinical employees coming into their rooms? – When you ask non-clinical employees to interact with patients in a clinical care setting how does this impact employee and patient safety? – Will patient satisfaction scores improve or decline due to non-clinical patient interaction in a clinical care setting? Barbara Julian Garner 42
  43. 43. Contribution to the Theory & Practice of Leadership The 7 Elements of Organizational Change Based on Randall 2004, p.38 Analyze the Organization & Its Need for Change Create A Shared Vision and Common Direction Create A Sense of Urgency Support a Strong Leader Role Craft an Implementation Plan Communicate and Involve People Reinforce & Institutionalize Change Barbara Julian Garner 43
  44. 44. Contribution to the Theory & Practice of Leadership – Organizational side of change – Kotter’s Eight Stage Change Model 2002 • • • • • • • • Establish a sense of urgency: Inspire people to move Build the guiding team Get the vision right Communicate for buy in Empower action Create short term wins Don’t let up Make the change stick – Prepare employees for the change – Communicate and involve people – Create a shared vision and common cirection Barbara Julian Garner 44
  45. 45. Contribution to the Theory & Practice of Leadership – The People Side of Change • It is people who change not organizations • Successful change occurs when the individual’s change matches the stages of organizational change (Hiatt 2006) – The Fear Involved with Change • • • • • • Fear of not having the ability to make the change Fear that the change will fail Fear that the change is inconsistent with his or her values Fear that the risks of change outweigh the benefits Fear that the change is going to make their jobs more difficult Fear that those who are responsible for the change can’t be trusted (Kotter 2002) Barbara Julian Garner 45
  46. 46. Self Evaluation: A Tool for Future Research – Being an employee in the organization was a plus and a minus. – I wish I would have drilled down on some questions. Example: When leadership failed to give reasons for their admitted failure to communicate, I wish I would have asked why. – The importance of asking for recommendations on surveys and in interviews. – Employees felt comfortable and safe for interviews. Had minimal issues with obtaining volunteers. – Had to constantly remind self not to lead the interviewees and at times got off track and was too chatty. Barbara Julian Garner 46
  47. 47. Acknowledgements My Committee: Dr. John Barnette Dr. John Sidor Dr. Ruth Panepinto Dr. Kathleen Jackson DEL Cohort WV01 – David -Bill – Kathleen -Kimberly – Stephanie -Dena Dedicated to my parents: John & Rose Abruzzino Julian Barbara Julian Garner 47
  48. 48. Questions & Comments Barbara Julian Garner 48