Role of Change Agents In Change Management

Running head: ROLE OF CHANGE AGENTS IN CHANGE MANAGEMENT 1
Role of Change Agents in Change Management
HRM 587
Ileana Delgado-Romero
i.romero1629@comcast.net
August, 2014

ROLE OF CHANGE AGENTS IN CHANGE MANAGEMENT 2
Executive Summary
Throughout the years change has been the common denominator for many organizations.
Globalization and technology have mandated change for many organizations that wish to
succeed in this ever-evolving universe. External and internal components demand that
companies look outside of the box to formulate visions, missions and goals that are important to
and resonate with the company, the employees and the customers. Consumers embraced e-
commerce as a way of life for all their needs. Technology and globalization has empowered their
search for quality goods. Demand for quality products and services are more than important to
many companies; it is imperative to survival and success. Organizations need to change their
processes in order to accommodate cultures and consumers from all over the world. Change
develops in different stages and from different circumstances depending on the situation of the
change. The company implements these changes; however, at times the company’s stakeholders
resist change, consider them unsustainable, or misunderstand, causing failure before the plan can
take flight.
Blue Jay Consulting is a change agent, primarily for the emergency room, that develops
solutions to implement process change in a hospital organization. Blue Jay Consulting navigates
and directs an organization through a processual approach that uses models and specific steps to
drive positive outcomes. Morgan Executive Development Institute (MEDI) is a change agent
that develops solutions in order to implement individual change. MEDI interprets and coaches
an organization through an organizational development change that uses participation at the
individual level. Both consulting agents practice different types of change processes, however,
both agents work to increase a company’s employee and customer satisfaction. Each agent
assists the company to target its weaknesses and threats and transition them into strengths and

opportunities. Blue Jay Consulting is a reputable agent whose expertise in the emergency
department is reinforced by increased positive outcomes. MEDI is a reputable agent whose
expertise in leadership coaching is reinforced by increased positive employee participation.
Health Central Hospital is a hospital that has resided in the West Orange Community for
the past100 years. Richard Irwin, former President and CEO, had a vision to move the hospital
from Winter Garden to Ocoee to make it into a large five-floor tower community hospital.
Irwin’s vision was made into reality in 1985. Health Central Hospital became a community
hospital that has resided in Ocoee for over 25 years. In 2010, the CEO announced that the
hospital would no longer be an independent hospital, and it would become part of a private
health system. After two years of deliberation the hospital merged with the Orlando Health
hospital system and its other eight hospitals in the system. The President/CEO retired as a heroic
leader, although, Health Central Hospital did not acquire the status of a heroic organization. The
hospital desperately needed to increase patient satisfaction and remove its reputation and
moniker of “Death Central”. The new President of Health Central Hospital proposed a new
vision and new goals. The primary focus was to change the internal culture to work together as a
team. The employee culture had to change and work collaboratively to achieve an enhanced goal
and reputation of ‘patient first’. The process needed to start in the emergency department; the
heart of the hospital, to reduce its wait times, change its overall processes and work as a team to
drive and embrace positive change for all stakeholders.
Health Central Hospital contracted both Blue Jay Consulting and MEDI to assist in the
emergency room process change and associated leadership coaching. This research paper will
show how both agents are able to assist the culture change of the hospital. The consulting agents
created models that continuously improve processes, break resistance, collect data, maintain

accountability, and create goals of sustainability. Blue Jay Consulting applied the change
management approach to create an easier flow throughput in the emergency department. MEDI
applied the organization development approach to create a participant team among employees
that would dissolve silos and hold for accountability. These methods proved, and continue to
demonstrate, that an organization can rely on more than one agent or model to reach its goals and
outcomes.
An organization does not necessarily need to follow one model in order to succeed; it can
rely on different combinations of models to improve processes and create cultural change. Dr.
John Kotter’s 8 Step Change Model, William Bridges Managing Transition Model and other
models will be used to reinforce this theory. A practice manager must have the knowledge and
skills of different situational approaches, including the approach of contracting a consulting
agent, in order to be prepared for all changes.
Literature Review
Over the past decade consulting agents have become a billion dollar industry that has
globally influenced leaders and organizations on changes. Different concepts of change such as
organizational development and change management approaches are just a few of the various
methods utilized by organizations. Consulting agents provide the skills, resources and tools to
assist organizations in interpreting plans, navigating the tasks, implementing the processes,
defining outcomes and sharing opportunities. According to McCormack et al (2013) in order for
an organization to first contract a change agency it must review these questions, “ what works
(how particular interventions [known as mechanisms] perform), for whom does it work (different
individuals or populations), in what circumstance (different characteristics), and why
(explanations of relationships between mechanisms and contextual characteristics)”. The

concept must match the need and culture of the organization. Health Central Hospital asked
questions along this thought stream. Would Blue Jay Consulting increase the emergency
department flow? Would it affect the skills set and knowledge of the employees? And, would it
decrease the wait times in the emergency room? The same questions were asked of MEDI. Was
MEDI competent as a transformational leader? Could MEDI train the leadership team to
champion the management team who would in turn champion the staff? Could they coach,
educate and lead the culture to work as a team to increase patient satisfaction?
“”Death Central”” was a name associated with Health Central Hospital for a very long
time. It was a very difficult journey for the hospital to change a bad reputation to a good
reputation. A necessary change for the hospital was to improve on the culture’s mindset from a
“task oriented” staff to a “caring for the “patient-oriented” staff. The hospital’s mission
statement states, “caring, compassion and commitment,” however, for years, it did not live up to
those expectations. Physicians, nurses, technicians and all employees needed to work together as
a team for the need of the patient. Why? An organization’s vision and mission statement is the
foundational image of the organization, internally and externally. A consumer depends on these
statements to be authentic and honest. An organization, or in this circumstance a hospital, that is
unable to live up to the expectations of its mission then the hospital will lose its reputation as a
good hospital. The entire organization needed to become a “caring” team, absolutely and
authentically.
Boykin and Schoenhofer (2001) understood the need for a caring environment stating
“committing oneself to living caring requires humility and a lifelong openness to grow in
knowing self and others as caring persons.” It was important to step back and hold employees
accountable to the nature and expectations of their collective purpose at the hospital. The new

president of Health Central Hospital needed to lead the team into a new vision. The vision of
caring for each patient that walks through the doors of Health Central every day and every time.
Up until then, the 25 year vision of a community hospital was not working for the needs and
expectations of the patients, families and caregivers. MEDI, as executive coaches, would assist
in changing the culture to create that goal. The hospital’s president led the team and set the stage
for change by pronouncing, “What we focus on, we achieve”. In turn, the leadership team gave
the management team the resources and tools to change the culture and guide stakeholders
toward positive outcomes.
The Affordable Care Act signed in 2010 was part of the external change, which prompted
Health Central Hospital and all hospitals in the United States to revisit their visions, missions and
goals. Hospitals partnered with other hospitals to create joint systems to cut healthcare costs,
share best practices and provide a better quality of care. The U.S. Legislation and Judiciary
reinforced this intention for change when in 2012 the Supreme Court began to issue deadlines on
all the action plans related to the Affordable Care Act. Consulting businesses contracted for
advice, hand over fist. Hospitals needed leaders, employees and processes that would make
quality care successful. Weise (2013) acknowledges this phenomenon in her article noting
“Thanks in part to the Affordable Care Act, health-care advice is now a $10.2 billion industry
that’s expected to grow six percent annually over the next five years, according to research firm
IBIS World.”
Consulting firms had to re-invent their practices to accommodate and teach healthcare
organizations about the new change in healthcare. Hospitals were in desperate need for leaders
to become coaches, employees to adapt to the change without resistance, and processes that were
efficient and less costly, and provided greater quality of care. This global impact was bringing

the culture to a very large-scale change. The heart of the culture change was in employees.
Employees needed the understanding and teaching of working in teams to produce an excellent
hospital. One influential process in change management was that of building self-managing
work teams (SMWT). Kirkman and Shapiro (1997) reinforced this theory, citing “SMWTs
consist primarily of two dynamic components: (1) the process of self-management and (2)
colloborative team work.”
Health Central Hospital started many organizational changes. ‘Caring Heart’ was a
change that the management team and employees implemented as a service recovery for patients,
families and caregivers. The Service Excellence Committee was started in order to appoint
‘Service Excellence Champions’ from every department who would mentor and coach
employees into providing the best service to all patients, families and caregivers. ‘Finish Strong’
was a summer campaign that requested employees to “create and share memories of kindness”
with the patients, families, caregivers, co-workers and community. These stories were published
on the hospital’s intranet during the summer months. Many of these changes became a ““flavor
of the month”’ that were easily started and done in a positive manner with great but limited
outcomes; the sustainability of these practices was low. The Lean Six Sigma program was the
only true program that lasted; it is still in practice today. According to Canato, etal (2013) “A
new practice requires change in an existing web of practices, and it creates a potential conflict
between what people are asked to do and the ways in which they feel it is appropriate that things
be done, which are reflected in their customary ways of handling organizational activities”.
The hospital introduced ‘Flavor of the Month’ campaigns or new practices that could be
easily implemented and completed. Health Central Hospital employees embraced these activities
with great enthusiasm and positive attitudes; they welcomed the change. Employees diligently

accomplished the goals and objectives associated with these activities. Then at a certain point
their collective mindset returned to the ‘flavor of the month’ activities versus a continual
sustainability of the new program. As stated by Quinn, etal (2012) “our staff have learned how
to collaborate with unfamiliar people, academic structures, policies and approaches and work
together to enhance and deliver each other’s approaches to teaching and learning”. Health
Central staff members learned to work as a team, but it did not learn how to hold each other
accountable to sustain the structure as a team. A consulting agent such as Blue Jay Consulting
would be key to re-organizing the processes to be implemented as long-term action plans. This
change management approach would enable the team to accept and use plans as everyday
occurrences rather than temporary activities. MEDI consulting agents would assist in the
individualized organizational approach to teach and coach each team members through the new
change. Team members would be educated and inspired to embrace changes and have the ability
to forward knowledge takeaways to other team members, thereby creating a ripple effect. These
various approaches would enable Health Central Hospital to mold its culture into one that fosters
a successful team.
Discussion and Conclusion
Change is constant; a drive that establishes heroic leaders who build heroic organizations.
A change can be intended, partial or unintended. Changes can come from a controlled or a
shaping source. It matters not where the source comes from, or what type of source it is. What is
crucial is that the change be reviewed by an organization and its leaders. An organization needs
to be prepared in order to drive more of a proactive rather than reactive outcome. Many
institutions such as governments, hospitals or technology are directed by controlled changes.
These changes usually have a large impact on the system. Organizations usually have an

awareness of changes that will surface in the future. Introduced in 2010, the Affordable Care
Act is a legislative change that no one took seriously. Once healthcare institutions received
deadlines to incorporate change plans, or face monetary penalties, hospitals then moved to
incorporate changes mandated by the act. A practice manager working in an agency would need
to have the skills to interpret these laws and navigate the people who would execute and enforce
the laws. A navigator would be able to control the intended change and through the right
processes navigate the implementation. The CEO and President of Health Central Hospital was a
heroic leader who was able to turn a small hospital into a large-scale community hospital in the
West Orange District. His vision of a caring community hospital was established. It was the
only hospital in the vicinity to serve the community. The hospital faltered when its reputation as
‘“Death Central”’ became a threat and weakness to the hospital’s standards. The Affordable Care
Act catalyzed an avoidable need to change the hospital’s culture and improve its reputation.
As the Affordable Care Act continues to mature, hospitals all over the United States are
shaping their short-term and long-term goals to reflect the needs of the patient. Better quality of
care at a lower cost is now the expectant service. To support this service expectation, Health
Central Hospital had to win back the trust of the community and increase patient satisfaction.
The emergency is the heart of all hospitals. Wait times are a common dissatisfaction or
satisfaction of any emergency room in the country. Health Central’s emergency room wait times
were on an average four to eight hours. Blue Jay Consulting, as a director and navigator, assisted
Health Central by using the change management approach. The change management approach
focused on step-by-step processes and models. Models such as Kotter’s 8-Step Model and
Rand’s Six Steps were and continue to be used to create specific changes. Models were arranged
specifically to the culture and the specific change in question. Blue Jay Consulting’s objective

was to decrease the length of wait times in the emergency room to raise patient satisfaction and
increase revenues.
Figure 1
As seen in Hoelz and Mason’s Health Central presentation (Figure1), Blue Jay
Consulting’s change management approach contained four phases of process improvements.
The first phase in the approach consisted of an assessment methodology which included data
review of patient throughput in the emergency room, interviews with all emergency staff and
leadership and a detailed observation of all areas that collaborated with the emergency room.
The second phase was an inclusive data analysis for one year (January to April, 2009) that gave a
detailed account of wait times, process times, work times and any other interrelated times which
were necessary and unnecessary in the emergency room. The third phase was the
implementation and recommendation phase which included the following (Figure 2):

Figure 2
These action plans were earmarked for implementation within a 26-week timetable. The
plan included revamping the staff and leadership team, increasing efficiency in triage, daily
consultant visits on a temporary basis, education and training of staff, monthly data reports and a
new concierge desk for incoming patients.
MEDI, as coach and interpreter, assisted Health Central by using the organization
development (OD) approach. The OD approach focused on individual development, as well as
the people of the organization. Organizational development models such as Appreciate Inquiry,
Positive Organizational Scholarship and Sense-Making approaches rely on the skills and
competencies of the individual. These models are used together or separately depending on the
need of the culture. MEDI’s organizational development approach included the following five
phases to human performance in an organization (Figure 3):

Figure 3
MEDI’s services rendered its coach services primarily to Health Central’s corporate
leadership team. The first two phases, competency requirements and talent pool, were the
beginning of the process where the MEDI agents gathered information. The two consulting
agents assigned to Health Central collected specific data regarding competency assessments,
education, work experience, leadership experience, and career motivation. Phase three,
assessment of potential, included a day of one-on-one meetings between leadership members and
consulting agents. This all-day meeting connected the consulting agent with the executive to
discuss needs, improvements and goals. Phase four of the individualized process change was
Talent Review. This enabled all executive leaders involved in the organizational development

process to meet with MEDI consultants for a session; the agenda consisted of review tools
analysis, discussion updates and planning of the next steps. The last phase in the process called
Talent Development involved the development of targeted needs future goals and the next steps.
The leadership executive teams connected with the consulting agents by conference call
meetings in which agents provided feedback, resources, tools and coaching for all leaders.
Leaders-coaching management, management-coaching-staff, and staff-coaching-staff was, and
remains, an important organization development process to assist Health Central with culture
change, driving it to think as one unified entity.
Presently, the West Orange Community no longer regards Health Central as ‘Death
Central’. The hospital has improved its status in the community in the last four years since its
merger with the Orlando Health hospital system. The Health Central team has consistently
shown its pride and excellent services during various occasions. As stated recently by the Center
of Medicaid Services (CMS), “Health Central is recognized as a mentor hospital for best
practices in reducing harm and re-admissions.” While working collaboratively with Blue Jay
Consulting and MEDI, Health Central Hospital has been lauded as a “Grade A Hospital for 24
months running by the Leapfrog Group; received full accreditation by the Joint Commission;
was recognized as an Ongoing Professional Practice Evaluation (OPPE) best practice by VHA
Southeast Bright Ideas magazine; was deemed the first and only fully accredited stroke receiving
hospital in Central Florida, and was noted as the number one hospital in the Orlando Health
organization for quality improvement for the last four years”. The hospital’s achievements were
hard-won through collaborative efforts from all members of the leadership executive team,
management, and staff to maintain the ‘patient first’ vision.

Reflections
Managing change is a skill that a practice manager must acquire to gain perspective in the
ever-changing business world. Reading various pieces of literatures and attending classes, I have
come to the conclusion that a manager can start out reflecting one image, however, depending on
the situation, the need, and the approach to the change success may require an entirely different
image. It is up to the manager to make sure they are flexible to handle any approach. The most
important concept I have learned is the situational approach. As a project manager, this
approach is very flexible and will help me effectively decide on the most beneficial images,
approaches and courses of action in the future. Although some models or approaches will be
preferable over others, collectively and interchangeably they can work for a successful
organization. I will challenge myself to become a director and coach who will be able to lead an
organization towards its goals and coach teams to work towards the same goals. As a director I
will always seek change management processes that are detailed and task orientated. As a Lean
Six Sigma user, a director can outline processes and implement changes with definite step-by-
step details. As a coach, the need to select and develop the right team to complete these
processes is also as important. One specific model might not service the need adequately or
answer all of the organization’s needs. A change management approach and an organizational
development approach, working collaboratively, can enhance an organization’s services and
culture. The following models are those that I would choose as a project manager when
implementing a change. The first priority in implementing a change is to assess if there is a need
for a change. Beckhard’s Change Model (Figure 4) teaches a method of using an equation to
assess the need for change.

Figure 4
An organization should always re-evaluate its vision and goals. It is important to assess
if there is a time for a change and if the change can be implemented. Internal resistance to
change can be a great hindrance to an organization, but by following Beckhard’s model, I can
execute a plan to proactively forecast and compensate for these resistances. Once the barriers are
identified, the next step will be to use William Bridge’s model of the 4 P’s. The four P’s is a tool
I would use to outline how I would proceed through executing the change. The first P stands for
purpose. Is there a purpose for this change? There could be dissatisfaction with the current state
of the organization, which demands the consideration of an internal change. There could be an
external component, such as the Affordable Care Act that has forced an organization to make a
change. The purpose is an initiative and a way to keep your plan focused on the goal. The
second P is ‘picture’. This is a necessary step in laying out your timeline and the ‘what if’s’ of
your plan. In Beckhard’s model (Figure 4) he states that the vision needs to be enticing. At this

point I would seek to interpret the vision, its meaning and determine if it is necessary to change
the organization’s current vision or create another one. The vision has always been the drive and
the image of the organization. In order to make sure that these changes will be a positive, it will
be important to “picture” the outcomes. This step would assist me in acting as interpreter and
navigator of the plan.
The next P is ‘plan’. As a practice manager, the planning of any change is crucial. There
is where I would use the Lean Six Sigma DMAIC Methodology (appendix page 20) and Kotter’s
8 Steps to Change (Appendix page 21) to direct the organization in the change process. The
DMAIC methodology is a simple process used by Lean Six Sigma to solve a problem or
implement a change. The five phases, as seen on page 20, consist of steps which include
defining, measuring, analyzing, improving and controlling. These steps contribute to a specific
method of creating change, measuring change and sustaining change. Kotter’s 8 Steps Process
Change will also assist by defining the 8 phases (Appendix page 21) that include creating
urgency, forming a coalition, developing a vision and strategy, communicating the vision,
enabling action and removal of obstacles, generating short term wins, holding the gains and
building on change and anchoring the change into the culture. These combined models will
ensure that I build a precise step-by-step change plan to assist in my change management
approach.
The last of the four P’s is ‘part’. This part for me is where I will implement the
organizational development approach to help me bring the culture into the change. This phase of
the P’s identifies who the players are, what role they are to play, and who is responsible for the
outcomes. I believe that a balance of both the change process approach and the organizational
development approach captures the organization and the individuals. According to Beckhard

(Allen, etal 2014), “the culture can resist or assist in implementing the change”. As a coach, I
would assist in creating a culture that can be part of the change. The team will need to be defined
in order to have the right measures and accountability needed for data analysis. Each team will
consist of the right member to fit the need with precision. A culture that has the right resources
and tools will be empowered to take ownership.
According to Dr. John Kotter (Printwise, 2012), “the rate of change is not going to slow
down anytime soon. If anything, competition in most industries will probably speed up even
more in the next few decades.” Change is here to stay and it would be futile for a practice
manager to be unaware or unprepared for changes that may occur in an organization. The
change management model on the page 18 is my concept on how to implement a change. It’s a
model created from various other models that work in change management processes. I have
learned that a practice manager always needs to increase their skills. Old processes will be re-
invented and new processes will be created, therefore, it would make sense for a practice
manager to make sure that education and training are routinely updated throughout their career.
Many seminars and conferences all over the world offer training in change processes. Practice
managers should also be aware of available resources and tools such as consulting agents who
can assist in large transformational changes. . Consulting agents are more than willing to visit
organizations for onsite consultations. Another important concept learned in this class is team
work. A leader cannot execute a change without a team that takes ownership of the change. It
will be the responsibility of the leader to communicate and involve the team throughout the
process of the vision, the change, and the rewards of the outcome. In the end, it is not the
processes that are important, but the execution of the processes. The process represents the

ability of an organization to culturally co-exist as one team for the goals of meeting consumer
expectations.

Beckhard's
Formula
DxVxF>R
PURPOSE
PICTUREPLAN
PART
• Communication
• Why - external or internal?
• Vision - old or new?
PURPOSE
• Communication
• Short term goals
• Long term goals
PICTURE
• Communication
• DMAIC
• Kotter's 8 Step Process
PLAN
Change Management
Approach
• Communication
• Development of Teams
• Coaching of Leaders
PART
Organizational
Development Approach

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Appendix

Kotter’s 8 Steps Process Change

Role of Change Agents In Change Management

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