Gaining and maintaining commitment to large-scale change in healthcare organizations

Abstract

Healthcare administrators have sought to improve the quality of healthcare services by using organizational change as a lever. Unfortunately, evaluations of organizational change efforts in areas such as total quality management (TQM), continuous quality improvement (CQI), and organizational restructuring have indicated that these change programmes have not fulfilled their promise in improving service delivery. Furthermore, there are no easy answers as to why so many large-scale change programmes are unsuccessful. The aim of this analysis is to provide insights into practices that may be utilized to improve the chances of successful change management. It is proposed that in order to effect change, implementers must first gain commitment to the change. This is done by ensuring organizational readiness for change, surfacing dissatisfaction with the present state, communicating a clear vision of the proposed change, promoting participation in the change effort, and developing a clear and consistent communication plan. However gaining commitment is not enough. Many change programmes have been initially perceived as being successful but long-term success has been elusive. Therefore, maintaining commitment during the uncertainty associated with the transition period is imperative. This can be done by successfully managing the transition using action steps such as consolidating change using feedback mechanisms and making the change a permanent part of the organization's culture.

Creating a Culture of Accountability in Health Care

“…The second part of this question relates to the fact that any significant organizational change initiative that is to be longlasting does not occur without changing the culture of an organization. 5,6 WHY IS A CULTURE OF ACCOUNTABILITY IMPORTANT?…”

“…Inadequate or inappropriate leadership has been identified as a key factor when attempts to change culture fail. 6 Within the context of leadership, there are also 2 management philosophies that are pervasive. They are commitment-based management and control-based management.…”

“…5,11 This is unlike transactional leadership, which works by trying to engender organizational compliance and control by using mostly material motivational factors such as reward systems. 6 Transformational leadership by contrast is based on inducing culture change for the long term by mapping onto employee-shared values such as stewardship for the health care system and by creating a compelling vision that communicates urgency for change. It also creates an environment of psychological safety that fosters open reporting, active listening, and frequent sharing of insights and concerns and by empowering and supporting team learning throughout the organization.…”

Organisational Culture, Leadership Styles and Employee’s Affective Commitment to Change: A Case of Yemen Public Sector

“…Peters and Waterman (1982) suggested that organisational culture has a considerable influence on organisations, particularly in areas such as commitment. Maintaining commitment during the uncertainty that is associated with the transition period is very important because it changes an internal part of organisational culture (Narine & Persaud, 2003). Furthermore, (Porter, et al, 1974) argued that organisational commitment starts with a firm belief in the acceptance of the organisation's goal and values and additionally the authors suggested that the internalization of organisational values should create a strong belief in these values, consequently creating a perception of individual commitment to the organisation.…”

Myers‐Briggs and psychological type and change style for hospital executives

“…Discontinuous change reforms the industry by restructuring and relocating its boundaries and the nature and base of its competition (Narine & Persaud, 2003). Transformational change focuses on ways to break the current organizational frame and think beyond the existing dominant ideas, and in the process it can disrupt the status quo in the industry (Bigelow & Arndt, 2005).…”