Ideological tensions amidst rapid and continuous organizational change in healthcare

Abstract

PurposeThe aim of this study was to explore the nature of frontline nurses' experiences of living with rapid and continuous organizational change.Design/methodology/approachA critical hermeneutic approach was utilized. This was a qualitative inquiry theoretically guided by critical management studies.FindingsParticipants recognized that many change initiatives reflected an ideological shift in healthcare that supported a culture of service, whilst sacrificing a culture of care. A culture of service prioritized cost-savings and efficiency, which saw nurses lose the time and resources required to provide quality, safe care.Practical implicationsNurses felt morally responsible to uphold a culture of care, which proved challenging and at times unobtainable. The inability to provide quality, safe care in light of organizational changes resulted in a multitude of negative emotional repercussions, which fostered moral distress.Originality/valueThe findings from this study bring to light ideological tensions that negatively impact nurses. This study supports the conclusion that the planning, implementation and evaluation of organizational change initiatives must reflect a culture of care in order to alleviate the many negative experiences of organizational change noted in this study.

Change fatigue in nursing: An integrative review

“…Although many authors reported homogeneity among their definitions of change fatigue, some had divergent definitions. For example, some authors recognized change fatigue manifests as a resistance to change or cynicism about change (Davis, 2002; Authors suggested that rapid and continuous practice initiatives have become the norm due to the constant need to improve healthcare delivery (Brown et al, 2018;Davis, 2002;McMillan, 2018;McMillan & Perron, 2013;Muir et al, 2021;Vestal, 2013). The current healthcare landscape of continued improvement results in Brown, 2016;Brown et al, 2018;Brown & Abuatiq, 2020;Summer Bryant, 2020;Camilleri et al, 2019;Gee et al, 2017;Kapping, 2021;Lind et al, 2018;Mayer & Hammelef, 2013;McMillan, 2018;McMillan & Perron, 2013, 2020bMuir & Keim-Malpas, 2020;Muir et al, 2021;Reineck, 2007;Szumilas, 2015;Valusek, 2007. Divergent definitions of change fatigue Davis, 2002;Huynh et al, 2018;Kapping, 2021;Mayer & Hammelef, 2013;Metusela et al, 2021;Reineck, 2007;Vestal, 2013. No definition provided Davis, 2002;Ead, 2015;Gee et al, 2017;Muir & Keim-Malpas, 2020;Wozniak et al, 2020.…”

“…Rapid and continuous change Brown et al, 2018;Camilleri et al, 2019;Davis, 2002;Ead, 2015;Havaei et al, 2021;Lind et al, 2018;McMillan, 2018;McMillan & Perron, 2013, 2020bMuir et al, 2021;Szumilas, 2015;Tracy, 2006;Vestal, 2013.…”

“…When changes are implemented, healthcare providers are expected to adjust their practice and balance numerous competing priorities. The continued pressure for change contributes to a phenomenon experienced by many healthcare providers, termed change fatigue (Bernerth et al, 2011; McMillan & Perron, 2020a).…”

“…Healthcare's changing landscape is driven by the need for continuous improvement in the provision of care (MacPhee, 2007; McMillan & Perron, 2020a). Amidst competing priorities, healthcare organizations face challenges implementing and sustaining multiple changes to facilitate best practices and ensure healthcare providers deliver safe, competent care (MacPhee, 2007).…”

Patients’ assessment of medical services quality – a determinant of changes in medical entity management on the example of Poland

“…Dysfunction of health systems related to the epidemic situation affects human health and life (Wong et al, 2020). In such conditions, the healthcare system requires transformation, reform and continuous improvement (McShane et al, 2020;McMillan and Perron, 2020). A substantive discussion on changes in the organisation and management of medical entities and their impact on the health and safety of the patient become necessary.…”