what is the key to organizational success for health care facilities?
- Research article
- Open Access
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Characteristics of successful changes in health care organizations: an interview report with physicians, registered nurses and assistant nurses
BMC Wellness Services Research volume 20, Article number:147 (2020) Cite this article
Abstract
Groundwork
Wellness care organizations are constantly changing as a result of technological advancements, ageing populations, irresolute disease patterns, new discoveries for the treatment of diseases and political reforms and policy initiatives. Changes tin be challenging considering they contradict humans' bones need for a stable environs. The nowadays study poses the question: what characterizes successful organizational changes in health care? The aim was to investigate the characteristics of changes of relevance for the work of health intendance professionals that they deemed successful.
Methods
The study was based on semi-structured interviews with thirty wellness care professionals: 11 physicians, 12 registered nurses and seven banana nurses employed in the Swedish health care system. An inductive approach was practical using questions based on the existing literature on organizational change and change responses. The questions concerned the interviewees' experiences and perceptions of whatsoever changes that they considered to accept affected their piece of work, regardless of whether these changes were "objectively" large or pocket-sized changes. The interviewees' responses were analysed using directed content analysis.
Results
The assay yielded three categories apropos characteristics of successful changes: having the opportunity to influence the change; existence prepared for the change; valuing the modify. The interviewees emphasized the importance of having the opportunity to influence the organizational changes that are implemented. Changes that were initiated by the professionals themselves were considered the easiest and were rarely resisted. Changes that were conspicuously communicated to allow for preparation increased the chances for success. The interviewees did not support organizational changes that were perceived to be implemented unexpectedly and/or without prior communication. They conveyed that it was important for them to empathise the need for and benefits of organizational changes. They particularly valued and perceived as successful organizational changes with a patient focus, with clear benefits to patients.
Conclusions
Organizational changes in health intendance are more probable to succeed when health intendance professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the modify, including perceiving the do good of the change for patients.
Peer Review reports
Background
The just constant in health care organizations, as the saying goes, is change. Technological advancements, ageing populations, changing disease patterns and new discoveries for the treatment of diseases require wellness care organizations and professionals to change almost constantly [1,2,iii,4]. Organizational changes are also needed to business relationship for evolving societal norms and values, some of which accept yielded higher expectations for admission to health care, improved patient experience and increased patient interest in care decision making [5, 6]. Continuous professional education has become increasingly important to ensure that health care professionals' competencies continue pace with current standards and to maintain and enhance the knowledge and skills needed to stay abreast of the newest prove [7].
Organizational changes affecting health care professionals also relate to political reforms and policy initiatives. The appearance of New Public Management (NPM) has challenged the traditional professional authorisation, introducing a logic of managerialism into health care, i.eastward. piece of work should exist organized and controlled by managers to achieve organizational goals of a cost-effective and efficient health intendance [8]. Wellness care professionals are increasingly expected to certificate their work, take on administrative tasks and participate in management-led quality improvement initiatives [9]. Changes besides relate to the testify-based move, which has emerged in the wake of NPM, with ambitions to provide a stronger scientific foundation for professional do [vii].
In general, changes can be challenging because they contradict humans' bones demand for a stable environment [10, 11]. Research has shown that organizational changes are often associated with employees' psychological uncertainty about how the changes will touch on their piece of work situation, role and overall life [iii, 12, 13]. High rates of organizational modify have well-documented effects on employee health and well-being, as assessed past a range of indicators, eastward.g. reduced organizational commitment, loss of productivity, work-related stress, emotional exhaustion, mental health bug, change fatigue, poor self-rated health, agin sleep patterns, sickness absence, infirmary admissions and stress-related prescriptions [fourteen,15,16].
Many changes in organizations fail to accomplish desired goals; a lxx% failure rate is ordinarily cited [17]. While generic success or failure rates tin can be questioned due to the context-dependent nature of change and challenges regarding definitions and measurement, in that location is nonetheless a considerable proportion of changes that do not neglect. This is the premise for the present newspaper: what characterizes successful organizational changes in wellness intendance? Based on interviews with wellness care professionals in Sweden, we aimed to investigate the characteristics of changes of relevance for the work of health care professionals that they accounted successful. Knowledge of weather condition associated with successful organizational change has the potential to improve selection, planning, implementation and management of ubiquitous changes in health care organizations.
Methods
Study setting, design and participants
Written report data come from interviews with Swedish health care professionals (physicians, registered nurses, assistant nurses). In the Swedish wellness care system, residents are insured past the authorities, with equal admission to health treat the entire population, although individual health care also exists. Sweden'south 21 regions are responsible for providing wellness care.
We conducted semi-structured individual interviews with 11 physicians, 12 registered nurses and seven assistant nurses – xxx health care professionals full (Tabular array i). The health care professionals were employed in six different health care units located in small- to mid-sized cities in s-eastern Sweden (populations of 67,000, 135,000 and 150,000 inhabitants, respectively).
To attain a sample of health care professionals that represented a broad spectrum of perceptions and experiences concerning changes in health care – i.eastward., working in master, secondary and tertiary health intendance facilities serving patients who varied in terms of health status and duration of stay – nosotros used a purposeful sampling strategy.
To recruit frontline health care professionals, we used an e-mail that briefly described the study. We sent the e-postal service request to the director of each work unit of measurement, with a request that they frontwards our request to physicians, registered nurses and assistant nurses. Nosotros then sent an informational letter describing the written report to those who responded to our email. No one declined to participate later receiving the data letter. We scheduled interviews at a time (between Jan and September 2018) and in a location convenient to participants, where they could experience comfortable almost speaking honestly (due east.g. office with a airtight door).
Information collection
We used an anterior arroyo to data drove, with a semi-structured interview guide developed by the authors. The interview guide is bachelor as an Boosted file. Interview questions were based on the existing literature on organizational alter and modify responses [xv, eighteen,19,20] and concerned the participants' experiences and perceptions of any changes that they considered to have affected their work. Of note, we asked participants to consider changes ranging from "objectively" big organizational changes, eastward.g. a re-structuring of the organisation, to small-scale changes, e.k. modification of an already existing workplace routine. This approach allowed us to assess both broad, more than general changes likewise every bit more specific examples of changes, such as the merging of the informant'south work unit with another unit of measurement, introduction of new information technology systems, or moving to new localities.
Although individuals' subjective feel may non correspond with more objective measures of organizational outcomes of changes, information technology is crucial to empathise health care professionals' views on changes in health care considering their attitudes towards changes may influence changes' success [21, 22]. As such, instead of asking nearly specific changes or providing lists or examples of changes, nosotros immune the participants to discuss any changes they considered to be relevant to their work; this approach reflects research that shows that experiences of are frequently individual (e.grand., one change may be bonny and imply advantages for some and be a source of stress and disadvantages for others) [23].
We began each interview with questions about the participant, the content of their piece of work, and their workplace. We then asked participants to depict examples of organizational changes that they considered to be successful. Then, we asked participants to offer a rationale for these changes' success. We asked a concluding open up-concluded question to capture any other reflections that participants had.
In 2 interviews, nosotros pilot tested the questions to appraise their meaningfulness and clarity of concepts. Pilot interview results suggested that the questions could exist used in different health care contexts, that the wording was articulate, and that the interview fit inside participants' maximum available time (lx min). We included the two pilot interviews in the study.
Private interviews were conducted by all the authors except SB, who does not speak Swedish, and were digitally recorded. Before the get-go of an interview, the participant was asked to re-read the information letter and give written informed consent to participate. Each interview lasted between 28 and 104 min (hateful, fifty.5 min). The interviews were transcribed verbatim by a professional transcription bureau and were and then reviewed past the researcher who conducted the interview.
Data analysis
Using an inductive approach, participants' responses were analysed using directed content assay according to descriptions by Hsieh and Shannon [24]. All authors except SB read the transcripts of the interviews individually to create a holistic view of the material. In the next footstep, each researcher performed a beginning analysis condensing meaning-bearing units and creating codes and subcategories. PN, IS, CE and KS and so met to discuss and compare their respective interpretations of the material. Tentative findings were reported to and discussed with SB. Following her input, PN, IS, CE and KS met again (as SB is located in the US) to discuss the preliminary findings. This word led to a proposal concerning the categories of analysis, which was and then fed back to SB for her comments. Eventually, consensus was reached on the categories and PN suggested labels which were accepted by the whole group. Representative quotations for reporting were jointly identified by PN, IS, CE and KS. PN, who is fluent in English, then translated the quotations from Swedish to English, which were and so examined by IS, CE and KS for accuracy. Finally, SB, whose showtime language is English, reviewed the English-language quotations for clarity.
Results
The analysis yielded three categories concerning characteristics of successful changes: having the opportunity to influence the change; being prepared for the modify; valuing the alter. The findings regarding these characteristics were every bit applicative to the physicians, registered nurses and banana nurses, with few notable differences among the three professional categories. The quotes are attributed to the physicians (P), registered nurses (RN) and banana nurses (AN), who were interviewed, numbered from 1 to 30.
Having the opportunity to influence the alter
The health care professionals emphasized the importance of having the opportunity to influence organizational changes that are implemented. Changes that were initiated by the professionals themselves were considered the easiest and rarely encountered resistance on the part of health care professionals. A md (4P) described the importance of "bottom-up" changes, "I think ane is particularly responsive to issues that are beingness raised in the organization from the ground upwards. It is from there, I retrieve, well-nigh frequently the smartest ideas volition sally, but and then it is important to ensure that you are responsive and assess [the ideas]." An assistant nurse (1AN) expressed a similar view, "Information technology'due south a expert change, I believe, [if] it's a alter that has occurred with me existence involved from the starting time and built [from there]." The health care professionals suggested that they are most knowledgeable about their work, putting them in an optimal position to place relevant problems and initiate advisable changes.
Apropos organizational changes initiated by the health care management and/or the higher political leadership level in the region, the health care professionals suggested that being involved early in the change procedure and existence able to accept an influence throughout the change procedure contributed to the change'south success. For example, a registered nurse (2RN) said, "If employees are involved from the beginning and believe this [change] is interesting, then I think there is a chance to succeed [with the change]." However, many complained about the difficulty of influencing changes because of the hierarchy of the health care system and the long distance to those in ability over most changes. A doc (13P) opinioned, "We don't have whatsoever channels to the political level or other higher management levels. You're restricted to the caput of the clinic to be your spokesperson." Another dr. (23P) complained, "There are administrators or controllers or economists who look into the [health care] system, simply they lack cognition about the actual intendance work, which makes me angry. They start their project, but don't involve united states of america."
Being prepared for the change
Co-ordinate to the health care professionals, organizational changes that were clearly communicated to permit for preparation increased the chances for successful changes. An banana nurse (22AN) argued that a relatively slow tempo of change is important when implementing change, "It [i.e. the modify] has to proceed at a calm stride and so that everyone is part of it, and so that you have a shared plan, that's the near important thing, I think." A registered nurse (5RN) talked virtually the importance of how changes are communicated, "I can't accept it all in, I can't handle information technology. You get this flow of mails with information, 'Now nosotros volition do this and that, now this will change and this is the starting appointment…' Information technology can be from mean solar day to day, nosotros cannot catch up."
The health intendance professionals did not support organizational changes that were perceived to be implemented unexpectedly and/or without prior communication. 1 of the physicians (3P) described such a change: "Discussions were ongoing during the fall, just you felt that the management didn't listen. Then came January with the conclusion: 'Y'all will be split, in 2 weeks you will exist 2 unlike clinics.' We felt so powerless and uninformed. We had two weeks to develop new systems and that results in considerable consequences." A registered nurse (21RN) likewise lamented a lack of time for preparation, "We had quick meetings. Sure, we met and talked almost it [the change], just we didn't accept much time. We had to solve information technology anyway."
Valuing the change
The health care professionals conveyed that it was important for them to empathize the need of organizational changes and how they benefitted themselves and/or the patients. The changes might otherwise be perceived every bit meaningless and unjustified, which may create change resistance. A physician (24P) stated, "I want to see a purpose for it [i.eastward. the modify], and if I practise [recognize the value of the alter], and it works, then I'm satisfied." Similarly, a registered nurse (5RN) emphasized the importance of the wellness care professionals recognizing the value of the change, "We need to feel that this change is non washed because the region has decided it, but because we actually believe that information technology will brand things better."
In particular, health care professionals valued and perceived as successful organizational changes with a patient focus, with articulate benefits to patients. According to a registered nurse (12RN), "As long equally yous meet that it [i.e. the change] benefits our patients, I recollect you lot have quite considerable motivation." Further, an assistant nurse (22AN) said that "i does information technology to arrive easier for the patients and maybe for the staff, that's the most important."
Discussion
Change is pervasive in modern health care. This study aimed to identify characteristics of successful organizational changes from the perspective of health care professionals at the frontline level of health care. An of import premise for the report was that the health care professionals' subjective experiences of changes influence the likelihood of achieving successful changes. The importance of individual responses to organizational changes has been increasingly emphasized [25].
Three categories (i.e. characteristics of successful changes) were found to be of central importance for a modify to be considered successful according to the statements of the health care professionals who were interviewed: that health care professionals (i) have the opportunity to influence the change, (2) are prepared for the change and (three) recognize the value of the change. Many of the statements by the participants were representative of more than ane category, suggesting an interdependency between the three categories of this triad of successful change characteristics. For example, a slower change allows for grooming, which facilitates involvement and influence, thus enabling an appreciation for the alter. Alternatively, recognizing the value of a alter, due east.g. its patient benefits, likely contributes to increased motivation amid health care professionals to go engaged and participate in conveying out the alter. This interdependence implies that successful change is more likely if more than i of the three categories is deemed for when planning and implementing changes. The importance of preparation for and interest in a change has been associated with decisional latitude [26] and valuing the modify in terms of experiencing personal gains has been linked with involvement in the change [27]. However, we accept not been able to find whatsoever previous study, either in health care settings or in other environments, which has identified the relevance of this item triad of characteristics or how they are interlinked. Although our findings suggest these interdependencies, we did not collect data to specifically investigate the underlying mechanisms; thus, exploring these interdependencies would be an important area for future research.
The health care professionals in our written report fastened great importance to existence able to influence changes that may influence their work. They expressed positive attitudes to changes that have been developed and emanate "bottom up" from themselves and/or the frontlines of health intendance. Many of the health care professionals complained well-nigh the power differential betwixt those who are afflicted by the changes and college management and political levels of the wellness care system who ordinarily decide on what changes to implement. Physicians in Sweden have often raised complaints that policy making and decisions concerning the medical profession are fabricated without physicians or their professional organizations existence involved in the determination-making procedure [28]. These findings underscore the importance of changes having frontline back up and being perceived every bit legitimate among the employees affected by the changes.
Organizational research has shown that participation in changes can yield increased acceptance. Indeed, widespread participation in the modify process is peradventure the almost oft cited approach to overcoming resistance to change [29, 30]. Even assuming a well-justified and well-planned change initiative, inquiry underscores the importance of managers edifice internal support for change by means of employee participation in the alter procedure [31]. These are common findings in organizational research in general, but they seem specially applicable in health care organizations because of the potent professional discretion in performing the work.
Health care professionals emphasized the importance of predictability for them to perceive organizational changes as successful. Individuals are better able to adjust their behaviour accordingly when they are prepared [iii]. The importance of managers' advice of information to prepare employees for organizational changes is frequently pointed out in the organizational change literature [31]. However, despite the relevance of predictability, many changes in our study seemed to be characterized past a lack of grooming. When individuals are unprepared, they have difficulties adjustment their thoughts, feelings and behaviours with the expectations of those who lead the changes [12, 32]. Our findings are consistent with Organizational Readiness to Change, a theory that posits that readiness depends on organization members' resolve to pursue the courses of activity involved in implementing modify (change commitment) and their beliefs in their capabilities to execute these actions (change efficacy). Contextual factors such as resources and civilisation as well influence their preparedness to implement change [33].
The importance of direction communicating the motives for changes was stressed past the health care professionals in our study. Consistent with our findings, organizational alter research has demonstrated that changes have a greater take a chance of succeeding if employees consider them to be well thought out and respect the managers responsible for the changes, whereas resistance to changes is more likely if employees consider the changes to have petty or no value for themselves [31]. The organizational alter literature also stresses the importance of change initiatives resting on coherent and audio causal thinking [34,35,36]. Employees who do not understand why a change is pursued will be reluctant to comply with the management'south requirement for the alter [25]. The health care professionals in our study argued that the changes must benefit patients to take value. This is consistent with research that shows that health care professionals' role identity is largely defined by patients and patients' needs [37].
The overall findings of our study may reflect a tension betwixt the traditional logic of professionalism and the managerial logic introduced into health care with the emergence of NPM. Whereas the logic of managerialism assumes that piece of work should exist direction led to achieve organizational goals, wellness care professionals tend to be loyal to their profession and their emotional rewards at work are primarily associated with their patients [ix]. NPM has led to an increase in the utilise of management systems, eastward.1000. auditing, guidelines, recommendations, agin event reporting systems and various incentive tools [38] that challenge the logic of professionalism in terms of professionals' autonomy and freedom of judgement in performing their piece of work [39,40,41]. Co-ordinate to professional theory, true professionals such as physicians and lawyers independently treat individual cases (due east.one thousand. patients and clients) and make decisions based on their knowledge and skills; they are highly educated and trained to use noesis and expertise in solving complex problems [42, 43]. Research suggests that physicians due to their stronger identification with professional logic are more likely than nurses to be critical of management-initiated changes [nine]. Several studies have shown how physicians respond with scepticism or suspicion to different forms of management-led changes in wellness intendance [44, 45].
Sweden has seen a lively public fence on NPM in contempo years, with many scholars, policy makers and both physicians and registered nurses critiquing core NPM principles and their consequences for health intendance professionals [46,47,48,49,50]. In response to the criticism of NPM principles, the Swedish government has recently introduced the concept of "trust-based governance," intended to integrate aspects of professional logic with NPM-based managerial logic, thus providing an culling to governing health care professionals through auditing, control and operation management [26, 51]. Governance past trust is intended to permit "the professionals be professional person" [52]. This initiative is new and nosotros are not aware of whatever studies of the concept, simply research is warranted to investigate how this concept is realized in practise. Hereafter research should appraise whether health care professionals perceive changes as more successful under trust-based governance than nether NPM principles.
The results of our study should be evaluated in the context of the methods that we chose to address our study question. We chose a qualitative approach because petty is known virtually responses to changes in Swedish wellness intendance. For this reason, we considered interviews with physicians, registered nurses, and assistant nurses to gain a deeper understanding of the topic. Participation was voluntary; the interviewees were selected and asked by their corresponding supervisors nearly participation in the study, which means that the participants may have been particularly interested in the subject.
The multidisciplinary research team was a strength of the study, considering it allowed different perspectives on the issue of changes in health intendance. The squad consisted of the following professions: behavioural economist (PN), political scientist (IS), registered nurse (KS), behavioural scientist (CE) and organizational sociologist (SB). Another force was the relatively loftier number of interviews (n = 30), although Malterud et al. [53] emphasizes that the strength of the information received (information power) is more of import than the size of the sample. Regardless, this enabled united states of america to use quotations from many unlike participants, calculation transparency and trustworthiness to the findings.
The primary contribution of the report lies in identifying a "triad of successful change characteristics" from the change recipients' point of view. While many findings of the study are in line with existing inquiry on organizational changes, no previous study has identified this particular triad of interdependent characteristics. The study provides important knowledge for wellness intendance organizations to plan and implement changes with better chances of being successful.
Conclusions
In conclusion, organizational changes in health intendance are more likely to succeed when health intendance professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the change, including perceiving the benefit of the change for patients. Although changes in health care organizations are inevitable, at that place are more or less effective ways to carry out changes. Our results provide of import implications for health care organizations concerning how changes in health care can exist planned, implemented and managed to increment the chances that they will be supported by health intendance professionals, which is crucial for successful changes.
Availability of data and materials
All interview data analysed during the current study are bachelor from the corresponding author on reasonable request.
Abbreviations
- AN:
-
Assistant nurses
- CE:
-
Carin Ericsson
- IS:
-
Ida Seing
- KS:
-
Kristina Schildmeijer
- NPM:
-
New Public Management
- P:
-
Physicians
- PN:
-
Per Nilsen
- RN:
-
Registered nurses
- SB:
-
Sarah A. Birken
- US:
-
Usa
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Acknowledgements
The authors would like to thank all the participating physicians, registered nurses and assistant nurses who participated in the interviews.
Funding
Open access funding provided past Linköping University. Dr. Birken's effort was supported by the National Middle for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR002490. The content is solely the responsibility of the authors and does not necessarily correspond the official views of the NIH.
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All authors (PN, IS, CE, SB, KS) made pregnant contributions to the manuscript. PN, IS, CE and KS collected the information. All analysed the data. PN drafted the manuscript, simply it was reviewed and critically revised for important intellectual content by all authors. All authors read and gave last approval of the version of the manuscript submitted for publication.
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The study was approved past the Local Ethics committee in Linköping, Sweden, Dnr: 2018/112–31. All the participants gave their written and oral consent to participate in the interviews. The report was performed co-ordinate to World Medical Clan Announcement of Helsinki ethical principles for medical enquiry involving human subjects. To maintain the principle of non-maleficence, the participants were guaranteed confidentiality, which was taken into account when reporting the findings through abstracted findings presented at the group level. In accordance with respecting the participants' autonomy, all the participants were informed that they had the right to withdraw from the projection at any fourth dimension without suffering any consequences for their hereafter care. In the interviews, the researchers were aware of ability issues, in that an interview is not a chat betwixt ii equal individuals. The interview fourth dimension was taken into careful consideration. The participants were given opportunity to reflect on what they said in the interviews, and time was also available for the participants to ask questions.
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Nilsen, P., Seing, I., Ericsson, C. et al. Characteristics of successful changes in health intendance organizations: an interview study with physicians, registered nurses and assistant nurses. BMC Health Serv Res twenty, 147 (2020). https://doi.org/ten.1186/s12913-020-4999-8
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DOI : https://doi.org/10.1186/s12913-020-4999-8
Keywords
- Organizational change
- Implementation
- Influence
- Preparedness
- Patient benefit
Source: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4999-8
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