Newcastle University IBM graduate
Module：8265 Managing Changes in Organization
Case Study Used
Implementing Change on the Front Lines: A Management Case Study of West Feliciana Parish Hospital by Chustz, Mark H.; Larson, James S.
Part 1
Case Study Summary
The Cases Study titled, “Implementing change on the front lines: A management case study of West Feliciana Parish Hospital. Public Administration Review” by Chustz and Larson (2006) explore the Medicare charity care policy. The focus was on how to implement the change of the policies on one of the healthcare facilities in Rural Louisiana Hospital. The Top-down Implementation theory was applied in the study to give an account of how the change took place. The case study analyzed the condition in the rural hospital as well as the need for change. The CEO of the health facility conducted an interview with the ailing people to form the grounds for formulating and implementing the charity policy. The research came up with six recommendations that explain how to implement the Medicare charity policy.
According to Chustz and Larson (2006), theories, as well as several frameworks, are challenged one or an organization that wants to implement a particular change. The change is aimed at achieving improving the condition of the working environment and the approach that the organization takes in providing the solution to hurdles that the company faces. The paper argues that it is very challenging for most public facilities to change the policies that control the operations of the facility. During the 1980s, a scholar on matters management ascertain that the biggest nightmare in changing most of the policies in public organization is the issue of implementing the change Konlechner et al. 2019). The literature adds that the specialists in implementing the changes should ensure they use the little available resources to achieve the change because the government institutions seem to be very strict in giving out money to fund the implementation process (Chustz and Larson, 2006). The implication is that government organizations have complex structures hence making a change at the low level of the organization, for instance, implementing change in rural hospitals is difficult to be achieved because the process will have to undergo very many steps before it succeeds.
While approaching the matter, the article also pointed out the relevance of having the knowledge of the psychology of people one interacts with to come up with a proper way of preparing and executing the program implementation. The connection is that the people are the ones who will use the policy hence there is the necessity of involving their views and interest to solve the problems affecting them. The process should be clear and simple so that the change can realize the result as soon as possible. The implementation of the charity policy in the rural hospital was needed following the letter that was sent to the healthcare facility from the Center of Medicare and Medicaid services that inquired if the hospital had the charity policy in its operation. The management of the hospital examined the relevance of having the policy in place and realized that it was of great benefit not only to the patients but also to the hospital. Hence the process of implementing the charity policy had to strategize to help the hospital address its problems. The Hospital Board of Commissioners, appointed by the government of West Feliciana Parish was given the responsibility of strategizing and implementing various policies that deem necessary for the collective good of both the patients and the hospital. However, the Chief Executive Officer and his staff were the individuals who came up with favorable policies because they are the ones who experience the conditions of the working and environment, and they can easily identify the needs of the patients. After formulating the policies, the Board takes them and evaluates them for approval, hence the down-top method of policy formulation.
The financial crisis in the hospital was the main motive behind implementing the policy because the hospital suffered financially in most cases and people had to support it by paying local taxes. The local taxes were also not enough to fund the hospital hence the hospital was in a threat of suffering from debt cases and closure due to inactiveness that happened in the rural hospital many times.
The researcher used the interview method to explore various ways in which the process of charity policy implementation went through. The leadership of the hospital had to find copies of how other hospitals approached the issue of implementing the charity policy. The copies were provided to evaluate how the implementation was done and the best methods of approaching the issue were arrived at by the management of the hospital. The policy aimed at ensuring that poor people in the society are able to access medication services (Whittle et al. 2016). For example, the charity policy suggested that the emergency room, as well as the inpatient facilities, should be free to the members of the society who earn less very low income that is below the poverty level in the society.
The hospital employed the use of a top-down process of implementing charity policy because the letter asking for the presence of charity order was written by the top management in the ministry of health (Watson and D’Annunzio, 1996). The Frontline workers were involved in examining the policy to assess its effectiveness in handling the problem facing the hospital. After the implementation of the policy, the workers at the admission section of the healthcare facility were tasked to provide the patients with information about the charity policy and its importance to patients (Konlechner et al. 2019). Thereafter, patients were availed with the forms to complete and get ready to access the charity service that the hospital had put in place to enhance the smooth and effective running of the rural hospital in the area.
Part 2
Theory Development
Top-down Implementation theory was the approach that the study used to explain the way information about the implementation of charity policy in Rural Louisiana Hospital was communicated. This theory suggests that change can take place if the top management of a company or an institution asks the managers and board of the company to create and implement policies that are vital in addressing a particular issue or improving the productivity of the company (Jarzabkowski, and Balogun, 2019). Essentially, the change that is often implemented to the frontline workers in health primarily focuses on the relationship between the medical providers and patients, as well as the working environment. The author of the case study used the top-down development theory to explain how a health facility in rural areas can exercise change effectively. First, the case study identified the case that involved the rural hospital facing the obstacles of providing consistent and quality medical services to the people in the community (Huy, Corley, and Kraatz, 2014). Secondly, the research explored how the health facility responded to the issue after receiving the letter to Centers for Medicare and Medicaid Services (CMC) to implement the change because the people of that area were suffering due to a lack of proper funds to facilitate sufficient services to the patients. Before the implementation process, the paper states how the CEO of the company worked hard in engaging the health care providers in charting the way forward of the policy. All the team players in the healthcare confirmed that the policy was good and no one was against it.
The author of the article used Matland’s approach on Ambiguity-Conflict Model to explain the implementation of the charity policy. The model asserts that if there is a low level of conflict that calls for the implementation of policy, then the ambiguity of the matter is also low. The theory is of significant importance to the implementation of policies in different organizations because it helps the management to identify the complexities of the issues hence creating policies that can respond to the complex conflicts (Huy, Corley, and Kraatz, 2014). As well, the theory explains that conflicts that are not complex are not ambiguous hence they can be handled more easily. According to the CEO of the rural hospital assumed that the policy to be implemented was not ambiguous because by referring to the ambiguity-conflict model to illustrate how the theory is applied by leaders in the various institution in assessing, analyzing, and formulating policies to address issues affecting the society. The CEO argued that the implementation of the charity policy would have insignificant change on the role of the employees in the hospital hence he believed that the healthcare providers will have little conflict or arguments about the implementation of the policy (Reissner, 2005). As a result, the nurses and other frontline employees agreed that the policy should be incorporated into the hospital system because its advantages outweighed some of the disadvantages that it could cause. In this regard, the value of the policy is what determines the conflict because the higher the value of something, the high the need of using it (Cutcher, 2009). Policies that have very little relevance might create a lot of conflict during their implementation because I will address little issues and cause more harm to the people or the organization at large.
After the interview about the policy, the CEO found out that not all the frontline workers were in agreement with the entire issues that were covered in the charity policy. The workers complained of certain issues that were not included in the policy implementation (O’Mahoney, 2016). The interview the CEO conducted with the patients and the staff confirmed that his assumption about the policy and how people will apply it effectively did not go as expected because people came out with a lot of issues, some saying that they were not told. The frontline workers and the patients brought about a lot of conflict over the issue because they were not engaged fully in what should be done on the policy implementation (Sharma et al. 2018). Only a few details on what the policy was supposed to address were shared. The conflict that was concerned with the issue of the amount of work one will have to deal with and workers were disturbed emotionally while providing details regarding the policy (Brown and Humphreys, 2003). The discomfort that the healthcare providers had a negative impact on how they attended to the patients because they viewed the entire process of training and teaching the patients about the policy had no significant benefit to them.
On the other hand, the author of the article states the hospital’s supervisor perceived the policy to be incomplete, hence terming it ‘too generous’ because it allowed people who had money to access free medical services that the policy addressed. The information gaps within the policy led to a lot of debates on how it should be improved since most of the people were not satisfied with how it was used to approach the problems affecting the hospital and the society in the rural area (Balogun and Johnson, 2005). Therefore, the case study ascertained that the process of the implementation of charity policy was not comprehensively done because many things were assured and individuals were not included in the discussions about how the policy should be implemented.
Part 3
Recommendation for Practice
The frontline workers and the patients were to be engaged fully in implementing the charity policy in the rural hospital. On the contrary, the CEO of the hospital assumed that the policy was not ambiguous, hence, he ignored to engage them fully because he felt that they will easily adopt the change. The CEO’s approached to the matter is enforced by the author of the article using the Ambiguity-Conflict Model. The Model asserts that a policy that is not ambiguous has little conflict. However, the case study disagrees with the theory by pointing out how the decision made by the CEO left a lot of gaps when implementing the charity policy. The conflict resulted because the CEO did not found out how the policy will be implemented and how each individual should take part in enhancing its success. From the mistake made by the CEO of the rural hospital, it is recommendable that organizations should include every person involved in the production and consumption in making the decision on how the policy should work in the favor of everyone so that conflict can be avoided. The managers should not assume that they understand how the employees and the consumer, instead, they should be given a chance to share their interests.
References
Balogun, J., & Johnson, G. (2005). From intended strategies to unintended outcomes: The impact of change recipient sensemaking. Organization Studies, 26(11), 1573-1601.
Brown, A. D., & Humphreys, M. (2003). Epic and tragic tales: Making sense of change. Journal of Applied Behavioral Science, 39(2), 121-144.
Chustz, M. H., & Larson, J. S. (2006). Implementing change on the front lines: A management case study of West Feliciana Parish Hospital. Public Administration Review, 66(5), 725-729.
Cutcher, L. (2009). Resisting change from within and without the organization. Journal of Organizational Change Management, 22(3), 275-289.
Huy, Q. N., Corley, K. G., & Kraatz, M. S. (2014). From support to mutiny: Shifting legitimacy judgments and emotional reactions impacting the implementation of radical change. Academy of Management Journal, 57(6), 1650-1680.
Jarzabkowski, P., Lê, J., & Balogun, J. (2019). The social practice of coevolving strategy and structure to realize mandated radical change. Academy of Management Journal 62(3), 850-882.
Konlechner, S., Latzke, M., Güttel, W. H., & Höfferer, E. (2019). Prospective sensemaking, frames, and planned change interventions: A comparison of change trajectories in two hospital units. Human Relations, 72(4), 706-732.
O’Mahoney, J., & Sturdy, A. (2016). Power and the diffusion of management ideas: The case of McKinsey & Co. Management Learning, 47(3): 247-265.
Reissner S.C. (2005) Learning and innovation: A narrative analysis. Journal of Organizational Change Management 18(5), 482-494.
Sharma, N., Herrnschmidt, J., Claes, V., Bachnick, S., De Geest, S., Simon, M. and MatchRN‐Study Group, 2018. Organizational readiness for implementing change in acute care hospitals: An analysis of a cross‐sectional, multicentre study. Journal of advanced nursing, 74(12), pp.2798-2808.
Watson, S., & D’Annunzio‐Green, N. (1996). Implementing cultural change through human resources: the elusive organization alchemy? International Journal of Contemporary Hospitality Management, 8(2): 25-30.
Whittle, A., Mueller, F., Gilchrist, A., & Lenney, P. (2016). Sensemaking, sense-censoring and strategic inaction: The discursive enactment of power and politics in a multinational corporation. Organization Studies, 37(9), 1323-1351.
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