Time to Change
Some older models of change suggest that current practices be eliminated and new processes and systems be designed from scratch. In reality, few organizations have the luxury of redesigning their processes or organizations from the ground up as people, equipment, and business knowledge cannot be so easily done away with...much as we might wish to do so!
In addition, organizational change is a learning process in which unanticipated obstacles and opportunities emerge that afford additional opportunity for growth. Recognizing this, theories such as Total Quality Management and Continuous Process Improvement have sought to institutionalize continuous learning and incremental improvement. However, it may not even be clear whether the best approach to a given need is radical change, incremental change, or no change at all, even if the outcome is clearly envisioned and represents a genuine improvement.
The difficulties many long term care organizations have had with change management are often based on the inherent difficulty in recognizing the interdependence between practice, technology, operations, and strategy. However beneficial a new machine, care delivery model, incentive system, product line, or decision-making structure may appear in isolation, the real issue is how it will interact with other aspects of the organization.
The British statesman, David Lloyd George, once said "Anything can be achieved in small, deliberate steps. But there are times you need the courage to take a great leap. You can't cross a chasm in two small jumps." The same wisdom applies to change. Increased competition, changes in care delivery, and advances in technology require new ways of running our organizations and caring for patients. However, many initiatives are doomed to failure and many projects fail to reach their intended goals. An organization may wish to become a "House of Quality" but instead becomes a "House of Cards" as near misses leave the organization in worse condition than if the change had never been attempted. Often, the problem is not that the proposed change is unworkable but that the transition proves more difficult than anyone anticipated.
The path to change has many stumbling blocks. The next several blogs will discuss various elements of the change process and suggest ways to be successful in adopting change. You may wish to review some of the change theories that have been developed at this Web site.