Radical Organizational Change Research Articles

Business Process Re‐engineering and Human Resource Management

Reviews the business process re‐engineering (BPR) vision of radical business process change, focusing on the use of information technology to facilitate a shift away from linear/sequential work organization towards parallel processing and multidisciplinary teamworking. Highlights BPR′s cursory treatment of the human dimension of its programme for radical organizational change and raises the question of how human resource management specialists are to respond to its trivialization of the complexities and dilemmas associated with the re‐engineering of work processes.

Patient-focused Care

The trend away from a departmental focus and toward "patient-focused" care in hospitals is described; advantages of and barriers to such a change and its effects on pharmacy are discussed. Patient-focused care is characterized by decentralization of services, cross-training of personnel from different departments to provide basic care, interdisciplinary collaboration, various degrees of organizational restructuring, use of "clinical pathways"--recommended components of care for patients with a particular diagnosis, simplification and redesign of work to eliminate steps and save time (e.g., providing care according to predetermined protocols and charting only exceptions to the protocol), and increased involvement of patients in their own care. Its objectives are to use nonclinical and clinical staff more effectively and to improve patients' perceptions of the quality of care and staff members' job satisfaction. It is unrealistic to expect quick reductions in hospital costs through patient-focused care, and workers will worry about job security if an institution overemphasizes this aspect. A 1993 survey of 311 hospitals found that almost half had or planned to have patient-focused care projects. Adoption of patient-focused care projects may be slowed by workers' fear of new responsibilities and new reporting relationships. However, not all patient-focused care models involve radical organizational changes, and reorganizations can be such that pharmacy staff members are still connected to the pharmacy department even if they are supervised by a nonpharmacist. In some institutions patient-focused care projects have given pharmacy its first opportunity for decentralization.(ABSTRACT TRUNCATED AT 250 WORDS)

CASE Tools as Organizational Change: Investigating Incremental and Radical Changes in Systems Development

This paper presents the findings of an empirical study into two organizations' experiences with the adoption and use of CASE tools over time. Using a grounded theory research approach, the study characterizes the organizations' experiences in terms of processes of incremental or radical organizational change. These findings are used to develop a theoretical framework for conceptualizing the organizational issues around the adoption and use of these tools-issues that have been largely missing from contemporary discussions of CASE tools. The paper thus has important implications for research and practice. Specifically, the framework and findings suggest that in order to account for the experiences and outcomes associated with CASE tools, researchers should consider the social context of systems development, the intentions and actions of key players, and the implementation process followed by the organization. Similarly, the paper suggests that practitioners will be better able to manage their organizations' experiences with CASE tools if they understand that such implementations involve a process of organizational change over time and not merely the installation of a new technology.

Middle Management and Quality Control: Strategies for Obstructionism

Quality control as developed in Japan is diametrically opposed to the traditional American corporate practices stemming from the so-called "Taylor scientific methods" which is based on a clearly defined hierarchy. American corporations attempting to implement quality control programs often run into difficulties with managers who perceive the democratic principles of quality control as a threat to their authority. This situation is particularly acute when full participation by middle and lower level managers has not been enlisted prior to implementation of the program and neither procedures nor goals have been clearly spelled out. In this study, the responses of middle and lower level managers under these conditions were observed. Several strategies emerged that were designed to minimize the perceived threat of quality control, including control of program activities and restricting employees' access to these activities. These covert and overt obstructionist tactics demonstrate the importance of careful planning of quality control programs before implementation and a willingness to make the radical organizational changes required by quality control if it is to be successful in American corporations.

A new look at nursing education

NURSES, like others, are expected to demonstrate knowledge, comprehension, analysis and synthesis of their subject. To meet those objectives the direction and method of teaching requires a radical organisational change. The student nurse who was ‘prepared for’ examination should ‘participate in’ the learning process. Teaching should be directed towards problem solving and be learner centred. Both theory and practice should go hand in hand. These principles are considered to be axiomatic if learning in the sense of understanding is to take place. Even so, with few exceptions, classroom teaching still takes place with little or no reference to what happens in the real world. Concurrent teaching of theory and practice can be visualised schematically. What we are looking at is a relationship between three areas: the student, the teacher and curriculum, and the graduate (see Fig. 1). In this paper I will describe the genesis of a course in “Child Growth and Development”, outline its teaching method which incorporates theory and practice and conclude with some general observations. The curriculum of the 4-yr nursing undergraduate programme in the Department of Advanced Nursing Studies at the Welsh National School of Medicine is that of a specialised programme facilitating exploration and understanding of nursing theory and practice. Preparation for clinical training is ensured during the first year by students’ exposure to the study of the biological and behavioural sciences, sociology and social administration and the development of nursing as a profession. A course in normal growth and development is taught as it is considered crucial to an understanding of pathology in whatever form it may appear. Successful examinations in these subjects at the end of the first year ensures students’ progression to clinical training. The clinical component of the programme introduces the student to major clinical nursing areas throughout the next three years. Concurrent teaching in nursing and allied subjects continues and will enable students to integrate into their nursing knowledge relevant concepts from the various sciences. During the final year there will be teaching in managing techniques, teaching methods and research appreciation. Flexible teaching experiences are planned throughout the