Organizational Change Strategies Research Articles

A Qualitative Analysis of Implementation of Antimicrobial Stewardship at 3 Academic Hospitals: Understanding the Key Influences on Success.

Inappropriate use of antimicrobials is linked to the development and spread of drug-resistant pathogens and is associated with increased morbidity, mortality, lengths of hospital stay, and health care costs. "Antimicrobial stewardship" is the umbrella term for an evidence-based knowledge translation strategy involving comprehensive quality improvement activities to optimize the use of antimicrobials, improve patient outcomes, reduce the development of antimicrobial resistance and hospital-acquired infections such as Clostridium difficile, and decrease health care costs. To assess the perceptions and experiences of antimicrobial stewardship program leaders in terms of clinicians' attitudes toward and behaviours related to antimicrobial prescribing. In this qualitative study, semistructured interviews were conducted with 6 antimicrobial stewards (2 physicians and 4 pharmacists) at 3 academic hospitals between June and August 2013. The following 3 key themes emerged from the interviews: getting the right people on board, building collegial relationships, and rapidly establishing a track record. The study results elucidated the role and mechanisms that the program leader and other antimicrobial stewards used to influence other clinicians to engage in effective utilization of antimicrobials. The results also highlighted the methods employed by members of the antimicrobial stewardship team to tailor their strategies to the local context and to stakeholders of participating units; to gain credibility by demonstrating the impact of the antimicrobial stewardship program on clinical outcomes and cost; and to engage senior leaders to endorse and invest in the antimicrobial stewardship program, thereby adding to the antimicrobial stewards' credibility and their ability to influence the uptake of effective antimicrobial use. Collectively, these results offer insight into processes and mechanisms of influence employed by antimicrobial stewards to enhance antimicrobial use among clinicians, which can in turn inform future implementation of antimicrobial stewardship and strategies for organizational change in hospitals.

Choosing change strategy for ISO/IEC 33014

AbstractThe ISO/IEC 33014.2013 standard on process improvement includes a core activity called ‘identify the overall change strategy’, which includes selecting a change strategy among the many available. This selection can be carried out using the ImprovAbility model in which there is a framework of how to select change strategy. The framework contains 10 different change strategies to choose from. But which ones are chosen in practice? To answer that, we have analyzed data from 134 assessments in 129 organizations that have used the framework. We give a ranking of strategies chosen, and we analyze how they adapt the change strategy to their specific conditions. We conclude that the most often recommended organizational change strategy is optionality followed by three other strategies: specialist‐driven, production‐organized, and learning‐driven. Copyright © 2015 John Wiley & Sons, Ltd.

Hospitals as professional organizations: challenges for reorientation towards health promotion

Health promotion, as one tool of hospital managers to reorient hospitals towards more client-oriented healthcare services, has been emphasized for almost three decades. Yet, it is recognized that change in hospitals is challenging and is more desired than substantially enacted. To overcome organizational challenges, health promotion has, so far, adapted organizational change strategies primarily applied in business organizations. However, in this paper, it is argued that such strategies do not adequately reflect the nature of hospitals as ‘professional organizations’. To gain a better understanding of the challenges for health promotion reorientation, this paper combines well-established theories from the sociology of professions and organizational science. These theories provide a useful framework that advances the role of professionals as powerful agents within any reorientation efforts in hospitals. This framework guided the narrative review of empirical literature on critical dimensions along which professionals engage with reorientation efforts in hospitals. Accordingly, specific managerial strategies to facilitate health promotion reorientation are formulated. With its theoretical underpinnings and related empirical studies, the paper offers a new perspective on the challenges of implementing health promotion and proposes strategies that may help hospital managers to push forward health promotion reorientation in their organizations.

Review of Effective Human Resource Management Techniques in Agile Software Project Management

Agile-driven human resource approaches are a departure from plan-driven traditional human resource management approaches. Moreover, research and surveys have shown that adopting agile human resource methodologies are an efficient way of excelling in agile software project management with significant advantages in production costs, time-to-market, complexity, and quality improvement over traditional human resource management methodologies. This paper reviews how effective human resource management techniques that can be applied to agile software project management core challenges. Drawing information from the literature issues like framework for agile organizational change and adoption strategies are examined. Data gathered from the organizations suggest that most of them are best suited in adopting new human resource management techniques. In a nutshell, human resource agility drives organizations to sustain a promising paradigm based on lessons learned towards going agile in software project management. General Terms Human resource management, agile software project management.

Training police for procedural justice

This paper reports the findings of an evaluation of a police training program on the principles of procedural justice. This training was part of a larger organizational change strategy aimed at improving the relationship between the police and the public in Chicago. The paper reports on the findings of two studies. The short-term effects study was a quasi-experimental test of the immediate effectiveness of the training conducted at the police academy. A longer-term effects study examined the subsequent views of trainees and a comparison group, officers who had not yet been to training. Statistical controls were used to increase confidence in the findings of the second study, which was based on observational data. In the short term, training increased officer support for all of the procedural justice dimensions included in the experiment. Post-training, officers were more likely to endorse the importance of giving citizens a voice, granting them dignity and respect, demonstrating neutrality, and (with the least enthusiasm) trusting them to do the right thing. All of the effects of training were strong, with standardized effect sizes ranging from 1.2 to 1.6. Longer-term, officers who had attended the procedural justice workshop continued to be more supportive of three of the four procedural justice principles introduced in training; the effect of training on trust was not statistically significant. There has been little systematic research on police training. This paper concludes that it can play a role in improving police–community relations. It also presents a discussion of some of the limitations of a training-based organizational change strategy.

Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers.

For health care systems in recent years, patient safety has increasingly become a priority issue. National and international strategies have been considered to attempt to overcome the most prominent hazards while patients are receiving health care. Thereby, clinical risk management (CRM) plays a dominant role in enabling the identification, analysis, and management of potential risks. CRM implementation into routine procedures within complex hospital organizations is challenging, as in the past, organizational change strategies using a top-down approach have often failed. Therefore, one of our main objectives was to educate a certain number of risk managers in facilitating CRM using a bottom-up approach. To achieve our primary purpose, five project strands were developed, and consequently followed, introducing CRM: corporate governance, risk management (RM) training, CRM process, information, and involvement. The core part of the CRM process involved the education of risk managers within each organizational unit. To account for the size of the existing organization, we assumed that a minimum of 1 % of the workforce had to be trained in RM to disseminate the continuous improvement of quality and safety. Following a roll-out plan, CRM was introduced in each unit and potential risks were identified. Alongside the changes in the corporate governance, a hospital-wide CRM process was introduced resulting in 158 trained risk managers correlating to 2.0 % of the total workforce. Currently, risk managers are present in every unit and have identified 360 operational risks. Among those, 176 risks were scored as strategic and clustered together into top risks. Effective meeting structures and opportunities to share information and knowledge were introduced. Thus far, 31 units have been externally audited in CRM. The CRM approach is unique with respect to its dimension; members of all health care professions were trained to be able to identify potential risks. A network of risk managers supported the centrally coordinated CRM process. There is a strong commitment among management, academia, clinicians, and administration to foster cooperation. The introduction of CRM led to a visible shift with regard to patient safety culture throughout the entire organization. Still, there is a long way to go to keep people engaged in CRM and work on national and international patient safety initiatives to continuously decrease potential hazards.

Modern Leadership in Singaporean and Thai Organizational Contexts

This study compares leadership traits among leaders from Singaporean and Thai organizations. It also investigates leadership styles in different cultural settings with a focus on organizational change. Data was collected by means of a series of structured in-depth interviews with leaders from a Singaporean multi-national corporation in the retail sector and leaders from a public organization in Thailand. Comparative analysis elicited the key categories of organizational culture, leadership styles and change strategies. The study demonstrates differences and similarities among Thai and Singaporean leaders with regard to leadership behaviours. Being direct, strong and knowledgeable are important for leaders who lead organization in the process of change in Thailand. Singaporean leaders, on the other hand, need to be flexible, decisive and approachable when changes are introduced to the organization. Thai staff may show unusually high deference (greng jai) towards those of senior status in the organization. Singaporean staff, however, may prefer to have an open discussion with their senior in the process of change. The results also imply, in order that organizational transition in Singaporean and Thai contexts occur as smoothly as possible, all aspects of change must be shared with staff of all levels and open for discussion.

Organizational factors and change strategies associated with medical home transformation.

There is limited information about how to transform primary care practices into medical homes. The research team surveyed leaders of the first 132 primary care practices in Minnesota to achieve medical home certification. These surveys measured priority for transformation, the presence of medical home practice systems, and the presence of various organizational factors and change strategies. Survey response rates were 98% for the Change Process Capability Questionnaire survey and 92% for the Physician Practice Connections survey. They showed that 80% to 100% of these certified clinics had 15 of the 18 organizational factors important for improving care processes and that 60% to 90% had successfully used 16 improvement strategies. Higher priority for this change (P = .001) and use of more strategies (P = .05) were predictive of greater change in systems. Clinics contemplating medical home transformation should consider the factors and strategies identified here and should be sure that such a change is indeed a high priority for them.

Power and Change in the US Cataloging Community

The US cataloging community is an interorganizational network with the Library of Congress (LC) as the lead organization, which reserves to itself the power to shape cataloging rules. Peripheral members of the network who are interested in modifying changes to the rules or to the network can use various strategies for organizational change that incorporate building ties to the decision-makers located at the hub of the network. The story of William E. Studwell’s campaign for a subject heading code illustrates how some traditional scholarly methods of urging change—papers and presentations—are insufficient to achieve reform in an interorganizational network, absent strategies to build alliances with the decision makers.

Changing practice to support self-management and recovery in mental illness: application of an implementation model

Health services introducing practice changes need effective implementation methods. Within the setting of a community mental health service offering recovery-oriented psychosocial support for people with mental illness, we aimed to: (i) identify a well-founded implementation model; and (ii) assess its practical usefulness in introducing a new programme for recovery-oriented self-management support. We reviewed the literature to identify implementation models applicable to community mental health organisations, and that also had corresponding measurement tools. We used one of these models to inform organisational change strategies. The literature review showed few models with corresponding tools. The Promoting Action on Research Implementation in Health Services (PARIHS) model and the related Organisational Readiness to Change Assessment (ORCA) tool were used. The PARIHS proposes prerequisites for health service change and the ORCA measures the extent to which these prerequisites are present. Application of the ORCA at two time points during implementation of the new programme showed strategy-related gains for some prerequisites but not for others, reflecting observed implementation progress. Additional strategies to address target prerequisites could be drawn from the PARIHS model. The PARIHS model and ORCA tool have potential in designing and monitoring practice change strategies in community mental health organisations. Further practical use and testing of implementation models appears justified in overcoming barriers to change.

The role of national culture in choosing a change strategy in organizations

In this paper, the causal relationship between certain dimensions of a national culture and certain organizational change strategies are analyzed. The paper uses two of the four dimensions of national culture, identified by G. Hofstede: the power distance and masculinity-femininity ones. On the other hand, the four organizational change strategies have been differentiated: the coercive strategy, the normative-reeducative strategy, the rational-empirical strategy and the creative strategy. The identified dimensions of national culture and the identified organizational change strategies differ from one another with respect to the same criteria: the distribution of power and task orientation versus people orientation. Based on this fact, it is possible to establish eight hypotheses about a causal relationship between certain types of national cultures and certain organizational change strategies.

Leadership and Organizational Change

In the research paper, we will collect, evaluate and apply the concepts, theories and strategies for leadership and organizational change. For this, purpose was selected Deep-Water Truck Company as an example for organizational changes. Then, the paper will include an interview with the leader of the organization. Where the information is provided by the leader, will be the basis for the paper.

Emerging areas in research on higher education for sustainable development – management education, sustainable consumption and perspectives from Central and Eastern Europe

Abstract Management education for sustainable development, sustainable consumption in higher education institutions, and higher education for sustainable development in Central and Eastern Europe can be considered as three highly relevant emerging areas in research on higher education for sustainable development. The transformation of management education to meet the increasing societal demands for responsible business has been reinforced in the light of the current economic situation. In this context, it is explored which competencies are needed for tomorrow's business professionals and which concepts and approaches are useful to foster these competencies. With regard to sustainable consumption, several universities have initiated creative projects that have transformed campus life and have had an impact on staff's and students' attitudes and behaviour. Moreover, initiatives in Central and Eastern Europe show interesting developments, for example how sustainability issues have been integrated into the curriculum, particularly in the context of intense coal mining as well as urban planning. Thus, this Special Volume of the Journal of Cleaner Production presents the current progress in concepts and practices in the three emerging areas management education for sustainable development, sustainable consumption in higher education institutions, and higher education for sustainable development in Central and Eastern Europe, which to date have not been intensively discussed in the scientific discourse on higher education for sustainable development. In an overall manner, the Special Volume provides evidence that the following issues are of particular importance for future research and development in higher education for sustainable development: measuring learning outcomes; accounting for different geographical, political and cultural contexts for higher education for sustainable development; and prioritising strategies for sustainable organisational change.

Organizational change strategies within healthcare

This study explores ways in which healthcare organizations can improve their organizational fitness for change using Beer and Nohria's framework of Theory E (concentrating on the economic value of change) and Theory O (concentrating on the organization's long-term capabilities for change). Data were collected from senior leaders/medical directors from health regions in Alberta. The results show that even though there is a tendency for reliance on Theory E change strategies, the respondents demonstrated other preferred approaches to change.

The Organizational Internal Environment as an Effective Factor for

AbstractBackground and AimThe internal environment of any organization is an effective factor on change management. Thereare many effective factors which should be determined and utilized for change management in anyorganization including nursing and midwifery schools. So, this study aimed to exploreorganizational internal environment of nursing and midwifery schools and it's effect on changemanagement.Materials and methodsThis study was the qualitative part of a mixed exploratory study. The participants were recruited bypurposeful sampling method from the managers of Tehran schools of nursing and midwifery. Datawere gathered by semi-structured interviews andconventional content analysis was used for dataanalysis.FindingsTotally, 171 conceptual codes were extracted which were categorized in 3 themes includingchanging process, internal organizational environment and external organizational environment.Internal organizational environment had 10 subcategories in 3 main categories includingmanagerial-, organizational- and individual-factorsConclusion:The concept of change management is a complicate procedure which is influenced bymanagerial-, organizational- and individual-factors. Faculty members, manager's duties, education,attitude and other factors should be considered for change management in schools of nursing andmidwifery.Keywords:Change management, Change, Nursing school.*Corresponding Author: Alice Khachian, Ph.D student of nursing, School of Nursing & Midwifery,Shahid Beheshti University of Medical SciencesE-mail : dr.houmanmanoochehri@gmail.com-Sange P (2007). A Fifth Discipline Resource: Dance of Change. Translated by Akbari H Soltani M. Tehran. AryanaIndustrial & Research Group. (Persian)-Andrew J Cameron H Harris M (2008). All Change? Managers’ experience of organizational change in theory andpractice. Journal of Organizational Change Management. 21 (3) 300-314.-Bianco A Schermerhorn J J(2006). Self-regulation, strategic leadership and paradox in organizational change. Journalof Organizational Change Management. 19(4)457-470.-Boswell C Cannon SH (2007). Introduction to Nursing Research: Incorporating Evidence-Based Practice. 2nd edition.Boston, Jones and Bartlett Publisher.-Gatto RP (2000). The Smart Manager's F.A.Q. guide: A Survival Handbook for Today's Workplace. San Francisco,Jossey- Bass.-Hsieh H Shannon SE (2005). Three approaches to qualitative content analysis. Qualitative Health Research. 15(9)1277-88.-Johansson C, Heide M (2008). Speaking of Change: Three Communication Approaches in Studies of OrganizationalChange. Corporate Communications: An International Journal. 13(3) 288-305.-Kordrostami M Aghakhani E (2006) [Change Management and Organizational Development]. Tehran, Darsi booksPublication. (Persian).-LoBiondo–Wood G, Haber J (2002) Nursing Research: Methods, Critical Appraisal and Utilization.6th Edition. USA,Mosby.-McCormick D (2007) Dramaturgical analysis of Organizational Change and Conflict. Journal of OrganizationalChange Management. 20(5)685-699.-David R (2009). [Strategic Management]. Translated by parsayan A, Aarabi M. Iran cultural Studies (Persian).-Reed J Vakola M (2006). What role can a training needs analysis play in organizational change. Journal ofOrganizational Change Management. 19 (3) 393-407.- Sadeghi D (2011). Alignment of organizational change strategies and its relationship with increasing organizations'performance. Procedia Social and Behavioral Sciences 20,1099-1107.-Saka A (2003). Internal Change Agents' View of the Management of Change Problem. Journal of OrganizationalChange Management. 16 (5) 480-496.-Salsali M Parvizi S Adib Hajbagheri M(2004). [Qualitative Research Methods]; 1st edition, Tehran BoshraPublications. (Persian).-Streubert Speziale HJ, Carpenter Rinaldi D(2007). Qualitative Research in Nursing, Advancing the HumanisticImperative. 4th edition. Philadelphia, Lippincott-Williams &Wilkins.-Van Dijk R Van Dick R (2009).Navigating Organizational Change: Change Leaders, Employee Resistance and Work-Based Identities. Journal of Change Management. 9(2)143-63.

Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial

BackgroundMore effective methods are needed to implement evidence-based findings into practice. The Advancing Recovery Framework offers a multi-level approach to evidence-based practice implementation by aligning purchasing and regulatory policies at the payer level with organizational change strategies at the organizational level.MethodsThe Advancing Recovery Buprenorphine Implementation Study is a cluster-randomized controlled trial designed to increase use of the evidence-based practice buprenorphine medication to treat opiate addiction. Ohio Alcohol, Drug Addiction, and Mental Health Services Boards (ADAMHS), who are payers, and their addiction treatment organizations were recruited for a trial to assess the effects of payer and treatment organization changes (using the Advancing Recovery Framework) versus treatment organization changes alone on the use of buprenorphine. A matched-pair randomization, based on county characteristics, was applied, resulting in seven county ADAMHS boards and twenty-five treatment organizations in each arm. Opioid dependent patients are nested within cluster (treatment organization), and treatment organization clusters are nested within ADAMHS county board. The primary outcome is the percentage of individuals with an opioid dependence diagnosis who use buprenorphine during the 24-month intervention period and the 12-month sustainability period. The trial is currently in the baseline data collection stage.DiscussionAlthough addiction treatment providers are under increasing pressure to implement evidence-based practices that have been proven to improve patient outcomes, adoption of these practices lags, compared to other areas of healthcare. Reasons frequently cited for the slow adoption of EBPs in addiction treatment include, regulatory issues, staff, or client resistance and lack of resources. Yet the way addiction treatment is funded, the payer’s role—has not received a lot of attention in research on EBP adoption.This research is unique because it investigates the role of payers in evidence-based practice implementation using a randomized controlled design instead of case examples. The testing of the Advancing Recovery Framework is designed to broaden the understanding of the impact payers have on evidence-based practice (EBP) adoption.Trial registrationhttp://NCT01702142 (ClinicalTrials.gov registry, USA)

A Matter of Leadership: Connecting a Grantmaker's Investments in Collaborative Leadership Development to Community Results

Keywords: Collaborative leadership, cross-sector collaboratives, networks, effective grantmakingWhy leadership? Leaders create forward movement through executing strategies for organizational and community change that results in sustained and positive outcomes. Collaborative leadership is especially important in cross-sector collaboratives; it is a specific type of leadership that promotes strategic relationship building, resource-sharing, honest and open dialogue, and a deeper understanding of the important social issues that collaboratives work to address. These skills are crucial when striving for significant results for communities that require collaborative efforts across agencies and sectors. Leadership can and must be developed to promote a focus on results, to create effective strategies to address major social challenges, and to align resources and actions that lead to the execution of strategies at a scope and scale high enough to make a difference.As cross-sector collaboratives become the rule rather than the exception in addressing social change, growing attention has been paid to the specific components that lead to collaborative success (e.g., Bryson, Crosby & Stone, 2006; Thomson & Perry, 2006). We build on recent discussions of collective impact' (Kania & Kramer, 2011) and argue that grantmakers can support self-sustaining and independent cross-sector collaboratives by building the leadership capacity of those individuals participating in collaboratives. A successful and pragmatic method to leadership development is to build the capacity of collaborative leaders while focusing them on their work. In this model of development, collaborative members are supported by neutral, but skillful, facilitators who work to develop participants' collaborative leadership skills and promote both public accountability for the group and individual accountability within the group. We also argue that although a skillful facilitator is critical, through strong collaborative leadership skills and improved accountability, it is the collaborative itself, rather than the facilitator, that influences positive community change. Using data collected from past participants of the Annie E. Casey Foundation's Leadership in Action Program (LAP), we test a model of collaborative success put forth in the Theory of Aligned Contributions (TOAC) (Pillsbury, 2008).This research makes significant contributions to the literature, as researchers have yet to demonstrate the direct impact of collaborative leadership skills on the success of the collaborative process and community-level change. Importantly, the findings presented here can be applied to grantmaking strategies, as we are testing a model that addresses the main challenges noted in the literature around collaboratives - namely, the issues related to accountability, relationshipbuilding, and performance.We first discuss the need for leadership development in collaborations, then discuss TOAC, which incorporates collaborative leadership development as a key component of collaborative success; and then describe how TOAC is implemented through LAP. We then summarize our research and findings and make specific recommendations based on those findings. We point to the most important aspects of collaborative implementation in relation to performance, and inform grantmakers on the most essential areas for investment. We provide examples from one LAP implemented in Marion County, Indiana, to illustrate how these components can be put into practice.Collaborative Leadership Development: A Necessary Ingredient for SuccessCollaboratives are created when two or more organizations join to share information and resources in an effort to create solutions to social problems that could not be achieved by organizations working independently (Bryson, Crosby, & Stone, 2006). Collaboratives are often very loosely structured, without formal leaders and with members typically volunteering to work across sectors and represent their organizations. …

Development and implementation of a biomedical informatics course for medical students: challenges of a large-scale blended-learning program.

Biomedical informatics (BMI) competencies are recognized as core requirements for the healthcare professional, but the amount of BMI educational interventions in the curricula of medical schools is limited. UNAM Faculty of Medicine in Mexico is a large public medical school, with more than 7000 undergraduate students. The undergraduate program recently underwent a major curricular revision, which includes BMI education. Two one-semester BMI courses (BMI-1 and BMI-2) were designed, with a blended-learning educational model. A department of BMI was created, with budget, offices and personnel. The first class of 1199 students started the course in 2010, with 32 groups of 40 students each. BMI-1 includes core conceptual notions of informatics applied to medicine (medical databases, electronic health record, telemedicine, among other topics), and BMI-2 embodies medical decision making and clinical reasoning. The program had a positive evaluation by students and teachers. BMI can be successfully incorporated in a large-scale medical school program in a developing country, using a blended-learning model and organizational change strategies.

From small acorns: An action research project aiming to improve current care services for people diagnosed with borderline personality disorder (BPD)

This paper describes a reflective process of problem solving to improve services for people attracting a personality disorder diagnosis. Descriptive statistics and qualitative material are discussed in terms of effecting local organisational change and broader national strategies.

Bridging the knowing-doing gap: Researching a new approach to disability and employment programming

Despite significant program efforts since the ADA was passed in 1990, the employment rates of people with disabilities have changed little. While the causes behind these disappointing outcomes are multi-facetted and complex, it is clear that a knowing-doing gap has limited the effectiveness of efforts to change these disappointing statistics. That is, though employers have a basic knowledge of the ADA, this knowledge is largely not being translated into actions or practices. Approaches are needed that go beyond merely disseminating information to actively engage employers in bringing about organizational change. We designed, implemented and researched a program aiming to bridge the knowing-doing gap. This program was based on a blended learning approach designed to build organizational change strategies and partnerships. A comprehensive program research effort included both a measure of immediate program impact (using the BIAT - a researcher-developed and validated tool) and longer-term impact (using a grounded theory, open-ended interviewing protocol). Implications for further research and practice are discussed using findings from both the short-term and long-term studies.