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Human Resource Management - managing change and dealing with employee resistance Print E-mail
The Quarterly 2014

This article was written by Dr Susan Keam, derived from material presented by Dr Alan Sandford & Ms Sophie Conabere on the 12th  of  April 2012 for the RACMA Interact Webinar series. A recording of the webinar can be found on the RACMA website here.

Health reforms overview

There are four major platforms/themes of national health reform for hospitals in Australia:
  • providing more hospital beds;
  • reducing public hospital waiting times;
  • making Australia’s biggest single investment in health infrastructure; and
  • improving how hospitals are funded and managed.
The last of these platforms relates to the role of medical manager and how we implement reforms and internal structure arrangements. It often creates challenges for medical managers around resistance to change and issues surrounding to allocation of resources within hospitals.

How health reforms affect medical management

There are several key human resource impacts of health reforms. These include:
  • Change in power structure/matrix of the current organisational structure and arrangements, which filter through and affect medical officers and manager;
  • Jurisdictional changes – political and bureaucratic, which may result in reorganisation;
  • Austere measures, which are the result of cutting costs, reducing expenditure and increasing efficiency. These  create tension and stress because the changes challenge what has been done previously;
  • Change in leadership and organisational redesign/restructure, which creates a sense of insecurity;
  • Creation of uncertainty or “fear” amongst the team (tribe) at all levels (from head of department to junior staff), leading to “bad behaviour”. Managers are charged with managing this effectively;
  • Dissonance of clinical objectives versus organisational or system compliance in reform. Medical managers face the challenge of maintaining the role of clinician as well as that of organisational custodian (where tasks include managing budgets, staff numbers (FTEs), and compliance issues imposed by governments or government departments). When this is added to reform, there is the extra challenge of effectively managing the way reform is implemented;
  • Re-alignment or reconfiguration of workforce, a dynamic process that often causes significant tension and angst among staff.
The consequences of change

Changes resulting from health reforms inevitably lead to significant changes in behavioural responses from medical groups and individuals within the groups. The challenge is how we manage our human resources and how we bring them on the journey, avoiding the entropy in resistance to change.
Senior medical staff may present with more profound and challenging behaviours than junior staff, and they may be more difficult to manage because they are senior peers.
Difficult and disruptive or destructive behaviours seen amongst senior medical staff include:
  • Treatment of junior staff or other colleagues (they are seen as lesser beings). This can be disruptive and destabilising for the department and organisation;
  • Ego – power play, patronizing behaviour towards individuals and other groups;
  • Organisational sabotage; associated with profound dysfunctionality. We need to look at the reasons for this - it may be resistance to change or the result of other more complex reasons;
  • Defiance and dissonance created within clinical department;
  • Tribal rivalry between professional groups. Competition between medical groups e.g. anaesthetists versus surgeons, rivalry between hospitals;
  • Creation of a “them and us” situation between medical managers and clinicians. Medical managers have a foot in both the clinical and management camps, and see themselves as clinicians. However, clinicians may not share this view;
  • Decreased productivity and “absenteeism” (clinicians who have “checked out”). These people don’t want to be a team player, and this may be a method of avoiding change.
The above behaviours may be exacerbated by organisational influences such as resistance or response to change; or may be triggered by internal influences within the individual.
Managing part-time or visiting medical officers may be challenging because they don’t always see themselves as part of the organisation (they may consider themselves to be external contractors). Clinical governance methods and using various common interest groups to influence through peer pressure can be useful in bringing this group of staff into the process. For instance, ask VMO’s/part time staff to act as a representative for their clinical group during the change management process.

Dynamics of Change

We need to think through how change affects all the people involved. We can identify, from personal experience of change, what dynamics we found were positive and what were negative, and then apply what we have learnt to the change process we are managing.

On average, 70% of change initiatives fail, predominantly because the time required for transformation and embedding the change is underestimated. Pressured to demonstrate results quickly, we skip steps in the change process. Leading Change Successfully 2nd Edition, Harvard Business Review OnPoint Collection, Feb 1, 2005

Change may be rushed as a result of trying to embed the changes as quickly as possible so that the transition period is minimised, and this may result in change activities that have not been managed appropriately.

Change management is about eliminating barriers and minimizing resistance (this is linked to risk management and proactive planning can actuate this) and promoting genuine acceptance and ownership of the new business way (linked to return on investment). We need to help people go through the stages of the change journey as quickly as possible.

The bottom line is that there is nothing soft or optional about change management when businesses in demanding operating environments are implementing projects. Change is tangible and there is a structured process within change management that helps bring about the outcome we want to achieve.

Why do change initiatives often fail?

In a survey conducted by the University of NSW’s Centre of Corporate change the most common reasons for change initiative failure were employee resistance (58% of responses) and  leadership issues (40%) followed by communication failure (29%), industrial relations issues (21%), skills issues (19%), planning issues (19%), culture (15%), financial issues (12%) and external Interference (12%).
Less likely reasons were staff rationalisation (5%), technology issues (4%), failure to manage business as usual during change (2%), and psychological aspects of change (2%).
When planning the change process, much of the focus is on having the right processes and procedures in place, with little thought about how the change will impact individuals (often a source of employee resistance).
Ultimately people make the change happen, so it is very important that they are included in all steps of the change process. We must also get leaders on board, promoting the change, modelling the desired behaviours, driving the process and proactively managing the new initiative and embedding the process.

Managing change

Change is the emergence of a new situation, made up of one or more events. Moving through change requires a transition from the current condition to the target condition. Transition is the psychological reorientation that people go through as they come to terms with the changes and the new situation triggered by the change.

Change management is about working on how to get from the current condition to the target condition. It is a series of actions that enable people to work confidently and effectively during the transition. One factor that should not be underestimated during the transition is the degree of resistance that may be seen. An effective way to limit this is to ensure that the transition process is not allowed to drag out.
The project change curve

Regardless of the type of change and the duration of the transition process, the change process follows a well-defined path. Initially people have high expectations, and see the change positively. Reality starts to set in as the project progresses and people start to understand the effort required to make the change happen and the complexity of the process, even to the extent that it can appear to be overwhelming. As the project continues to progress, and the end is in sight, perceptions of the project improve and optimism grows.

The project change curve illustrated here summarises these steps and  also highlights the differences in the process and result between   proactively managed and unmanaged  change. The main difference is that during the process, peaks and troughs are smaller and the final outcome is better with managed change, and the anticipated benefits of the change are more likely to be realised.

Change management lessons learnt

There are numerous lessons that we have learnt during change processes:
  • Prepare, prepare, prepare and make the changes tangible. Get people on board by explaining the “Five W’s”: what the change is, why it is being done, who the key stakeholders are, who will be impacted and what the expected outcome is
  • Provide a clear description of the change and a picture of success. Show clearly what the desired end is
  • Find and remove obstacles before the change occurs
  • Allow adequate time for people to accept the change
  • Involve affected people in planning the change
  • Find and utilize resources and people that support the change
  • Change management must begin on day one of the project
  • Make good use of your project sponsor/s and use them to leverage during the change
  • Allow the change to be shaped by ongoing feedback, especially the effects of unexpected consequences
  • Provide clear implementation objectives for all people involved in the change. Make sure that key people are involved from early on in the project so that they can leverage implementation
  • Need to embed a complete training and documentation solution up-front
  • Continually monitor the change and adjust resource levels
  • Reinforce the new behaviours through formal and informal methods
  • View leading others through change as an ongoing process
  • Ensure clear accountability and no ambiguity
  • Change resources aligned and embedded in functional teams
  • Make sure “ownership” is clearly understood.
It’s important to manage the consultation process thoroughly, and to overcome the challenges of resistance to change.

Case Study: effectively managing an employee resisting change

Problem: a senior leader in a department that required significant reorganisation  to be cost effective was resisting the change.

  • The reorganisation required an appropriate redistribution of skills across the department to create effectiveness, and meant that rosters would be less generous to some employees.
  • The senior leader, who was responsible for organising the rosters, liked being generous to some employees and therefore resisted the change.
  • Resistance was demonstrated in a number of behaviours, including denigrating the person implementing the change, and creating dissonance and encouraging resistance among the other staff.
  • These behaviours caused emotional drain on the person resisting change (creating a them and us situation) and on the person implementing the change
  • Person implementing the change needed to maintain linkages within their peer group to maintain sanity
  • Effective use of Human Resources team (partner with HR in a proactive way)
  • Think about the way in which change impacts individuals, as well as effects/impacts on the group
  • Make sure appropriate processes to implement the change have been put in place
  • Link performance management to implementing change
Dr Alan Sandford & Ms Sophie Conabere

The Royal Australasian College of Medical Administrators
Dr Alan Sandford & Ms Sophie Conabere, , p
www.racma.edu.au /index.php?option=com_content&view=article&id=675&Itemid=399