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Response to Bridging a Great Divide: Translation of Strategy to Operational Reality

Dr Chandrasiri’s article in the October 2016 edition of The Quarterly examines the difficulties encountered by medical leaders when attempting to translate theory into practice, particularly from the angle of turning lofty strategies into functional operation plans. She recommends utilising change management thinking when considering this, particularly drawing on the Kotter eight-step model, as this has been utilised successfully for change management in healthcare previously.
Considering change management theory and models for this purpose is a good proposal, but there is a further element to be considered, that perhaps is missed in simply drawing on Kotter; this is the importance of physician engagement, as promoted by Lee & Cosgrove in their 2014 article “Engaging Doctors in the Healthcare Revolution”.
A criticism of Kotter’s eight-step model is the rigidity of its approach and the thought that the linear eight steps might lead to a “check box mentality” (Skovgaard 2013, 21). The employees of the organisation are represented in a very binary fashion: either relative pawns who will allow change to happen without complaint or those negative influences that will block or resist change (Skovgaard 2013, 22; Applebaum et al. 2012, 775; Hughes 2015, 459). The wording used in this article is interesting here:  Chandrasiri mentions deciding “how and when” key stakeholders “should be engaged” and that this should match the level of financial commitment required; this doesn’t give enough credence to the central role hospital staff play, day to day, in bringing this imposed strategy to life (Chandrasiri 2016, para. 6 and 8).
Lee & Cosgrove’s theory, however, emphasises the key role engagement plays. They warn against the folly of an organisation trying to “win over” doctors by “combining good intentions with a few broad interventions” (Lee & Cosgrove 2014, para. 7). Stakeholder engagement, rather than just being one link in the chain, is of paramount importance. Appealing to physicians’ sense of noble shared purpose, satisfying their self-interest, earning their respect and embracing their tradition – and not simply quantifying the amount of time and energy spent on this element on the basis of financial dividends.
This article perhaps concentrates too heavily on the logistics of change management, using Kotter as a roadmap and methodically applying the steps, without enough consideration for guided leadership in the management of change. Reality and vision do not need to be viewed as such fractured principles if one concentrates on the fundamental role that engagement plays.
Dr Amber Winter
RACMA Candidate
Last Updated on Thursday, 29 June 2017 11:30