Workplace Reengineering, Reorganization, and Redesign From Nursing Management: Principles and Practice

Patricia Stanfill Edens, RN, MS, MBA, FACHE

September 13, 2005

In This Article

Change in the Organization

In the popular guide to change, Who Moved My Cheese, a line in the book stated, "I keep doing the same things over and over again and wonder why things don't get better" (Johnson, 1998, p. 43). The need for change in the organization can be generated from external pressures, such as reimbursement declines, or internal pressures, such as a failure in process like slow turnover times in surgery leading to surgeon dissatisfaction. Consistently doing things the same way without considering either system weaknesses or external impacts dooms the organization to failure, at the worst, or to mediocrity, at best. The organization will not get better unless the managers are willing to risk change.

If planned or unplanned change occurs in an organization, the manner in which it is handled can dictate success or failure. Regardless of source, "a change imposed is a change imposed" (Johnson, 1998, p. 91). Leading change within an organization requires an ability to clearly state vision and direction and the ability to involve all parties and motivate them to accomplish the plan. Knowledge of change theory assists the leader in effecting change in a positive and timely manner. The implementation of a strategic plan or a workplace redesign implies a change in the status quo. The primary goal of the manager is to educate employees so that they know what to expect as change occurs in the organization. The pace of change in the healthcare environment can be rapid. The ability of an organization to respond to both internal and external influences and implement a strategy to respond without self-destructing is critical to survival. Organizational change takes a toll on the people within the organization. Involving them in the process of change can mitigate some of the stress of change.

Pollard (2001), in a two-year study of 98 women and 86 men, determined that the lowest mental well-being (self-reported) occurred right before reorganization. Physiologic measures such as blood pressure readings and total cholesterol reached their highest levels, again, prior to reorganization. Both managers and employees must acknowledge that change is stressful to the point of physical symptoms. Pollard further stressed time for self, appropriate nutrition, exercise, and verbalization to supportive people as strategies to manage the stress of change (Pollard). Managers should be cognizant of their employees' need to ventilate but should not be reactive to their comments. Managers also should consider verbalization to supportive people but not necessarily to peers and never to subordinates.

Leaders of change in an organization may not always be the managers. Lack of managerial leadership may result in negative consequences, such as staff turnover, union discussions, and poor morale that impacts patient care. To control the environment, managers must communicate clearly to employees and develop an open communication model. Employees must be able to verbalize that change is occurring and comprehend the impact of this change on the organization, their department, and on themselves. If employees cannot understand the need for reactive change because of external factors, the facility will not survive. Managers must have the trust of their employees on an ongoing basis and well in advance of change in order to bring forth the agenda necessary to direct the facility through uncertain or difficult times. Educating staff to current global and local market factors on an ongoing basis is one way to ensure that change in response to external factors does not come as a total surprise.

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