Executive Summary
The residential care home Hope and Happy has been placed under special measures by the Care Quality Commission (CQC) due to several deficiencies in the care provided. To improve the quality of care, the registered manager has approached a team of change consultants, who used the ProSci ADKAR model and McKinsey’s 7S model as approaches for managing change. The Prosci ADKAR model focuses on individual change, knowledge, and competence, as well as reinforcement, whereas McKinsey’s 7S model concentrates on managing shared values, style, skills, and staff. Both models have provided practical solutions for the three issues identified by the CQC, including a lack of detail in care plans, inadequate staff training, and poor infection prevention and control practices.
Introduction
Hope and Happy is a residential care home that has recently been placed under special measures by the CQC due to several deficiencies in the care provided. The organization will be examined through the lens of change management theory. As a result of the analysis, strategies and recommendations will be provided to combat the issues identified by the CQC. Such recommendations include fostering a culture of personalized care, updating staff training, and adjusting services to comply with regulations.
Practical Steps to Manage the Implementation of Changes Within the Care Home
Nature of Change
On a fundamental level, change is a reaction to a discrepancy between what a company is doing now and what it needs to do to remain relevant, competitive, or viable. The exact aims of the change effort, the size and complexity of the organization, as well as its culture and history, can all influence the type of change (Schell, 2019). Additionally, it can be either proactive or reactive, with businesses either proactively seeking opportunities for improvement or reactively responding to issues as they arise (Gräßler et al., 2021, p. 1694).
Regardless of the type of change, the change management process typically begins with a clear understanding of the organization’s current and anticipated future state. The nature of change in change management is, therefore, varied and complicated. It involves both reactive and proactive efforts, as well as a broad spectrum of change activities, ranging from small and incremental to large and transformational.
Force Field Analysis
The force field analysis, developed by Kurt Lewin, is a comprehensive framework that provides a foundation for understanding and managing change. According to Lewin’s theory, change is caused by the tension between forces that encourage change and those that suppress it (Jabri, 2018, p. 99). By identifying and studying the specific influence of these forces on Hope and Happy, the consultants can gain critical insight into the situation and create effective change plans.
Certain factors are crucial for comprehending the driving forces behind the case of Hope and Happy. They include the need for better treatment, knowledge of existing recommendations, and CQC regulation and oversight. The level of care provided to residents will be enhanced directly by refining care plans and ensuring that staff members possess the necessary knowledge and skills.
Finally, the CQC’s regulation and oversight are a driving force, as they provide a framework for progress and hold Hope and Happy accountable for adhering to specified criteria. On the other side, restraining forces are the elements that oppose change and cause it to proceed more slowly or not at all. A lack of resources, competing goals, reluctance to change, and a lack of stakeholder support are among the forces that hinder progress.
The restraining forces for change at Hope and Happy are resident and staff resistance, a lack of resources, and ineffective management. As it stands, staff and resident resistance to change can significantly delay implementation. This opposition may stem from a desire to preserve the status quo or from a fear of the future (Vernooij et al., 2022, p. 210).
The absence of finance, personnel, and training is another restraining force in this situation, as Hope and Happy might not have the necessary resources to meet the CQC’s standards. Finally, inadequate management can also be a restraining force in this scenario. If the management is not equipped or adequately trained to implement the necessary changes, it can make it challenging to achieve the standards set by the CQC.
Strategic Drift
Strategic drift is the process through which companies progressively become less aligned with their external environments as a result of internal forces that encourage inertia. Many organizations are reluctant to change, which creates a growing mismatch that ultimately prompts them to undergo a significant transformation (Hayes, 2014, p. 47). In this situation, Hope and Happy have experienced a form of strategic drift, having drifted away from their external environment, specifically the CQC requirements. The lack of detail in care plans, the failure to evaluate staff competencies, and inadequate procedures all point to the registered manager’s concern that the home was not responding appropriately to changing conditions.
Kinds of Change
As it stands, research has outlined many existing classifications of change. For instance, Jabri (2018, p. 14) defines the following types of change: episodic, transitional, and transformative. The kind of change appropriate for Hope and Happy is likely to be transformative.
The shortcomings cited by the CQC point to fundamental difficulties with the current systems and procedures. Transformational change, being radical in nature, has the capacity to address these problems by making significant and extensive changes that are meant to fundamentally enhance the organization’s culture, operations, and performance.
Drivers of Change
In change management, change can be driven by a wide range of internal and external variables. Changes in the larger context in which an organization operates are frequently one of the external drives of change (Banfield and Kay, 2018, p. 293). Additionally, internal drivers of change may also be essential. The drivers of change at Hope and Happy would include the need to raise the standard of assistance and care given to residents, adhere to regulations and standards, and preserve the care home’s good name and reputation. These drivers would be led by a desire to protect residents’ health, well-being, and safety, as well as to keep the care facility’s operating permit.
Triggers of Change
Similarly, triggers of change might originate both internally and externally. New opportunities for growth and improvement, or the realization that outdated procedures are ineffective, can lead to changes within an organization (Jabri, 2018, p. 6). The trigger for change in the case of Hope and Happy is the inspection conducted by the CQC and the subsequent placement of the home under special measures. The inspection’s unfavorable findings have made it clear that the care home needs significant improvements.
ProSci ADKAR Model
A prominent approach for managing change in businesses is the ProSci ADKAR model. Five components make up the model: “Awareness, Desire, Knowledge, Ability, and Reinforcement” (Jabri, 2018, p. 129). In the case of Hope and Happy, the ProSci ADKAR model could be a valuable tool for the registered manager in addressing the issues identified by the CQC and improving the care provided at the facility.
The ADKAR model’s first stage involves raising awareness of the need for change and the consequences of doing nothing. In this case, the recent CQC inspection has already rendered the registered manager and the employees aware of the care home’s shortcomings. The next step is to build a desire for change among the workers. However, the fact that the registered manager has already approached change consultants demonstrates their desire to resolve the care home’s issues.
Once the desire for change has been established, the next step is to equip personnel with the necessary knowledge to implement the required changes. After acquiring knowledge, the staff and registered management must learn how to implement the new procedures effectively. This can be accomplished through practical instruction, mentoring, and assistance from change experts (Northouse, p. 153). The last step is to reinforce the modifications by incorporating them into the organization’s standard operating procedures. This can be achieved by monitoring changes, providing staff and registered management with feedback, and consistently reinforcing new behaviors with praise and rewards.
Other Models
Lewin’s three-step model is another widely used and uncomplicated framework for understanding and managing organizational transformation. The “Unfreeze-Change-Refreeze” approach deconstructs the change process into three distinct stages (Jabri, 2018, pp. 107–110). Lewin’s paradigm places more emphasis on the process of change than it does on the precise actions that must be accomplished. Although this model helps provide a broad perspective on the change process, it may not be detailed enough to assist businesses in implementing specific changes.
A more formal approach that offers an organized method for directing change projects is Kotter’s eight-step model of change management. This strategy comprises eight specific steps, including developing a sense of urgency, assembling a coalition, and creating a transformational vision (Kotter, 2012). This model is designed with a primary focus on the specific actions that organizations can take, all of which are necessary to execute change successfully.
Model Similarities and Differences
All three models—Lewin’s three-step Model, Kotter’s eight-step model, and ProSci ADKAR model—are intended to aid businesses in navigating change, which is where they share similarities. They all offer a change roadmap, assisting companies in comprehending the change process and determining what must be done to implement change successfully. All three models also emphasize the importance of preparation, stakeholder involvement, and effective communication in the change process. As for the differences, the three models vary in their focus and degree of detail vary between the three models. The Prosci ADKAR model is the most comprehensive of the three, emphasizing the impact of change on individuals at the personal level.
Unfreezing is the first stage in Lewin’s three-step model, occurring when individuals become aware of their existing condition and recognize the need for change. The first stage of Kotter’s eight-step model, in contrast, is building a sense of urgency, which aims to create a coalition of support for change by establishing a clear understanding of why the change is necessary.
The second stage of Lewin’s model is the changing stage, where new behaviors or practices are introduced to bring about the desired change. Kotter’s second and third steps involve forming a powerful coalition and creating a vision for change. Lewin’s third and final stage is refreezing, which involves institutionalizing the new practices and integrating them into the organization’s culture. In contrast, Kotter’s final two steps consolidate gains and generate further change to anchor new methods into the organization’s culture.
The emphasis on empowering people is a similarity between the Prosci ADKAR model and Kotter’s concept. The Prosci ADKAR model places a strong emphasis on knowledge as a key factor in successfully executing change. Similar to this, Kotter’s approach emphasizes the importance of involving stakeholders and employees in the change process, as they will play a crucial role in its success.
The emphasis on reinforcement is another similarity between the theories. The Prosci ADKAR model recognizes that change requires ongoing support and reinforcement to be sustained. Lewin’s model emphasizes the significance of building a supportive environment for change to be successful. In contrast, Kotter’s model stresses the significance of integrating new approaches into the organization’s culture and processes.
Benefits of the ProSci ADKAR Model
Of the three proposed models, the ProSci ADKAR model, in particular, may be beneficial for the Hope and Happy case. Specifically, the ProSci ADKAR model considers how change affects individuals, which is crucial in Hope and Happy, where residents’ welfare is given close attention. The first issue noted by the CQC can be addressed by the model’s emphasis on individual-level change, which can help ensure that the care provided is tailored to each resident’s specific needs. Furthermore, by implementing the Prosci ADKAR model into the change process, the registered manager can focus on ensuring that staff members understand their training and are qualified to deliver safe and effective care. This will solve the second problem noted by the CQC.
On another note, the model’s focus on knowledge and competence helps ensure that personnel are prepared to deal with change and have the essential abilities to provide residents with optimal care. Moreover, the ProSci ADKAR model’s emphasis on reinforcement can help guarantee that changes are long-lasting. The registered manager can address the third problem noted by the CQC by implementing continuing assistance and reinforcement. This ensures that infection prevention and control methods in the home are consistent with current recommendations and are maintained over time.
The Applicability of McKinsey’s 7S Model
McKinsey Model
A helpful approach for examining and overcoming the problems associated with change management is McKinsey’s 7S model. The four “soft” S elements of the model are shared values, style, skills, and staff (Hayes, 2014, p. 137). They are particularly pertinent in the case of Hope and Happy, as they address the difficulties raised in the inspection. The lack of detail and individualized support in care plans is the first issue that needs to be addressed. The way to apply McKinsey’s 7S model involves ensuring that all parties have a clear understanding of the principles and objectives of the care facility, which is one way to address this issue.
Another crucial aspect to consider is Hope and Happy’s style. In particular, it is critical to evaluate the management’s leadership style and decision-making and problem-solving methods. A management approach that is overly directive or opaque may be contributing to the problems the CQC has detected. In this situation, management may need to adopt a more cooperative stance, involving employees and residents in the decision-making process, and ensuring that their interactions are open and transparent.
In line with McKinsey’s 7S model, the management’s failure to evaluate the staff’s skills and competencies is the second issue noted by the CQC. To resolve this problem, it may be essential to train the staff so that they possess the necessary skills and knowledge to deliver safe and efficient care (Moussa et al., 2019, p. 284). Two aspects of this are offering continual chances for learning and growth, as well as conducting frequent evaluations of staff skill levels.
The final ‘soft’ S factor to consider is the staff themselves. A motivated and engaged team is crucial for ensuring that individuals receive safe and effective care and assistance. Management may need to assess the work culture and environment, and implement measures to enhance engagement and morale. This could include opportunities for staff to express their concerns and suggestions, as well as frequent staff feedback and appreciation programs.
Strategy
In the context of change management, strategy is a methodical, comprehensive plan of action designed to address the opportunities and challenges presented by change. Intending to enhance the outcomes and performance of that organization or system, it is a purposeful and intentional method to bring about change in those structures. The goals of change management methods are to maximize the advantages of the change while minimizing the adverse effects on the company and its stakeholders.
Actionable measures must be implemented to address the identified soft-factor difficulties and enhance the service. Establishing a culture of resident-centered care is one approach to bolster care plans and personalized support. This can be accomplished by directing the organization’s shared values toward delivering personalized care (Deal and Kennedy, 1982, p. 27). Senior management can set an example by promoting and exhibiting this culture by including residents, families, and employees in decision-making processes.
Empowering personnel to offer specialized care and support is another helpful approach for the Hope and Happy case. Senior management can change from a top-down to a participative management style, where employees are encouraged to express their opinions and thoughts (Fournier et al., 2022). Top management should evaluate the staff’s comprehension of their training and identify any gaps to ensure they possess the necessary skills and competencies to deliver safe and effective care.
Stakeholder Analysis
Stakeholder analysis is a crucial aspect of change management, as it helps identify the individuals or groups that will be affected by the changes being implemented. The Mendelow model stakeholder analysis provides a practical framework for evaluating the influence of stakeholders on an organization’s decisions and actions. Using a matrix, the Mendelow model divides stakeholders into four groups based on their level of power and interest (Mohamadian et al., 2022). It can be used to identify which stakeholders are more significant and deserve special consideration.
Firstly, the staff are the stakeholders with high power and high interest. The daily operations of the care facility and the standard of care given to the residents are significantly influenced by the staff. The staff are also likely interested in any modifications suggested by the registered manager and change consultants, as they may have an impact on their employment functions and responsibilities.
On the other hand, the high-power, low-interest stakeholders in this situation are the CQC and local authorities. Although these regulatory agencies may not be directly interested in the specifics of the changes advised by the registered manager and change consultants, they do have considerable power to compel change in the care facility. They might be more concerned with making sure the nursing home complies with the relevant requirements.
The low-power, high-interest stakeholders in this situation are the residents, their relatives, and friends. Although they may not have much influence over the modifications made to the care facility, they have a keen interest in the standard of care provided to the residents. They may have a considerable impact on the care home’s reputation because they are likely to be emotionally invested in the welfare and care of their loved ones.
Finally, the low-power, low-interest stakeholders in this situation are the general public. They could be generally interested in the care home’s operation. However, they are unlikely to exert any influence over the registered managers’ and change consultants’ judgments. Thus, it is evident that this group of stakeholders should receive the least attention compared to others, as discussed above.
Recommendations
Senior management may take several actions to address the issues and improve service quality. The first recommendation is to foster a culture that values providing residents with personalized care. This will facilitate customized care plans that meet the specific needs of each individual, providing them with the necessary support.
The second strategy entails enabling personnel to provide individualized care and support. The senior management of Hope and Happy should also assess any gaps in the staff’s comprehension of their training (Hofstede, 2003, p. 335). Additional training and development initiatives must be implemented to close these gaps. Finally, management should also routinely update personnel training and stay current on industry standards and best practices.
The final recommendation is that senior management should become aware of current industry standards and regulations to address the issue of infection control procedures that do not follow current guidelines. They should then relay this knowledge to their staff, providing them with the necessary training once again. Similarly, regular audits and inspections should be conducted to ensure compliance, and any necessary corrective actions should be implemented promptly.
Conclusion
The implementation of a robust change program is necessary to improve the quality of care provided at HaH. The Prosci ADKAR model and McKinsey’s 7S model can both provide practical approaches for managing change in care homes. McKinsey’s 7S model can provide solutions by ensuring that all parties have a clear understanding of the care home’s principles and objectives, examining how management leads the organization, training staff, and boosting staff motivation and engagement.
Reference List
Banfield, P. and Kay, R. (2012) Introduction to human resource management. 2nd edn. Oxford: Oxford University Press.
Deal, T. and Kennedy, A. (1982) Corporate cultures: the rites and rituals of corporate life. Harmondsworth: Penguin.
Fournier, P.-L., Moisan, L. and Lagacé, D. (2022) ‘Seizing the opportunity: the emergence of shared leadership during the deployment of an integrated performance management system’, BMC Health Services Research, 22(1). Web.
Gräßler, I. et al. (2021) ‘Handling of explicit uncertainty in requirements change management’, Proceedings of the Design Society, 1, pp. 1687–1696. Web.
Hayes, J. (2014) The theory and practice of change management. 4th edn. London: Palgrave Macmillan.
Hofstede, G. (2003) Cultures and organisations: Intercultural cooperation and its importance for survival: Software of the mind. London: Profile Books Ltd.
Jabri, M. (2018) Managing organizational change: Process, social construction and dialogue. 2nd edn. London: Palgrave.
Kotter, J. (2012) Leading change. Boston: Harvard Business Review Press.
Mohamadian, M. et al. (2022) ‘Stakeholders analysis of COVID-19 management and control: A case of Iran’, BMC Public Health, 22(1). Web.
Moussa, L., Garcia-Cardenas, V. and Benrimoj, S. (2019) ‘Change Facilitation Strategies Used in the Implementation of Innovations in Healthcare Practice: A Systematic Review’, Journal of Change Management, 19(4), pp. 283–301. Web.
Northouse, P. G. (2015) Leadership: Theory and practice. 7th edn. London: Sage Publications Ltd.
Schell, W. (2019) ‘Leadership and change management’, Traffic Safety Culture, pp. 191–218. Web.
Vernooij, C., et al. (2022) Organizational behaviour and change management. New York: Routledge.