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Three different types of organizational change can be implemented when a particular problem has to be solved. Those are developmental, transitional and transformational changes. Every one of them has its strengths and weaknesses, as well as divergences in structures and applications, which make them efficient in one type of cases and inefficient in the others.
In this paper, it is shown how the developmental approach can address the problem of surgeons’ lateness for scheduled surgical procedures. It is also explained why this model is the best option and how the results of its implementation can be estimated.
Identifying the Problem: Statistics, Importance, Urgency
Delay in the operating rooms is a very frequent problem that has an adverse impact on the organization of work, the schedule, and even the efficiency of operations. Besides, it usually affects the patient flow since delays show the incompetence of the personnel. According to research conducted by Wong, Khu, Kaderali, and Bernstein (2010), who studied 1531 surgical cases, delays in the operating room were the most common mistakes (33.6%) in medical practice (p. 189). Moreover, there was at least one delay in approximately 50% of all surgical cases (Wong et al., 2010, p. 189). As for the causes of those delays, the same study asserted that the most frequent one was an equipment failure (Wong et al., 2010, p. 189). However, Wright, Roche, and Khoury (2010) stated that just the opposite was true in their case: “the most common reasons for delay were surgeon and anesthesiologist unavailability and lack of preparedness of patients” (p. 167). Therefore, surgeons’ lateness indeed is an important problem, which has to be addressed as a matter of urgency.
The Change Model that Address the Problem
There is no right answer to the question, which change model is the best in this particular case. Developmental change is a change “within the box” (Anderson & Anderson, 2010, p. 52). It is aimed to develop the current state by improving existing skills and systems. A transitional model takes a current state and replaces it with another one, completely new. Finally, the transformational type of change is the most difficult one. It implies building a new state with the help of replacing current systems, error discovery and regular changes of strategies.
To address the problem of surgeons’ lateness, the developmental type of change has been chosen. The choice was made by exclusion. The surgeons’ lateness problem can be solved locally, and a transformation of the whole system is not necessary. That is why the transitional model is not needed for this kind of change. The transformational approach is too complicated and takes a lot of efforts and time, which is not necessary in this case as well. Therefore, a developmental model is the one that should be used here. Besides, this type of organizational change is both people- and goal-oriented, and the risks connected to this approach, as well as the number of unpredictable variables, are lower in comparison with other types.
Implementation of Change
Hall (2015) believes that the change is much more complicated than a single event – it is a process. Fullan (2014) adds that this process is nonlinear, and change can not be managed: “the best way to ‘manage’ change is to allow for it to happen” (p. 33). However, the change process can still be planned, although it may be necessary to retreat from the original plan during the process of implementation.
The plan of developmental change in the case of surgeons’ lateness is presented below.
The first thing that should be done is identifying the causes of the problem. Surgeons can be late for scheduled surgical procedures for many reasons: because of personal circumstances, technical faults, overloaded schedule (when they are needed by other patients or staff members), etc.
Since it is better to focus on encouragements instead of punishments or forcing, the intervention should begin with the attempts to make people understand the problem. That can be realized with the help of presentations, meetings, workshops, etc. As far as this problem concerns not only surgeons but all members of the staff, especially nurses and anesthesiologists, all of them should be present at those meetings.
The next step is to choose a group of leaders who will control the further intervention, encourage people and analyze any progress or regress. Those guiding coalitions should clearly establish short-term goals and communicate them to all staff members. For example, nurses should be told to write down the start time of every operation. If it has not been started in time, they should also write down the cause of it (lateness of surgeon/anesthetist/nurse, technical faults and so on). If surgeon’s lateness causes the delay, he or she should explain the reason, and it has to be written down as well. That will transform the necessary information into measurable variables and make further analysis and estimation of change model possible.
To encourage the surgeons to come in time, a hospital can implement a bonus system. For instance, those who have not been late for any scheduled surgical procedure within a month more than for 3 minutes will get a small one-time increase to the salary.
Plan for Assessing the Implementation of the Change Model
To understand whether a change model is efficient or not, it should be regularly estimated. The easiest way to do this is to collect statistical data. First of all, it is necessary to collect statistics from the very beginning, before the change model is implemented. The results can even be demonstrated to the staff members – to illustrate the real situation. Then, the same information should be systematically gathered during the whole period of intervention.
To evaluate the efficiency of the chosen change model, all these data should be regularly compared. Perhaps, it would be useful to present the results of a comparison in the form of a graph or a diagram and demonstrate those to the staff members at weekly meetings.
The chosen type of organizational change is easy to both comprehend and implement. It is also flexible and people-oriented, and due to that, it is more likely to make the staff members cooperate. This moment is imperative since “the people in the organization… shape the structure of the organization”, and only because of their cooperation any change becomes possible (Owens & Valesky, 2014, p. 90). Besides, this method does not violate the usual course of work and addresses only one problem, doing it locally. Finally, it does not take a lot of efforts and time from a group of leaders, and its efficiency can be easily estimated. In the research conducted by Wright et al. (2010), a similar change model was implemented, and the “percentage of operations that began on time… increased from about 6% to 60% over a 9-month period” (p. 167). So, the efficiency of this approach is really high enough.
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Anderson, D., & Anderson, L. A. (2010). Beyond Change Management: How to Achieve Breakthrough Results Through Conscious Change Leadership (2nd ed.). San Francisco, CA: John Wiley & Sons.
Fullan, M. (2014). Leading in a Culture of Change. Hoboken, NJ: John Willey & Sons.
Hall, G. E. (2015). Implementing Change: Patterns, Principles, and Potholes (4th ed.). Upper Saddle River, NJ: Pearson Education.
Owens, R. G. & Valesky, T. C. (2014). Organizational Behavior in Education: Leadership and School Reform (10 ed.). Upper Saddle River, NJ: Pearson Education.
Wong, J., Khu, K. J., Kaderali, Z., & Bernstein, M. (2010). Delays in the operating room: signs of an imperfect system. Canadian Journal of Surgery, 53(3), 189-195.
Wright, J. G., Roche, A., & Khoury, A. E. (2010). Improving on-time surgical starts in an operating room. Canadian Journal of Surgery, 53(3), 167-170.