Two health organizations in Australia initiated transformational changes to promote the culture of learning organization within the specific institutions. These are the New South Wales (NSW) Health and the Flinders Medical Center (FMC) both located in South Australia (McGrath, Bennett, Ben-Tovim, Boyages, Lyons & O’Connell, 2008).
Need for change
The need for change arose because of increasing pressure on available resources especially in terms of the number of in-patient beds available for the increasing number of older patients in the north south wales region. This led to over occupancy of the Emergency Departments of most of the hospitals in the region such as at the Flinders Medical Center Australia (McGrath, Bennett, Ben-Tovim, Boyages, Lyons & O’Connell, 2008). As a result of this a lot of patients were subjected to long queues in the waiting bays of the hospital which were over crowded, since the hospitals had fewer in-patient beds as compared to the number of patients received daily.
Flinders Medical Center a 500 bed hospital that a coverage of over 300,000 people. Though this population is catered for by other hospitals, FMC is the major player in Complex and emergency procedures. It is estimated that 70% of the patients presenting at FMC’s ED required emergency care and 40% of these patients are ultimately admitted as in-patients. Because of this, the hospital experienced unmanageable cases of overcrowding at its emergency department, which required immediate attention (O’Connell, Ben-Tovim, McCaughan, Szwarcbord & McGrath, 2008).
Stakeholders involved in the change
A wide range of stakeholders was involved at different stages of the transformational change process. At first, the government of New South Wales in collaboration with the various public hospitals in the region ran an educational program to the public prior to initiation of the change. The NSW Director-General of Health directly supervised this program. Furthermore, the senior management of the hospital including the C.E.O. was part of the team.
The whole staffs of the Hospital were intensively educated on the need to embrace the change process. Finally, the patients were educated on the need for change and were made part for the transformation. Each of these people was required to act as a teacher to others hence reinforcing the learning organization (O’Connell, Ben-Tovim, McCaughan, Szwarcbord & McGrath, 2008).
Time frame of the change process
The period of the change process was set at 3 years for the NSW and 5 years for the FMC. NSW initiated the change process in 2002 while FMC initiated the process in November 2003 (McGrath, Bennett, Ben-Tovim, Boyages, Lyons & O’Connell, 2008).
Financial resources
The New South Wales regional government provided the bulk of the funding. The funding was implemented in three phases with each phase running for a period of twelve months. The whole phase took three years and it cost an estimated $ 70 million.
Challenges encountered during the change process
During the change process especially in the initial stages, the program faced opposition from members of the community that wanted more hospitals built instead of initiating change in the already existing institutions. In addition, patients perceived the change to be a waste of money, since in the early stages no tangible results were being observed. Furthermore, the change process almost hit a snag when some patients were reluctant in taking part in the change process (Johnson, 2009).
Some clinicians were reluctant to embrace the new processes aimed at improving care especially in the Emergency Department since some thought the change involved change in clinical procedures, which in essence would be met with resistance. Furthermore, the absence of resources stipulated in the change process design in the initial stages led to some of the clinicians casting doubt on the success of the whole process.
The fear that the whole program would come tumbling down was of concern especially in circumstances where resources were limited. Furthermore, the staff had the fear that jobs will be lost if they supported the process of change. This led to reluctance to participate in some of the implementation process such as when new technological devices were introduced.
Outcomes of the Change Process
The gains of the change process were clear and evident in every area that the change was implemented. It has been observed that the umber of patients complaining of poor services has realty declined since the initiation of the change process despite an increase in emergency patient numbers within the same period.
It was further observed that in the wake of the changes the number of patients admitted within eight hours of arrival at the emergency department increased tremendously with some days clogging more than 90% admissions within the same period. In addition, the number of patients outgoing from the emergency department within eight hours of presentation tremendously increased. Consequently, an accelerated increase in number of patients attending ED was observed.
Effects of the change process were also observed in the surgical units of the Flinders Medical Center and other hospitals that implemented the change. It was observed that the number of patients put on the waiting list for a period of greater than twelve months declined immensely. Moreover, total time of hospitalization was noted to decrease with progression of the change process because of reduced bureaucratic processes saving an approximate 15000 bed days (Ben-Tovim, Bassham, Bennett, Dougherty, Martin, O’Neill, et al, 2008).
Of importance to the whole process was the significant decrease in rate of mortality and morbidity. Over and after the period of change the death rate at all NSW facilities significantly decreased. This was attributed to the change process that greatly cut short on the waiting times in the various departments.
It was observed that the number of patients who vacated the ED without being attend to declined sharply with initiation of the change process especially in the area of proper allocation of patients to specific staff. This was evidence enough of patient fulfillment with the type of services offered at the ED of the various hospitals that implemented the change. Furthermore, shortage of staff a once common occurrence declined because of staff stabilization after the change process.
Of importance to note is that with all these gains there was no change in staff ratios or working space, rather the change involved redesigning programs on how things are done at these sites. Furthermore, the FMC’s client base increased tremendously showing evidence of a successful change process.
Institutional lessons learned from the change process
From this change process, it is evident that for a change process to succeed it needs to involve all stakeholders in the change process and they should feel that their solution to the problem is vital to drive the whole change process. When all the members of an organization feel they are out to achieve a gainful change, then the change process will be smooth. Consequently, it is evident that involvement of the highest office in the organization greatly gives a boost to the change process. For instance, it was observed that with the presence of The NSW Director-General of Health in the supervision of the change process (Johnson, 2009).
The importance of period in designing the change process is evident in this scenario. With a defined period, the members of organization are aware of the importance of meeting the targets within the specified time or risk being out run by events.
To achieve results, the mental attitudes of the members of the organization need to be refined and made to accept the change. This was accomplished through educating the patients and training the staff of the need for change and its effect on the overall patient care (Ben-Tovim, Bassham, Bennett, Dougherty, Martin, O’Neill, et al, 2008).
NSW Health initiated a shared idea across all the hospitals in the region creating a sense of a common aspiration that facilitated accomplishments of set goals in decongesting the Emergency Departments. This was achieved through the realization that almost all individuals wanted something to be done about the situation at ED. As such, the change initiator built on this shared desire to drive the staff and patients alike into being part and parcel of the change process (Johnson, 2009).
To initiate the changes, it was observed that it was easier to educate people as a team rather than as individuals since this allowed a dialogue with varied viewpoints, which gave the initiators on how the whole process should be initiated, built and implemented.
References
Ben-Tovim, I.D., Bassham, J.E., Bennett, D.M., Dougherty, M.L., Martin, M.A., O’Neill, S.J., et al. (2008). Redesigning care at the Flinders Medical Centre: Clinical process redesign using “lean thinking”, The Medical Journal of Australia, 188(6), 27-31.
Johnson, J. A. (2009). Health organizations: Theory, behavior, and development. Sudbury, MA: Jones and Bartlett Publishers.
McGrath, K.M., Bennett, D.M., Ben-Tovim, I.D., Boyages, S. C., Lyons, N.J., & O’Connell, T.J. (2008). Implementing and sustaining transformational change in health care: Lessons learnt about clinical process redesign. The Medical Journal of Australia, 188, 32-35.
O’Connell, T.J., Ben-Tovim, I.D., McCaughan, B.C., Szwarcbord, M.G., & McGrath, K.M. (2008). Health services under siege: The case for clinical process redesign. The Medical Journal of Australia, 188(6), 9-13.