Effective change management in a regional Sub-acute Ambulatory Care Services setting
Bruce W. CampbellLatrobe Regional Hospital, PO Box 424, Traralgon, Vic. 3844, Australia. Email: bcampbell@lrh.com.au
Australian Health Review 36(1) 39-42 https://doi.org/10.1071/AH11031
Submitted: 5 April 2011 Accepted: 4 November 2011 Published: 9 February 2012
Abstract
Government policies and community expectations in Australia continually lead to calls for healthcare change. These changes are often met with resistance from clinicians and managers. Making change happen requires consideration of the way policies, culture, context, shared vision and leadership can drive or impede change. This reflective case study critically investigates one change process; the evolution of a Sub-acute Ambulatory Care Services (SACS) program in an Australian regional hospital over a 3-year period. The new Community Rehabilitation Services (CRS) program evolved from a merger of Centre and Home Based Rehabilitation (CBR and HBR). Hospital amalgamations, closures and privatisation, and the Department of Health policy relating to SACS, ambulatory care and rehabilitation were some of the key elements explored in this paper.
What is known about the topic? Healthcare is an industry constantly focussed on improving services and care to patients. There has been a lot written about change management in healthcare. Change can be difficult to implement and is a dynamic phenomenon. There are many factors which can assist or hinder change.
What does this paper add? This reflective case study outlines the change process in this particular regional healthcare setting context within a multidisciplinary team. This paper adds to the body of knowledge by considering the influences of the unique history and culture of the setting, and the complex interrelated nature of factors which can affect change.
What are the implications for practitioners? Healthcare service managers need to understand that the change process is complex and can be confusing. Government policy constantly drives change in this industry to improve patient care, but how an organisation works through this is unique to the setting. One size does not fit all, and understanding the organisation, staff, culture and having a vision at that point in time is an essential prerequisite. Any change requires working with people who need time to adapt, up skill and learn new processes and procedures. Reanalysing the change process and being flexible during the journey can assist in reaching the desired change outcome.
References
[1] Victorian Patient Satisfaction Monitor Year 8 Annual Report. Ultra Feedback Pty Ltd; 2009. Available at http://www.health.vic.gov.au/patsat/vpsm_annual_report_year_8_p1.pdf [verified 21 February 2011].[2] Walshe L. Healthcare in the valley of power: a history of Central Gippsland Hospital, Traralgon. Traralgon, Vic.: The LV Printers Pty Ltd; 1992.
[3] McClelland JE. A report on the capital requirements of publicly funded health services in Victoria for the next ten years. Melbourne: Health Commission of Victoria; 1983.
[4] Annual Report 1999/2000. Sale, Vic.: Central Gippsland Health Service; 2000.
[5] Dow S. Hospital is ‘on verge of collapse’. The Age, 5 September 1995. p. 6.
[6] Dow S. Plan to privatise hospital attacked. The Age, 11 October 1995. p. 4.
[7] Kaye T, Winkler T. Contractor is chosen for Latrobe Hospital. The Age, 16 October 1996. p. 2.
[8] Report on Public Sector Agencies. June 2002. Part 3 – Human Services. Melbourne: Victorian Auditor-General’s Office; 2002.
[9] Rehabilitation into the 21st Century: a vision for Victoria. Melbourne: Department of Human Services; 1997.
[10] Rural directions for a better state of health. Melbourne: Victorian Government Department of Human Services, Rural and Regional Health Services Branch; 2005.
[11] Improving care for older people: a policy for Health Services. Melbourne: Department of Human Services; 2003.
[12] Health independence programs guidelines. Melbourne: Victorian Government Department of Human Services; 2008.
[13] Sub-acute ambulatory care services. Department of Health; 2010. Available at http://www.health.vic.gov.au/agedcare/services/subacute.htm [verified 7 December 2010].
[14] Care in your community – a planning framework for integrated ambulatory health care. Melbourne: Victorian Government Department of Human Services; 2006.
[15] Community rehabilitation centres generic brief. Melbourne: Victorian Government Department of Human Services; 2000.
[16] Dewey J. How we think. Boston: D.C. Heath and Company; 1933.
[17] Kinsella EA. Professional knowledge and the epistemology of reflective practice. Nurs Philos 2010; 11 3–14.
| Professional knowledge and the epistemology of reflective practice.Crossref | GoogleScholarGoogle Scholar | 20017878PubMed |
[18] Gill R. Change management – or change leadership? J Change Manag 2002; 3 307–18. [Revised 2003]
| Change management – or change leadership?Crossref | GoogleScholarGoogle Scholar |
[19] Karp T, Helgo TIT. From change management to change leadership: embracing chaotic change in public service organizations. J Change Manag 2008; 8 85–96.
| From change management to change leadership: embracing chaotic change in public service organizations.Crossref | GoogleScholarGoogle Scholar |
[20] Lorenzi NM, Riley RT. Managing change: an overview. J Am Med Inform Assoc 2000; 7 116–24.
| Managing change: an overview.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7pt1ygtQ%3D%3D&md5=49201aed9a4a7af27ed01e2b97035e39CAS | 10730594PubMed |
[21] Garside P. Organisational context for quality: lessons from the fields of organisational development and change management. Qual Health Care 1998; 7 s8–15.
| 10339039PubMed |
[22] Improvement leaders guide: managing the human dimensions of change. Coventry: NHS Institute of Innovation and Improvement; 2005.
[23] Managing organisational change. Brisbane: Queensland Health; 1999.
[24] Supporting employees through organisational change. Brisbane: Queensland Health; 1999.
[25] van Dijk R. Navigating organizational change: change leaders, employee resistance and work-based identities. J Change Manag 2009; 9 143–63.
| Navigating organizational change: change leaders, employee resistance and work-based identities.Crossref | GoogleScholarGoogle Scholar |
[26] Successfully implementing change. Melbourne: Victorian Quality Council; 2006.
[27] Weber V, Joshi MS. Effecting and leading change in health care organizations. Jt Comm J Qual Improv 2000; 26 388–99.
| 1:STN:280:DC%2BD3M%2FisValuw%3D%3D&md5=0c81f5fd3cbaad7ef3ad65bc7b5ef144CAS | 10897456PubMed |
[28] Waldman JD, Smith HL, Hood JN. Corporate culture: the missing piece of the healthcare puzzle. Hosp Top 2003; 81 5–14.
| Corporate culture: the missing piece of the healthcare puzzle.Crossref | GoogleScholarGoogle Scholar | 14513744PubMed |
[29] Lacey P. Interdisciplinary training for staff working with people with profound and multiple learning disabilities. J Interprof Care 1998; 12 43–52.
| Interdisciplinary training for staff working with people with profound and multiple learning disabilities.Crossref | GoogleScholarGoogle Scholar |
[30] Mockett L, Horsfall J, O’Callaghan W. Education leadership in the clinical health care setting: a framework for nursing education development. Nurse Educ Today 2006; 26 712–8.
| Education leadership in the clinical health care setting: a framework for nursing education development.Crossref | GoogleScholarGoogle Scholar | 17028073PubMed |
[31] Narine L, Persaud DD. Gaining and maintaining commitment to large-scale change in healthcare organizations. Health Serv Manage Res 2003; 16 179–87.
| Gaining and maintaining commitment to large-scale change in healthcare organizations.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3sznsFSmtw%3D%3D&md5=ee620e296bea8d22fed77ab183ce62c4CAS | 12908992PubMed |
[32] S2S Service Coordination. Welcome to S2S. 2010. Available at http://info.s2s.org.au/ [verified 13 December 2010].
