role of change agents in change management

Running head: ROLE OF CHANGE AGENTS IN CHANGE MANAGEMENT 1

Role of Change Agents in Change Management

HRM 587

Ileana Delgado-Romero

[email protected]

August, 2014

ROLE OF CHANGE AGENTS IN CHANGE MANAGEMENT 2

Executive Summary

Throughout the years change has been the common denominator for many organizations.

Globalization and technology have mandated change for many organizations that wish to

succeed in this ever-evolving universe. External and internal components demand that

companies look outside of the box to formulate visions, missions and goals that are important to

and resonate with the company, the employees and the customers. Consumers embraced e-

commerce as a way of life for all their needs. Technology and globalization has empowered their

search for quality goods. Demand for quality products and services are more than important to

many companies; it is imperative to survival and success. Organizations need to change their

processes in order to accommodate cultures and consumers from all over the world. Change

develops in different stages and from different circumstances depending on the situation of the

change. The company implements these changes; however, at times the company’s stakeholders

resist change, consider them unsustainable, or misunderstand, causing failure before the plan can

take flight.

Blue Jay Consulting is a change agent, primarily for the emergency room, that develops

solutions to implement process change in a hospital organization. Blue Jay Consulting navigates

and directs an organization through a processual approach that uses models and specific steps to

drive positive outcomes. Morgan Executive Development Institute (MEDI) is a change agent

that develops solutions in order to implement individual change. MEDI interprets and coaches

an organization through an organizational development change that uses participation at the

individual level. Both consulting agents practice different types of change processes, however,

both agents work to increase a company’s employee and customer satisfaction. Each agent

assists the company to target its weaknesses and threats and transition them into strengths and


opportunities. Blue Jay Consulting is a reputable agent whose expertise in the emergency

department is reinforced by increased positive outcomes. MEDI is a reputable agent whose

expertise in leadership coaching is reinforced by increased positive employee participation.

Health Central Hospital is a hospital that has resided in the West Orange Community for

the past100 years. Richard Irwin, former President and CEO, had a vision to move the hospital

from Winter Garden to Ocoee to make it into a large five-floor tower community hospital.

Irwin’s vision was made into reality in 1985. Health Central Hospital became a community

hospital that has resided in Ocoee for over 25 years. In 2010, the CEO announced that the

hospital would no longer be an independent hospital, and it would become part of a private

health system. After two years of deliberation the hospital merged with the Orlando Health

hospital system and its other eight hospitals in the system. The President/CEO retired as a heroic

leader, although, Health Central Hospital did not acquire the status of a heroic organization. The

hospital desperately needed to increase patient satisfaction and remove its reputation and

moniker of “Death Central”. The new President of Health Central Hospital proposed a new

vision and new goals. The primary focus was to change the internal culture to work together as a

team. The employee culture had to change and work collaboratively to achieve an enhanced goal

and reputation of ‘patient first’. The process needed to start in the emergency department; the

heart of the hospital, to reduce its wait times, change its overall processes and work as a team to

drive and embrace positive change for all stakeholders.

Health Central Hospital contracted both Blue Jay Consulting and MEDI to assist in the

emergency room process change and associated leadership coaching. This research paper will

show how both agents are able to assist the culture change of the hospital. The consulting agents

created models that continuously improve processes, break resistance, collect data, maintain


accountability, and create goals of sustainability. Blue Jay Consulting applied the change

management approach to create an easier flow throughput in the emergency department. MEDI

applied the organization development approach to create a participant team among employees

that would dissolve silos and hold for accountability. These methods proved, and continue to

demonstrate, that an organization can rely on more than one agent or model to reach its goals and

outcomes.

An organization does not necessarily need to follow one model in order to succeed; it can

rely on different combinations of models to improve processes and create cultural change. Dr.

John Kotter’s 8 Step Change Model, William Bridges Managing Transition Model and other

models will be used to reinforce this theory. A practice manager must have the knowledge and

skills of different situational approaches, including the approach of contracting a consulting

agent, in order to be prepared for all changes.

Literature Review

Over the past decade consulting agents have become a billion dollar industry that has

globally influenced leaders and organizations on changes. Different concepts of change such as

organizational development and change management approaches are just a few of the various

methods utilized by organizations. Consulting agents provide the skills, resources and tools to

assist organizations in interpreting plans, navigating the tasks, implementing the processes,

defining outcomes and sharing opportunities. According to McCormack et al (2013) in order for

an organization to first contract a change agency it must review these questions, “ what works

(how particular interventions [known as mechanisms] perform), for whom does it work (different

individuals or populations), in what circumstance (different characteristics), and why

(explanations of relationships between mechanisms and contextual characteristics)”. The


concept must match the need and culture of the organization. Health Central Hospital asked

questions along this thought stream. Would Blue Jay Consulting increase the emergency

department flow? Would it affect the skills set and knowledge of the employees? And, would it

decrease the wait times in the emergency room? The same questions were asked of MEDI. Was

MEDI competent as a transformational leader? Could MEDI train the leadership team to

champion the management team who would in turn champion the staff? Could they coach,

educate and lead the culture to work as a team to increase patient satisfaction?

“”Death Central”” was a name associated with Health Central Hospital for a very long

time. It was a very difficult journey for the hospital to change a bad reputation to a good

reputation. A necessary change for the hospital was to improve on the culture’s mindset from a

“task oriented” staff to a “caring for the “patient-oriented” staff. The hospital’s mission

statement states, “caring, compassion and commitment,” however, for years, it did not live up to

those expectations. Physicians, nurses, technicians and all employees needed to work together as

a team for the need of the patient. Why? An organization’s vision and mission statement is the

foundational image of the organization, internally and externally. A consumer depends on these

statements to be authentic and honest. An organization, or in this circumstance a hospital, that is

unable to live up to the expectations of its mission then the hospital will lose its reputation as a

good hospital. The entire organization needed to become a “caring” team, absolutely and

authentically.

Boykin and Schoenhofer (2001) understood the need for a caring environment stating

“committing oneself to living caring requires humility and a lifelong openness to grow in

knowing self and others as caring persons.” It was important to step back and hold employees

accountable to the nature and expectations of their collective purpose at the hospital. The new


president of Health Central Hospital needed to lead the team into a new vision. The vision of

caring for each patient that walks through the doors of Health Central every day and every time.

Up until then, the 25 year vision of a community hospital was not working for the needs and

expectations of the patients, families and caregivers. MEDI, as executive coaches, would assist

in changing the culture to create that goal. The hospital’s president led the team and set the stage

for change by pronouncing, “What we focus on, we achieve”. In turn, the leadership team gave

the management team the resources and tools to change the culture and guide stakeholders

toward positive outcomes.

The Affordable Care Act signed in 2010 was part of the external change, which prompted

Health Central Hospital and all hospitals in the United States to revisit their visions, missions and

goals. Hospitals partnered with other hospitals to create joint systems to cut healthcare costs,

share best practices and provide a better quality of care. The U.S. Legislation and Judiciary

reinforced this intention for change when in 2012 the Supreme Court began to issue deadlines on

all the action plans related to the Affordable Care Act. Consulting businesses contracted for

advice, hand over fist. Hospitals needed leaders, employees and processes that would make

quality care successful. Weise (2013) acknowledges this phenomenon in her article noting

“Thanks in part to the Affordable Care Act, health-care advice is now a $10.2 billion industry

that’s expected to grow six percent annually over the next five years, according to research firm

IBIS World.”

Consulting firms had to re-invent their practices to accommodate and teach healthcare

organizations about the new change in healthcare. Hospitals were in desperate need for leaders

to become coaches, employees to adapt to the change without resistance, and processes that were

efficient and less costly, and provided greater quality of care. This global impact was bringing


the culture to a very large-scale change. The heart of the culture change was in employees.

Employees needed the understanding and teaching of working in teams to produce an excellent

hospital. One influential process in change management was that of building self-managing

work teams (SMWT). Kirkman and Shapiro (1997) reinforced this theory, citing “SMWTs

consist primarily of two dynamic components: (1) the process of self-management and (2)

colloborative team work.”

Health Central Hospital started many organizational changes. ‘Caring Heart’ was a

change that the management team and employees implemented as a service recovery for patients,

families and caregivers. The Service Excellence Committee was started in order to appoint

‘Service Excellence Champions’ from every department who would mentor and coach

employees into providing the best service to all patients, families and caregivers. ‘Finish Strong’

was a summer campaign that requested employees to “create and share memories of kindness”

with the patients, families, caregivers, co-workers and community. These stories were published

on the hospital’s intranet during the summer months. Many of these changes became a ““flavor

of the month”’ that were easily started and done in a positive manner with great but limited

outcomes; the sustainability of these practices was low. The Lean Six Sigma program was the

only true program that lasted; it is still in practice today. According to Canato, etal (2013) “A

new practice requires change in an existing web of practices, and it creates a potential conflict

between what people are asked to do and the ways in which they feel it is appropriate that things

be done, which are reflected in their customary ways of handling organizational activities”.

The hospital introduced ‘Flavor of the Month’ campaigns or new practices that could be

easily implemented and completed. Health Central Hospital employees embraced these activities

with great enthusiasm and positive attitudes; they welcomed the change. Employees diligently


accomplished the goals and objectives associated with these activities. Then at a certain point

their collective mindset returned to the ‘flavor of the month’ activities versus a continual

sustainability of the new program. As stated by Quinn, etal (2012) “our staff have learned how

to collaborate with unfamiliar people, academic structures, policies and approaches and work

together to enhance and deliver each other’s approaches to teaching and learning”. Health

Central staff members learned to work as a team, but it did not learn how to hold each other

accountable to sustain the structure as a team. A consulting agent such as Blue Jay Consulting

would be key to re-organizing the processes to be implemented as long-term action plans. This

change management approach would enable the team to accept and use plans as everyday

occurrences rather than temporary activities. MEDI consulting agents would assist in the

individualized organizational approach to teach and coach each team members through the new

change. Team members would be educated and inspired to embrace changes and have the ability

to forward knowledge takeaways to other team members, thereby creating a ripple effect. These

various approaches would enable Health Central Hospital to mold its culture into one that fosters

a successful team.

Discussion and Conclusion

Change is constant; a drive that establishes heroic leaders who build heroic organizations.

A change can be intended, partial or unintended. Changes can come from a controlled or a

shaping source. It matters not where the source comes from, or what type of source it is. What is

crucial is that the change be reviewed by an organization and its leaders. An organization needs

to be prepared in order to drive more of a proactive rather than reactive outcome. Many

institutions such as governments, hospitals or technology are directed by controlled changes.

These changes usually have a large impact on the system. Organizations usually have an


awareness of changes that will surface in the future. Introduced in 2010, the Affordable Care

Act is a legislative change that no one took seriously. Once healthcare institutions received

deadlines to incorporate change plans, or face monetary penalties, hospitals then moved to

incorporate changes mandated by the act. A practice manager working in an agency would need

to have the skills to interpret these laws and navigate the people who would execute and enforce

the laws. A navigator would be able to control the intended change and through the right

processes navigate the implementation. The CEO and President of Health Central Hospital was a

heroic leader who was able to turn a small hospital into a large-scale community hospital in the

West Orange District. His vision of a caring community hospital was established. It was the

only hospital in the vicinity to serve the community. The hospital faltered when its reputation as

‘“Death Central”’ became a threat and weakness to the hospital’s standards. The Affordable Care

Act catalyzed an avoidable need to change the hospital’s culture and improve its reputation.

As the Affordable Care Act continues to mature, hospitals all over the United States are

shaping their short-term and long-term goals to reflect the needs of the patient. Better quality of

care at a lower cost is now the expectant service. To support this service expectation, Health

Central Hospital had to win back the trust of the community and increase patient satisfaction.

The emergency is the heart of all hospitals. Wait times are a common dissatisfaction or

satisfaction of any emergency room in the country. Health Central’s emergency room wait times

were on an average four to eight hours. Blue Jay Consulting, as a director and navigator, assisted

Health Central by using the change management approach. The change management approach

focused on step-by-step processes and models. Models such as Kotter’s 8-Step Model and

Rand’s Six Steps were and continue to be used to create specific changes. Models were arranged

specifically to the culture and the specific change in question. Blue Jay Consulting’s objective


was to decrease the length of wait times in the emergency room to raise patient satisfaction and

increase revenues.

Figure 1

As seen in Hoelz and Mason’s Health Central presentation (Figure1), Blue Jay

Consulting’s change management approach contained four phases of process improvements.

The first phase in the approach consisted of an assessment methodology which included data

review of patient throughput in the emergency room, interviews with all emergency staff and

leadership and a detailed observation of all areas that collaborated with the emergency room.

The second phase was an inclusive data analysis for one year (January to April, 2009) that gave a

detailed account of wait times, process times, work times and any other interrelated times which

were necessary and unnecessary in the emergency room. The third phase was the

implementation and recommendation phase which included the following (Figure 2):


Figure 2

These action plans were earmarked for implementation within a 26-week timetable. The

plan included revamping the staff and leadership team, increasing efficiency in triage, daily

consultant visits on a temporary basis, education and training of staff, monthly data reports and a

new concierge desk for incoming patients.

MEDI, as coach and interpreter, assisted Health Central by using the organization

development (OD) approach. The OD approach focused on individual development, as well as

the people of the organization. Organizational development models such as Appreciate Inquiry,

Positive Organizational Scholarship and Sense-Making approaches rely on the skills and

competencies of the individual. These models are used together or separately depending on the

need of the culture. MEDI’s organizational development approach included the following five

phases to human performance in an organization (Figure 3):


Figure 3

MEDI’s services rendered its coach services primarily to Health Central’s corporate

leadership team. The first two phases, competency requirements and talent pool, were the

beginning of the process where the MEDI agents gathered information. The two consulting

agents assigned to Health Central collected specific data regarding competency assessments,

education, work experience, leadership experience, and career motivation. Phase three,

assessment of potential, included a day of one-on-one meetings between leadership members and

consulting agents. This all-day meeting connected the consulting agent with the executive to

discuss needs, improvements and goals. Phase four of the individualized process change was

Talent Review. This enabled all executive leaders involved in the organizational development


process to meet with MEDI consultants for a session; the agenda consisted of review tools

analysis, discussion updates and planning of the next steps. The last phase in the process called

Talent Development involved the development of targeted needs future goals and the next steps.

The leadership executive teams connected with the consulting agents by conference call

meetings in which agents provided feedback, resources, tools and coaching for all leaders.

Leaders-coaching management, management-coaching-staff, and staff-coaching-staff was, and

remains, an important organization development process to assist Health Central with culture

change, driving it to think as one unified entity.

Presently, the West Orange Community no longer regards Health Central as ‘Death

Central’. The hospital has improved its status in the community in the last four years since its

merger with the Orlando Health hospital system. The Health Central team has consistently

shown its pride and excellent services during various occasions. As stated recently by the Center

of Medicaid Services (CMS), “Health Central is recognized as a mentor hospital for best

practices in reducing harm and re-admissions.” While working collaboratively with Blue Jay

Consulting and MEDI, Health Central Hospital has been lauded as a “Grade A Hospital for 24

months running by the Leapfrog Group; received full accreditation by the Joint Commission;

was recognized as an Ongoing Professional Practice Evaluation (OPPE) best practice by VHA

Southeast Bright Ideas magazine; was deemed the first and only fully accredited stroke receiving

hospital in Central Florida, and was noted as the number one hospital in the Orlando Health

organization for quality improvement for the last four years”. The hospital’s achievements were

hard-won through collaborative efforts from all members of the leadership executive team,

management, and staff to maintain the ‘patient first’ vision.


Reflections

Managing change is a skill that a practice manager must acquire to gain perspective in the

ever-changing business world. Reading various pieces of literatures and attending classes, I have

come to the conclusion that a manager can start out reflecting one image, however, depending on

the situation, the need, and the approach to the change success may require an entirely different

image. It is up to the manager to make sure they are flexible to handle any approach. The most

important concept I have learned is the situational approach. As a project manager, this

approach is very flexible and will help me effectively decide on the most beneficial images,

approaches and courses of action in the future. Although some models or approaches will be

preferable over others, collectively and interchangeably they can work for a successful

organization. I will challenge myself to become a director and coach who will be able to lead an

organization towards its goals and coach teams to work towards the same goals. As a director I

will always seek change management processes that are detailed and task orientated. As a Lean

Six Sigma user, a director can outline processes and implement changes with definite step-by-

step details. As a coach, the need to select and develop the right team to complete these

processes is also as important. One specific model might not service the need adequately or

answer all of the organization’s needs. A change management approach and an organizational

development approach, working collaboratively, can enhance an organization’s services and

culture. The following models are those that I would choose as a project manager when

implementing a change. The first priority in implementing a change is to assess if there is a need

for a change. Beckhard’s Change Model (Figure 4) teaches a method of using an equation to

assess the need for change.


Figure 4

An organization should always re-evaluate its vision and goals. It is important to assess

if there is a time for a change and if the change can be implemented. Internal resistance to

change can be a great hindrance to an organization, but by following Beckhard’s model, I can

execute a plan to proactively forecast and compensate for these resistances. Once the barriers are

identified, the next step will be to use William Bridge’s model of the 4 P’s. The four P’s is a tool

I would use to outline how I would proceed through executing the change. The first P stands for

purpose. Is there a purpose for this change? There could be dissatisfaction with the current state

of the organization, which demands the consideration of an internal change. There could be an

external component, such as the Affordable Care Act that has forced an organization to make a

change. The purpose is an initiative and a way to keep your plan focused on the goal. The

second P is ‘picture’. This is a necessary step in laying out your timeline and the ‘what if’s’ of

your plan. In Beckhard’s model (Figure 4) he states that the vision needs to be enticing. At this


point I would seek to interpret the vision, its meaning and determine if it is necessary to change

the organization’s current vision or create another one. The vision has always been the drive and

the image of the organization. In order to make sure that these changes will be a positive, it will

be important to “picture” the outcomes. This step would assist me in acting as interpreter and

navigator of the plan.

The next P is ‘plan’. As a practice manager, the planning of any change is crucial. There

is where I would use the Lean Six Sigma DMAIC Methodology (appendix page 20) and Kotter’s

8 Steps to Change (Appendix page 21) to direct the organization in the change process. The

DMAIC methodology is a simple process used by Lean Six Sigma to solve a problem or

implement a change. The five phases, as seen on page 20, consist of steps which include

defining, measuring, analyzing, improving and controlling. These steps contribute to a specific

method of creating change, measuring change and sustaining change. Kotter’s 8 Steps Process

Change will also assist by defining the 8 phases (Appendix page 21) that include creating

urgency, forming a coalition, developing a vision and strategy, communicating the vision,

enabling action and removal of obstacles, generating short term wins, holding the gains and

building on change and anchoring the change into the culture. These combined models will

ensure that I build a precise step-by-step change plan to assist in my change management

approach.

The last of the four P’s is ‘part’. This part for me is where I will implement the

organizational development approach to help me bring the culture into the change. This phase of

the P’s identifies who the players are, what role they are to play, and who is responsible for the

outcomes. I believe that a balance of both the change process approach and the organizational

development approach captures the organization and the individuals. According to Beckhard


(Allen, etal 2014), “the culture can resist or assist in implementing the change”. As a coach, I

would assist in creating a culture that can be part of the change. The team will need to be defined

in order to have the right measures and accountability needed for data analysis. Each team will

consist of the right member to fit the need with precision. A culture that has the right resources

and tools will be empowered to take ownership.

According to Dr. John Kotter (Printwise, 2012), “the rate of change is not going to slow

down anytime soon. If anything, competition in most industries will probably speed up even

more in the next few decades.” Change is here to stay and it would be futile for a practice

manager to be unaware or unprepared for changes that may occur in an organization. The

change management model on the page 18 is my concept on how to implement a change. It’s a

model created from various other models that work in change management processes. I have

learned that a practice manager always needs to increase their skills. Old processes will be re-

invented and new processes will be created, therefore, it would make sense for a practice

manager to make sure that education and training are routinely updated throughout their career.

Many seminars and conferences all over the world offer training in change processes. Practice

managers should also be aware of available resources and tools such as consulting agents who

can assist in large transformational changes. . Consulting agents are more than willing to visit

organizations for onsite consultations. Another important concept learned in this class is team

work. A leader cannot execute a change without a team that takes ownership of the change. It

will be the responsibility of the leader to communicate and involve the team throughout the

process of the vision, the change, and the rewards of the outcome. In the end, it is not the

processes that are important, but the execution of the processes. The process represents the


ability of an organization to culturally co-exist as one team for the goals of meeting consumer

expectations.


Beckhard's Formula DxVxF>R

PURPOSE

PICTURE PLAN

PART

• Communication • Why - external or internal? • Vision - old or new?

PURPOSE

• Communication • Short term goals • Long term goals

PICTURE

• Communication • DMAIC • Kotter's 8 Step Process

PLAN Change Management

Approach

• Communication • Development of Teams • Coaching of Leaders

PART Organizational

Development Approach


References

Allen, A. & Angus L. (2014). Morgan Executive Development Institute (MEDI) A Novis

Healthways Company.

Boykin, A. & Schoenhofer, S. (2001). The role of nursing leadership in creating caring

Environments in health care delivery systems. Nursing Administration Quarterly,

Spring, 25(3), 1-7.

Bridges, W. (2006). Getting them through the wilderness – a leader’s guide to transition.

William Bridges & Associates Resources for Organizations in Transition. Retrieved

from www.wmbridges.com/pdf/getting-thru-wilderness-2006-v2.pdf on July 14, 2014.

Bridges, W. (2014). Managing transitions. Retrieved from salvos.org.au/…/Transitions/

SLIDES_-_The_Bridges_Transition_Model.pdf on July 14, 2014.

Canato, A., Ravasi, D., & Phillips, N. (2013). Coerced practice implementation in cases of

low cultural fit: cultural changed and practice adaptation during the implementation of

six sigma at 3M. Academy of Management Journal, 56(6), 1724-1753. Doi:10.5465/

amj.2011.0093. Retrieved from http://search.ebscohost.com on July 14, 2014

Go Lean Six Sigma. (2012) DMAIC: The 5 phases of Lean Six Sigma. Retrieved from

www.goleansixsigma.com on August 1, 2014.

Health Central Hospital. (2014). Best practices – your achievements in action. Insight,

August 1, 2014, 6(16), 2.

Hoelz, J. & Mason, D. (1997). Ed assessment findings health central. Blue Jay Consulting.

Power point presentation.

Hutton, D.H. & Chapin, L. (2011). Easing the transition. Trustee. November/December, 2011.

Hutton, D.H. & Moulton, S.C. (2009). A leaders guide for establishing a succession planning

http://www.wmbridges.com/pdf/getting-thru-wilderness-2006-v2.pdf

http://search.ebscohost.com/

http://www.goleansixsigma.com/


& management process. Action Insight – Charting a Course for Human Performance.

Kirkman, B.L. & Shapiro, D.L. (1997). The impact of cultural values on employee resistance to

Teams: toward a model of globalized self-managing work team effectiveness. Academy

of Management Review, 22(3), 730-757. Doi:10.5465/AMR.1997.9708210724.

Retrieved from http://search.ebscohost.com on July 14, 2014.

Managing Change Handout. (2014). Change Models and Individual Change Models.

Retrieved from https://depts.washington.edu/oei/…/managing_change_handout.pdf.

on July 14, 2014.

McCormack, B., Rycroft-Malone, J., DeCorby, K., Hutchinson, A.M., Bucknall, T., Kent, B., &

Wilson, V. (2013). A realist review of interventions and strategies to promote evidence-

informed healthcare: a focus on change agency. Implementation Science, 8(1), 1-12.

Doi:10.1186/1748-5908-8-107. Retrieved from http://search.ebscohost.com on July 14,

2014.

PrintWise. (2012). Change management implementation guide. Retrieved from https://

Strategicsourcing.gov/…/guiding_principles_for_leading_change_guide_vjune2012.pdf

on July 14, 2014.

Quinn, D., Amer, Y., Lonie, A., Blackmore, K., Thompson, L., & Pettigrove, M., (2012).

Leading change: applying change management approaches to engage students in blended

Learning. Australasian Journal of Educational Technology, 2012, 28(1), 16-29.

Retrieved from http://www.ascilite.org.au/ajet/ajet28/quinn.html on July 14, 2014.

RBS Group. (2013). The 8-step process for leading change Dr. Kotter’s methodology of change

leadership. RBSGroup Change Mangement. Retrieved from www.rbsgroup.ed/…pdfs

2013_THE_8-STEP_PROCESS_FOR_LEADING_CHANGE.pdf on July 14, 2014.




Weise, K. (2013). Consultants Cash in on Obamacare. Businessweek.Com, 26. Retrieved from

http://search.ebscohost.com on July 14, 2014.



Appendix


Kotter’s 8 Steps Process Change

role of change agents in change management

Documents

years change

individual change

role of change agents

change management hrm

hospital organization

independent hospital

health central hospital

consulting agents