Thoughtful application can reduce resistance and improve overall operations, if consistent steps are followed.
During the coronavirus disease 2019 (COVID-19) pandemic, organizations have promoted concepts such as "We are in this together" to ensure buy-in and build communication with employees and the public.
However, we should consider post-pandemic times. We do not always have a crisis to solve or a critical body of evidence to point to when we need to change a work process, influence employees to support changes, improve products, or increase medication safety. As leaders, we should always ask ourselves: Is change necessary? How do we effectively implement the change? How do we articulate the benefits of the change? How do we sustain efforts after the change?
Change management (CM) is a well-organized framework for managing the people side of change.1 It includes practices, processes, and planned activities designed to facilitate and lead organizations to move from the present state to a desired state.2 The goal of CM is not to eliminate resistance but to anticipate it, proactively plan for it, continuously manage it, and mitigate the consequences.3
In some settings, such as hospitals, there are important challenges to changing processes. Clinicians have high individual autonomy and show various degrees of professional dominance over management and patients, which gives them control and power.4,5 CM practices are often only considered retrospectively in practice after challenges or implementation difficulty occur.6
STEP 1: IDENTIFYING WHAT NEEDS TO BE CHANGED
The first step in most CM models is identifying what needs to be changed. A good way to examine this in health care is the Swiss cheese model related to patient safety.7 Perhaps the task or item is not meeting expectations or there is a need to increase effectiveness, operational efficiency, patient safety, or productivity. In either event, the element that needs to be changed is identified. Then we recognize what exactly should change, who will be affected, and who the stakeholders are. Leadership must realize that change may not be positive for all stakeholders and may be perceived as negative by some.
An example is rationing products for personal protective equipment (PPE) during supply chain disruptions from the pandemic. Another is increasing telepharmacy use to provide care and education to patients while protecting clinicians and patients from unnecessary exposure to COVID-19 and advancing medication management and safety. In these cases, what needed to change was apparent to those involved. If a patient could not come to the clinic to get care or equipment was not available, an alternative was required.
STEP 2: DETERMINING THE NEW WAY OF DOING BUSINESS
Once a needed change is identified, a new process should be identified. One case in pharmacy practice is using alternative compounded products instead of commercially available products to address supply shortages caused by stressors during the pandemic. A matrix can be developed to aid in this process, such as the Six Thinking Hats, in which various points of view are considered to evaluate the best ideas.8 This type of thinking can help determine the best choice and provide feedback to stakeholders about why the option(s) being proposed are better. This will allow the proposed change to build critical mass to support the change.
STEP 3: IMPLEMENT AND MAINTAIN
To implement and sustain change, it must address who is going to do what and when. An example would be inventory-control functions for the COVID-19 vaccine supply. Everyone involved with the supply chain and planning needs to understand their role. The COVID-19 vaccine supply chain includes managing cold storage, thawing, and complex administration and scheduling processes.
Once a plan is in place, stakeholders need to be informed that the change is starting. Once implemented, it should be determined if the results were obtained. Depending on the change, a new policy may be written and employees trained accordingly to sustain the change. Step 3 is the point in which CM can fail and cause a new process to increase the number of errors in the short term, if the new standard work is not written clearly. Finally, there is a need to codify the change so the process does not backslide over time.
The pandemic has caused leadership to implement change more rapidly than usual and rethink how business and process operates, including managing the supply chain, deploying staff, ensuring medication safety, and using personal protective equipment. Additionally, to effectively manage identified change, CM should encompass a standardized procedure. Although CM can be a daunting process, a thoughtful application will reduce the resistance to change and improve overall operations, regardless of where it is applied if it follows consistent steps.
1. Hiatt J, Creasey TJ. Change Management: The People Side of Change. Prosci Learning Center Publications; 2012.
2. Stouten J, Rousseau DM, De Cremer D. Successful organizational change: integrating the management practice and scholarly literatures. Acad Manag Ann. 2018;12(2):752-788. doi:10.5465/annals.2016.0095
3. Erwin DG, Garman AN. Resistance to organizational change: linking research and practice. Leadership & Organizational Development Journal. 2010;31(1):39-56. doi:10.1108/01437731011010371
4. Kotter JP, Schlesinger LA. Choosing strategies for change. Harvard Business Review. July-August 2008. Accessed March 8, 2021. https://hbr.org/2008/07/choosing-strategies-for-change
5. Gagnon MP, Godin G, Gagne C, et al. An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians. Int J Med Inform. 2003;71(2-3):103-115. doi:10.1016/s1386-5056(03)00094-7
6. Reason J. Human error: models and management. BMJ. 2000;320(7237):768-770. doi:10.1136/bmj.320.7237.768
7. Burke WW. Organization Change: Theory and Practice. Sage Publications Inc; 2017.
8. de Bono E. Six Thinking Hats. Back Bay Books; 1999.