In their research, Carman et al. (2019) leveraged the Kotter's eight-step method for implementing change in a federally qualified rural healthcare facility, The White House Clinics. The study was focused on complementing a POE (Proactive Officer Encounter) model in alleviating preventive care services delivery, closing healthcare gaps, and reducing healthcare disparities between patients. Carman et al. 's study interviewed 21 clinicians directly engaged in POE implementation and garnered evidence of steps one through seven of Kotter's eight stages of fostering change in the performance of POE. Notably, the eighth step, fortifying new viewpoints in the culture of the organization, was an area recommended for improvement.
Provision of quality preventive healthcare services to adults, for instance, immunizations, screening of cancer, screening of cholesterol, and much more, are essential to alleviating the health of a given population. In the book of Jeremiah (New International Version, 33:6), God promises to bring health and healing to his people, and let them experience an abundance of peace and security. Nevertheless, gaps usually exist between the best practices recommended in delivering preventive healthcare services and the services that are, in reality, given to adults. To proficiently close the disparity in healthcare delivery ecosystems, organizational changes must be implemented to improve the existing workflow efficiency, corporate culture, and improvements in workflow efficiency. When Naaman went to visit the Prophet Elisha for healing, he took with him plenty of gifts, including 6000 shekels, of gold, ten talents of silver, and sets of clothing. Naaman expected the Prophet to utter words of healing to restore his condition. Still, contrary to his expectations, the Prophet Elisha told him to go and wash seven times in River Jordan (2 Kings 5 New International Version). For healing to be effected, changes had to be introduced to Naaman's ordinary way of doing things, and he agreed to dip himself in the river Jordan seven times as had been advised by the Prophet. Just like there was a change for Naaman to receive healing, this paper scrutinizes how a spatialized approach guided by Kotter's eight-step process can be implemented for exploring, monitoring, and closing healthcare gaps in rural areas.
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Section 1: Identification of Industry and Area in Need of Change
(GIS) Geospatial Information Systems is often deemed as a tool that helps users in capturing, managing, analyzing, and displaying data that has been spatially referenced. The rapid growth of GIS technology, as well as its collaboration with other geospatial discoveries, have led to the blossoming of Geospatial Information Systems as a scientific field. The are several forms of spatially referenced information provided by GIS, such as global positioning systems (GPS), cartography, censuses, and surveys such as administrative and statutory data, earth-observation satellite data. These GIS forms are widely accessible to health researchers as they have broadened their scope in focusing on questions that were impossible to answer previously (Rai & Nathawat, 2016). GIS data is progressively being leveraged to visualize relationships between potential health predictors such as trends in public health and interrelationships existing between different causative factors. By using mud as a tool to heal a blind man, Jesus set an example that human beings can as well implement various mechanisms in the process of administering better healthcare to patients (John 9:1-12, New International Version).
Notably, the healthcare industry can leverage GIS technology for exploring, monitoring, and closing the existing gaps in healthcare in rural areas. With spatially referenced data, healthcare researchers focused on rural regions can attentively analyze various causative factors and conceptualize why they matter for the well-being of an individual and a community at large (Wang, 2019). Among the Israelites, the disease was majorly associated with one's sins and or his parent's sins, giving a simple analysis of the causative factors related to a disease ( John 9:3, New International Version). GIS will help the researchers move beyond simple visualization techniques used in scrutinizing health outcomes and their relationships with the physical environment to analyze more comprehensive influences of the immediate surrounding on an individual. Thus, GIS explains health behaviors, which results in a context that has been localized (Aghajani et al. 2017). This type of study leverages residential attributes in examining how social and physical factors yield different health outcomes. Examples of characteristics of social environments include the socioeconomic status of individuals such as social capital, social ties, and social efficacy.
In collaboration with the White House Clinics in Rural Kentucky, an evaluation of the implementation of GIS in exploring, monitoring, and closing healthcare disparities anchored on Kotter's model can be carried out. The overall goal will be to determine whether GIS implementation at the healthcare facility as a tool for exploring, monitoring, and closing healthcare gaps in the rural area can be viewed as a successful organizational change. One of the vital evaluation exercises will be to conduct an array of interviews with the clinicians directly involved in implementing GIS. Such personnel includes clinic administrators, physicians, and nurses, healthcare coordinators responsible for managing patient's health records, and medical assistants who provide direct healthcare services to patients.
Section 2: Plan for Implementing the Change
Creating a Sense of Urgency
According to Kotter (2012), initiating a transformation program demands the aggressive collaboration of many individuals. For a transformation to succeed, at least three-quarters of managers must believe in the need for change. Therefore, clinicians directly involved in patient care should be asked to scrutinize and share the organization's implementation of GIS technologies in closing the existing healthcare disparities in the rural Kentucky area. Hebrews (NIV, 11:1) encourages us to have faith in whatever things we anticipate and certainties of whatever things we do not see.
Establishing a Particular Group To Guide The Change
From the interviewed clinicians, a group of individuals committed to alleviating the transformation will be identified to affect the change in the organization. The group should not be necessarily large and should include different stakeholders, including senior administrators, influential clinicians, and board members. Kotter (2012) states that the inclusion of stakeholders from different levels of the organization will enable the institution to form a guiding coalition formation to lead the transformation. In Exodus (NIV, 18:13-27), Moses took Jethro's advice and appointed Judges, who were capable men identified from the Israelites, and were to serve as Judges on permanent grounds.
Defining the End Goal
A clear vision of what the implementation of GIS in narrowing healthcare disparities in the rural area will achieve overtime should be created and communicated to all the employees and stakeholders of the healthcare facility. Transformations are difficult to support if employees and other stakeholders do not comprehend the end goal. Kotter (2012) cites that a vision that cannot be communicated to someone in at most five minutes indicates an end goal that has not been clearly defined.
Sharing the End Goal and Encouraging Participation
According to Grenny et al. (2013), mastering the art of motivating and enabling others to change their actions could be one of the most crucial skills one can acquire. Unfortunately, most people cannot verbalize their theory of influence. For successful implementation of GIS in the White House Clinics as a tool for improving healthcare gaps, the end goals should be often communicated and advertised to all channels. During this phase, any identified obstacles to executing the change must be eliminated.
Setting Short-term Goals and Persisting in Driving Change
In their book, Christ-centered exposition: Exalting Jesus in 1 & 2 Kings, Merida et al. (2015) give an account of Elijah and Ahab. The latter blamed Elijah, the Prophet, for the troubles that were encountered by Israel. In response, and to end the blame game, Elijah came up with a short-term goal at Mount Carmel, urging two rival groups to seek their deity's assistance in burning the displayed sacrifice (NIV, 1 Kings 18:16-45). In encapsulation, Elijah ended up humiliating the prophets of Baal after the failed attempt to call on their God for help in burning the offered gifts. Consequently, from the circus on Mount Carmel, more crowds were diverted towards believing the God of Elijah.
Like in the case of Elijah, most people give up on long-term goals unless compelled by evidence that their efforts are likely to produce results. Therefore, to successfully implement GIS in the health organization, the drivers of change should plan to achieve short term goals with the technology to demonstrate visible growths. Once the short term goals are met, they can be used as motivators to implementing even more significant changes.
Connecting Change to Organization Culture
Kotter (2012) warns that a flawed succession decision detected in the management of an organization can sabotage hard work and success that took a decade to achieve. Therefore, various stakeholders involved in the transformation should consciously and consistently link the incorporation of GIS technology into the organizational culture in managing different communal health challenges while at the same time cultivating leaders who will keep fostering the transformation.
Conclusion
The incorporation of spatially defined data in the exploration, monitoring, and closing of healthcare gaps in rural areas gives healthcare researches the ability to identify the causal factors of rural healthcare disparities that spread beyond a person's biological, behavioral, or genetic factors. The growing availability of information on data connected to both social and built environments has enabled questions that could not be previously addressed or comprehensively scrutinized. Just like Jesus used mud as a tool to heal a blind man, by incorporating Kotter's model in the implementation of GIS technologies, rural health facilities such as the White House Clinics can fasten the process of successfully narrowing the existing healthcare disparities in rural areas. Nevertheless, despite the incorporation of GIS in health care research anchored on Kotter's model untangling the relationship between different causal factors in rural healthcare disparities, a knowledge of the technology needs to be fortified among healthcare stakeholders for seamless and proficient utilization.
References
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