Huntington Memorial Hospital is a 125-year-old not-for-profit hospital in Pasadena, California. Its mission is "to provide excellent health care and compassionate service to each person by bringing together outstanding physicians, caring nurses, professional staff, and advanced technologies." (Huntington Hospital, 2020, para. 30). Officially known as Pasadena Hospital doing business as Huntington Memorial Hospital, the facility has a capacity of 609 beds. The facility provides acute and community care to the residents of the Western San Gabriel Valley and its environs (Huntington Hospital, 2020). However, it is renown worldwide for its prostrate cancer, epilepsy, and bariatric surgery departments. As a facility that is critical to providing quality health care services to the local community, it is essential that it reduces its rates of hospital-acquired infections. According to Bowles (2019), physicians at Huntington have the lowest compliance with handwashing procedures (50%). This paper is a proposal oh how the human resources department at Huntington Hospital should create a new leadership position and select the right physician leader to influence others to comply with handwashing procedures.
Factors Driving the Change
Hospital-acquired infections (HAIs) are a significant cause of patient morbidity and mortality. HAIs affect over 1 million patients every year (Han et al., 2017). According to Bowles (2019), health care works, such as primary care physicians, are the main conduit that facilitates the spread of infections. Furthermore, if the rate of hospital-acquired infections is to be reduced, they are the primary targets. Huntington Hospital has several interventions (institutional) implemented to ensure that its health care workers do not spread infections and pathogens to the patients. According to Bowles (2019), the facility uses a hand hygiene protocol modeled from the Five Moments of Hand Hygiene created by the World Health Organization (WHO). The interventions, however, are useless if health care workers do not comply.
Delegate your assignment to our experts and they will do the rest.
Therefore, part of targeting the physicians and increasing their compliance rates with the hand hygiene program involves approaching the problem from a human resource management perspective. The proposal is that the Huntington physicians require new leadership, a new position that should be filled to provide an authority that will oversee the implementation of better interventions or improve existing ones by targeting the reasons that drive half of the physician's non-compliance with hand hygiene program.
Resistance to Change
Change in business and the health care industry is constant and occurs at all levels. The change proposed in this paper, however, focuses on Huntington physicians and aims to use a leadership approach to improve their compliance with the hospital's hand hygiene program. The changes to be introduced are expected to face resistance from all involved stakeholders for the following reasons. First, the physicians will be reluctant to accept the authority of the newly created position because it adds an extra layer of oversight and reduces their autonomy; however insignificant it might be (Yaqoob & Azeem, 2017). Furthermore, they will be resistant to the change because they are not familiar with the leadership methods the recruited and selected leader will use to improve their compliance.
Secondly, the change proposed could be opposed by other health care workers because it could impact their practice (Yaqoob & Azeem, 2017). For instance, during the recruitment and selection process, it is unclear whether the chosen leader will come from the inside or outside. If the newly created position is filled by an individual from the outside, the health care workers will be unreluctant to follow them as they would be viewed as an outsider. On the other hand, if the position is filled from the inside (such as by another physician), their familiarity with the peers will diminish the authority of the new position, thus creating an implicit resistance to the change proposed. In other words, they will not make the changes proposed seriously because they are familiar with the leader in a different capacity.
Lastly, the changes proposed by the new leader could be opposed by the hospital administration and senior managers if it increases the operating costs of the hospital or if the hospital is experiencing financial difficulties (Lattarulo et al., 2019). Note that the list of potential sources of resistance is not exhaustive.
Change Management Theories
The first applicable change management theory is Lewin's change management model. It proposes that any change should be implemented in three phases: unfreezing, change, refreezing (Hussain et al., 2018). The unfreezing phase creates disequilibria within the organization and breaks the status quo. It helps the organization to accept and prepare for the change that is to be introduced. The second phase is where the actual change will be implemented. In the context of Huntington Hospital, it is the phase where HR would carry out their recruitment and selection activities. The last stage is the freezing step, and it ensures that the changes introduced are sustained (Hussain et al., 2018). The freezing step is where the newly created leadership position will improve and sustain the compliance rates for the hospital's hand hygiene program. Note that the primary aim of Lewin's change management model is to transition the organization from one equilibrium (undesirable) to a preferred equilibrium or status quo.
While Lewin's change management theory focuses on the big picture view of the change process and its implementation, the ADKAR model approaches the change from the bottom-up. Furthermore, the change model approaches the process from the health care worker's perspective. Instead of the HR department creating a new position to lead and sustain the change, the model recommends that a conversation happens between the HR and the workers about the need for the change. The outcome is that the employees will be more receptive and supportive of the change than if they were mandated to implement the changes. The ADKAR model is non-sequential and an acronym that stands for Awareness, Desire, Knowledge, Ability, and Reinforcement (Kachian et al., 2018). The model, however, is suited to organizations that implement changes in small incremental steps to prevent disrupting the organization and its processes significantly.
However, Lewin's change management theory was selected for the proposal for the following reasons. First, the model is sequential. Therefore, its implementation becomes compatible with HR's recruitment and selection activities (which are in phase two). Secondly, the model emphasizes that change is constant and maintaining the desired equilibrium requires sustained efforts (Hussain et al., 2018). The compliance rates for Huntington physicians can be sustained if an effective leader applying effective leadership styles is actively involved in overseeing the physicians. Compared to the ADKAR model, however, Lewin's change management model is not human-centric and does not deal with the resistance to change as efficiently. On the other hand, the changes proposed in this paper are neither small nor could be implemented in small incremental steps.
Application of Systems Thinking
If the proposal is implemented and the proposed changes are successful, the entire organization will be impacted as the hospital's rates for HAIs will drop. The reduction might not be statistically significant. However, they will be clinically significant. Patient outcomes will improve as well as the quality of health care (Han et al., 2017). As a result, readmission rates will reduce. The hospital will benefit both from the increased quality of services and reduced operating costs under the provisions of the Affordable Care Act (ACA).
The success might prompt the hospital administration to expand the scope and authority of the created position from Huntington physicians to all of its health care workers and staff. If the hospital administration and senior management are informed of the potential, their resistance to implementing the change will be reduced (Han et al., 2017). On the other hand, the other hospital workers who recognize the leadership position as a source of future uncertainty that could disrupt their work will be opposed to the changes. If they communicate their thoughts and insights to their peers and manage to convince them, the resistance to the change will impact the hospital's current performance as the staff will be divided. The outcome will be that other unrelated health care services will be impacted as the staff will be pre-occupied with the internal politics of the proposed changes. Note that these scenarios are based on reasonable assumptions about the organization's culture and employee behavior but are not guaranteed to document the sequence of events. Furthermore, there are other possible scenarios. However, their discussion is beyond the scope of this proposal.
Stakeholders and the Role of Communication
Communication will play the largest role in determining the success of the proposed changes. In the first step (unfreezing), communication will be used to convince different stakeholders about the need for change and the associated benefits if the change is successful (Palmer et al., 2017). There are two main stakeholders who would have to be convinced. The first group is the Huntington physicians and other health care, workers. Their support with the proposed changes will ensure that the newly instituted leader's work will be implemented as efficiently as possible. The strategy used to convince these stakeholders is to remind them of their duty and responsibility to their patients and how the changes will help. Communication will also aid in facilitating feedback, especially about potential misunderstandings and concerns that would have to be handled or incorporated into the change process.
The second group will the Huntington's administration and senior management, who might be reluctant to support the proposed changes, especially since they will be footing the bill for the entire process. Communication will play a role in convincing them that the changes are a worthwhile investment in the long-term (Palmer et al., 2017). The strategy to be used is two-fold. First, the newly created position will be treated like a pilot or experimental study. If the changes introduced are beneficial to the hospital, the scope and authority of the leader can be expanded provisionally. Secondly, the management will have to be convinced of the potential benefits the hospital stands to gain, especially concerning the reduced operating costs and the benefits ACA provides to health care facilities that reduce their readmission rates and increase the quality of their health care services.
Recommended Strategies, Innovation, Training, and Support
The health care industry in the US is increasingly moving towards a value-based system supported by teams rather than individuals. Leaders, therefore, become integrated into the organizations as team leaders rather than their original positions. The recommended strategy to use when recruiting and selecting the new leader will be to prioritize ethics and teamwork over experience and technical skills (Duckett et al., 2019). The newly appointed leader will be in a position to work better with the existing employees (especially if they are an outsider) because they will not be filling their leadership capacity but become more of team leaders. The proposed innovative strategy is known as hiring for attitude.
Training and support, on the other hand, will be provided by modeling the current system Huntington is experimenting on. The campaign is known as High Five-Low Five. According to Bowles (2019), a co-worker observed using the proper handwashing procedure will be given a high give or a low five if they are not. The leader's responsibility will be to train the physicians on the campaign and provide the support needed, such as to resolve concerns and troubleshoot problems. The high five-low five campaign is effective because it holds all stakeholders socially accountable for implementing and sustaining organizational change. The strategy is also scalable because the employees at Huntington will be monitoring each other's compliance, thus eliminating the HR or the leaders from having to follow through.
Evaluating and Sustaining Change
The leader's performance and success of the proposed changes will be evaluated by monitoring compliance with the handwashing procedures among the physicians. At the beginning of the plan, a baseline study will be conducted to establish a benchmark and set the target (Boyce, 2019). An observation and follow-up period will commence (covering the implementation of the changes) with regular re-evaluation phases every six months. Continuous monitoring will ensure that compliance with handwashing procedures is above the set benchmark, thus help to sustain the change, especially if compliance starts to drop.
Conclusion
In conclusion, this paper has proposed a recruitment and selection strategy to be implemented by the HR department at Huntington Hospital. Its purpose is to introduce organizational changes that will improve the compliance rates for its physicians relating to hand washing protocols. Evaluation, monitoring, and sustaining the change will be achieved by continuously observing the compliance rates and taking measures to prevent the rates from going below a set benchmark. A new leadership position is proposed whose responsibility will be to implement and sustain the change among Huntington physicians. If they are successful, the scope of their work will be expanded to cover the other health care workers and staff at the hospital.
References
Bowles, H. (2019). Don't be a Bum Wash off the Scum . Pasadena: Huntington Hospital. Retrieved from https://www.huntingtonhospital.org/wp-content/uploads/2019/11/MSN-June-2019.pdf
Boyce, J. M. (2019). Current issues in hand hygiene. American journal of infection control , 47 , A46-A52.
Duckett, S., Nichol, J., Roten, R., & Khazaeni, B. (2019). Hiring for Attitude. The Western Journal of Emergency Medicine , 20 (4).
Han, A., Conway, L. J., Moore, C., McCreight, L., Ragan, K., So, J., ... & McGeer, A. (2017). Unit-specific rates of hand hygiene opportunities in an acute-care hospital. infection control & hospital epidemiology , 38 (4), 411-416.
Huntington Hospital. (2020). The History of Huntington Hospital | Huntington Hospital . Huntington Hospital. Retrieved 13 November 2020, from https://www.huntingtonhospital.org/about-us/history/.
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin's change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge , 3 (3), 123-127.
Kachian, A., Elyasi, S., & Haghani, H. (2018). ADKAR Model and Nurses' Readiness for Change., 4 (4)
Lattarulo, P., Masucci, V., & Pazienza, M. G. (2019). Resistance to change: Car use and routines. Transport policy , 74 , 63-72.
Palmer, I., Dunford, R., & Buchanan, D. A. (2017). Managing organizational change: A multiple perspectives approach . New York: McGraw-Hill Education.
Yaqoob, M., & Azeem, K. (2017). Change administration: Resistance to change: A case study of banking industry of Pakistan. Public Policy and Administration Research , 7 (2).
