ATTC Messenger November 2016 Managing Organizational Change Initiatives
Managing Organizational Change Initiatives
An Excerpt from the ATTC Network White Paper:
Building Capacity for Behavioral Health Services Within Primary Care and Medical Settings
ATTC Network Workforce Development Workgroup:
Michael Chaple, PhD, Northeast & Caribbean ATTC
Marjean Searcy, SSW, Central Rockies ATTC
Beth Rutkowski, MPH, Pacific Southwest ATTC
Miguel Cruz, PhD, National Hispanic & Latino ATTC
Managing Organizational Change Initiatives
Recommendations for Managing Organizational Change
Solicit training & technical assistance in organizational change models that will help to:
1. Engage leadership
2. Identify effective ways to get staff input
3. Develop a change process
4. Identify change champions
5. Draft implementation plans
6. Monitor ongoing quality improvement
Much has been written about the nature of organizational change and the best methods to facilitate, implement, and manage change initiatives. Based on a growing body of research, a better understanding now exists of the processes that are most integral to the success of organizational change initiatives. Essentially, changing the goal or the direction of an organization often means changing work responsibilities for a large majority of employees. However good the intention, employees will often react with resistance, which can jeopardize effective organizational transformation.
Diamond (1996) illustrates the underlying psychological dynamics of organizational change in his article, “Innovation and Diffusion of Technology: A Human Process.” The article demonstrates the need for experts and managers to recognize the human processing of and resistance to change and learning. Asking staff to approach their work differently requires them to make a cognitive shift, resulting in emotional demands on their feelings of competence. This increases the individual’s stress, especially when there is a lack of information, uncertainty, and a lack of participation. Until workers feel ownership of the new system, they may feel anger or anxiety. Providing a “transitional space” allows members of the organization to work through their feelings. During this process, workers will need to acknowledge what they are losing and what they are gaining. To some degree, it is a four-phase grief process (numbing, yearning, disorganization and despair, reorganization).
Providing a forum to facilitate this process increases the likelihood of successful implementation. Efforts required to achieve integration of behavioral health services within medical settings are both substantial and complex, and given what appears to be a daunting challenge, many providers may be reluctant to invest in such efforts. The following strategies may enhance integration efforts and minimize resistance to change.
Obtain Leadership Support
Leadership buy-in and involvement, in other words “top-down support,” is essential to the successful implementation of any new innovation (Dezdar & Ainin, 2011; Forsner, Hansson, Brommels, Wistedt, & Forsell, 2010; Hung, Chen, & Wang, 2014). Because leaders of an organization influence company culture, their lack of buy-in and commitment to any innovation would all but ensure that these interventions will not be adopted in practice, embraced by staff, or implemented to their full potential. Most importantly, absent the support of leadership, the resources necessary to facilitate implementation may not be made available to staff who are implementing a new practice, and organizational barriers that emerge during implementation are unlikely to be effectively addressed. Therefore, all workforce development initiatives undertaken to enhance integrated care should engage executive leadership to establish the foundation for implementation success.
Solicit Staff Participation
When implementing change initiatives, it is vital to involve the entire organization. Changing organizational goals without consulting with staff will often result in opposition by and demoralization of employees. Research suggests that people are more likely to invest in and commit to organizational policies that they have helped to shape, as opposed to policies that have been imposed upon them (Cotton, 1995; Sagie, 1995; Wanberg & Banas, 2000). In fact, research has shown that, even when staff is not directly involved in the decision, people are more willing to accept administrator-derived policies when their input is considered during the actual implementation process (Sagie, Elizur, & Koslowsky, 1990, 1995). Thus, it is critical to ask for staff participation throughout the implementation process. Simply put, once staff are made aware of the change to be implemented, they should be given the opportunity to shape that change. The best way to plan for change is to solicit knowledge from staff already familiar with the job at hand. From the perspective of leadership, this would acknowledge that “we know more than me.”
NIATx (formerly The Network for the Improvement of Addiction Treatment) offers a variety of free online resources on managing organizational change.
Establish a Change Process
Although leadership buy-in and staff input are necessary for the successful implementation of new initiatives, they are not sufficient. That is, the motivation to change, even when accompanied by a tentative plan for achieving that change, will likely lose momentum and fall short of the intended goal without the benefit of a more structured framework for managing implementation efforts.
Given the complexity of efforts required to achieve the integration of behavioral health services within medical settings, challenges to implementation will arise that must be promptly addressed to ensure success. Having a structure in place to manage the change effort will ensure that this occurs. This can be done via formally structured “change teams” or informal partnerships between staff (NIATx, 2014).
Identify Organizational “Champions” or “Change Agents”
Once a change process has been established, it will be important to identify staff who will be responsible for managing the change initiative. In health care, there is long-held wisdom that champions are a key aspect of organizational change. Champions are staff members who voluntarily take an interest in a policy, program, or project, advocating for its adoption and encouraging implementation throughout the organization, which often will include negotiation through entrenched internal resistance to change. Simply put, select staff can function as “purveyors” (Fixsen, Naoom, Blasé, Friedman, & Wallace, 2005) or “change agents” (Havelock & Havelock, 1973) to guide implementation of a programmatic practice. Without these individuals to manage various critical aspects of implementation, the proposed initiative will lack credibility and efforts are likely to lose focus and momentum.
Develop an Implementation Plan
With the infrastructure in place for the proposed change initiative, it is important to develop an organization-wide implementation plan that specifies goals and objectives for enhancing integrated care. This plan will specify the types of procedures and services to be implemented and will serve as the working document that informs change team activities. Initially, the plan should focus on short-term, achievable, and measurable goals and objectives that are critical to establishing a foundation for a more sustainable model of integrated care. The plan should outline what is to be accomplished, by whom, by when, and how. Without the benefit of a structured implementation plan, efforts to integrate behavioral health services will lack needed direction, and again, are likely to lose focus and momentum. Implementation plans should be revised often as specific goals/objectives are met to establish new goals and to adjust in response to barriers faced and lessons learned.
Implement Ongoing Quality Improvement Process
The change team should monitor the implementation plan closely to ensure that integration efforts are proceeding as planned. A popular mechanism or framework for this is the Plan Do Study Act (PDSA) cycle (Shewhart, 1939). The Plan step involves identifying a goal or purpose, defining success metrics, and putting the plan into action. The Do step involves implementing the components of the plan. The Study step involves the monitoring of outcomes for signs of progress and success, or problems and areas for improvement. The Act step integrates the learning generated throughout the process, which can then be used to adjust the goal, change methods for achieving the goal, or reformulate altogether. These steps are repeated as part of a continuous cycle of quality improvement
The ATTC Network has developed practical applications for facilitating integration, and the following are two widely disseminated resources:
1. The ATTC Technology Transfer Model is a multi-tiered change process used for successful implementation of evidence-based practices that assists stakeholders in determining how to best utilize limited resources to increase the use of evidence-based practices (EBPs; ATTC Network, 2011); and
2. The Change Book is a landmark technology transfer tool designed to assist both practitioners and organizations to improve prevention and treatment outcomes across systems (ATTC Network, 2010) by offering principles, steps, strategies and activities for implementing change initiatives at the organizational level.
Excerpted from the ATTC Network White Paper, Building Capacity for Behavioral Health Services Within Primary Care and Medical Settings. This white paper was produced as part of the Addiction Technology Transfer Center Network's initiaitve, "Advancing the Integration of Substance Use Disorder Services and Health Care."