Managing Change for Health Information Professionals (MCHIP)  

Managing change, an example: the House Officer’s Tale

One approach is to ignore, rather than manage, change, like the nineteenth century official who suggested closing down the Patent Office as everything that could be invented (railways, telegraphs and the electric light bulb) had already been invented: “Er…sorry we haven’t allowed for the twenty-first century. You don’t mind if I sit it out, do you?” Such attitudes mean you get overtaken by, rather than avoid, change: “Oh dear, we appear to have been taken over and closed down!” A more proactive approach cannot avoid change, but it can produce more positive outcomes: “We are being taken over and integrated.”

Most organisations perpetuate a degree of inertia: “If in doubt, do nowt.” I remember a  notice in Sister’s Office on a hospital ward which itemised “Twenty reasons for not changing practice,” ranging from “The boss wouldn’t like it” down to “No-one else in the NHS does it like that.” Though part joke, part defence of ward based traditions this reflects that change, by its very nature, means an end to certainty, a threat to an organisational system and often a sense of loss. Not all environmental variations require wholesale analysis: some are minor or predictable: “Wow, look at all these medical students in the Library.” “Yes, isn’t it odd how they suddenly appear every October, must be to do with the weather.”

On the other hand, the environment does need watching for trends which upset such predictable cycles: the above complacency is misplaced if the medical school your library serves is expanding undergraduate numbers by 25% next academic year.

Maybe “organisational strategy” needs bit of expansion. Strategy refers to long term planning, to reach definite objectives, such as growth, improved quality or stronger market positions. It includes examining what the organisation does, what its environment is, who the stakeholders are, what the values and expectations of the stakeholders are, and assessing what resources and capacity the organisation has to deliver these.

One simple example of change management will suffice. Traditionally, junior hospital doctors (the house officers), usually hold six-month rotating posts, with “all change” on August 1^st and February  1^st (a good reason not to be admitted to hospital in August, as most house officers have just graduated from medical school: at least in February most have six months practice under their belts!). This means that from 9am on January 31^st until 8.59am on February 1st, a house officer could be on call for a renal unit in Bristol…and at 9.01am, could (in theory) be on call for surgery in Newcastle! One year, the powers that be decided  to stagger the August date from the first of the month to the first Monday in the month for all future years. The personnel department at our hospital adopted the “If in doubt, do nowt” school of change management: “Yes, we have had a circular about it, but we haven’t decided what to do.” “It’s in two weeks.”  “Er…that sounds about right.”

So, in the end the junior medical staff implemented an “emergency change management plan,” to cover vital work like admissions and labour suite and maintain a reasonable and safe medical service to the local population:

• Analyse situation: which staff are rotating to posts in other hospitals, which are staying, are any taking breaks and may have flexibility, who has already booked holiday (personnel failed to notice all the contracts were dated to expire July 31^st, the new staff were booked to start August 4^th  that year: unaware that many posts would be 48-72 hours with no incumbent).

• Draw up list of staff who might be willing to remain in post.

• Negotiate conditions for extra-contractual work (for those staying on time in lieu, rates of pay etc)

• Compile list of duties to be covered and divide them into “must do” (staff in Accident and Emergency [A&E], duty doctor for Coronary Care Unit), “should do” (ward cover), and “might do” (out-patient clinics).

• Identify “fall back” plans, such as local GP cover and locum agencies.

• Match staff to duties.

• Decide what could be covered and what could not (resulting in cancellation of all out-patient clinics in the two days affected and offering patients alternative dates).

• Draw up rotas

• Present this to personnel and  senior staff as fait accompli.

The plan was accepted, worked well and had several advantages for both the individuals (the medical staff) and the organisation (the hospital):

• Emergency duties were covered

• No untoward events or bad publicity occurred during the change over.

• Outpatient clinics were re-arranged in an orderly way, rather than patients turning up and sitting for hours because available medical staff were looking after emergency admissions.

• Staff who worked the extra days received appropriate remuneration, but personnel was spared paying agency overheads, by the very limited need for locum cover.

• Staff could be pro-active in deciding which duties they felt competent to take over.

• There were no disputes between personnel and medical staff over contractual obligations

• Staff were not bullied into taking on cover duties  “otherwise patients will die.”

WHAT YOU NEED TO DO:

HAVING READ THE HOUSE OFFICER’S TALE (ABOVE), WHAT EXAMPLES CAN YOU GIVE OF ORGANISATIONAL CHANGE THAT HAS AFFECTED YOU AND/OR YOUR SERVICE?