The final stage of the organizational change process is the refreezing stage, where change is reinforced so that it blends neatly into the order of things. Since change means modifying employee or stakeholder behaviors, it is necessary to support employees’ adoption of the change until it becomes completely accepted as part of their work routine. An important component of the final stage is evaluation, which entails measuring the outcomes to determine if these translate into goal attainment indicative of success. In this paper, a brief summary of the planning and implementing stages is given followed by a discussion of how evaluation can be accomplished.
Summary: Planning and Implementation
The proposed change involves modifying the mode of communication with physicians regarding the need for missing patient chart information and the mode of communication of responses from their end. This entails shifting from the use of fax machines to the e-mail system and the use of a standard form or tool to make sure that only necessary information is communicated back to evaluate nurses. Regarding the policies, guidelines and criteria governing the review and approval process to the physicians and conducting a pilot study of the new protocol are some of the key features of the change project.
Organizational change follows a step-by-step process in accordance with the Lewin model for change, namely unfreezing, moving and refreezing. For the proposed change, the primary stakeholders, who are the utilization review team, are involved in all phases of the process. The participatory approach to change management is adopted because giving each stakeholder a role increases the likelihood that solid support is obtained, an element that is crucial to success.
In the planning stage, the problem is identified and the solution is decided upon. Factors internal and external to the organization, which can impact the change process, are adequately explored. Elements that influence or hinder change are identified, and evaluating organizational readiness is also done. Possible sources of resistance and ways of dealing with them are considered. Moreover, external and internal resources are assessed to see if these are adequate or if added resources needed.
During implementation, monitoring for stakeholder resistance and for weaknesses in the plan is done by engaging the stakeholders individually and as a group during staff meetings. Using open communication in these encounters, the change manager obtains feedback, elicits ideas on how to troubleshoot arising problems, gauges the degree of commitment that the utilization review team is giving to the change, and deals with continuing resistance. In this same stage, the change manager also capitalizes on the organizational systems and processes, which positively contribute to the change process.
Evaluating the Outcomes of the Change Plan
Given the nature of the proposed change, effectiveness can be ascertained if all resistance has been addressed and if all stakeholders finally give solid support to the plan consistent with the participatory approach. In the utilization review department, this means that an active change in work routines to accommodate the new protocol can be observed in the workplace on the first day of implementation, when it is expected that: 1. Work may slow down a little bit as the review team familiarize themselves with the new way of doing things and learn new skills, 2. That questions will be asked and the change manager needs to be there to answer them, and 3. The change manager should provide all support required by the team. By day 5, full adjustment to the change should have been achieved and close supervision is no longer necessary. In this manner, the new behaviors are reinforced until they are seamlessly integrated into the work flow.
In the medical services department, change is effective if physicians adhere to the e-mail system as the new method of communicating missing chart information and use the standard tool in the process. Similarly, they would undergo an initial adjustment period in relation to the modifications in the way things are done and supporting their performance of the planned behaviors is likewise necessary. Samples of filled out forms can be provided to the physicians to help them use these forms correctly, and a contact person when problems arise should be designated. Feedback regarding the use of the standard form, if incorrectly filled out, should be relayed to the concerned physician as soon as possible.
Following the adjustment period when organizational stability is attained, the measurement of outcomes is now feasible. The traditional outcome measurement strategy focuses on the financial gains that result out of the change project, wherein costs and productivity are the only factors considered. However, the use of both quantitative and qualitative evaluation measures beyond financial data is of more value to organizational settings today, as cost effectiveness is not the sole determinant of success. It cannot capture other equally important evaluation criteria needed by the organization for decision making in the future.
In an evaluation of organizational change concerning the shift from a primary care setting to a patient-centered medical home, outcomes considered were patient, staff and physician experiences and the quality of preventive, acute and chronic disease management services. The evaluation team developed a framework, which required quantitative data such as surveys of baseline practices and patient outcomes, and also an audit of medical records. Qualitative data was also used and included the observations of the change facilitator and the content of communication exchanges between the facilitator and the stakeholders. The decision to use this evaluation strategy was based on the complexity of the change plan and past change experiences (Jaen et al., 2010).
In a separate study, improvements in assessment and rehabilitation services catering to older adults were implemented. The evaluation criteria encompassed “team development, interagency working, outcomes from multiple perspectives (client, carer, clinical and service), and the cost effectiveness of the service”. In this manner, the application of the new model within the organization, and how this has led to improvements became clear. Summative and formative evaluation was used in the context of action research, which was conducted during implementation. This evaluation strategy fulfilled the needs of the organization for continued learning, adaptation and improvement. The value of formative evaluation was in its capacity to provide managerial insights on the different stages of the change process, while summative evaluation provided information on costs and patient outcomes.
Another example of evaluation concerns an initiative integrating the youth services of different providers with the juvenile justice system to improve service delivery and access. Evaluation was based on two elements, namely analyzing the social network to look for changes in collaboration practices among the involved providers, and conducting a stakeholder survey regarding their perceptions of quality of both services and coordination. In this study, only outcomes at the organizational level were evaluated. The use of social network analysis in the evaluation process is consistent with the objectives of the project, which was to better integrate the juvenile justice system with related interventions.
Evaluation can also focus only on the change project as it relate to patients. This is exemplified in a study which used the RE-AIM strategy to evaluate the effects of a nursing-led cognitive-behavioral intervention to decrease lifestyle-related risk factors to disease. RE-AIM stands for: “Reach of the program, Effectiveness, Adoption by intermediaries and users, Implementation according to plan; and Maintenance for a long enough time”. Reach indicates the population covered by the intervention, effectiveness measures changes in lifestyle, and adoption reflects the acquisition of skills by nurses implementing the program. Implementation confirms if nurses’ task performance complies with standard procedures, and maintenance involves the effects of the program after a given period of time.
Concerning the proposed change, job quality, costs and employee satisfaction are some aspects to be considered when describing the outcomes. Job quality is determined by a decrease in the number of communications for missing data (indicating a similar decrease in incomplete patient charts). In cases, where there is missing data, less time is spent filtering through communicated information from physicians; increase in the number of reviews accomplished per day and increase in rates of approval. Cost effectiveness is measured by the total capital and operational costs compared against changes in productivity from baseline. Job satisfaction is quantified using utilization review personnel satisfaction surveys and qualified in individual interviews. The latter is a way of determining effects that cannot be measured, such as insights into the change experience or personal and professional growth.
Overall, change should be accepted as a continuing reality in the work setting. As the organization’s external environment changes, the need to adapt becomes apparent. Without instituting the necessary changes, the organization cannot effectively compete and is left behind. The challenge in ensuring the success of the change project primarily rests on the change agent. However, involving all stakeholders ensures that everyone contributes to attaining the vision, and constant effective communication is a vital element in obtaining such participation.
Finally, evaluation should meet the information needs and goals of the organization by providing a comprehensive view of the change process and its results. It does not entail a one-size-fits-all formula, but rather evaluation frameworks needs to be adapted or formulated to capture the indicators necessary for further learning and decision making. This can be done using quantitative and qualitative methods, established models or frameworks developed by an evaluation team. The importance of evaluation is its role in organizational growth wherein learning from previous experiences is made possible. The lessons gained subsequently serve as a springboard for future change projects.