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Overview of Prosci ADKAR Model and Implementation in Healthcare

Current changes which impact practice in health sector

The healthcare organizations change constantly because of the technological advancements, patterns of changing disease, ageing populations as well as new inventions for the cure of diseases along with some political changes and policy initiatives. Changes can be extremely difficult as they basic need of humans for a stable environment (Jayatilleke, and Lai, 2018). The sudden increase in the use of tele health and a reduction in the elective process are some of the drivers for change in the health care sector which wants to remain competitive.

Following are the examples are some of the most well known models of change management in sector of healthcare.

The Prosci ADKAR Model

The Prosci ADKAR Model which can be made use in the healthcare’s strategy of change management is among the most popular as it is based on the need of the people of traversing it through a change in a successful manner, (Akbar, et al., 2019).

There are two main pieces which explains the way of implementation of change in healthcare using the Prosci ADKAR Model:

  • A 3-phase procedure

People go through the following five things in the ADKAR stages:

  • Change awareness
  • Desire for providing support to the change
  • Knowledge of the want of changing
  • Potential of adopting the skills/behaviour required
  • Change reinforcement

The procedure of 3-phase is extremely detailed and it offers help in the implementation of change in healthcare industry. The overview of the key stages of ADKAR is:

  • Groundwork for the change
  • Management of the change
  • Reinforcement of the change

Some of the advantage of this particular model of change is:

  • It provides steps which are easy to understand
  • It makes use of simple language
  • It emphasizes on driving individual modification from the bottom up

Bridge’s transition change model

Bridge’s transition change model comprises of three stages which explains the general procedure of change. The model is more descriptive as far as what is felt by the people at the time of a process of change (Dzwigol, et al., 2019). When the evaluation of change in healthcare is done, there is a need of addressing emotions successfully from transiting people through the change. The three stages of bridges are:

  • Ending, losing as well as letting go
  • The neutral zone
  • The new beginning

It is among those models of change management in healthcare which is completely emphasized on those people who are going through change (Bousquet, et al., 2019). In each and every step, the focus is on the various feelings which might be experienced by people and the way of addressing them.

Some of the benefits of utilising the Bridge’s transition model for changes in the healthcare industry are:

  • It deals with the emotions of people who are involved in the change.
  • It is comprehensive and very easy to follow
  • This approach is bottom up and focused on people

Change is extremely critical for the future of healthcare. Healthcare is complicated. With the increasing costs as well as complications, the customers are more disgruntled than before. At present, there has been emergence of technology start-ups with some new solutions and they have compelled some healthcare companies to innovate (Alqatawenh, 2018). Companies in the industry of healthcare are trying to change by going to the experts who are their own employee. With the help of crowdsourced technology of innovation, companies are helping in a better employee engagement for sharing their ideas for the identification of new opportunities of growth, operational improvements as well as new products as well as services.

Following are some of the factors which have been identified that drives the recent changes in healthcare:

Advantages of Prosci ADKAR Model

Dissatisfied customers- A study states that 81% of the consumers are dissatisfied with their experience of healthcare. the increasing costs for the prescribed drugs along with the long waiting times at the offices of doctor are some of the grievances of the customers (AlManei, Salonitisand Tsinopoulos, 2018).

Increased cost sharing- Since the past few years, there has been a drastic increaser in the out-of-pocket medical expenses for the employees. In fact, a study states that 40% of the consumers declines medical care. the employers and the healthcare organisations both have a hit when the skeptical customers turn down a medical service.

Increasing costs of the prescription drugs- the skyrocketing costs of the drugs have a domino effect. If the drugs cannot be afforded by the consumers, they will stop buying them, this means that the drugs will not be carried be the facilitates (Matthews, et al., 2018).  In the end, there are pharmaceutical companies who limits the amount of money which can be spent on the research and development of the new drugs.

Complications in healthcare – Among the medical facilities, pharmaceutical companies, doctors, billing of healthcare as well as insurers, everything becomes extremely complicated. In most of the cases, the consumers fail to understand who they owe and for what reason.

Changemanagement is said to be a collective word for every approach of preparation, supporting as well as helping people, teams as well as organisations in making changes in the organisation (Bögel, et al., 2019).  It comprises of the methods which redirects or redefines the utilisation of resources, process of business, allocation of budget or other operational modes which brings changes in a company or organisation.

Under the health insurance programs of the government which are designed for ameliorating unequal access to the services of healthcare caused by the inequality of income, the government tried the initiation of programs which caped rising expenditures of healthcare. A policy change was implemented by the government which switched from a reimbursement system based on cost, the fee for service system to a scheme of capitalization (Buschow, and Suhr, 2022).  The changes helped in addressing the efficiency of allocation of the resources and have decreased expenditures without having any impact on the utilisation of the services of healthcare. The current downturn of the economy has caused a huge decrease in the benefits of health insurance offered to the employer. In order to provide support to the change, the national policy should be on the basis of a clear understanding of the way successful change happens at the front line. On the one hand the national body can have a unified vision on the things that has to be changed in the local NHS but on the other hand, they do not have a common understanding of the way in which they can provide support to the changes across every part of the spectrum of the performance.

The coalition government developed from the conservatives as well as liberal democrats took over in the year 2010 after a hung parliament (Cameron, and Green, 2019). The changes which were proposed by them consisted of enactment of the restructuring of NHS. This resulted in the squeezing of funding for NHS for about a generation. This was in part because of the austerity measures that resulted from the economic downturn after the 2008 banking crisis. Restructuring meant that there was a reduction in the budget of NHS which resulted in the saving having to be made by the trust of NHS along with the remaining publicly funded sector of healthcare reaping the results. The changes resulted in the shut down of certain services of hospitals, primary care services as well as changes in the A&E services, community services as well as GP services (Cohan, et al., 2018).

Overview of Bridge’s Transition Change Model and its Benefits

At present, the national bodies have competing and numerous assumptions about and methodologies of the way in which they should support as well as drive local change. The thing which is needed the most is the single theory of change with explicit agreed assumptions which can be examined as well as the one which underpins the activities of every national bodies. The theory’s design matters (Houben, et al., 2020). The design should be collective as well as co-produced with the NHS along with the staffs as well as leaders who have a track record in the delivery of frontline. This can develop on the work of the NHS change model along with the factors of change. In the recent time, the main focus of the national strategy has been on the designing of correct blend of policies for nudging the health care providers for making improvements, be it through an approach on the basis of hierarchy or incentives. There is a scope of refining these levers, for instance, by the establishment of more sophisticated currencies of payment or regulatory approaches (Som, Chan, and Dumitrascu, 2020). For proving support to the organisations for initiating the change and improving, success should be judged by the national bodies through a wider set of criteria. This can comprise of the performance but also looking at the potential for changing, patient, staff experience as well as the limit up to which local health economy is benefitted from the actions.

The readiness of an organisation for change is a new concept which means the limit up to which the employee will begin or continue to engage in behaviours which are associated with change. The organisational readiness for change was conceptualized as consisting of four dimensions of readiness- appropriateness, which means that the employees think that the change is good for the organisation; managerial support., which means that the employees thinks that the managers are supportive of the change; self-efficacy which means that the employees think that they have the skills as well as competencies of successfully coping up with the change (Ahmad, et al., 2018). A range of climate variables is considered as an important predictor of readiness of organisation for change. Organizational climate can be explained by the people’s point of view of their environment of work and it has been operationalized by the measurement of different factors or the subscales of the environment of work. There are numerous reported variables of organizational climate which are find out through measuring factors levels like the workplace cohesion, pressure, autonomy, support, innovation, fairness as well as recognition. Some of the factors of organizational climate like role clarity, commitment, innovation as well as trusts have been identified to be the significant antecedents to the organizational readiness for change (Guerola-Navarro, eta l., 2019).  There is a direct relation between the organizational commitment with the rest of the three of the four elements of the readiness for change.

The readiness of change has been applied in many studies for understanding the starting phase of the process of implementation of change in the healthcare sector. Organisation readiness has been described as a shared state of psychology in which the members of organization feel committed to the implementation of the organisational change as well as confident in their potential of doing so (Paja, et al., 2018). Aconceptual framework has been formed in the sector of healthcare for evaluating the readiness of the caregivers that can be classified into three various divisions like the psychological factors, level of analysis as well as structural factors. Some authors have developed electronic health record for the enhancement of the delivery of healthcare by making use of the readiness for change. The perception as well as the potential of carrying meaningful use of readiness along with its changes in electronic health record is examined. Some authors have made use perception of the readiness of organisation for change in the system of clinical information that is important for home care, integrated care network as well as primary care. The identification of the variables rate done from the change management’s literature as well as information system for studying the readiness of the clinical information system. The existence of change readiness at the individual level consists of the personal knowledge and skills for the agents of change, self-efficacy, competence of analytic as well as implementation tools. In the same way, the levels of organization comprise of awareness, continuous learning and culture (Bahamdan, and Al-Subaie, 2021).  Organisational readiness is also applied for the creation of better strategy of implementation for boosting up the screening quality as well as treatment based on evidence to a disease in primary care.

Factors Driving Recent Changes in Healthcare

Change management plan

If a heath care company wants to grow and expand, it must go through the necessary changes. Change management is considered to be one of the most challenging concepts of business. The importance of change management is generally underestimated by many organizations. Many companies face difficulties in completely understanding the impact of changes on the business. the principles of change management are applicable to an effective change management plan (Stouten, Rousseau, and De Cremer, 2018). A plan of change management strays in the overall framework of a large schedule of project. It is the responsibility of a project manager to establish the change plan and apply management of project integration for making the whole initiative a cohesive whole. The piece of change needs its own deliverables set and includes the use of techniques of project management as well as planning its own right.

Following are some of the principles pertain for the management of change in the organization:

  • Goals- Just like the project have some goals as well as objectives to attain, a plan of change management has its own target sets. Every plan of change management has two main goals:
  • Raising the awareness of the impending change in the organisation.
  • Helping the affected teams in the adoption of change.

As a part of these two goals, a set of quantifiable key performance indicators must be identified. After the implementation of change, the KPIs help in finding out if the plan was efficient.

Communication- Communication is the main component of the plan of change management. the communication of change management should be considered in a careful manner and executed constantly all throughout the process of change (Teague, 2019).  Channels for a two-way discussion must be created through communication.

Resistant management- every change management plan has some degree of risk. With respect to change, resistance is the biggest risk from the people who have to adopt the changes. It is difficult for the people to adjust to something new as they have been performing the same work for a long time. There must be preparation for meeting the resistance and incorporation of the strategies for addressing it.

Training- in order to help the employees to adapt to the changes, there is a need of some kind of training. Special sessions can be designed for introducing as well as educating the staff on the changes (Dumas, and Beinecke, 2018). In order to make the transition smooth, the employees should be given documents which can be used h them for examining for refreshing their memory.

Few healthcare organisations can survive without implanting any change. Even though it can be difficult to tackle change, it is the work of a leader to prepare their employees for these inevitable shifts in the way in which things are done. This can range from minor restructuring of staffs to merging as well as acquiring any other organisation (Tahir, Esmaail, and Awla, 2018). While the changes can be needed for the company’s future, there is a great chance of facing some barriers as well as challenges. Having an anticipation of these roadblocks can help people in avoiding them before thy turn out to be major problems in the implementation of change in the organization.

Following are some of the major challenges faced in a change management plan along with the strategies of addressing it:

Lack of proper planning- Any change in the organisation will tend to fall apart or might be the reason behind problems than benefit. People need to understand what exact changes are going to take place and the easy in which these changes are going to occur. For instance, if the organisation is changing into a new content management system, people will have to know if the new system installed is compatible with the old system (Lahr, Brown, and Fink, 2019). People also need to know the way there will be transition of the old information into the new system and if there is going to be restricted access at the time of transition. The roles have to be allocated to the people who have the responsibility for the change so that all the duties are covered up.

Low morale of employee- there might be many situations in which the employees might dislike the change until and unless it is the one that they had requested for, that means that getting buy-in is a major barrier to change. Low morale can become a barrier to the change in the organisation as the employees will be more likely to resist the changes, the resistance will make it extremely difficult for people to facilitate a good transition and might affect efficiency as well as productivity.

Adapting to new technology- one of the biggest challenges is the integration of the new technology with the present platform in a way which doesn’t cause huge issues of logistics. Another major problem is getting the staff updated the way of using the new technology The employees are considered as the end users when it comes to the implementation of a new system at the workplace (Rosidi, andAndayani, 2021). This barrier can be overcome through communicating the specific ways in which the technology will streamline the process of work.

Creation of the plan is only the first step. The main task is the execution of the process of change.

Following are some of the suggestions for a successful implementation of a change management plan:

  • Creation of a process of decision making- for the identification of all the implications of a change in the business in advance is not easy, so the problems are bound to occur. For example, the flow of work can be affected that was not taken into consideration before, making it compulsory to make swift decision for sorting out a solution (Hussain, yet al., 2018). Therefore, a process must be outlined for resolving problems of these kinds quickly.
  • Addressing resistance- changes are resisted by people because of various reasons. There is a chance that people can be demoted as a part of the process of change or the employees feel that they might lose their jobs. For addressing resistance in an effective way, employees must be persuaded to take part in the process of change and be as communicative and transparent as possible from the very beginning.
  • Development of momentum- for building up the confidence in the company that transformation is working as well as positive, every win must be identified as well as communicated (Makate, et al., 2019). Incentives should also be provided in order to embrace the change. For instance, a party can be organized for the employees that will be the first to make a new system of software. Through developing momentum behind the change in this manner, the emotional energy of the employees are harnesses and there is a creation of cultural willingness for accepting that there is a constant growth in the change. Natural resistance also gets reduced through this particular approach.

Through the introduction of Software-as-a-solution (SaaS) applications as well as other technologies based on cloud, majority of the tools which are implemented by the organisations are ready to use, easy to carry out and doesn’t need the same amount of planning that they used to. Through a lot of means, the options of SaaS offer the organisation with a number of benefits (Amarantou, et al., 2019).  There is one big disadvantage of the ease of implementation- it does not need the same amount of planning. This means that having a plan of organisational change management is more crucial now than it was ever before. The employees must not only be prepared for the change which is going to take place but also to exactly plan out which tools are going to be implemented and the way they are going to work together in the environment. Through the introduction of new tools, generally the organizations skip the process of change management and the way in which it impacts the end users. It is summed that since it is easy to be implemented in the organisation, it is also easy for the employees to implement.

Change management is the most important challenge of leadership of the decade. Nowadays, the heath care organizations are working in an environment of fast change very often that is driven by technological innovation (Errida, Lotfi, and Semma, 2018). The scale of change is far reaching because the process of business and the usage of system are so inter-dependent that a change in one can impact many other functions as well as departments.

  • Delivery of structural change by the introduction of some new systems, procedures, people, commodities as well as service innovation and the development of new markets, customers, competitors as well as suppliers.
  • Behavioural change resulting in a new focus, new values and cultures as well as changed priorities for every person that gets effected through structural change.

The delivery of structural change can be mechanised depending on the foundation of project management skills as well as procedures. There can be identification of activities, their estimated duration as well as schedules as well as developed plans with some reasonable certainty level. Behavioural change needs an understanding of the way the organisations function as a living being, the power play which operates beneath the surface of the structure of the organisation, the values which is applied by people to their work as well as the forces which makes commitment, motivation as well as loyalty (Grimolizzi-Jensen, 2018). Behavioural change can produce confusion, stress, resistance, decreased productivity as well as distancing of the people from the organisational good. As with the structural change, the behavioural change resources should be allocated to the role for the development as well as application of the methodology of change management, communicating all throughout the change, constantly measuring the progress, recognising, providing reward to the result as well as reinforcing change so that it becomes embedded in culture.

Some of the researchers coded, gathered as well as classified the data to themes as well as sub themes. The results of the classification as well as analysis came up with the model’s five themes. The five themes were- strategy, leadership, resources and capabilities, initiative management as well as culture (Love, and Matthews 2019). The main essence of this model is to offer a connection in between the major five themes to ensure a successful change. Each and every theme is said to be an area of specialization that comprises of certain elements which can be practiced at any moment all throughout the course of change. As per the analysis of the effect of the elements on the program of change, the following seven components had the most impact on the success of change:

  • Establishment of the vision
  • Development of the model of governance
  • Examining the effect and readiness
  • Communicating and understanding different perspectives
  • Management of resistance
  • Caching
  • Understanding culture

There is existence of few models for the prediction of the outcomes of organizational change. These models specify the factors of utilization which are critical for the successful enhancement. but they fail to offer an integrated framework for the selection of project which considers the benefits, costs as well as the chance of the success of a project. Core participation of the stakeholder is extremely significant in the projects of organisational change (Matthysen, and Harris, 2018).  The capacity of the stakeholder to influence does not mean that they will actively try to make use of this influence for the promotion of change. The actions of stakeholders are strongly impacted through existing incentives to resist or promote change. If the change is going to be permanent then the incentives of the stakeholders have to be appropriate at the time of the process of change. Having an understanding of the present scenario as well as having some clearly defined goals are the minimum needs for the motivation of change (Hameed, et al., 2018).  Participation is driven through the stakeholder’s predicted change benefits, costs as well as perceived risks of not reaching objectives. The opportunism level is described as the attitude and decision of the stakeholders which is based majorly on the sub optimization or the consideration of the aggregate advantage of change (Neves, Almeida and Velez, 2018). The need for systematic as well as integration of project management is the greatest when various parts of the enterprise are needed to work together. The complication of change can be measured as the number of involved stakeholders and the needed interaction as well as co-ordination between them. If there is an increase in the stakeholder then the values and goals are more competing which cause more complexity in the implementation. Many changes in the organisation entail growing interaction between stakeholders (Horn, Ferreira, and Kalantari, 2022). This can need new channels of information as well as informal network and compel the stakeholders to take into consideration the activities of the organisation from a more comprehensive perspective.


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