Staff attitudes to change in view of reform at St Luke's Hospital.

Abstract

In most developing and transition countries, the health care and public service systems are in a process of dramatic change, often referred to as reform. Organisational change can generate skepticism and resistance in employees, making it sometimes difficult or even impossible to implement organisational improvements. In this management project the attitudes to change of hospital staff working in two units at St Luke's Hospital were studied in view of current and planned reforms at that hospital. This project incorporates a mixed-method approach including both quantitative and qualitative components. The methods used to collect data were a self-administered questionnaire, interviews and focus groups. A multistage cluster probability sample was used for the quantitative component of this study while a purposeful sampling strategy was used for the qualitative sample. Three main areas of attitudes were investigated which include: orientation towards change in general, understanding and acceptance of current changes and how change is managed. The findings of this project indicate that positive attitudes prevail amongst the participants towards change in general. In fact they recognised that change was a normal practice in every day situations. The next area studied was how organisational change was managed. Respondents expressed negative attitudes to how change was being managed especially when it comes to communication, consultation with staff members and support for people before and during change processes. Finally, respondents showed positive attitudes on acceptance and understanding of current changes. The majority agreed that this organisation had a vision and a direction although these were not clearly communicated. Several emergent themes were identified from the textual data of interviews and focus groups. Emergent themes associated with orientation towards change in general included the effect of management style on change, feelings and emotions associated with change, the importance of organizational culture. There was only one emergent sub theme associated with the understanding and acceptance of current changes which was that the organisation was perceived as without policies and standard operating procedures. The emergent sub themes related to how change is managed were the need for counselling to employees, the lack of information about reforms and the impact of differences in management style. From the practical point of view, the results imply that there are deficiencies in this organisation that need to be addressed prior to embarking seriously on any change processes. These include management, staff, departmental and communication issues. The senior management team at St Luke's hospital must make sure that staff members are involved in the planning and decision making processes that usually accompany change. Managers must provide the big picture by showing the importance of each individual in making meaningful decisions and contributing to the success of the larger organisation instead of the individual sections. This organisation, through effective leadership, must struggle through the transition from command and control to organisational learning and employee empowerment. An effective communication strategy is necessary in this organisation to ensure that all messages support the strategic objectives of change within the organisation. The leaders of this organisation must frame a motivational message as one of opportunity and hope for the future. A clear vision allows the transformation of dreams and ideas into strategic goals.