Challenges that Healthcare Leaders Face during the Change


Change implementation challenges may manifest in different forms. In the healthcare environment, change is impacted by operational, organizational, regulation, and technological factors. While areas of challenges are broad, organizations benefit largely from the implementation of change. However, several difficulties hinder institutions and users from making full use of the benefits that come with transformation. This study sought to explore the various challenges that healthcare leaders face while promoting change in their institutions. A rapid evidence assessment was utilized to search for articles to be included in the study and the analysis completed through thematic analysis. The findings were classified into three themes: challenges experienced during the design of the interventions, those emanating from organizational and leadership contexts, and those relating to sustainability and mitigation of adverse effects of the change initiative.

Keywords: healthcare, change, challenge, leader

1.0  Introduction

The healthcare environment is continuously evolving. The rapid transformations require the institutions to adapt promptly to realize or maintain competitive advantage and realize positive patient outcomes (Amelung, 2013). The greatest challenge facing all healthcare systems in the world relates to the difficulty of efficient and cost-effective provision of the best quality of care to the highest number of patients. In an effort to respond to the challenge, management of healthcare institutions has sought to consistently change their approach to providing care using various methods. However, as Amelung (2013) argues, in the process of aligning their strategy to meet the changing healthcare systems, the managers are frequently faced with a number of challenges from different aspects of the organization. The challenges, which can be classified into environmental variables, such as economic, political, technological, and social factors, may influence the process (Grol et al., 2013). Mitigation of the challenges that threaten an organization from realizing the benefits of change, therefore, becomes a critical competitive asset (Amarasingham et al., 2014). The deliberate actions taken by the management to reduce the impact of the challenges during a change episode constitute what is referred in literature as change management.

Typically, the anticipated changes may manifest in different forms. In this case, change may take shape through operational, institutional, or regulatory transformations. While areas of challenges are broad, institutions benefit largely from change implementation. The different difficulties experienced while implementing change may severely affect the outcomes of the proposed changes. Furthermore, the process of instituting any form of change is an exceedingly exhaustive and costly undertaking that may result in a loss of organizational resources if the management fails to recognize the challenges and offer timely solutions during the implementation stage. Understanding the significance of identifying the challenges that an institution implementing a change may face is a critical factor in anticipating and planning for the appropriate response to mitigate the adverse effects of the challenges (Buchbinder & Shanks 2011). The current study explores the different obstacles that healthcare managers experience while implementing changes to their organizations. The study will seek to contribute to the existing literature by analyzing the findings through thematic analysis to arrive at patterns that indicate the various challenges the managers experience.

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2.0  Literature Review

2.1 Change in a Healthcare Environment

Organizational change describes the entire process of reshaping the overall structure of a business or implementing the general change of a culture with the aim of responding to the shifting environment and attaining competitive advantage (Grol et al., 2013). Change is necessitated by advancements in technology, new business practices, entry into a new market, and the overall need to improve the efficiency of the operations of an institution. Therefore, it is mandatory that an effective organizational change should have determined guidelines. In healthcare organizations, the management is charged with the responsibility of planning the development of change to avoid adverse effects, including the wastage of resources and most significantly harm to the patients (Grol et al., 2013). The change process is usually divided into measurable goals with specified timelines. The manager responsible for the change development and implementation must communicate, enable, involve, and carry out the facilitation, which brings people together (Northouse, 2018). The enforcement of the considered processes has to happen during the early stages of project planning. Such an undertaking makes it possible to carry out assessments to determine what works and what does not work. Healthcare managers measure the possible change options that become suitable for the organization. The focus is then directed to the most significant reason why change should get enforced or the aspect that will yield most returns.

Building momentum and addressing possible fears prevailing in a healthcare setup are imperative. Drew et al. (2016) contend that the management should provide the employees working in the institution with the reasons why the aspect of change anticipated by the institution is necessary. The employees being significant stakeholders in the change process ought to be involved from the conceptualization stage. Such measures ensure that the staff is critical in ensuring acceptance of the change and minimizing resistance (Drew et al., 2016). The employees are allowed to share information, learn new skills, and work to achieve the set reasonable targets (Dixon-Woods et al., 2012). Operational change, which occurs in most healthcare setups, typically relates to the frequent adjustments happening in specific job roles, reporting structures, or working processes.

2.2 Organizational Change Theory: Improvisational Change Model

The improvisational approach contends that managers should react to change in an ad-hoc manner. Department heads are required to begin with an objective rather than a plan. The argument is that the traditional Lewinian change techniques are misleading because they employ the assumption that transformation is constant and arises during a particular period. Orlikowski and Hofman (1997) applied the improvisational change model on new IT projects. The study demonstrated the critical importance of situated change carried out by an entity’s members. The model disagrees with the claim that changes should be predetermined. The argument is that radical change always takes place rapidly and discontinuously.

The model assumes that changes associated with the technology projects represent a continuing process rather than an occurrence, with an endpoint after which the business can go back to a state of equilibrium. The second assumption is that the organizational and technological changes related to the ongoing process are not predictable. Three types of changes have been identified based on these assumptions. They include anticipated change, emergent change, and opportunity-based change. The anticipated form occurs as intended and, therefore, such changes can be planned ahead of time. The opportunity-based approaches are deliberately introduced during the project and are not initially anticipated. The emergent ones arise unexpectedly from the events that are not initially intended.

The model maintains that both opportunity-based and anticipated changes entail premeditated action, which is usually triggered by an institution’s members’ actions. In addition, they assert all three kinds of changes support each other in an indeterminate order over time. According to Orlikowski and Hofman (1997), practical management of change under the improvisational approach necessitates predetermined procedures and means to identify the various forms of change as they happen to be effectively responded to. Orlikowski and Hofman (1997) note that various elements have to be taken into account to ensure the successful adoption of the model.

First, adequate funds must be apportioned continuously to support the change process. The second condition is the presence of the mutually supporting link between the technology and the change model. The interaction between the key factors must ideally align. The improvisational change model is a necessity for modern companies that consider the ability to manage change as a competitive necessity. Institutions require adapting to changes in the environments in which they operate. Environmental variables, such as economic, political, technological, and sociological peculiarities, may influence an entity to change. The unsteady environmental conditions in which contemporary firms operate mean successfully managing organizational change is a key competitive asset (Orlikowski & Hoffman, 1997; Berwick, 2003).

2.3 Challenges Facing Managers

Managers in the healthcare environment experience a variety of setbacks during the process of change implementation. Such healthcare changes as necessitated by the managements of healthcare organizations seeking to improve the provision of services to the customers and the maintenance of competitive advantage. As a result of the advancements realized in the healthcare field, instituting significant change has become part of the best business practices (Grol et al., 2013). The authors further argue that while the last couple of decades have experienced substantive changes in leading and management of the healthcare organizations, the process is also anticipated with the advancements in technology and business environment; thus, more changes will be observed in the future. Therefore, the management of the healthcare institutions should create a versatile leadership capacity which would assist in succeeding and adopting necessary change. The nature of change makes it challenging to implement and develop sound processes and methodologies (Amarasingham et al., 2014). The following sections will discuss the various challenges that face healthcare organizational while implementing change.

2.3.1 Organizational Challenges

Organizational challenges towards the execution of change include structure, culture and business processes. To effectively implement change, managers must align the organization with the change process. Amelung, (2013) argues that a failed change is one that does not deliver according to its requirements or in line with expectations. Successful implementation of change, according to Amarasingham et al. (2014), requires proper planning to anticipate failure due to risks associated with changes. The importance of management function is to monitor and analyze change implementation progress and help identify the risk triggers (Amelung, 2013).

Other organizational factors include policies and guidelines (Grol et al., 2013). The changes adopted may need to be followed up and ensure that they are operational. In this case, Grol et al. (2013) argue that change implementation focuses on the well-documented stages which companies have to follow as they evolve. Thus, it is critical to maintain control over the change by setting and managing all change activities. Without adequate resources, change objectives may not be achieved. Therefore, a manager is required to communicate, involve, enable, and facilitate involvement from people, as early as possible, identify the risks involved, build momentum, and address the resistance (Conti et al., 2012).

2.3.2 Operational Challenges

Operational changes typically relate to the frequent changes which prevail in the workplace environment (Drew et al., 2016). The rising costs and inadequate resources needed to finance the change initiative present some of the common operational challenges. For example, by introducing technology, the institution is likely to breach privacy issues which may result in legal suits and lost productivity. Moreover, the ease in access to tech is likely to cause additional risks and expenses such as increased cost of maintenance, lack of independence, confidentiality and security concerns. Drew et al. (2016) assert that as a result of the changes, companies will be forced to invest in equipment and human resources that will help in securing user information. Similarly, healthcare systems and organizations are required to invest significant funds and resources on allocation of resources to set up and maintain such technology (El Khaddar et al., 2012).

2.3.3 Legislative Challenges

Healthcare organizations are continuously faced with increased regulations and compliance requirements due to the critical role they play in the society (Dixon-Woods et al., 2012). Such healthcare policies and legislations, including HIPAA and Affordable Healthcare (ObamaCare), are examples that seek to regulate the industry. Healthcare managers are also faced with the burden to comply with a variety of newly revised standards, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Health Insurance Portability and Accountability Act (HIPAA). Such minimum regulatory requirements increase costs as firms are forced to adapt new changes and at the same time update reporting requirements. Currently, such procedures have made most American hospitals to receive a low increment in the collected payments and added risks (Dixon-Woods et al., 2012). Moreover, hospitals suffer from increased management burden since they have to track these programs. Dixon-Woods et al. (2012) opine that with the increased regulatory framework, the margins related to the Medicaid and the Medicare programs have been decreasing and resulting to the revision of approaches to raise revenue and remain competitive. Hence, hospitals have for long periods relied on the influence of profitable business associated with private payers to cover up the loss margin. The profits drawn from successful organizations operating in the private sector seems to provide the only hope which saves hospitals from recording negative profit margins.

2.3.4 Technological Challenges

The modern society is faced with a relentless advancement in technologies in almost all fields. Research into the role of technology in healthcare management indicates that the growth has not only significantly contributed to the realization of better patient care practices, but also led to economic development (Frankel, 2012). However, Frankel (2012) also acknowledges that healthcare managers face crucial challenges while implementing change related to technology in the organizations. The technology implemented within a healthcare set up poses significant setbacks to an institution’s financial systems. For instance, most medical equipment used by hospitals have been found to be five times more expensive than ones used in other institutions.

Technologies, such as mobile computing, support the establishment of critical systems in the healthcare sector. Currently, there has been a rise in the number of patients; thus, the healthcare organizations have to be creative to remain competitive and provide quality services (Frankel, 2012). To do so, firms have adopted the mobile computing tech because it provides accessible solutions to any client owning a smartphone. Furthermore, these institutions require enterprise class features such as wireless connectivity, security technologies that enhance manageability and data capturing technologies that are dependable (Reid & Silver, 2013; Kothari, 2013). The purpose of these components is to revolutionize from storing personal health information in filing cabinets and instead store them in drives and cloud systems that are easily retrievable. According to Reid and Silver (2013), patient data in the current healthcare setting can reside anywhere, and the use of mobile computing has significantly improved the process of communicating and analyzing data. Moreover, the tech takes advantage of the rampant use of personal devices is work set ups. They utilize the platform to improve productivity, which eventually provides economic benefits to both the users and the healthcare facilities (Reid & Silver, 2013).

However, these technologies pose a unique challenge to healthcare management. The most significant one is related to the usability of new systems (Frankel, 2012). Other challenges range from the mobile network itself, privacy concerns, and control of the software and hardware (Tierney, 2017). Managers also face the challenge of availability and quality of mobile technology, especially in the synthesis and accuracy of analyzing healthcare information. For instance, the transmission of clinical data through some local area networks poses dangers of being hacked and exposing the private and confidential records of the clients. Besides, the data may be shared cross several mobile devices, by multiple users which create vulnerabilities that are common with most operating systems. At times, the mobile devices can get lost or even stolen and sensitive information may be lost or end up with fraudsters. Without a prior understanding of the challenges that new technologies bring, it can be difficult to implement the change process (Gupta, 2008).

2.4 Impacts of the Challenges

In her research, Rosabeth Moss Kanter, a Harvard professor, concluded that the pacesetting firms never wait until they developed a perfectly convincing plan to implement change. Instead, these organizations create better strategies for change management (Buchbinder & Shanks, 2011). Buchbinder and Shanks (2011) suggest that it is necessary for the healthcare managers to remain responsive and flexible to the new organizational realities. However, the considered direction does not have to be random. Leadership should be guided by drawing reference from strategic sense which acknowledges entrepreneurial and intuitive approaches. Conti et al. (2012) opine that such leadership enhances the provision of a unique blend of thinking, intuition, analysis, and performance. Any new change enforced within the healthcare industry may not become easy as projected and may seem overwhelming. In this case, the burning question would hold whether these hospitals will become the pioneers of change or have their change delayed until later times. The best way to enforce change should have health care organizations understanding what most modern hospitals need today (Carroll & Edmondson, 2002).

3.0 Methodology

3.1 Introduction

Conducting an adequate inquiry requires the utilization of an appropriate methodology (Neuman, 2013). For this investigation, a rapid evidence assessment (REA) was used to collect and analyze information about the identified research question. In the section, the strengths and weaknesses of the chosen methodology are highlighted, in addition to the strategy adopted in searching for the articles to be included in the inquiry.

3.2 REA as a Research Methodology

Systematic review of literature is one of the most commonly used methods in scientific research as it is highly reliable, transparent, reduces possibility of bias, verifiable and reproducible. The rapid evidence assessment utilizes similar approaches to systematic reviews which include starting with providing a background, defining a research question, identifying the articles and appraising them, presentation of results, synthesis of findings before concluding (Moher et al., 2015). However, the REA in its quality of being rapid is less deep, broad, and comprehensive while searching for the articles. Normally, the research is limited in scope, fewer databases are searched, and a strict criteria for including articles used. The main advantage of the REA lies in its simplicity to conduct the review as it requires a skilled researcher unlike a systematic review that may need a team of experts (Moher et al., 2015). Besides, the REA takes a shorter period compared to SRs. For these reasons, this study utilized the REA as the search methodology. However, the main limitation lies in sacrificing on the depth and breadth, the method presents possible biases in the identification of the materials to be utilized.

3.3 Search Strategy

Materials to be used in this review were sourced through the search of online databases and search engines including Google Scholar, CINAHAL, EMBASE, International Journal of Healthcare Management, and Journal of Health Management. The study used both primary and secondary articles that discussed the challenges facing the management of healthcare organizations when implementing change. To establish the most relevant articles, a Boolean search which allows researchers to combine phrases and keywords with modifiers to identify the articles in the databases was used. For this study, the keywords used were as follows: challenges/ obstacles/ shortcomings; healthcare managers/ healthcare leaders/ healthcare management; encounter/ face/ experience; change process.

The summary of the search used is provided in the table 1 below.

Table 1

The summary of the search made using keywords

Challenges OR




AND Healthcare leaders OR

Healthcare managers OR

Healthcare management

Healthcare leaders OR

Healthcare managers OR

Healthcare management

AND Experience OR

Face OR


AND When managing change OR

During change process

3.4 Inclusion and Exclusion Criteria

Utilizing the above criteria, the investigator identified 120 articles. This number was still high for the REA analysis, so that the inclusion and exclusion criteria were developed to identify the most relevant articles. For articles to be included in this study, they must have been not older than 20 years, written in English, and been either systematic reviews or empirical studies. Studies written in other languages, older than 20 years, and those that lacked some text were excluded. The process yielded 10 articles that the researcher analyzed.

3.5 Analysis of Findings

The articles were reviewed using thematic analysis. Braun and Clarke (2014) opine that the method is suitable for a researcher, who has the capacity to complete identification, assessment, and recording of patterns existing in a provided set of data. The method further requires that the researcher uses the six steps in performing thematic evaluation, namely understanding the available data, generating dominant codes, searching for themes, reassessing the designs, designing and producing a report, and presenting the findings.

3.6 Conclusion

The method chapter is critical to any inquiry as it provides information on what will be completed and how it will be completed. In the current investigation, the REA was selected because it requires less time to produce reliable results. Furthermore, the method does not require a team of highly specialized individuals to complete the study. Searching for articles to be included in the REA used a Boolean approach that allowed combining of keywords with operators AND and OR to extract the most relevant articles to the question under investigation. With the help of an inclusion and exclusion criteria, 10 articles from the initial 120 were identified and analyzed by thematic analysis.

4. 0 Results

4.1 Introduction

This rapid evidence assessment sought to establish the challenges that healthcare management teams encounter while managing change within their organizations. This chapter provides the results of the materials that were included in the review. The findings show wide ranging challenges faced by the leaders in the healthcare institutions especially when implementing change. This analysis identified three themes that were prevalent in most of the articles that were assessed: designing the interventions for improvement; organizational and leadership; and assessment of sustainability and addressing the unintended outcomes. These are presented in further details below.

4.2 Theme 1: Designing the Interventions for Change

The studies assessed have indicated that during the preliminary and conceptions stages, the designers of the change are usually faced with the difficulties of bringing employees on board to the idea, determining whether the change would work, collecting appropriate data, and establishing measurable and achievable goals (Anderson & Anderson, 2010; Dixon-Woods et al., 2012; Ting et al., 2011). Anderson and Anderson (2010) argue that “managing change in the systems set by most healthcare institutions involves understanding and handling the naturally complex procedures processes. Change management entails evaluating, implementing, and planning operations, and ensuring that the enforced change is relevant and worthwhile.” Similar sentiments are presented by the study by Dixon-Woods et al. (2012), arguing that project change managers ought to convince the staff that the intended changes are necessary as they will positively impact healthcare delivery. Furthermore, the authors contend that the management team ought to provide a solution to the fears of the employees who fear if the anticipated change will work when it is implemented. The study by Ting et al. (2011) acknowledges the complexity of healthcare change management as any mistake in a procedure may result to severe outcomes. During the design, the goals of the project may be too ambitious, thus resulting in a project failure. The studies have pointed out the need to have a management team that anticipates the possible threats and unexpected events and design solutions to mitigate the adverse effects of the happenings.

4.3 Theme 2: Organizational Contexts Including Leadership

The assessment of the studies has indicated various factors associated with how the management of an institution is done may present critical challenges to the implementation of change (Adler-Milstein & Bates, 2010; Dixon-Woods et al., 2012; Macfarlane et al., 2011; Mazzocato et al., 2010). The most common challenges experienced in regards to the organization include the governance structure, the culture and the business strategies, technological challenges and legislative limitations. The study by Macfarlane et al. (2011) has identified operational difficulties relating to the rising and the inadequacy of resources to finance the initiatives as significant organizational barriers to successful implementation of change. The authors acknowledge that some projects demand significant resources including human capital that may put pressure on the management. Competent human resources were identified as possible challenges towards the realization of successful changes in healthcare. Poor staff engagements and lack of ownership may be fueled by tribalism and poor assigning of roles to team members (Dixon-Woods et al., 2012).

Further studies by Anderson and Anderson (2010), Fine et al. (2009), Macfarlane et al. (2011), and Stoller (2009) have identified leadership as a critical element that may lead to failure or success of a project. Improving quality in a healthcare institution, according to Anderson and Anderson (2010) requires a leadership that favors inclusion, is visionary, is excellent in communication and motivates the followers to own the project. Transformational leadership qualities have been found to be people-oriented. Stoller (2009) and Delmatoff and Lazarus (2014) contend that a more-relaxed and quieter leader who offers incentives to the employees is likely to receive loyalty and support in his vision.

4.4 Theme Three: Mitigating Unexpected Outcomes and Achieving Sustainability

The analysis of the evidence points to the fact that the possibility of causing some harm to an aspect of an organization during a quality improvement undertaking is not uncommon (Anderson & Anderson, 2010; Dixon-Woods et al., 2012; Macfarlane et al., 2011). The leadership and the management of the quality improvement team may fail to consider issues surrounding the sustainability of the undertaking. The studies argue that perceiving the change initiatives and leaving them to rely on particular individuals is one of the mistakes that healthcare managers can make. Besides, when problems occur as a result of the change initiative, people begin to lose faith in the entire project.

5.0 Discussion

5.1 Introduction

This chapter provides a discussion of the results that were presented in the previous section. The discussion is divided into the three themes that were identified in the results chapter. The findings of the study indicate that all challenges facing healthcare leaders while implementing change can be grouped into three groups: Designing the interventions, organizational and leadership challenges and sustainability and adverse effects mitigation difficulties.

5.2 Theme 1: Designing the Interventions

In the ever-changing world, it is essential for healthcare managers and providers to quickly adapt to change. The utilization of a more conventional thinking service system has higher chances to have health care quality improved continuously throughout the institution. The future and change witnessed in the healthcare field relate directly to the improvements in safety and quality as well as the ability to meet specific opportunities of incorporating new ideas to the practices carried out in everyday healthcare operations. In the process, healthcare institutions find it easy to carry out specific change management processes. Firms would then have their risks minimized. Both intentional and unintentional change compels the management of healthcare institutions to react in response to the environmental processes.

The first phase set in the approach relates to the overall development of a feasible and concrete proposal needed for the proper improvement of the already existing process. Such a plan may focus to incorporate new routines, practices and guidelines for efficient care and the provision of new procedures and techniques into the existing medical works, or the possible insights which concern the organization caring for the patient processes. The findings show that just like many innovations, change has to get developed carefully. Healthcare managers have to ensure that quality becomes a priority, meets the set needs of the targeted group. The ultimate success or the adoption of the considered change strategy requires that the healthcare management understands the characteristics which amalgamate to lead the desired innovation and change. These findings are supported by Carrol and Edmondson (2002) and Grol et al. (2013), who argue that the initial conception phase where the objectives are set should be carefully planned out to ensure success. The authors also contend that substantive data should be collected analyzed to support the claims that the project once implemented will benefit the entire institution.

5.3 Theme Two: Organizational and Leadership Challenges

The results of this REA have indicated that various factors related to the organization have a significant impact on the success or otherwise of a change initiative. Such factors that were identified by the studies include the culture and the capacities to not only implement the change but also sustain it were identified. Inadequate capacity and adverse culture do not present the best conditions for implementing a change. In contrast, the cultures that encourage personal and professional growth of the employees get their workers committed to the change initiative. The evidence proves that the functions of the human resource management departments within organizations are critical as they plan and assign out human capital for various functions. It is, therefore, critical that these departments focus on not only selecting and recruiting talented workers, but also develop training and development programs that will continuously increase the capacity of the employees to meet the challenges faced in healthcare service provision. These findings agree with those presented by McCallum and Roggenhofer (2016), who assert that the HR departments will need to invest in human capital that adequately meets the operational challenges faced by institutions.

Leaders whose firms have to enter the rapid phase of periodic transition have to set critical professional goals. They must work while again ensuring that an institution’s leadership maintains, develops, or restores confidence. It is mandatory for leaders to prove the commitment which they have to the organization’s objectives and mission. Meanwhile, leaders have to establish trust among the members within the organization, and in the process, the entity’s members would have the power to provide direction and sometimes the lifesaving change as desired within the organization.

The leader’s objective set for the transitional period would undoubtedly include taking appropriate stages to assess various issues. Typically, these issues require a transition to the newly set organizational approaches. Having healthcare leaders and possibly a pool of consultants to participate in this assessment will ensure that change becomes successful. Because of such influences, the leader should then direct a series of informational sessions at various levels, and this should further ensure that the findings get discussed. The results then create instructions, which have to get incorporated in the projected change. The transition plan will have to get implemented during conflicts, difficulty, and in case of optimism. At the same time, new developments will need to be approved, and applied to ensure transition.

Dealing with change is naturally rapid and complex, and it requires proper management. Strong leadership ensures that the individuals in charge understand the implications and nature of the change and the need for creating effective strategies that account for the revolution. The ability and the courage to actively change an organization’s momentum help build a positive impact. These approaches refer to strategic management which provides the desired energy and direction for the targeted change. Healthcare leaders should create a new vision which focuses on enhancing success, and they should as well get prepared to honor significant improvements.

5.4 Theme Three: Sustainability and Mitigating Adverse Outcomes

The REA results showed that during and after implementation of quality improvement initiatives, the leaders and the implementing team ought to look and assess for any potential adverse effects that my occur in other units of the organization. Discussing lean process, Fine et al. (2009) argue that implementing sophisticated changes such as lean management requires the designers to think about reinforcement and sustainability. Similar observations were made by Ting et al. (2011), who realized that implementing a new technology in a healthcare facility requires a leadership that is able to focus on sustainability and vision to forecast potential challenges. Such leaders will then provide solutions to the challenges and avoid despair from the employees who might reject the initiative with the first sign of trouble.

Sustaining and initiating an action without setting some of the organizationally predetermined logical plans is a riskier strategy to utilize when implementing a project. In the health care profession, a manager should focus to learn and establish newly formulated decisions over time. Managers may then use the created analytical method to enhance strategy development by ensuring that they understand the external environment where the organization operates. The findings from this study mirror those that were identified in the literature review section especially the change management resource by (Amelung, 2013). An operational type of change management, through its program, tends to become more active when implemented strategically in different phases or stages. By breaking down the step by step framework for achieving the strategy, the company will ensure that the program is implemented in a timely, effective and efficient manner and that the adverse effects are mitigated while planning for sustainability.

6.0 Conclusion

The study findings show that managers in healthcare organizations face an array of challenges in change implementation. The major challenges grouped into design of interventions, organizational and leadership challenges, and sustaining and mitigating unexpected events. The design of the changes needed is a critical phase as it allows for the conceptualization of the entire project and the possible threats. During this stage, the leaders should convince the employees that the change is needed and once it is implemented, it will work. Technologies such as mobile computing have the benefit of providing support during implementation of change. Thus, the constant increase in the number of patients forces the healthcare facilities to be more creative, so that they can provide quality services. Computing tech is popular in the healthcare industry because it enhances efficiency and ease of accessibility by use of smartphone. Organizational challenges include structure, culture, and business processes. To effectively implement change, managers must align the organization with the change processes. A failed change process is one that does not deliver according to its requirements or in line with expectations. Proper planning is needed as it is important to anticipate failure due to risks associated with changes. The importance of management function is to monitor and analyze change implementation progress and help identify the risk triggers (Kotter, 2012). Operational change typically relates to the frequent changes, which prevail in the workplace environment.

Technological challenges arise from usability of the system, lack of properly functioning networks, privacy issues and poor management of applications. Inadequacy in management of technology may lead to breach of confidentiality, inaccuracy and unnecessary dissemination of sensitive clinical data and information. Lastly, Healthcare managers are also faced with the burden to comply with a variety of newly revised standards, including the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Health Insurance Portability and Accountability Act (HIPAA). Such regulatory requirements have an effect of increasing the costs of implementing change and offering quality care.

Regardless of what the healthcare management focuses on when accomplishing their goals, it is important to ensure that change gets managed appropriately to ensure the realization of positive outcomes. At different times, the process of implementing something new as a result of change may create undesirable consequences. It is essential for the healthcare managers to plan and develop everything before the implementation of any change, especially during the enforcement of operational change. The operations associated with healthcare management require that managers have to acquire appropriate training which would assist them in handling multiple issues. Healthcare managers should note the various concerns affecting healthcare institutions stems from specific concerns. These concerns include insurance claims, financing, incident reports, emergency preparedness, clinical issues, as well as behavioral health issues. Evaluation of healthcare change assists managers to evaluate the possible risks to ensure the overall reduction of injury among the healthcare staff, visitors, and patients operating within a healthcare organization. While assessing risks, healthcare managers should work reactively and proactively to either minimize or prevent possible incidences where health-related challenges may affect the organization.



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