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Leading and Managing Change

Leading and Managing Change

Order Instructions:

Case study research assignment (50%): An essay of 3,000 words identifying a strategic planning or
change management initiative within an organisation with which you are working or with which you are
familiar. The requirement can be past, present or future. The essay will need to draw heavily upon the

learnings from the workshops supported by students� own research.

Leading and Managing Change

Assessment of the strategic initiatives employed in the case study: Journey of Hong Kong
Public Teaching Hospital in Preparation of Hospital Accreditation will be based on Kotter’s 8-
Step Change Model. Strategic planning refers to a disciplined attempt that offers basic decisions
and actions, which contribute to the shaping and guiding what a firm is, what a firm does, and
why such a firm does what is does, in relation to the future (Heward, Hutchins & Keleher, 2007,
176). Strategic planning focuses on three cyclical elements, which are often known as the ABCs
of strategic planning. They include: moving from component A to component B takes into
consideration the clarification of vision, mission and objectives; moving from component A to
component C represents a process of strategy development/formulation, whereas moving from
component C to component B represents the aspect of strategy implementation. The case study
focuses on the aspect of preparation accreditation, which is aimed at transforming Queen Mary
Hospital’s culture and fostering safety, effectiveness, reliability of services and quality.
In 2008, Hong Kong SAR Administration and Hospital Authority’s Food and Health
Bureau launched a pilot plan of hospital accreditation. Accreditation involves a process in which
health institutions/hospitals struggle to offer high quality care in relation to the external peer-
reviewed standards (Chiu, Seto & Lai, 2011, pp. 231). This concept is gaining a global
popularity, but happens to be a novel idea in Hong Kong’s health care system. Most of the
workers are ignorant of the concept or means of preparation. As such, developing new ideas can
be discouraging to both frontline staff and hospital executives. This problem can be compounded
by situations in which health care facilities lack sound and robust quality management
In relation to Kotter’s 8-Steps Change model, Queen Mary’s management should be
developing a sense of necessity/urgency, which is step 1. Major projects of change can emerge

successful when they obtain adequate support from the organization’s employees. As such,
organizations should ensure that they begin the process of transforming their institutions by
convincing members of staff of the significance and urgency of moving a new direction. In
relation to this, the hospital’s management should gather it staff members and inform them about
the hospital need for accreditation (Heward, Hutchins & Keleher, 2007, 177). Being that
accreditation is aimed at improving the quality of health care services in hospitals, Queen Mary’s
management should inform its staff about this necessity. Moreover, since many health care
employees are unaware of this concept, the hospital’s management should use this opportunity to
inform them about it, and its significance. This step is significant in ensuring that the hospital’s
employees develop the determination/willpower to move and win.
A false sense of necessity/urgency and complacency alongside anger, frustration and
anxiety act as the principle stumbling blocks to change in organizations. To succeed individuals
should often focus on the significant/important aspects of change. Creating a sense of urgency
will ensure that the hospital’s management succeeds in minimizing cases of complacency, anger
and anxiety among its employees in relation to the intended change. In the real sense, urgency
not only acts as a significant trigger for the change, but also serves as the engine or driving force
of change (Hillol & Viswanath, 2013, pp. 1125). Successful creation of a sense of necessity
among staff members requires that change management leaders, point out the risks and potential
opportunities that arise from the business environment in relation to the intended change.
Successful leaders often accomplish this goal by appealing to the minds and hearts of workers.
One of the approaches that the firm’s management can employ in accomplishing this goal is
conducting a SWOT analysis.

SWOT analysis will play a vital role in pointing out the external environmental aspects,
which are the threats and opportunities, and the internal environmental aspects/company’s
internal environment dimensions, which are weaknesses and threats. While addressing
weaknesses and threats, focusing on the opportunities provides suitable platform on which the
organization’s management can build strengths and enhance performance (Heward, Hutchins &
Keleher, 2007, 178). Exploring the hospitals internal environment helps in the revelation of its
core competencies alongside its distinctive core competencies as shown below:
 Significance of Queen Mary Hospital to the community: the hospital acts as a tertiary
referral center kidney, heart, liver, bone marrow transplantation and lung (Chiu, Seto &
Lai, 2011, pp. 231). Moreover, the institution is affiliated to the University of Hong
Kong, which makes it significant to students who often conduct some of their learning it.
 Financial position of the institution: Currently, the hospital’s annual is estimated to be
over HK$30 billion. This robust financial position is significant in funding the intended
change (Chiu, Seto & Lai, 2011, pp. 231).
 Robust Partnership: Being a public teaching hospital, the Hong Kong SAR
Administration and Hospital Authority’s Food and Health Bureau has opted to partner
with the firm in enhancing the implementation of the change.
 Robust staff Capacity: The hospital employees more than 4800 individuals who can be
employed in leveraging the process of delivering of high quality care.
 Many staff members with the organization are not aware of the concept of accreditation
(Chiu, Seto & Lai, 2011, pp. 231).

 The hospital lacks a suitable mechanism of ensuring that its staff members deliver high
quality care to patients.
Conducting an assessment on the external environment will help the hospital’s management
identify the following threats and opportunities.
 Support from the government: Hong Kong’s government aims at enhancing the process
of change implementation in Queen Mary Hospital (QMH) through the Food and Health
 Support from the NGOs: Apart from the government , the change implementation
process in the hospital is supported by the ACHS (Australian Council of Health
 Most health institutions in the country have not implemented this concept: the hospital is
at an advantage of gaining a competitive benefit over its rivals who in terms of delivery
high quality care to patients. Many health care institutions (Hong Kong Authority
Hospitals) have not implemented the concept as it is not popular in Hong Kong.
 Threat from the Inclusion of other Hospitals in Change’s Pilot Scheme: other
hospitals are also inclined towards the implementation of the same change in their
institutions. The accreditation exercise has been joined by three private health care
institutions and five public hospitals (Chiu, Seto & Lai, 2011, pp. 231). As such, the
organization is likely to face an intense rivalry from these institutions in terms of
funding from the sponsors. Besides, the Queen Mary Hospital is likely to witness

intense rivalry from these institutions in relation to the delivery of high quality health
care, which is the principle purpose of the accreditation process.

Step 2: Establishing a Guiding Coalition
Formation of a coalition of individuals to be in charge of leading the change exercise
process acts a significant step towards the realization of a successful change implementation
process. Members of the team should have enough expertise, credibility, power, and excellent
skills of leadership. Moreover, these individuals should have a share aim as it is vital in the
realization of a successful strategy implementation process (Hillol & Viswanath, 2013, pp.
1127). When members of the change implementation team have a common objectives, issues
such as conflicts, which are always associated with different interests, can be minimized in an
effective manner. Moreover, lack of a shared objective among individuals selected to spearhead
the project can result into wastage of resources. As such, organizations should ensure that they
are involved in the selection of individuals who have shared goals to lead the change exercise.
The consideration of aspects of leadership skills, expertise, credibility and power is also
significant in ensuring that individual who are selected to lead the strategy implementation have
the necessary physical and intellectual abilities, which are required for successful execution of
the change implementation exercise. Such abilities are vial in ensuring that these individuals
provide adequate guidance to other people who are included in the change process. Furthermore,
the possession of such potentials is significant in ensuring that the core team is at a suitable
position of addressing challenges that can be encountered during the strategy implementation
process in an effective manner.
Queen Mary Hospital’s management responded to the accreditation exercise an effective
way. This reaction occurred twenty-four months prior to the formal process of accrediting QMH.

The formation of the projects core team took into consideration individuals from with robust
leadership skills, credibility and expertise (Hillol & Viswanath, 2013, pp. 1129). These
individuals were recruited from various disciplines such as allied health, nursing, laboratory,
administration, clinical specialties and pharmacy among others. Such a selection was significant
in ensuring that issues from various perspectives cold be integrated, thereby leading to the
realization of a rational decision-making process. QMH’s Chief Executive acted as the core
team’s patron. The core team’s function was to oversee the entire change
implementation/accreditation exercise.
Step 3: Establishing a Change Vision
The third step that could have been followed during the implementation of the change is
development of a vision for the strategy. This role was to be played by the core team. The
establishment of a vision for the change could have served as a basis for efficient decision-
making. Efficient decision-making during change implementation can be accomplished in an
effective manner when an appropriate vision is developed for the exercise. Developing a vision
for a change implementation exercise ensures that strategy executors have a clear direction of as
to where the project heads.
Developing a vision for the project could have also contributed to the motivation of the
core team members towards taking action in the appropriate direction in case the initial steps of
the project happened to be painful. Strategy implantation is not a smooth process as it is always
associated with other drawbacks such lack of adequate funding, conflicts among core members
and resistance (Scott, 2010, 481). As such, establishing a clear vision for the process is vital in
ensuring that core team members remain in the right path despite encountering such challenges.

Furthermore, such vision offers a significant meaning to individuals. It also serves as glue that
binds every aspect of the change implantation process.
QMC’s management could have ensured that a clear vision is developed for the
accreditation exercise. This vision needed to be imaginable, desirable, feasible, focused, flexible
and communicable. By being imaginable, the vision could have ensured that it conveys a clear
picture/view of what the future would be to the organization. This feature could have contributed
positively to the motivation of core team members, and other stake holders. The aspect of
desirability could have ensured that the vision remain appealing to the long-term interests of the
organization’s management, staff and other stakeholders, thereby minimizing cases of resistance
(Hafiz, Ali-Fazal & Fareeha, 2014, 194). The aspect of feasibility could have ensured that the
accreditation’s vision contain attainable and realistic goals. For instance, change’s vision could
have been developed in manner that does not compromise the organization’s financial potential
of HK$30 million. This undertaking could have ensured that the company’s resources are taken
into consideration, thereby minimizing the wastage of the firm’s resources. By being focused, the
strategy’s vision could have provided a clear guidance on the direction that should be taken in
relation to the realization of an effective decision-making process. Consequently, the aspect of
flexibility could have ensured that the strategy’s vision allow alternative responses and
individual initiative in relation to the changing circumstances involved in the accreditation
exercise. Some of the factors that could have been considered in the attainment of this goal are
the company’s resources and other alternatives of funding. By being communicable, the change’s
vision could have ensured that it is explained in an easy and quick manner to the target group or
stakeholders (Foltin & Keller, 2012). This aspect could have also contributed significantly to the
minimization of cases of resistance from the firm’s employees/staff members.

Step 4: Communication of the Vision for Buy-In
The next step that could have been embraced by QMH’s management is spreading the
strategy’s vision through the firm/organization. This approach could have ensured assisted the
organization management in receiving opinions of employees about the vision (Feyerherm et al,
2014, pp. 1167). As such, it could have provided a suitable platform on which changes that
matched the interest of employees could have been made. Moreover, this step could have
provided a suitable platform on which employee engagement could have been achieved.
Employee engagement in a strategy implementation exercise helps in minimizing cases of
resistance as it makes them feel as part of the change process.
Effective communication of the change’s vision is significant in ensuring that all
individuals involved in the change implementation exercise comprehend the process. As such,
QMH’s management could have ensured that they employ various mechanisms in
communicating the strategy’s vision to employees and other stakeholders. For instance, the
organization’s management could have attempted to employ mechanisms such as story telling in
communicating the vision to the target groups (employees and stakeholders). Such an approach
could have helped in making the strategy’s vision more vivid than in a situation in which only
words were used in communicating it (Decker et al, 2012, pp. 43). Leaders should ensure that
they motivate and inspire employees as this helps in overcoming cases of mistrusts in the
Step 5: Empowerment of Borad-Based Action
Once QMH’s management had ascertained that its employees had accepted the novel
vision, it could have adopted measures that are aimed at empowering employees to act upon the
new vision. The core team can contribute significantly to the realization for this goal. This team

can achieve this objective by engaging in an active removal of barriers, which are associated
with the accreditation process. In the case study, is clear that the core team engaged in the
identification and elimination of barriers that were encountered during the accreditation exercise.
Some of these barriers were complacency, vested interest, technical businesses terms, inertia,
lack of alignment of key stake holders and core team members understanding and ideology on
accreditation and poorly managed meeting among others (Diane et al, 2014, pp. 75). Leaders
should ensure that they are involved in a active process of addressing the barriers or resistances
to change.
The Four types of resistance that leaders should focus on addressing are rational factors
that arise from different evaluations between management and employees concerning the need
for change and results, non-rational factors such as emotional responses, poor management and
political factors. As seen in the Case study, individuals often resist organizational change due to
self-interest or vested interest. Besides, individuals can resist change due to issues such as
disturbance/interruption of social networks, loss of face, and fear of unknown outcomes and
change-averse among others (Canato, Ravasi &Philips, 2013, 1743). Some of the methods that
people often employ in resisting change are anticipation and humor. As such, leaders should
prepare adequately to address such issues as resistance can lead to skill gaps. After addressing
such issues, QMH’s management could have ensured that all members possess appropriate
systems, tools and skills that are needed in the realization of the intended change. In addition, the
organization’s information systems and human resource systems could have been employed in
implementing the vision at this stage.
Step 6: Generation of Short-Term

QMH’s management could have then proceeded to the generation of short-term wins
stage. Major and long-term efforts of change often lose their momentum earlier than expected.
For change implementers to uphold/maintain the sense of urgency and motivation of everyone
involved, they need to point out their short term successes. This step could have involved the
mentioning of the successes that the company has achieved prior to the achievement of the main
objective (Casida & Parker, 2011, pp. 484). Besides, the company could have enhanced this step
by celebrating such achievements. This often plays often contributes positively to members’
motivation, which is essential for the accomplishment of the project’s main objective.
Short-term wins also contributes to the taking out of winds of sails of resistors and
cynics. Research indicates that organizations that witness significant short-term successes have
higher chances of completing their transformation processes in successful ways that those firms
that do not witness significant short-term wins (Casida & Parker, 2011, pp. 485). Such
organizations are often characterized by high levels of motivation on the part of employees and
members of core teams.
Step 7: Consolidation of Gains and Production of More Change
Declaration of victor prior to the full incorporation of the business improvement and
changes into the organization’s culture can lead to a significant failure. As such, firms should not
overindulge in the celebration of short-term success as such this tendency may lead to the loss of
focus on the major vision. Moreover, such an act can result into the killing of the ongoing
momentum, thereby allowing resistors to gain control of the process (Taina, 2013, pp. 54). In
relation to this, the company’s management should have also taken this aspect into its
consideration while celebrating its short-term wins during the change implementation exercise.

Project leaders should use this stage a suitable platform on which they can realize more
change. They should ensure that they employ the increased credibility from the previous wins in
enhancing the change process. At this stage, QMH’s management could have involved new
groups of individuals in the process of accreditation (Taina, 2013, pp. 56). Moreover, such
individual could have been promoted to major roles. The level of focus and urgency should be
kept constant to avoid people from engaging in activities or actions that can derail the change
implementation process.
Step 8: Incorporation of Changes into the organization’s Culture
The final stage of the Kotter’s 8-steps Change model involves the incorporation of the
changes into the organization’s culture. In relation to this, QHM’s management could have
finalized the accreditation process by incorporating the policies and guidelines that are associated
with it into the organization’s culture. After incorporating these approaches into the firm’s
culture, the management could have embarked on constant process of communicating the
improvements or benefits realized from the accreditation process (Tyler & Jonathan, 2014, 327).
Consequently, this stage should be accompanied by the establishment of leadership succession
and development plans, which are in line with the norms and values of accreditation.
Processes of change often put significant demands on managers and executives alongside
the entire organization. Kotter’s 8-step framework offers a robust checklist for many things that
should be taken into consideration during the process of change execution (Wilson, 2014, pp.
49). The key requirements/prerequisites for the steps involved in this model are a sense of
urgency, excellent leadership, open information exchange or open communication among the
involved groups and constant communication across various levels of the company.



Reference List

Canato, A., Ravasi, D & Philips, N. (2013). “Coerced Practice Implementation in Cases of Low
Cultural Fit: Cultural Change and Practice Adaptation during the Implementation of Six
Sigma at 3M,” Academy of Management Journal, 56(6), pp. 1724-753.
Casida, J & Parker, J. (2011). “Staff Nurse Perceptions of Nurse Manager Leadership Styles and
Outcomes,” Journal of Nursing Management, 19(1), pp. 478-486
Chiu, A., Seto, W & Lai, L. (2011). “Journey of a Hong Kong Public Teaching Hospital in
Preparation of Hospital Accreditation,” Hong Kong Medical Journal, 17(1), pp. 231-236.
Decker et al. (2012). “Predicting Implementation Failure in Organization Change. Journal of
Organizational Culture,” Communications & Conflict, 16(2), pp. 39-59.
Diane et al. (2014). “A Theory of Organization HER Affordance Actualization,” Journal of
Association for Information Systems, 15(2), pp. 53-85.
Feyerherm et al. (2014). “Partners for a Healthy City: Implementing Policies and Environmental
Changes within Organizations to Promote Health,” American Journal of Public Health,
104(7), pp. 1165-1168

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