Organizational Change Explained

Case Studies on Transformational Change in Organizations

Sarah Coleman, Bob Thomas

• Publisher: Kogan Page
• Year: 2017
• ISBN:
  9780749475482
• Edition: 1
• Topic: Business
• Subtopic: Human Resource Management
• Index: Business

The best way to learn how to navigate change successfully is to look at practical examples of change management programmes. Organizational Change Explained shares stories and insights from experienced change practitioners so professionals can reflect on their own work, respond critically to what others have done, and take away new tools and techniques to apply to their own change management practice. The book includes a range of cases from different sectors and countries including GlaxoSmithKline and the NHS to offer insights no matter the scale of the change management programme. Organized around central themes such as shaping and design, change leadership, and communication and engagement, Organizational Change Explained presents each case alongside an introduction, conclusion, list of key learning points, questions for reflection and sources of further reading. The book is invaluable to anyone tasked with leading or managing change within their teams, projects, departments or divisions, whether at local level or across geographic locations, countries and cultures.

PART 1

The reality of organizational change – practitioner case studies and insights

01

Changing culture through conversation

Organizational development in the NHS

KELLY ANGUS, KAREN DUMAIN AND PAUL TAYLOR

Introduction

Organizational development (OD) practitioners have a significant role in leading culture change initiatives by embedding theory into practice. The NHS OD community came together to develop a new digital resource (Do OD, 2014a) that focuses on culture change, learning much about the process along the way. Here we will describe that journey, illustrated by a case study from a successful NHS organization that explored and developed their culture despite complex and challenging circumstances. We’ll conclude with reflections on culture change, and tips to help you in your own culture change work, as well as questions to help you reflect on your approach.

We take the view that it is possible to change culture. When you pay attention to organizational culture and take action, you can change it. Our stance assumes that organizations are socially constructed, meaning-making systems. Therefore, culture changes as the conversations in the organizations change. Culture is created in the interactions between people, in our relationships and our behaviour. Culture is everything we say and do. We are the culture of our organizations.

Background

The National Health Service is the largest employer in the UK. Over 1.3 million staff work in the NHS, with over a million patients being seen every 36 hours. Change in the NHS is constant, but in recent years the scale and pace of change have increased exponentially. In 2012, the then Chief Executive of the NHS described the changes needed as ‘so big they could be seen from space’.

The NHS is a source of national and public pride in the UK. Public perception of the NHS remains high, despite challenging circumstances. An IPSOS MORI poll in 2013 showed 71 per cent of people agreeing that ‘Britain’s National Health Service is one of the best in the world’. In the opening ceremony of the 2012 Olympics, the NHS was showcased as a shining example of British culture. The NHS Five Year Forward View – the document that sets out the shared vision for the future of the NHS – notes significant progress in the last decade, including better outcomes in cancer and cardiac care, shorter waits and increased patient satisfaction. However, the Five Year Forward View also notes that the quality of care across the system can vary and that we need to be responding more effectively to the changing needs of our patients.

The changing needs of the population are set against a challenging financial backdrop, described by the Nuffield Trust as ‘an unprecedented financial challenge’.

The London School of Economics has stated that the NHS needs to respond to the expectations of its patients, who want care delivered closer to home and their wellbeing to be prioritized.

Culture change

Culture change is one aspect of OD. While we focus here primarily on culture as the key factor, we recognize that aspects of organizations such as leadership, skills, structures, systems and staff engagement are also intrinsically connected. Leading culture change is, in itself, a significant challenge. It’s widely acknowledged that organizational change is difficult and takes time. People respond very differently to change. Working in a people-centric context means acknowledging that change is a subjective experience and that there are many differing responses among individuals. One NHS ward manager told us: ‘Change is difficult and staff perceive it as a difficult challenge ahead as it is the unknown’, whereas another NHS team leader said: ‘One of the things I don’t like is when they use that phrase “people don’t like change” because I love change. So if I hear somebody say “oh, nobody likes change”, I say I do.’

Despite a continual cycle of change over recent years, helping staff to embrace change, and in particular culture change, is key to the future success of the NHS.

Why do we take culture seriously in the NHS?

Over the past few years, culture and culture change have been at the top of the NHS agenda. Turn on the radio, watch the news, and there is very likely to be a discussion on the state of the NHS and invariably on how the culture of the top team, or the organization, has played a big part. While the NHS is used to being in the media, underneath this public scrutiny sits a very real concern and understanding of the need for ensuring a compassionate culture across the NHS.

What do we mean by a compassionate culture? Following the extensive inquiry into failings at Mid Staffordshire NHS Foundation Trust, Robert Francis QC published his final report in February 2013. It told a story of suffering of many patients, in a culture of secrecy and defensiveness. The inquiry highlighted a whole-system failure, one that should have had checks and balances in place to ensure that patients were treated with dignity. The 1,782-page Francis Report that was the outcome of investigations into Mid Staffordshire Hospitals NHS Trust had 290 recommendations, with major implications for all levels of the health service across England. It called for a whole-service, patient-centred focus. The detailed recommendations did not call for a reorganization of the system, but for a re-emphasis on what is important. The report noted that the extent of failure of the system suggested that a fundamental culture change was needed, and there were four key messages:

• This was a system failure as well as a failure of an organization.
• No single recommendation should be regarded as the solution.
• A fundamental change in culture is required across the NHS.
• There is a need to secure the engagement of every single person serving patients in the change that needs to happen.

Mid Staffordshire was, of course, only one Healthcare Trust, but it was a call to action across the NHS to ensure that such a situation as this was not repeated and that a culture of compassionate care should be the standard for all NHS healthcare organizations. This is amid a changing, complex world and an NHS that strives to support healthcare in the 21st century. The Five Year Forward View recognized that the NHS was at a crossroads and needed to change to move forward.

Meeting the healthcare challenges of the 21st century and of the Francis Review and others has put culture to the fore as a key determinant in what creates safe healthcare systems.

So what’s the evidence that culture change is possible? Increasingly there has been a wealth of evidence, most significantly from the work of West and Dawson (2012) on positive links between organizational culture, leadership and reduction in patient mortality. Many definitions of culture – see Schein (1984, 2010) – have in common an emphasis on the shared basic assumptions, norms and values and repeated patterns of behaviours of particular groups and teams. Culture becomes ‘the way things are done around here’. Edgar Schein and complexity experts such as Glenda Eoyang at the Human Systems Dynamics Institute (www.hsdinstitute.org) suggest that identifying these patterns, similarities and differences is the first step to changing culture.

Also highly influential in the NHS has been the work of West et al (2001), who have analysed data and information from annual staff surveys in which all NHS healthcare organizations are required to take part. Professor West has been able to evidence very clearly that high staff engagement, and creating the right culture and conditions, lead to better patient care and lower mortality. As we look at whole systems and what makes a healthy organization, we know that organizational culture is one of the key variables or elements that contribute to high-performing and effective healthcare organizations.

Leading global experts in the field of organizational development have developed ‘big system’ models that identify the vital components that, working together, make effective high-performing organizations. Two well-known and well-used models, Dr Mee-Yan Cheung-Judge’s four frames model (2015) and the Burke–Litwin (1992) model, both identify culture as a key component.

OD practitioners leading culture change

The NHS has a rich history of OD practice as a lever for change. Here we turn our attention to the role of OD practitioners leading and facilitating culture change. In the NHS we describe one of the characteristics of OD practice as enabling people to transform systems. We highlight the importance of using an OD model to diagnose issues and respond by structuring interventions that go beyond culture change as well as looking at the capability of OD practitioners leading change.

Culture change sits firmly in the domain of OD – a field of practice rooted in behavioural science that enables people to transform systems. Practitioners of OD think systemically about how an organization can improve its abilities to deliver strategic goals by examining the levers of change a...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• About the editors
• About the contributors
• Foreword
• Introduction
• PART 1 The reality of organizational change – practitioner case studies and insights
• PART 2 The future of organizational change – opinion pieces from future thinkers
• Index
• Backcover