Leading and Managing Change Assignment

Leading and Managing Change
Leading and Managing Change

Leading and Managing Change

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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 schemes/plans.

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 Bureau
  • Support from the NGOs: Apart from the government , the change implementation process in the hospital is supported by the ACHS (Australian Council of Health Standards)
  • 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 organization.

 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

Foltin, A & Keller, R. (2012). “Leading Change with Emotional Intelligence,” Nursing Management: Retrieved from: www.nursingmanagement.com

Hafiz, N., Ali-Fazal, A & Fareeha, Z. (2014). “Four Factors to Influence Organization & Employee Commitment to Change within Pakistan,” International Journal of Information Business & Management, 6(4), pp. 183-200

Heward, S., Hutchins, C & Keleher, H. (2007). “Organizational Change-Key to Capacity Building and Effective Health Promotion,” Health Promotion International, 22(2), pp. 170-178

Hillol, B & Viswanath, V. (2013). “Changes in Employee’ Job Characteristics During an Enterprise System Implementation: A Latent Growth Modeling Perspective,” MIS Quarterly, 37(4), pp. 1113-1135.

Scott, S. (2010). “We’Re Changing or Are We? Untangling the Role of Progressive, Regressive and Stability Narratives during Strategic Change Implementation,” Academy of Management Journal, 53(3), pp. 477-512

Sotanto et al. (2008). “Change Management in Inter-organizational Systems for the Public” Journal of Management Information Systems, 25(3), pp. 133-175

Taina, S. (2013). “Change Implementation in Intercultural Context: A Case Study of Creating Readiness to Change,” Journal of Global Business Issues, 7(2), pp. 51-58

Tyler, T & Jonathan, C. (2014). “Pressure and Performance: Buffering Capacity and the Cyclical Impact of Accreditation Inspections on Risk-Adjusted Mortality,” Journal of Healthcare Management, 59(5), pp. 323-335

Wilson, J. (2014). “Managing Change Successfully,” Journal of Accountancy, 217(4), pp. 38-41

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