An Exploration of Unique Barriers in Organizational Development – and How to Combat Them

For the month of April, I will be sharing things I’ve written in the process of obtaining my MS in Health Care Administration which I finished up this past fall.

Organizational development (OD) is the “process of continuous diagnosis, action planning, implementation and evaluation, with the goal of transferring knowledge and skills to organizations to improve their capacity for solving problems and managing future change” (Blalock, et al., n.d.).  While this is popular within business organizations, it also has a growing following within healthcare.  With this growing popularity, though, it is important to address the additional barriers organizational development tactics face when applied to the healthcare realm.  First, let us examine the basics of OD, then barriers, and, finally, how to counteract these barriers for the most efficient use of OD within healthcare.

OD Basics

Organizational development is a path to planned change within an organization.  This change can take place in one or many areas but consists often of ideas from a wide variety of fields such as communication, interpersonal sciences, and business (Anderson, 2015, p. 2).  This is meant to be a long-term change or the use of a one-size-fits-all mentality (Anderson, 2015, p. 9).  OD developed as a way to address practices within management, quality improvement, employee involvement in change, organizational culture, learning, and ways to go about change (Anderson, 2015, pp. 25-36).  This change can vary in size, reach, continuity, and planning (Anderson, 2015, p. 67).

In order to conduct proper OD, the change agent needs to understand that organization in its current state.  This means not only understanding organizational culture but also values inherent to the organization and its employees.  These things are important as “they are the underlying beliefs that are enduring and broader than any single consulting engagement or intervention” (Anderson, 2015, p. 41).

One thing that separates OD from other forms of consulting is the power dynamic between the change agent and the client.  With many forms of consulting, either the client or the change agent is the expert and really takes the lead on anything from gathering information to final changes and evaluation (Anderson, 2015, p. 95).  With OD, however, the role of the expert is a shared one between those in the client organization and the change agent (Anderson, 2015, p. 95).

Another important distinction between OD work and consulting is gathering data.  It is an incredibly important piece of OD work.  Data gathering is very similar to the process of testing for a medical diagnosis – it is a process that takes time to do but is necessary in order to find the correct treatments for a malady (Anderson, 2015, p. 161).  In OD work, this data gathering is key.  At times, people within an organization may see employee burnout, for example, as the main problem when it is a symptom of an organizational culture issue.  In this case, data gathering reveals the real roots of the issues and can bring up additional symptoms or diagnoses that someone within the organization may not have seen.

Just like in the medical diagnosis process, one must be careful to only stick to diagnoses the data supports (Anderson, 2015, p. 168).  This is why a change agent must not necessarily be a part of an organization but from the outside.  It is easier to refrain from jumping to conclusions that support any one person and/or group if there is little to no relationship with these people.

Data gathering is not always as straightforward as simply shooting out a survey or shadowing employees.  The first step is to “determine the approach to be used” – will interviews, surveys, observations, focus groups, or less invasive measures such as environment, historical information, and documents yield the best information (Anderson, 2015, pp. 129-130, 144)?  In order to decide the best steps, one needs to examine the pros and cons to using each for each environment (Anderson, 2015, p. 148).

That said, there are different strategies for dealing with individual, team, and organization-wide changes.  In the individual realm, there tend to be fewer steps to interventions or change as “feedback is given directly to the participant” (Anderson, 2015, p. 211).  A lot of personal growth tools like personality assessments and planning can assist in these changes (Anderson, 2015, p. 214).  Coaching and mentoring are key in individual interventions, from personal to professional development.

With team improvement projects, there are more nuances to work with.  Communication, expectations, trust, and leadership are all needed.  Issues around workgroup roles and conflict come up often here as well.  Within organizations, issues also center on organizational culture and design, values and ethics, and management/training styles.

Just as with enacting change, sustaining it is not an easy task.  Most changes are harder to put in place at first due to resistance.  Still, there are many instances of people falling back into old habits after a short time of sustained change, regardless of their enthusiasm for said change.  In order to act against this possibility, continuous reinforcement and training need to occur across the organization.

Healthcare-Related Barriers

Healthcare today is full of change.  In order to stay relevant, health organizations have to undergo nearly constant changes including those in training to workflows to new equipment.  Those who work in assisting doctors also have a learning curve as many doctors do things differently.  That said, with global forces pushing “individual organizations to change accordingly in order to proceed ahead,” change does not always stick (Al-Abri, 2007).  Due to this constant change, clinic managers and others in leadership positions must focus on perseverance, correcting lapses in training/change quickly, and time with each employee (Al-Abri, 2007).

With most health organizations being larger, a focus on bureaucratic structures over any employee feedback will make it harder for changes to take place (Al-Abri, 2007).  This is an instance where culture is more important than strategy (Rick, 2012).  While important in all organizations, this is especially true in healthcare.  When employees feel valued and are engaged, they work harder and focus more on the overall mission of an organization (Kruse, 2015).

Healthcare as an industry is so involved with our mortality that it presents new problems to traditional OD ideals.  In a normal organization, engagement is important and contributes to lower employee turnover (Dickson, 2015).  In healthcare, engagement can mean the difference between life and death.  Nurse engagement is “the number one variable correlating to mortality, even beating out the number of nurses per patient” (Kruse, 2015).  The variability between engaged employees is “tied to the manager” (Kruse, 2015).  Therefore, managers who know how to create employee engagement and satisfaction actually save lives through improved patient satisfaction and care quality (Sherwood, 2013).

Many healthcare organizations, whether tied to government agencies or free-standing, lack in various qualities deemed important for employee satisfaction.  Healthcare professionals at all levels are being worked hard for low salaries and without many opportunities for advancement (Fields, 2011).  Due to the stresses of the work hours, there are poor fits between employees and managers/bosses and a general poor organizational culture (Fields, 2011).

Like within other organizations, many healthcare professionals do not necessarily see the need to take over tasks from others.  Some changes shift responsibilities from medical assistants to physicians due to changes in licensing requirements or Electronic Medical Record systems.  In these cases, physicians often do not appreciate having extra steps, especially if they perceive these tasks as beneath them.  This contributes to a major resistance to change – a combination of ideas that this change isn’t needed or productive and it requires work below their pay grade (Rick, 2013).  In many clinics, the physicians or head nurses lead the way for everyone else to follow.  If one physician isn’t following a workflow, it becomes easier for everyone else at a site to disregard it, too.

Fixing Barriers

Many healthcare organizations rely on quality improvement departments to work towards the same or similar projects as OD change agents.  While it is beneficial to have people on staff who work within various organization-specific programs, this can compromise how impartial or objective they are when working with others.  In order to have the most impartial data gathering, interpreting, and institutions of change, it is preferable to have an outsider working with departments or the organization as a whole.  This does not mean that a different OD firm needs to be used each time or even a new lead on projects, but simply separate.

Employee engagement issues are central to many of the changes that need to be implemented within healthcare organizations.  There is a high rate of turnover within healthcare fields due to low wages, long hours, poor benefits, and interpersonal issues (Pexton, 2017).  The biggest issue, then, is to solve these problems very unique to healthcare.

In order to limit turnover, employees need to feel valued.  In an ideal world, organizations would increase income while hiring more workers to address both the low wages and long hours.   Unfortunately, this isn’t a reality for many organizations with how their current setup sits.  Even if an organization does not necessarily have the funding to increase income or hire more employees, there are still steps organizations can take to improve employee satisfaction.

Creating interpersonal groups that do fun things off-the-clock together can be beneficial.  The Pediatrics group at the East Clinic at UW Health in Madison, Wisconsin, enjoy spending time with each other’s families, attending events together, and more (Plumb, MD, 2017).  This helps to create a more amiable and supportive setting amongst providers at the clinic (Plumb, MD, 2017).

Improving communication skills will help to improve a feeling of camaraderie as well (Pexton, 2017).  This will additionally help to serve the organization well during any periods of change.  Effective communication will help with the patient side of the world as well.  When communication skills improve overall, there are fewer communication mix-ups with patients and fewer medical errors (Pexton, 2017).  Patients will be more satisfied with their care as well (Pexton, 2017).  With the passage of the Affordable Care Act, the focus of healthcare is supposed to be more on quality (Sebelius, 2013).  Whether or not the ACA will be repealed remains to be seen, but the strides made in a focus on quality and patient-centered care are incredible.

By working on these simple steps to provide employees and patients more security and connection, it has a side effect of being able to improve the organization overall while setting it up to be the most accepting of change.  This also helps employees to become more invested in the change process, bringing their expertise to potential change. 

Conclusion

Organizational development (OD) is a fantastic interdisciplinary tool to guide people in change agent positions and organizations through the change process.  While OD is an effective tool, healthcare organizations face unique challenges in regards to OD change strategies.  There are challenges unique to OD work in healthcare that make it difficult to enact and sustain change.  These barriers can be overcome by preparation, improved employee satisfaction, and communication skills.

References

Al-Abri, R. (2007). Managing Change in Healthcare. Oman Medical Journal, 22(3), 9-10. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294155/

Anderson, D. L. (2015). Organization Development: The Process of Leading Organizational Change (3 ed.). Thousand Oaks, California: Sage Publications.

Blalock, S. J., Bone, L., Brewer, N. T., Butterfoss, F. D., Chamption, V. L., Epstein, R. E., . . . Wilson, N. (n.d.). Organizational Development Theory. (K. Glanz, B. K. Rimer, & K. Viswanath, Editors) Retrieved from Health Behavior and Health Education: Theory, Research, And Practice: http://www.med.upenn.edu/hbhe4/part4-ch15-organizational-development-theory.shtml

Dickson, G. (2015, November 18). 10 Dead Simple Ways to Improve Your Company Culture. Retrieved from Bonusly: http://blog.bonus.ly/10-dead-simple-ways-improve-company-culture/

Fields, R. (2011, April 05). The Top 10 Challenges Facing Healthcare Workers. Retrieved from Becker’s Hospital Review: http://www.beckershospitalreview.com/hospital-management-administration/the-top-10-challenges-facing-healthcare-workers.html

Kruse, K. (2015, February 26). The ROI of Employee Engagement In Hospitals. Retrieved from Forbes: https://www.forbes.com/sites/kevinkruse/2015/02/26/the-roi-of-employee-engagement-in-hospitals/#64032c5b54ce

Pexton, C. (2017). Overcoming the Barriers to Change in Healthcare System. Retrieved from iSix Sigma: https://www.isixsigma.com/implementation/change-management-implementation/overcoming-barriers-change-healthcare-system/

Plumb, MD, A. J. (2017, January 20). UW Health East Pediatrics. (K. Schultz, Interviewer)

Rick, T. (2012, September 27). Organizational Culture: More Important Than Strategy. Retrieved from Meliorate: https://www.torbenrick.eu/blog/culture/is-culture-more-important-than-strategy/

Rick, T. (2013, March 8). Change is Not The Problem – Resistance to Change is the Problem. Retrieved from Meliorate: https://www.torbenrick.eu/blog/change-management/change-is-not-the-problem-resistance-to-change-is-the-problem/

Sebelius, K. (2013, March 20). The Affordable Care Act At Three: Paying For Quality Saves Health Care Dollars. Retrieved from Health Affairs Blog: http://healthaffairs.org/blog/2013/03/20/the-affordable-care-act-at-three-paying-for-quality-saves-health-care-dollars/

Sherwood, R. (2013, October 30). Employee Engagement Drives Health Care Quality and Financial Returns. Retrieved from Harvard Business Review: https://hbr.org/2013/10/employee-engagement-drives-health-care-quality-and-financial-returns.