Organizational Change Plan Part II
Mia A. Lowe
HCS/587
December 2, 2013
Dr. Sonnia Oliva

Organizational Change Plan Part II Moving, which is the implementation phase is the second phase in Kurt Lewin’s theory. During this phase, organizations begin to implement changes and the behaviors of the employees start to change (Spector, 2010). According to Lewin (2010), “Those new behaviors, must become permanent, for at least a desired period of time” (p. 29). The stakeholder’s agreement to implement a Telemedicine Intensive Care Unit (tele-ICU) in the Medical Intensive Care Unit (MICU) becomes operational. The second part of this Organizational Change Plan focuses on strategies for implementing a tele-ICU in the MICU. The chief medical director assigns a project manager to the project to oversee the implementation of the tele-ICU. The project manager schedules large weekly meetings with the stakeholders to ensure everyone is completing their assigned tasks. The project manager has an issues log containing issues categorized by subject, owner, and pending due date or completed date. The purpose of the issues log is to track and resolve issues as identified to keep the project moving forward. If the stakeholders in the meeting cannot resolve the issues, the project manager reviews the issues with the chief medical director for resolution. In addition, the project manager schedules small group meeting with different departments. The small groups report to the larger group to keep everyone abreast of all activities. The clinical subgroup committee is a group that oversees the clinical integration of this project. The tele-ICU clinicians reside in the Cincinnati VA medical center. These clinicians have experience in managing the tele-ICU. The Cincinnati clinicians met with the Cleveland clinicians, the MICU manager, the ICU educator, and a staff nurse to develop policies, procedures, and protocols to identify the roles and responsibility of the employees at each facility. The policies, procedures, and protocols will detail standards of practice for tele-ICU clinician sign-out to MICU clinician, clinical rounds to include times, management of issues such as sepsis and ventilation, just to name a few. Collaboration between each site is paramount. “The ability of the off-site and bedside team members to cooperate and communicate with each other is central to efficiency and acceptance” (Lily & Thomas, 2012, p. 19). The project manager will take minutes during each meeting and document identified issues on the issues log. He or she will review the issues during the weekly implementation meeting. The installation subgroup committee oversees the installation and integration of the tele-ICU units. The subgroup includes the IT manager, the MICU manager and assistant manager, the tele-ICU manufacturer’s representatives, the project manager, and the clinical educator. The group purpose is to ensure the tele-ICU units installation and integration is timely and successful. The organization chose a unit that would integrate with the main system within the facility. The group members discuss the integration and coordination of the installation. During the meeting, the stakeholders discuss the need for paper charting during installation, length of time for installation, system downtime, unexpected service interruptions, in person and telephonic support during and after installation, and training for all stakeholders. Bedside clinicians will accept the program if they have real-time resolution of technical issues such as system access (Lily & Thomas, 2012). The project manager will take minutes during each meeting and document identified issues on the issues log. He or she will review the issues during the weekly implementation meeting. Allowing employees to participate in the development of policies, procedures, and solutions for change increases the acceptance, thus decreasing resistance to change (Borkowski, 2005). The inclusion of all stakeholders in this change implementation project should lessen employee’s resistance to the change, but it is not a guarantee. Some employees may continue with the status quo attitude and resist the change. “Employees do not naturally resist change, but they often resist change because of the way change is implemented” (Spector, 2010, p. 9). Leadership must ensure people alignment is in place. People alignment is to have the right people in place with patterns of behavior consistent with the organizations’ new strategic plan and removing people “who cannot or will not alter their patterns of behavior in ways consistent with the newly defined roles, responsibilities, and relationships” (Spector, 2010, p. 45). During this phase, all stakeholders receive training about the operations of the tele-ICU unit. All stakeholders review, discuss, amend the policies, procedures, and protocols before implementation. Employees will receive other skills related training, as needed upon identification. All stakeholders have the opportunity to provide feedback. Mutual engagement throughout the change implementation process builds commitment and helps with learning (Spector, 2010). The project manager will use a Status Report and an Issues log to monitor implementation of the tele-ICU. A status report is a communication tool that gives the stakeholders an update on the project’s progress (Faucheux, 2011). “An effective status report is a clearly written report that informs the reader what the project is, and communicates what the team has accomplished and what still needs to be accomplished” (Faucheux, 2011, para. 3). An Excel standard template is a tool used to capture information required in a status report. Throughout any project, unexpected issues will arise such as technical failures, issues with staff, or training delays. Stakeholders who respond promptly to issues ensures the project stays on track, meet set goals, and prevent a negative impact on the project implementation. An issues log is a reporting and communication tool detailing identified issues (MindTools, 2011). An issue log allows the project manager to do the following: Have a safe and reliable method for the team to raise issues, track and assign responsibility to specific people for each issue, analyze and prioritize issues more easily, record issue resolution for future reference and project learning, and monitor overall project health and status (MindTools, 2011, para. 8). An issues log can track the following information: issue type, identifier, timing, description, priority, assignment/owner, and target resolution date (MindTools, 2011). The project manager will review the status reports and issues log during weekly implementation meetings. The chief medical director will provide resolution for unresolved issues. The implementation of a tele-ICU in the MICU will affect the organizations processes, and professional roles of the residents and fellows. The tele-ICU will not affect the personal or professional role of the bedside nurse, but the tele-ICU implementation will affect the way the nurses communicate with the physician. The MICU nurses will collaborate with the tele-ICU physicians via the monitor in the patient’s room. The tele-ICU clinicians have access to the facility’s electronic medical record to review the patient’s medical record and write orders. The tele-ICU physicians have the decision-making authority during 7:00 p.m. and 7:00 a.m. so the fellows and residents take orders from the off-site physicians. The fellows and residents may not have an issue with the lack of authority. “Having an awake critical care physician with access to a patient’s full medical record is perceived by residents to enhance training and improve patient care” (Lily & Thomas, 2010, p. 19). The tele-ICU will not affect the organization’s system. If a technical failure happens and the tele-ICU is not operational, the MICU charge will activate the contingency plan. The contingency plan allows the resident and fellow to take charge until the tele-ICU is operational. In addition, the MICU charge nurse will notify the SICU intensivist who will assist with patient care as needed. Communication between all stakeholders throughout the change implementation process is vital to ensure everyone is aware of the project’s progress and address identified issues. The chief medical director and other members of the leadership team attend the implementation meeting in person every other week to answer questions and communicate the reasons for the tele-ICU (decrease mortality rates, decrease length of stay, and provide consistent ICU physician coverage). Their presence demonstrates their commitment and support to the project. “Communication is the creation or exchange of thoughts, ideas, emotions, and understanding between sender(s) and receivers(s)” (Spector, 2010, p. 78). Communication is effective when employees have the opportunity to give feedback. When employees do not have the opportunity to give feedback, or if feedback is ignored, some feedback will occur instinctively and typically in a negative form (Spector, 2010). Face-to-face meeting, videoconference, fax, electronic mail, formal written letters, newsletters, and formal written reports, logs, newsletters are methods to communicate information. The project manager documents all issues on the issues log and reviews the issues face-to-face weekly in the implementation meeting. A face-to-face meeting is a verbal communication channel, which is one of the highest forms of communication channels (Spector, 2010). This form of communication allows the transmittal of information-rich material and emotions to all stakeholders and gives all stakeholders the opportunity to give immediate feedback (Spector, 2010). Managers must ensure they provide emotional support and communicate positive reinforcement during the implementation phase. The focus of this second part of the Organizational Change Plan is strategies to implementing the tele-ICU. During this phase, monitoring the implementation and addressing issues as they arise provides time for adequate feedback and keeps the project on track. Leadership involvement at this stage and throughout the project is paramount so staff is aware of the vision for the future as well as the leadership’s support and commitment. Communication techniques such as face-to-face meetings are essential to keep all stakeholders abreast of the project’s progress. Training and retraining to ensure employees have the tools to perform their job is essential. Aligning the right staff with the patterns of behavior to support the project is a vital role for leadership. In addition, managers must understand the impact tele- ICU implementation has on the organizations processes, systems, and personal and professional roles.

References Borkowski, N. (2005). Organizational behavior in health care. Retrieved from The University of Phoenix eBook Collection database Faucheux, M. (2011). Writing your own status report. Retrieved form http://www.brighthubpm.com/resource-management/2514-writing-your-first-status-report/ Lily, C. M., & Thomas, E. J. (2010). Tele-ICU: Experience to date. Journal of Intensive Care Medicine, 25(1), 16-22. doi: 10.1177/0885066609349216 MindTools. (2011). Project issues management: Identifying and resolving issues. Retrieved from http://www.mindtools.com/pages/article/newPPM_69.htm Spector, B. (2010). Implementing organizational change: Theory into practice (2nd ed.). Upper Saddle River, NJ: Pearson/Prentice Hall