The information in this chapter furnishes several insights into how Huntington Memorial Hospital’s administrators should reach decisions about enacting a change at the hospital. Such administrators should evaluate the change in relation to the degree that it better enables the hospital to fulfill its mission. Administrators should focus only on making changes that help the hospital to better accomplish its mission. If the hospital wants continued success over the long run, major changes will have to be made many times. In fact, appropriate change is so important to an organization that the administrators might want to consider initiating a program to encourage employees to submit their ideas on a continuing basis regarding how the hospital could continue to improve its performance. When considering possible changes, however, the administrators need to remember that some level of stability is also necessary if the hospital is to survive and serve the community over the long term.

In the Challenge Case, it was clear that there needed to be change agents in Huntington’s administration. Given the impact of electronic health records on all levels of the organization, including its physicians, it was important that change agents existed at the highest as well as at the lower levels of the administration. These individuals needed to evaluate the overall advantages and disadvantages of converting each part of the paper-based record-keeping system to an electronic record-keeping system and then to actually making the changes if advisable. Like the administrators in the case, change agents must recognize that people affected by organizational change, like the physicians, should be involved in helping to make needed changes. Such involvement will help to lower the resistance to proposed changes and increase the commitment to making the changes work.

In general, change agents must be able to use behavioral science tools to influence organization members during the implementation of a planned change. For example, they must determine how much change an organization’s employees can withstand and perhaps implement each change gradually so that employees will not be overwhelmed. Huntington seemed to address these issues by identifying an appropriate type of electronic record to start with and by phasing in the system gradually. Overall, the ability to use behavioral science tools will help the change agent succeed in implementing needed change at an organization.

Huntington’s administrators can make many different types of changes. They can change technological factors, people factors, and structural factors to increase the organization’s effectiveness. Huntington’s record-keeping decisions discussed in the Challenge Case emphasized technological factors, but these decisions often have an impact on people and structure as well. For example, the hospital needs people to work with the software vendor and probably will need an information technology staff with the skill to keep the system working on a day-to-day basis. It will have to continue making training available as new people come on board and need to learn how to use the system. If the paper system was less efficient than the electronic one is, that implies there were people whose jobs involved managing the paper and moving it from place to place. If so, the hospital may need to eliminate such jobs in the future, and those who do manage the new flow of information may require a different, perhaps more advanced, set of skills.

The complete changeover from paper to electronic medical records could radically change how the hospital carries out its mission. As a result, Huntington may find it useful to implement organization development (OD) to spur the people change that will be required. Alternatively, Huntington may use grid OD to modify management styles. Of course, the hospital could use both of these techniques to train the managers needed to ensure the organizational change succeeds.

Huntington’s administrators realize that even though they may formulate structural change that would benefit the organization, any attempt to implement this change could prove unsuccessful if the implementation does not appropriately consider the people affected by the change. For example, creating a new department to coordinate electronic patient record keeping might cause doctors and their staff to worry that using electronic records may interfere with their ability to deliver patient care in the ways they did in the past. As a result, they may subtly resist the change.

To overcome such resistance, Huntington could use strategies such as giving employees enough time to fully evaluate and understand the change. In fact, the hospital has offered extensive training and has involved doctors in the evaluation process. Huntington’s administrators also could present a positive attitude about the change. If resistance is strong, administrators could say that the proposed change will be tentative until it is fully evaluated.

All changes at Huntington Hospital need to be evaluated after implementation to learn whether further organizational change is necessary and whether the change process used might be improved for the future. For example, the hospital could collect data on doctors’ satisfaction, treatment costs, and patient outcomes to measure whether the system is improving financial performance and patients’ health. If not, further changes to the system might be necessary.

Huntington should be careful not to create too much stress in other organization members as a result of planned change. Such stress could be significant enough to eliminate any planned improvement at the hospital and could eventually result in employees having physical symptoms and the inability to make sound decisions. These stress impacts are especially detrimental in caregiving situations such as a hospital.

Although some additional stress on employees as a result of changes might improve the organization’s effectiveness, too much stress could have a negative impact on the care given to patients. Signs to look for include constant fatigue, increased aggression, temper outbursts, and chronic worrying.

If Huntington’s administrators determine that undesirably high levels of stress have resulted from implementing the electronic medical records, they should try to reduce the stress. They may be able to do so through training programs aimed at better equipping employees to execute the new job demands, or they may simply decide to slow the implementation rate of the change.

It would probably be wise for Huntington to take action to prevent unwanted, damaging stressors from developing as a result of planned change. To do so, the hospital could ensure that its organizational climate is supportive of individual needs and that jobs resulting from the planned change are as effective and as interesting as possible.

The administrators also should keep in mind that conflict is a usual by-product of planning and implementing organizational change. In handling this conflict, the administrators can compromise (settle on a modified solution that reflects a change in the ideas of all conflicting parties but that all parties find acceptable), avoid (pretend that no conflict exists), force (demand that a change be made), or resolve (confront the problems causing the conflict and resolve them).

The introduction of electronic medical records is intended to improve both patient care outcomes and efficiency in the delivery of care. Sharing electronic information online also opens up the possibility of making use of virtual work arrangements. It is unlikely that the hospital would become a virtual corporation, but it could establish virtual teams.

Huntington could choose among various options to have a virtual dimension. For example, it could set up a virtual office in which the billing department employees telecommute. Other options for a virtual office include workers “hoteling,” being tethered in the office, being home-based with some mobility, or being fully mobile. The rational for establishing this type of virtual office probably would include cost savings in rent and enhanced worker productivity.

As with any type of change, establishing a virtual dimension at Huntington Hospital would include a number of important challenges that would need to be overcome. Perhaps the most significant challenge would be appropriately integrating virtual employees into the hospital’s organizational culture. Building good communication among Huntington’s managers and virtual workers would be an important step in integrating these workers into the culture and maintaining their continued presence. To create this communication, Huntington’s administrators could take steps that include establishing regular communication times with virtual workers, publishing an online newsletter aimed at helping the virtual workers deal with their precise problems, and having regular social events where virtual workers could meet and interact with one another and with the hospital’s on-location employees.