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Leading change

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... Nowadays the afore mentioned propositions require more intense attention, since our experience from CoViD-19 pandemic, demonstrated globally that the current organisation of public health sector poses obstacles for the management and must be reorganized with the application of horizontal procedures which should overcome the slow bureaucratic rhythms and the conventional hierarchical system structure (Whitwell, Maynard, Barry, Cowling, & Taraet, 2020). An important factor towards success, by implementing lean management or other organisational changes, is the existence of efficient and competent managers who promote collective work (Kotter, 1996;Diefenbach, 2013;Lytras, 2016: p. 40) while at the same time, we must bear in mind that professionally defined strategies, "resting upon clearly defined laws, rules, and principles, as a foundation" and under "complete written instructions" (Taylor, 2003: pp. 119, 138), forcefully segment the labor, and in a repulsive way towards its cooperative notion. ...
... Several studies confirm that in times of complex change, such as during radical DT, managing and changing user behaviours in accordance with rules, in order to align individual and organisation perspectives is a critical success factor (e.g., Argyris, 1990;Kotter, 2012;Westerman et al., 2014). Change attributes (such as timing, scale, rate and duration of change) have a profound impact on the individual's ability to change, such as in their emotional focus (Liang et al., 2019). ...
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Individuals are complex bundles of thoughts, beliefs, emotions, and behaviours. For a digital transformation (DT) to be successful, it is necessary to understand how these bundles impact individuals’ reactions to an impending change to then intervene to increase the likelihood of its success. Cognition is the mental action or process of acquiring understanding through thoughts, beliefs and emotions. Cognitive Models (CMs) describing these thoughts, beliefs, emotions and behaviours are applied and researched in psychology. On the other hand, the Information Systems (IS) domain is dominated by a behaviourist rather than a cognitivist approach. In this paper, we investigate what we can learn from these other sciences. By combining the research from the IS domain with that from the psychology domain, this paper presents a theoretical Cognitive Model for Digital Transformation (CMDT) that is a move towards explaining individual cognitive predispositions to DT and change decision making.
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Over‐fasting before surgery can lead to dehydration, irritability, lethargy, nausea, hypoglycaemia, tricky intravenous cannulation and decreased patient satisfaction1. We used ‘Kotter’s 8 steps for change’ as an approach to tackling the problem of over‐fasting in our day surgery unit2. Using a video of a patient’s experience with overfasting we created a sense of urgency and need for change (Step1: create urgency). We formed a multi‐disciplinary Fasting Improvement Team (FIT) (Step2: form a powerful coalition) and conducted a retrospective data analysis to establish a baseline. We then studied the system thoroughly using Ishikawa charts, process mapping, bench‐marking, user surveys and Pareto charts. Using these findings, we created a vision for our change (Step3: create a vision for change). Within six months we aimed for 90% of patients to have a fluid fasting time of less than two hours and for 90% of afternoon patients to have had breakfast. We communicated this vision to all staff involved in the day surgery (Step4: communicate the vision). Following, we empowered them (Step5: empower action) by asking for their opinions for changes and let them take over various tasks without micromanagement. The Institute for Healthcare Improvement (IHI) Psychology of Change Framework described a focus on the human side of change, to increase the likelihood that improvement efforts will succeed by activating people’s agency3. Our change ideas were divided into “quick wins”, “doable” and “challenging”. We focussed on creating short term wins (Step6: create quick wins) and celebrated successes along the way to create initial momentum. We did this in parallel with working on longer term changes. We continued to work on cementing these new ideas (Step7: build on the changes) so that transformation in the day surgery would persist before using the same system to spread the change to the rest of the hospital (Step8: making it stick).
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This paper investigated how change outcomes of development cooperation projects can be institutionalized within the beneficiary organization. While a lot of attention has been paid to sustainability in scientific research on issues, projects, and policies related to environmental, industrial, and agricultural production and sustainability management, there are limited studies on the sustainability of organizational-level change outcomes of aid-based project interventions. Using the lens of organizational change institutionalization models, we examined how internal stakeholders’ change-related beliefs, organizational characteristics, and project characteristics relate to the institutionalization process of project outcomes. Data were collected using a questionnaire returned by 130 respondents from a university in the Global South implementing institutional development cooperation projects. Using partial least squares structural equation modeling (PLS-SEM) to analyze the data, we found that organizational characteristics and change-related beliefs both had direct positive effects on the institutionalization process, while project characteristics had negative effects. Additionally, this study reveals that stakeholder change-related beliefs mediated the relationship between organizational and project characteristics and the institutionalization process. The findings support the continual engagement of organizational internal stakeholders in institutionalization efforts throughout the project life cycle, rather than waiting for the project to end. In contrast to the mechanistic, linear result chain approaches that dominate development project discourses, there is a need for more iterative approaches that allow the development of necessary attitudes and behaviors among the beneficiary organization’s internal stakeholders to sustain the project-induced changes.
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Background: Trauma evaluation and management skills are not taught enough in medical school undergraduate curriculums worldwide. It has been recommended by trauma educators to incorporate trauma training in medical schools’ curriculum as first-line management of trauma cases is usually required by junior doctors in ERs. The introduction of formal trauma training in the form of the Trauma Evaluation and Management TEAM® course is a change introduced into the curriculum. Even when introducing such a simple change, certain factors need to be considered including the stakeholders’ apprehensions and involvement, the complexity of the internal and external environment, cultural context and political influences, and finally the psychological impact of change. Methods: Based primarily on the “ Twelve tips for applying change models to curriculum design, development and delivery” by McKimm and Jones (2018), these 12 tips provide educators, involved in curriculum or program development, a practical example of the systematic and organized outlines to improve medical curricula. Results & Conclusions: While addressing these factors, this framework can guide educators for the successful development and implementation of a suggested change in the existing curriculum.
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Goal: Little is known about how physicians conceptualize leadership, what factors influence that conceptualization, and how their conceptualization may impact willingness to lead. We sought to explore how physicians conceptualize leadership. Methods: We conducted an exploratory study of data from a convenience sample of physicians across the United States using an anonymous, 54-item, online survey. We devised a novel leadership resonance score (LRS) to distinguish between leadership and management based on published definitions and prior pilot work. The activities fit on a spectrum from purely leadership actions to purely management actions, and we assigned a numeric value to each activity, allowing for quantification of a respondent's conceptualization of leadership as either more managing or more leading. Principal findings: There were 206 respondents (57% male; median age of 43 years [interquartile ranges, IQR: 32, 72]) who completed the survey. Respondents viewed leadership abilities to be highly important for physicians, with a median importance score of 80 (range 0-100, IQR: 50, 100). LRS indicated most physicians conflate leadership and management. Compared to other physicians, respondents assessed their own preparedness for leadership highly (median preparedness score: 70, IQR: 2, 100). Respondents' assessment of their preparedness for leadership was associated with age (Spearman's rho = 0.24, p < .001). LRS was not associated with preparedness for leadership (Spearman's rho = 0.12, p = .08). "Aversion to politics" was the most common barrier to interest in leadership (45%, 93/206), with "loss of personal time" being second (30%, 62/206). Applications to practice: Our data demonstrate physicians misunderstand the differences between leadership and management. We surmise that if an accurate conceptualization of leadership by physicians is associated with increased willingness to lead, then educational activities designed to improve physicians' understanding of leadership could be beneficial in increasing physicians' willingness to take on leadership positions. An increased willingness by physicians to take on leadership roles would ultimately have a positive impact not only on individual patient care, but also on the healthcare system as a whole.
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