Table of Contents
Lewin Change Model..
Leadership Styles of Nurse Manager..
Resistance to Emr..
An electronic medical records system (EMR) is a revolutionary step towards increasing efficiencies of healthcare units. It boosts the satisfaction of nurses, doctors and patients in a healthcare facility. The purpose of EMR is to store the medical records of patient such as patient’s age, name, past medical history, medication and others on an online portal and also retrieve the information from that website when needed. The integrated information system significantly reduces the communication errors of nurse managers and also enhance the efficiency of the patient care. Health safety of patients is greatly affected by the dissatisfaction of hospital staff, high time of searching medical records and file loss in a traditional hospital. All these issues are effectively mitigated by an automated file record system that keeps the medical data over a secured network server (Fuller, 2019). However, there are several hurdles in implementing a computer information management system in healthcare organization. Only a dynamic leader with excellent interpersonal communication skills and visionary approach can overcome hurdles in implementing change management in organization. This essay evaluates the leadership ability of unit nurse manager in implementing the EMR system in hospital wards.
Research scholars elaborate EMR in different ways. Liew et al. (2018) describes EMR as an integrated information management system that reduces the human errors, clinical examination time and increases work efficiencies of hospital staff. The hurdles in implementing change management system in healthcare organisation are high installation cost of new system, traditional views of hospital employees about new technology and government regulations.
Electrical medical records (EMR) system is a communication channel between patients and healthcare service providers. It is a secured platform of patient’s information that can be accessed by the registered health practitioners of hospital (Miles et al., 2019). Chuang et al. (2019) view EMR as systematic keeping of inpatient and outpatient information over IT network. The objectives of EMR are to deliver cost effective and superior healthcare services to patients in a specific time period. Tsapepas et al. (2019) describes EMS as computerized clinical support (CCS) system to ensure safe medication practice and efficient management of nursing orders and clinical data of patients. The clinical data such as admission, discharge, treatment and medications prescribed for particular condition over a computerized platform facilitate quick treatment of a particular disease condition of patients by hospitals.
Some healthcare literatures also outline usefulness of EMR utility in disease prediction. Medical practitioners such as physicians, surgeons and nurses examine past medical records of patients in computer system and assess the disease type of the new patients. The early detection of patient’s illness help government and medical insurance companies in formulation of new policies for general people (Hossain et al., 2019).
Renowned scholar Kurt Lewin in his article, “Human Relations” propounded the three step model theory to describe the change process in business organisations. The change model of lewin depicts implementation of change management process in three steps i.e., unfreezing, changing and refreezing. The Unfreezing is the first stage of change process to make resources such as people and infrastructure ready for change modules. The second step is changing which involves transferring the change management system (CMS) into the organisation. The refreezing is the last step that involves restarting the work and formulating objectives under the new system. Lewin’s change management theory applies to both social and business organisations. The organisation restructuring plan should begin with specific objective and be completed in a specified time frame. For example with the new EMR setup, hospitals aim to reduce cost and time inefficiencies and increase satisfaction level of both staff members and patients. However, the timeframe for execution of change proposal may exceed based on financial health of organisation and other factors. Any transformation such as adoption of new technology and organizational restructuring faces stiff opposition by certain interest groups such as workers, customers and creditors. The resistance to CMS is mainly due to communication gap between leader and workers, possibility of workforce reduction and non-clarity about the effectiveness of new changes. The role of a leader therefore, becomes very important in initiating confidence building measures among the resisting groups and making them ready for proposed changes in the organisation. The leaders of healthcare organisations must identify the requirements and revise their plans and projects according to new transformation such as EMR (Burnes, 2020).
Lewin’s unfreezing-changing-refreezing concept is classical approach of change management and severely criticized by many researchers and social scientists. Many compares Lewin’s change theory with Aristotle’s theory of psychology. It is too simplistic and justifiable for a planned change in organisation. Robbins in his book titled “Resistance to change” in 1986 redefined Lewin’s three steps change model as unfreeze, movement and refreezing. The new theory replaces the change stage of Lewin’s theory with movement that means implementing changes with managing resisting agents (Cummings et al., 2016).
Transformational leadership is one of the most powerful leadership styles for emerging changes in healthcare sector. This leadership approach has yielded fruitful outcomes for healthcare industry and also increased the nurses’ satisfaction level. Nurse leaders adopt different leadership approaches i.e., transformational, transactional and democratic depending upon the situations. Initiating changes such as EMR in a healthcare facility is a cumbersome process and needs a systematic plan. Nurse manager must analyze the present challenges of the hospital and benefits of proposed transformation. To alley the fear of resisting groups about the proposed change plan, nurse leader should also demonstrate excellent communication and motivational skills. All these traits are demonstrated in a transformational leader who convinces the team members about their interests in the new change management system and prepare ground for its implementation (McKibben, 2017).
Transformational leader always focuses on achieving desired objective. On the contrary, transactional leader does not look into long term vision and engages his team members in routine tasks. The transactional leadership motivates team members for job efficiency in the present organisation setup but does not look beyond the specific boundaries. However, transformational leadership always drive the forces of change in organisation and sets a long term vision. Democratic leadership style is very much similar to the transformational leadership as both opens up communication channels between the leader and subordinates and allows participation of team members in decision making process. Depending upon situation and personal skills, nurse manager can adopt more than one leadership styles (Puni, Mohammed & Asamoah, 2018).
Every change process in an organisation has to face stiff resistance to certain interest groups such as workers and business partners. In this case study, the nurse unit managers are assigned task of implementing a computerized record system in a mid-sized hospital in New South Wales (NSW). Adoption of a new technology changes many processes in an organisation and affects the job profiles or prospects of working staff in a hospital. All the staff members who think their employment might be at stake in the new transformed set-up, will resist the change policy of the hospital management. Technical issue is another hurdle in the way of installing new EMR facility in the hospital. Technical issue is the problem arising during hardware and software installation of computerized data system. However, both issues can be effectively dealt by nurse managers through a well-structured resolution mechanism with workers’ groups and vendors. Nurse leaders should use their superior communication skills to educate hospital employees about the change proposal and assure the team members about complete security of their jobs in the transformed environment (Barrett, 2018).
Nurturing healthy staff-management relations is the main pillar of the success of any change management process. Changes are inevitable in the organisation but at the same time, any unfavorable outcomes regarding jobs due to transformation must also be addressed by leaders. Involvement of workers in the decision making process, workers’ training, motivational schemes are some of the steps that can significantly mitigate human relation problems in organisation initiating a change policy (Day, Crown & Ivany, 2017). Cost and time overruns are also major hiccups in organizational change. This may happen due to the modification in the change policy, delay in supply materials by vendors, issues with business partners and other reasons. Delay in migration into new system, might also hinders the desired objective of an organisation (Lavikka et al., 2019).
EMR is an efficient tool of managing patient’s records and other hospital data on a secured computer network. It boosts the efficiencies of nurse leaders and subordinates and minimizes medication and communication errors. Before initiating a change process in a healthcare facility, leader must chalk out a comprehensive program such as present challenges, benefits, human and technical issues of the new system. Leader for implementing a new change must mitigate the resistance factors using an appropriate leadership style i.e., transformational, transactional or democratic. Adoption of a leadership approach depends upon the skills, knowledge and change requirements of leader. Lewin’s change management theory though defines classical approach of change, is still very popular in clinical organisations. It categorizes organization transformation into three stages i.e., freezing, changing and refreezing. However, complex transformation does not follow linear change model as suggested by Lewin. Changes in a large healthcare organisation requires a series of reconciliation exercise of leaders with employees and other stakeholders and also modification in the existing organizational restructuring plan.
Burnes, B. (2020). The Origins of Lewin’s Three-Step Model of Change. The Journal of Applied Behavioral Science, 56(1), 32-59. https://dspace.stir.ac.uk/bitstream/1893/30461/1/A-Lewin%203-Step%20ModelV1%20Accepted%20Version.pdf
Barrett, A. K. (2018). Electronic health record (EHR) organizational change: explaining resistance through profession, organizational experience, and EHR communication quality. Health communication, 33(4), 496-506. http://dx.doi.org/10.1080/10410236.2016.1278506
Chuang, T. Y. A., Yii, N., Nyandowe, M., & Iyer, R. (2019). Examine the impact of the implementation of an electronic medical record system on operating theatre efficiency at a teaching hospital in Australia. International Surgery Journal, 6(5), 1453-1457. https://mail.ijsurgery.com/index.php/isj/article/viewFile/4037/2813
Cummings, S., Bridgman, T., & Brown, K. G. (2016). Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Human relations, 69(1), 33-60.
Day, A., Crown, S. N., & Ivany, M. (2017). Organisational change and employee burnout: The moderating effects of support and job control. Safety science, 100, 4-12.
Fuller, A. (2019). Electronic Medication Administration Records and Barcode Medication Administration to Support Safe Medication Practices in Long-term Care Facilities. https://era.library.ualberta.ca/items/5f13a1b6-a1e2-4f13-8b1d-7ea531d24c42/view/817ef87b-382e-42ff-980e-d775886cde06/Fuller_Andrew_201909_MSc.pdf
Hossain, M. E., Khan, A., Moni, M. A., & Uddin, S. (2019). Use of electronic health data for disease prediction: A comprehensive literature review. IEEE/ACM transactions on computational biology and bioinformatics.
Liew, E. J., Poh, Y. H., Koh, S. G., French, J. A., & Teh, P. L. (2018). The Use of Electronic Medical Record System on Dynamic Capabilities and Physician Productivity.
Lavikka, R. H., Kyrö, R., Peltokorpi, A., & Särkilahti, A. (2019). Revealing change dynamics in hospital construction projects. Engineering, Construction and Architectural Management.
Moon, S. E., Van Dam, P. J., & Kitsos, A. (2019, December). Measuring Transformational Leadership in Establishing Nursing Care Excellence. In Healthcare (Vol. 7, No. 4, p. 132). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare7040132
Miles, P., Hugman, A., Ryan, A., Landgren, F., & Liong, G. (2019). Towards routine use of national electronic health records in Australian emergency departments. The Medical journal of Australia, 210, S7-S9.
McKibben, L. (2017). Conflict management: importance and implications. British Journal of Nursing, 26(2), 100-103.
Puni, A., Mohammed, I., & Asamoah, E. (2018). Transformational leadership and job satisfaction: the moderating effect of contingent reward. Leadership & Organization Development Journal.
Tsapepas, D., Der-Nigoghossian, C., Patel, K., Berger, K., Vawdrey, D. K., & Salmasian, H. (2019). Medication stewardship using computerized clinical decision support: A case study on intravenous immunoglobulins. Pharmacology Research & Perspectives, 7(5), e00508.
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