change management today

BBA313 CHANGE MANAGEMENT Final Assignment

Task

Scenario

At the end of 2014, a large university hospital in the Netherlands launched a procurement tender exercise for surgical suture material. The rationale for
hospital management to initiate this procedure was cost-cutting and standardization. The award criteria were focussed on the most economically
advantageous tender. There were different suppliers on the market that were able to produce and deliver high-quality surgical suture material for a
lower price than was currently being paid. Consequently, the tender was awarded to a new supplier. The top managers and purchasing manager who
initiated the tender trod carefully and implemented this relatively small-scale change initiative according to some basic change management principles
(e.g. Kotter, 2012): they built a guiding coalition that incorporated renowned medical specialists, they consulted department heads and they
communicated the change to surgeons through different channels. Furthermore, it was recorded in the tender that the new supplier should provide
value-adding services such as e-learning modules for surgeons, facilitate lengthy trial-use periods and offer workshops and support to the operating
theatre. Hospital management conceived this first initiative as a test case for more extensive cost-cutting operations that were to follow. This project
was supposed to be relatively easy, both in scale and in complexity. However, in the preparations ahead of the trial phase, a concern was raised by the
cardiac surgeons to one part of the tender package involving sutures specifically used for cardiac surgery. Nevertheless, surgeons were forced to
participate in testing the products supplied in the whole tender, including those products used in their specific specialities. Meanwhile, the initiators of
the project felt that careful preparations of the testing phase had been made.

So, what went wrong? In mid-2015 – when this research project started – hospital management eventually met with fierce resistance from some of the
hospital’s cardiothoracic surgeons. They adamantly refused to work with the new suture material. The resistance took the form of surgeons expressing
anger at management, stockpiling their own supplies of surgical suture, refusing to operate, holding managers accountable for patient deaths that could
arise from use of the new suture and threatening to go to the press if such a thing indeed were to happen. Hospital management had anticipated some
resistance, but not of this intensity. The end result was that the contract was eventually cancelled for sutures specifically used in cardiac surgery.

Data collection

Data collection took place in a year starting from mid-2015. In total, 17 in-depth interviews were conducted that each lasted approximately 1 h. The
respondents were targeted through maximum variation sampling until saturation was achieved and are listed in Table I. Patients were excluded
beforehand. The interviews were audio-recorded after verbal consent was given. All but one interviewee agreed to be audio-recorded. This interviewee
was comfortable, though, with the interviewer (EG) taking notes. The interviews were transcribed and anonymized. Apart from formal interviewing,
extensive informal conversations on the topic took place with surgeons from different medical specialities.

Field notes were made on the observations of a trial session and a workshop facilitated by the new supplier. These notes were divided into four
categories: observational notes, theoretical notes, methodological notes and reflective notes (Baarda et al., 2013).

Economic/managerial discourse

Transitioning to new surgical suture was often constructed by members of the hospital management as a test case for more extensive cost-cutting
operations to follow:

We are confronted with an enormous challenge. We have to drastically cut costs. This was an important test case, because more and bigger cuts are
pending. This appeared to us as an easy win. However, …[1]. (Head of operating theatres)
This construction is embedded in an economic discourse that provides a legitimate rationale for the change. A prerequisite for providing sustainable,
high-quality health care is a financially healthy position. Some managers were genuinely astounded by how inefficient the current purchasing policies of
the hospital were. Often managers posited the professional autonomy of medical surgeons as the main barrier to change. Other perceived barriers to
change were constructed in ways that characterize particular professional roles. The purchasing manager, for example, typically suggested another
barrier:
Not only with surgical suture, but in general medical specialists resist change. That is because these suppliers have a powerful and very effective sales
force. It is what we call vendor lock-in. (Purchasing manager)

As evident in the aforementioned quotation, depending on the formal positions participants took up in this change initiative, they came up with their
own hypotheses of why they thought new surgical suture was resisted by medical professionals. In another instance, a proponent of the initiative to
replace surgical suture suggested people were being overly emotional:
I get that those boys [cardiothoracic surgeons] … what they are doing is very precise and technical. And surgical suture and needles are of crucial
importance. On the other hand, there are always these sentiments. I mean, there are many medical centres, also abroad, where cardiothoracic surgeons
suture with XXX [brand name of new supplier] and it is not turned into a complicated affair. But you cannot take away these sentiments just like that.
We took note of these feelings, and nudged our staff to give it [the new surgical suture] a try and comply as much as possible. But to be honest,
according to me at cardiac surgery there is a lot of emotion involved surrounding suture, … and it is not working for me. (Department head, surgery)

However, some surgeons, especially cardiothoracic surgeons, presented other considerations as motivating their unwillingness to change, using
arguments of quality of the new sutures:
The initiator – the manager that came up with the idea to supposedly cut costs – does not know that suture curls and curls more-or-less depending on
the brand. He does not know whether needles are round or angular. And he doesn’t care. But for my work this is very relevant. It has nothing to do with
professional autonomy. (Cardiothoracic surgeon)

One might argue with this cardiothoracic surgeon that this is exactly what the notion of professional autonomy refers to; in this case, the autonomy to
decide for yourself, as a medical professional, which materials to work with. But that is not the point this cardiothoracic surgeon is making per se.
Apparently, in the daily jargon of healthcare managers, the notion of professional autonomy is employed as a stopgap explanation for resistance so
often that this surgeon anticipated its negative connotation related to changing surgical suture and change more general. For him at least, the
superimposition of professional autonomy as an explanation does not do justice to how he relates to the issue of changing surgical suture. For him it is
not an abstract affair, but genuinely felt, both in a tactile and in an emotional sense. Also note that academic definitions of professional autonomy
(conceptual) do not always correspond to how such notions are employed in daily usage (performative). The cardiothoracic surgeons spoken to

frequently drew upon a competitive/professional discourse in relation to surgical suture, enriched with examples and in far less abstract manner than
those that posited professional autonomy as the main cause of change resistance.

Competitive/professional discourse

In formal interviews and casual conversations with surgeons, the comparison with practicing sports – and the physicality that characterizes both
practicing sports and conducting an operation – was frequently made. One cardiothoracic surgeon compared his surgical suture to the shoes of soccer
player Zlatan Ibrahimović. Another surgeon name-dropped a famous tennis player in the following manner:
He [Roger Federer] goes down in the history books as the best professional tennis player ever. And that is because he has spent endless hours on the
court practising and refining his skills. His tennis racket has become a natural extension of his arm. His tennis racket is his instrument. My instrument is
my suture … suture and needles. (Cardiothoracic surgeon)

Whilst conversing with surgeons, it became evident that performing cardiothoracic surgery is perceived as practicing a top-level sport. It is both
physically and mentally challenging, only the stakes involved are much higher. Surgical suture is embedded within an arrangement that specifically
characterizes members of the cardiothoracic speciality. As such, attempting to change or replace this single tactile element feels like tearing down the
entire arrangement. It might seem a bit far-fetched or exaggerated, but the emotions and feelings that were triggered by pushing forward with this
initiative were real and so were the consequences of attempting to bypass these emotions and feelings. One cardiothoracic surgeon detailed his
professional involvement in the following manner:

I didn’t just go to medical school. After that I have done my residency, with a Ph.D., et cetera. All in all an extra 10 years. Everything that you are
supposed to do, I did that, to become the best possible professional and to be able to deliver the best possible care for the patient. This is not some
quick course. This is really … six years of medical school and then postgraduate for another six years. That isn’t nothing. You have to be motivated, driven
and persistent. And you hope to end up working for an institution that enables you to profess your passion. (Cardiothoracic surgeon)

It is important to note that the cardiothoracic surgeons quoted here did not exclusively drew upon this competitive/professional discourse that implies
sacrifice, persistence and drive. But when they did, they challenged the economic/managerial discourse without actually talking about finances. In a way,
to put it bluntly, money from this perspective should not be an object, or, at least, it should never be a priority.

Discourse on patient care

It would be too one-sided to emphasize the aforementioned competitive/professional discourse that the surgeons frequently drew upon without
pointing out another manner in which surgical suture was spoken about. During the interviews and casual conversations with surgeons, it became
evident that the well-being of their patients was a primary concern. One cardiothoracic surgeon positioned himself as the patient’s main advocate – as
opposed to hospital managers, who only maintain quality in a more general, abstract manner – by asking the following rhetorical question:
Let’s say … I am going to operate your father with XXX [brand name of new supplier], but I am not used to working with that suture. It curls more and the
needles go blunt quicker and the needles are square and therefore more difficult to position in the needle holder. So I need to focus more and I need to

stress … I need to work [with the utmost precision]. Well, I am curious whether that manager would let me operate on his father. (Cardiothoracic
surgeon)

Surgical suture was constructed as a lifeline on which the cardiothoracic surgeon relies on behalf of the patient. Replacing surgical suture is perceived as
an unacceptable potential cause of failure. So whereas the competitive/professional discourse places the concerns and aspirations of the medical
professional front and centre, this discourse on patient care places the concerns of the patient front and centre by means of the medical professional as
his advocate. Implicit in both discourses, though, is that money should not be an object. As such, these discourses are counter-discourses to the
economic/managerial discourse that legitimizes replacing surgical suture by that of a cheaper brand.

Discourse on safety and quality

Related to the aforementioned construction of surgical suture as a lifeline located within a particular discourse on patient care is the construction of
surgical suture as a risk factor. This construction is located within a slightly different discourse on safety and quality, because it relates to health
authorities, medical trials, accountability, transparency, statistics, performance measures, institutional reputation, safety and quality management
rather than to direct and personal involvement with the patient. The direct relationship between the surgeons’ handicraft and the possibly life-
threatening consequences inherent in cardiac surgery amplifies the sensitivity of the subject.

So many things can go wrong. So changing surgical suture presents an additional risk. We prefer to operate a patient’s heart only once and then never
again. (Cardiothoracic surgeon)

When a medical professional draws upon this discourse, it provides a strong counter-discourse to the economic argument that is more frequently used
by those working in hospital management. The Chairman of the Board, even though he formally has the power to push forward, by now has realized he
had reached the limits of changeability:
If medical specialists use the argument of safety, patient safety, then you are finished. As an executive it is over. You start thinking, what if he is right;
and I force him to work with this suture and something goes horribly wrong. He only has to say: “I told you it wasn’t safe!” And then you, as an
executive, are gone. Of course, you have to challenge and not be naive, but ultimately it is a show stopper … that safety argument. Another factor was,
that my colleague in the Executive Board and I are not [cardiothoracic] surgeons. So we could not weigh in from our own experience. (Chairman of the
Board)

The best of the best: being part of an elite professional group

Among the surgeons of different specialities, the cardiothoracic surgeons stood out amongst those interviewed in this case study. A theatre nurse prided
herself on being a member of this elite group in the following manner:
Those boys [cardiothoracic surgeons] – or men I should say – are so bloody good in what they do. And you [as a nurse operating theatre] also want to be
part of that, to pass cum laude. They stand for their profession, each time they give it a hundred and ten percent. And they perform procedures that no
one else dares to perform. For us it is a joy to assist them. You share in the pride and get into that special workflow. (Nurse, operating theatre)

The Chairman of the Board had learned that in dealing with different professional groups, especially when they are tightly-knit and its members have
unique histories, training, skills and responsibilities, one does better to adopt a contextualized approach to change:

Well, our group of cardiac surgeons consists of individuals with a unique history at this hospital. They are not known to be particularly dynamic or
flexible. Let’s keep it at that. So, to get them on board with our plans requires some extra effort on our part. (Chairman of the Board)

The following account of a cardiothoracic surgeon exemplifies just how difficult it is to understand the actual practice of operating on someone’s heart.
I have studied and practiced endlessly. And we [other cardiothoracic specialists] frequently consult one another. But sometimes when I have to decide
fast, during a very complex operation, medicine is almost more like an art-form. I feel when something might go wrong and I anticipate what to do. And
when someone later asks me: “Why did you do this or that?”, of course I will formulate an answer, but in reality I acted upon the experience I have and
on what I have learned from my mentors. In these moments everyone in my team knows what to do. I do not even have to tell them. However, I cannot
accept that someone who has no idea what we are doing, decides that I have to work with that suture. (Cardiothoracic surgeon)

The prediction that deeply embodied practices that are learned over time through mentorship, explicit instruction and implicit attunement of the senses
are not to be changed by outsiders in a pick-and-choose manner is confirmed by this surgeon.

Instructions for scenario:
Develop a change management strategy, considering the scenario stakeholders that incorporates the following sections:

1. Conduct a stakeholder analysis for case and summarize the results in a stakeholder map highlighting interest, engagement, and influence
groupings.

2. Use the results of the stakeholder analysis to identify and evaluate resistance to the change process.
3. Use the Kotter´s change management model to apply in the case.
4. Critically discuss the involvement of the functional areas in developing a change plan
5. Draft a strategic change plan for your case by applying the selected change management model with timelines and SMART progression metrics.

Formalities:

• Wordcount: 2000-2500 words.
• Cover, Table of Contents, References and Appendix are excluded of the total wordcount.
• Font: Arial 12,5 pts.
• Text alignment: Justified.
• The in-text References and the Bibliography must be in Harvard’s citation style.

Submission: Via Moodle (Turnitin). Friday 20th January 2023, 23:59.

Weight: This task is a 60% of your total grade for this subject.

Rubrics

Learning Descriptors Fail Below 60% Marginal Fail 60-69% Fair 70-79 % Good 80-89% Exceptional 90-100%

Content

KNOWLEDGE &
UNDERSTANDING

20%

Content is unclear, inaccurate
and/or incomplete. Brief and
irrelevant. Descriptive. Only
personal views offered.

Unsubstantiated and does
not support the purpose,
argument or goals of the
project. Reader gains no
insight through the content
of the project.

Limited content that does not
really support the purpose of
the report. Very poor
coverage.

Displays only rudimentary
knowledge of the content
area. Reader gains few if any
insights

Presents some information
that adequately supports
the central purpose,
arguments, goals, or
research questions of the
project. Although parts
missing, it demonstrates a
level of partially proficient
knowledge of the content
area. Reader gains some
insights.

Presents clear and
appropriate information
that adequately supports
the central purpose,
arguments, goals or research
questions of the project.

Demonstrates satisfactory
knowledge of the content
area. Reader gains proficient
insights.

Presents balanced, significant
and valid information that
clearly and convincingly
supports the central purpose,
arguments, research
questions or goals of the
project. Demonstrates in-
depth and specialized
knowledge of the content
area. The reader gains
important insights.

Organization

COMMUNICATION

15%

Information/content is not
logically organized or
presented.
Topics/paragraphs are
frequently disjointed and fail
to make sense together.
Reader cannot identify a line
of reasoning and loses
interest.

Information/content is not, at
times, logically organized or
presented. Topics/paragraphs
are frequently disjointed
which makes the content
hard to follow. The reader
finds it hard to understand
the flow of the report.

Information/content is
presented in a reasonable
sequence.

Topic/paragraph transition is
unclear in places with
linkages for the most part.
Reader can generally
understand and follow the
line of reasoning, although
work needed to be
proficiently organized.

Information/content is
presented in a clear and
understandable sequence.
Topic/paragraph transition is
good with clear linkages
between sections and
arguments. Reader can
understand and follow the
line of reasoning.

Information/content is
presented in a logical,
interesting and effective
sequence. Topics and
arguments flow smoothly
and coherently from one to
another and are clearly
linked.

Reader can easily follow
the line of reasoning and
enjoyed reading the
report.

Style & Tone

COMMUNICATION

15%

Writing is poor, unclear and
unengaging, and the reader
finds it difficult to read and
maintain interest. Tone is
not professional or suitable
for an academic research
project. A reorganization
and rewrite is needed.

Writing is unengaging and
reader finds it difficult to
maintain interest. Tone is not
consistently professional or
suitable for an academic
research project. Work
needed on academic writing
style.

Writing is usually engaging
and keeps the reader’s
attention. Tone is generally
appropriate for an academic
research project, although a
clearer and more
professional style and tone is
needed.

Writing style and tone is
generally good and sustains
interest throughout. Tone is
professional and appropriate
for an academic research
project.

Writing is compelling and
sustains interest throughout.
Tone is consistently
professional and appropriate
for an academic research
project.

Analytical / Critical
Thinking Skills

CRITICAL THINKING

25%

Research problem, concept or
idea is not clearly articulated,
or its component elements
are not identified or
described. Research
information is poorly
organized, categorized
and/or not examined;
research information is often
inaccurate or incomplete.
Presents little if any analysis
or interpretation;
inaccurately and/or
inappropriately applies
research methods,
techniques, models,
frameworks and/or theories
to the analysis. Presents few
solutions or conclusions;
solutions or conclusions are
often not well supported, are
inaccurate and/or
inconsistent, and are
presented in a vague or
rudimentary manner.

Research problem, concept
or idea is not clearly
articulated at times and
confusing. Research
information is badly
organized, categorized,
and/or only superficially
examined; research
information is often
incomplete. Presents limited
analysis or interpretation;
inaccurately and/or
inappropriately applies
research methods,
techniques, models,
frameworks and/or theories
to the analysis. Presents
some solutions or
conclusions but they are
often not well supported, or
logical.

Adequately identifies and

describes (or sketches out)
the research problem,
concept or idea and its
components. Gathers and
examines information
relating to the research
problem, concept or idea;
presents and appraises
research information with
some minor inconsistencies,
irrelevancies or omissions.
Generally applies
appropriate research
methods, techniques,
models, frameworks and/or
theories although with
inaccuracies. Outlines
solutions or conclusions that
are somewhat logical and
consistent with the analysis
and evidence; identifies
and/or lists solutions or
conclusions although not
always clearly.

Formulates a clear
description of the research
problem, concept or idea,
and specifies major elements
to be examined. Selects
information appropriate to
addressing the research
problem, concept or idea;
accurately and appropriately
analyses and interprets
relevant research
information. Effectively
applies appropriate research
methods, techniques,
models, frameworks and/or
theories in developing and
justifying multiple solutions
or conclusions; solutions or
conclusions are coherent,
well supported and
complete.

Effectively formulates a clear
description of the research
problem, concept or idea,
and specifies major elements
to be examined. Selects and
prioritizes information
appropriate to addressing
the research problem,
concept, or idea; accurately
and appropriately analyzes
and interprets relevant
research information.

Precisely and effectively
applies appropriate research
methods, employs advanced
skills to conduct research.
Uses techniques, models,
frameworks and/or theories
in developing and justifying
multiple solutions or
conclusions; solutions or
conclusions are insightful,
coherent, well supported,
logically consistent and
complete. Displays a mastery
of complex and specialized
areas.

Integration Skills

APPLICATION &
EVALUATION

25%

Shows little ability to employ
theory and practice across
the functional areas of
business in the assessment
of issues relating to the
research problem, concept,
or idea. Does not recognize
or correctly identify cross-
functional organizational
issues relevant to the
research problem, concept
or idea. Does not
adequately evaluate the
research problem, concept
or idea in light of relevant

Shows some ability to employ
theory and practice across the
functional areas of business in
the assessment of issues
relating to the research
problem, concept or idea.
Recognizes organizational
issues relevant to the research
problem, concept or idea but
does not show
understanding. Does not
adequately evaluate the
research problem, concept or
idea in light of relevant
principles, theories and

Exhibits application of
principles, theories and
practices across the
functional areas of business
to the analysis of the
research problem, concept
or idea. With some
exceptions, outlines and
describes (or sketches out)
some cross- functional
organizational issues that
are relevant to the research
problem, concept or idea.

Adequately identifies and

Demonstrates an ability to
integrate and apply
principles, theories and
practices across the
functional areas of business
to the analysis of the
research problem, concept
or idea.

Identifies, examines and
critically evaluates important
cross- functional
organizational issues
associated with the research
problem, concept or idea.

Demonstrates well-
developed ability to
integrate and apply
principles, theories and
practices across the
functional areas of business
to the analysis of the
research problem, concept
or idea. Effectively identifies,
examines and critically
evaluates important cross-
functional organizational
issues associated with the
research problem, concept,
or idea. Clearly and

principles, theories and
practices across the
business functional areas.
Few if any solutions,
recommendations for action,
or conclusions are
presented, and/or they are
not appropriately justified
or supported.

practices across the business
functional areas. Some
solutions offered but difficult
to understand.
Recommendations for action,
or conclusions are presented,
but they are often not well
supported, or logical.

describes (or summarizes)
solutions, recommendations
for action, or conclusions
that are, for the most part,
appropriate, but which need
to be more aligned with
principles and concepts in
the functional areas of
business.

Clearly justifies solutions,
recommendations for action,
or conclusions based on
analytics and an insightful
synthesis of cross-
disciplinary principles and
concepts in the functional
areas of business.

effectively justifies solutions,
recommendations for
action, or conclusions based
on strong analytics and an
insightful synthesis of cross-
disciplinary principles and
concepts in the functional
areas of business. Can link
thinking across disciplines
and contexts.