Background
Theoretical framework
Forms of response | Description | |
Commitment | The most powerful acceptance of change, which requires employee empowerment and acceptance of values and goals for achieving the organization’s mission. | |
Involvement | A strong form of acceptance of change, which is demonstrated by taking part in the change by means of cooperation and participative behavior. | |
Support | Displayed through positive views on change although one does not necessarily act to promote or participate in it. | |
Indifference | The midpoint of the framework is characterized by neutral attitudes and passive resignation to change. Also described as the fourth form of resistance to change. | |
Passive resistance | A mild opposition to change (e.g., voicing negative views and considering quitting one’s job). | |
Active resistance | A strong opposition to change, which involves negative attitudes and impeding behaviors (e.g., protesting). | |
Aggressive resistance | The most extreme form of opposition to change, which may involve efforts to prevent change (e.g., by means of spreading rumors, strikes, and even sabotage). |
Methods
Study design and setting
Participants
Specialty | Department |
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Medical specialty | Department of Cardiology Department of Gastroenterology (medical) Department of Infectious Diseases Department of Internal Medicine (including Department of Respiratory Medicine and Department of Endocrinology) |
Surgical specialty | Department of Orthopedic Surgery Department of Gastroenterology (surgical) |
Emergency specialty | Emergency Department |
Other | Department of Clinical Biochemistry Department of Obstetrics and Gynecology Department of Pediatrics and Adolescence Medicine Department of Radiology |
Interviews
Themes | Questions |
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Introduction Thank you for your participation, written and oral consent Introduction of the research project and purpose Information about anonymity, confidentiality, recording, structure, and duration of the interview | |
Introduction – About you | What is your job title and for how long have you been employed at the hospital? What is your role in relation to the establishment of the new ED? |
Experiences with organizational changes | What are your experiences with other changes in your professional life? What kind of changes has succeeded? And why do you think they succeeded? What kind of changes has not succeeded? What went wrong? |
The forthcoming implementation of the new ED | How do your previous experiences with change differ from the change you are facing with the establishment of the new ED? How would you describe your general attitude towards the new ED? |
Preparation of the implementation | Please describe your thoughts and considerations in connection with the establishment of the new ED. What are the biggest benefits of establishing the new ED? (What are you looking forward to?) What do you see as the biggest organizational disadvantages of establishing the new ED? What do you get out of the new ED? What must you relinquish? What are your considerations on the physical framework of the new ED? (Worries and benefits) Are there certain physical conditions (e.g. rooms, appliances, etc.) that you find particularly important to be present in the new ED? Are there certain social conditions (e.g. events or activities) that you find particularly important to be present in the new ED? Optional: How will the ED influence your workflows and ways of working together/interacting? What did you think when you first heard about the new ED? |
Opinions about the process of implementing a new ED | Do you experience a predominantly negative or positive attitude towards the upcoming ED among your colleagues? (How is it expressed?) In your experience, what are the employees occupied with in connection to the establishment of the new ED? (What kind of questions do they ask? And what do you answer them?) What stories are told in your department when the new ED is discussed (among employees and managers)? (Do you find that attitudes to (or reactions) vary according to (or are related to) the employees' professional background?) |
Ideal conditions for change | What does it take for the new ED to succeed? What do you need? What do you want to do to make the transition to the new ED as good as possible for yourself and your co-workers? Do you do anything to convince your employees/colleagues that the new ED is a good/bad thing? If so - what do you do? And why? |
Communication and information about the implementation of the new ED | How do you experience the atmosphere when the new ED is discussed with representatives from other departments at the hospital? (Optional: What words do people use about the process?) Who has the mandate in your department to make final decisions regarding the establishment of the new ED? (In relation todesign, organization, etc.) (Optional: Who do you think should have the mandate to make the final decisions regarding the establishment and organization of the new ED?) To what extent do you and your management team feel that you have an influence on the establishment of the new ED? Do you feel involved in the process? In what ways? How would you like to be involved? Is it your experience that there are decisions regarding the new ED that you are not involved in, but where you wish to be involved? How can you leave your mark on the new ED? |
Rounding off and thanks | Do you have something on your mind? (Anything you think we need to know?) |
Data analysis
Overall change response: Indifference | ||||
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Quote | ID no. | Position and department | Condensed meaning unit | Code(s) |
“[…] I just had a meeting with one of the deputy managing directors and all of the senior physicians to talk about his perspective on it [the new ED] and how to do it. How it is going to be and talk about it as it is a sort of condition that we cannot really discuss. This is the way it goes in the entire region and Denmark, so sure we can talk about it, but we can probably not change it.” | 10 | A representative from a medical specialty | We talk about the new ED, and I have attended meetings with the board of directors. The new ED is a condition, we can discuss but not change. | Indifference; the terms of the new EDs are final; surrender; top-down decision |
Results
Change responses
Forms of change response (Coetsee) | Categories identified in the material |
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1. Commitment | (a) I feel a moral and ethical duty to promote the change (b) I believe in the value of the change |
2. Involvement | (c) I work towards involving my medical specialty and profession in the change (d) My position in the organization obliges me to take part in the preparation for the change |
3. Support | (e) I do not participate in the work towards the change, but I trust that the process is well-managed (f) I support the change because the new ED becomes a good learning environment (g) I support the change because I believe it will increase and improve the collaboration between the ED and specialist departments |
4. Indifference | (h) I do not deal with the change (i) I believe that the change is a result of top-down decisions, which I cannot change (j) I feel ambivalent about the change |
5. Passive resistance | (k) I am worried about the way the change is managed and conducted (l) I am worried about the outcome of the change |
6. Active resistance | (m) I actively utter critique because the implementation process is not transparent and properly conducted (n) I do not believe that the change will bring about improvement |
7. Aggressive resistance | Not detected in the material |
Commitment
“I must be able to get up in the morning and look at myself in the mirror and say: ‘You know what? What you are doing is the right thing’ guided by a moral slash ethical slash human compass.”
“We prepare them [the staff] all the time by telling them: ‘Listen, this will be the biggest change of the health care system in the next 40-50 years. You can influence it and show your initiative.”
Involvement
“The ED plays a very big role and it is a very big focus I have in my approach to being a manager of [my department]. [Our specialty] plays a big role in an acute hospital. And I take that very seriously. And I think we need a strong collaboration with the ED.”
Support
“One has learned to stay in the process, and on the way, things will fall into place, right? […] I have great confidence in the board of directors, that they have the complete overview, which I do not need to have.”
Indifference
“This is the way it goes in the entire region and Denmark, so sure we can talk about it, but we can probably not change it.”
“There are so many uncertainties […] so in terms of management, we do not know. We are really in […] limbo, because if you could just say: ‘that is the way it is going to be’, it would be much easier.”
Passive resistance
“I would rather like to have a board of directors who actually made some decisions. In reality, I find them non-existent, and I can hardly perceive them as my bosses in this process because they seem like they do not have an opinion […] or in fact have the competencies to manage this process.”
“Internal medicine physicians […] take care of the outpatient clinics, so we also have a culture of actually wanting to work on day duty and then go home […] Every time our presence in taking shifts is increased, it has consequences for other day functions […]”
Active resistance
“And then we had to say: ‘no way, we simply do not want that’. And we feared that it would leak out to the staff. If that were to become the rumor, there’s the devil to pay. That is a real concern, either that they quit […] or that it ends in failure.”
“[…] To me it would be good if they could announce who has the decision-making authority […] who decides because it would be […] more respectful. Instead, you have the feeling that there is an underlying agenda of which we hear nothing of.”
“If one believes in breaking the professional competence by forcing the people to work somewhere because one has a political idea that it is a good idea, you will be in trouble.”
Perceptions of the new ED
Perceptions of the new ED | Short description |
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1. Changing patient pathways | Disagreements on what constitutes the best possible acute patient pathway and whether the planned organization of the new ED would redeem this |
2. Changing the physical layout of the ED | Different opinions about the new ED’s location in a newly built wing of the hospital, which poses both potentials and challenges |
3. A new medical specialty gaining its foothold | Hopeful and frustrated statements about the newly established medical specialty of EM, which is related to the implementation of the new ED |
Changing patient pathways
“So, it may well be the case that patients get a more competent treatment, but it may well be that it gets less good because it is not in our interest to tend to minor injuries and such.”
Changing the physical layout of the ED
“[…] the physical environment is not thought through in our world, but it may be thought through in an architect’s world.”
A new medical specialty gaining its foothold
“It is important that it is articulated throughout the organization […] that this is what we want, […] and that the emergency medicine specialty is here to stay.”
“Once physicians graduate from university, they are physicians. However, it will not take long before they are either endocrinologists, cardiologists […] and you name it […] and there will always be teasing across specialties. So, I am not sure whether it is this [teasing] or the lack of professional expertise that finds expression in the description of emergency medicine specialists as ‘radiator physicians’ […]. It comes from when you lean against a radiator, that you look at a screen and […] you do not do much more.”
“[…] It is not cool to be an emergency medicine physician […]. Maybe among emergency medicine physicians but other than that it is not too cool. And it is a limping specialty, not because we do not need it […] there is no formal education […] maybe in ten years it will be different.”