Applicability of Lewin´s Change Management Model in a Hospital Setting

Summary

Objectives: Today’s socio-economic developments in the healthcare area require continued optimization of processes and cost structures at hospitals, often associated with process changes for different occupational groups in the hospital. Formal methods for managing change have been established in other industries. The goal of this study was to assess the applicability of Kurt Lewin’s change management method to a health informatics-related project at a German university hospital.

Methods: A project at the University Hospital Erlangen introducing changed requirements in the documentation of costly material in the surgical area was conducted following the concept of Lewin’s approach based on field theory, group dynamics, action research and the three steps of change. A data warehouse contributed information to several steps in the change process.

Results: The model was successfully applied to the change project. Socio-dynamic forces relevant to the project goals were identified and considered in the design of the new documentation concept. The achieved documentation level met the new requirements and in some areas even exceeded them.

Conclusions: Based on the project experiences, we consider Kurt Lewin’s approach applicable to change management projects in the hospital sector without a requirement for substantial additional resources, however, specific hospital characteristics need to be taken into account. The data warehouse played an important role by providing essential contributions throughout the entire change process.

Keywords

Change management - organizational innovation - diffusion of innovation - data warehouse - hospital information systems

• References

• 1 Ehlers F, Ammenwerth E, Haux R. Process potential screening – an instrument to improve business processes in hospitals. Methods Inf Med 2006; 45 (05) 506-514.
• 2 Huber E. Health care reform as a development of the health care system. Z Arztl Fortbild Qualitatssich 2007; 101 (06) 397-406.
• 3 Töpfer A, Albrecht D. Erfolgreiches Change Management im Krankenhaus. Berlin, Heidelberg: Springer Verlag; 2006
• 4 Plag M. Veränderungsmanagement in Bundesministerien. Gabler Verlag; 2008
• 5 Brender J, Ammenwerth E, Nykanen P, Talmon J. Factors influencing success and failure of health informatics systems – a pilot Delphi study. Methods Inf Med 2006; 45 (01) 125-136.
• 6 Garde S, Wolff AC, Kutscha U, Wetter T, Knaup P. CSI-ISC – Concepts for smooth integration of health care information system components into established processes of patient care. Methods Inf Med 2006; 45 (01) 10-18.
• 7 Aarts J, Doorewaard H, Berg M. Understanding implementation: the case of a computerized physician order entry system in a large Dutch university medical center. J Am Med Inform Assoc 2004 11 (3).
• 8 Aarts J, Berg M. Same systems, different outcomes – comparing the implementation of computerized physician order entry in two Dutch hospitals. Methods Inf Med 2006; 45 (01) 53-61.
• 9 Southon G, Sauer C, Dampney K. Lessons from a failed information systems initiative: issues for complex organizations. Int J Med Inform 1999; 55 (01) 33-46.
• 10 Ash J, Anderson J, Gorman P, Zielstorff R, Norcross NJP. et al. Managing change: analysis of a hypothetical case. J Am Med Inform Assoc 2000; 7 (02) 125-134.
• 11 Berg M, Aarts J, van der Lei J. ICT in health care: sociotechnical approaches. Methods Inf Med 2003 42 (4).
• 12 Lewin K. Frontiers in Group Dynamics: Concept, Method and Reality in Social Science; Social Equilibria and Social Change. Human Relations 1947; 1: 5-41.
• 13 Lewin K. Frontiers in Group Dynamics: II. Channels of Group Life; Social Planning and Action Research. Human Relations 1947; 1: 143-153.
• 14 Schein EH. Organizational Psychology. 3rd ed. London:: Prentice Hall; 1988. p 239.
• 15 Doppler K, Lauterburg C. Change Management – Den Unternehmenswandel gestalten. Frankfurt/ Main: Campus Verlag GmbH; 2005
• 16 Forthman MT, Wooster LD, Hill WC, Homa-Lowry JM, DesHarnais SI. Insights into successful change management: empirically supported techniques for improving medical practice patterns. Am J Med Qual 2003; 18 (05) 181-189.
• 17 Lorenzi MN, Riley TR. Managing Change: An overview. J Am Med Inform Assoc 2000; 7: 116-124.
• 18 Shanley C. Management of change for nurses: lessons from the discipline of organizational studies. J Nurs Manag 2007; 15 (05) 538-546.
• 19 Bennett M. Implementing new clinical guidelines: the manager as agent of change. Nurs Manag (Harrow) 2003; 10 (07) 20-23.
• 20 Kassean HK, Jagoo ZB. Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius. BMC Nursing 2005; 4: 1-6.
• 21 Menix KD. Educating to manage the accelerated change environment effectively: Part 1. J Nurses Staff Dev 2000; 16 (06) 282-288.
• 22 Muller M. Change management in health services: the South African experience. Curationis 1997; 20 (04) 27-31.
• 23 Mustain JM, Lowry LW, Wilhoit KW. Change readiness assessment for conversion to electronic medical records. J Nurs Adm 2008; 38 (09) 379-385.
• 24 Redfern S, Christian S. Achieving change in health care practice. Journal of Evaluation in Clinical Practice 2003; 9 (02) 225-2 38.
• 25 InEK-Handbook.. InEK – Institute for the Hospital Remuneration System (cited 17.10.2008). Available from: http://www.g-drg.de/cms/index.php/inek_site_de/Kalkulation/Kalkulationshandbuch/Kalkulationshandbuch_V3_070918.pdf
• 26 Lewin K. Action research and minority problems. Resolving social conflict. 1946
• 27 Scheese R. Data warehousing as a healthcare business solution. Healthc Financ Manage 1998; 52 (02) 56-59.
• 28 Muranaga F, Kumamoto I, Uto Y. Development of hospital data warehouse for cost analysis of DPC based on medical costs. Methods Inf Med 2007; 46 (06) 679-685.
• 29 Tang ST, Huang YF, Hsiao ML, Yang SH, Young ST. Rapid prototyping strategy for a surgical data warehouse. Methods Inf Med 2003; 42 (03) 243-250.
• 30 Dugas M, Lange M, Berdel WE, Muller-Tidow C. Workflow to improve patient recruitment for clinical trials within hospital information systems – a case-study. Trials 2008; 9: 2.
• 31 Lang M, Kirpekar N, Bürkle T, Laumann S, Prokosch HU. Results from data mining in a radiology department: the relevance of data quality. Medinfo 2008; 12 Pt [phone].
• 32 Zhang Q, Matsumura Y, Teratani T, Yoshimoto S, Mineno T, Nakagawa K. et al. The application of an institutional clinical data warehouse to the assessment of adverse drug reactions (ADRs). Evaluation of aminoglycoside and cephalosporin associated nephrotoxicity. Methods Inf Med 2007; 46 (05) 516-522.
• 33 Silver M, Sakata T, Su HC, Herman C, Dolins SB, O’Shea MJ. Case study: how to apply data mining techniques in a healthcare data warehouse. J Healthc Inf Manag 2001; 15 (02) 155-164.
• 34 Ganslandt T, Kunzmann U, Diesch K, Palffy P, Prokosch HU. Semantic challenges in database Federation: lessons learned. Studies in health technology and informatics 2005; 116: 551-556.
• 35 Back KW. This business of topology. Journal of Social Issues 1992; 48 (02) 51-66.
• 36 Lewin K. Psychological ecology. Field Theory in Social Science 1943 p 172.
• 37 Lewin K. Group decisions and social change. Readings in Social Psychology 1947
• 38 Burnes B. Kurt Lewin and the Planned Approach to Change: A Re-appraisal. Journal of Management Studies 2004; 41 (06) 977-1002.
• 39 Kippenberger T. Planned change: Kurt Lewin’s legacy. The Antidote: 1998. 14 (10–12).
• 40 Bernstein L. Management Development. London: Business Book; 1968
• 41 Dent EB, Goldberg SG. Challenging resistance to change. Journal of Applied Behavioral Science 1999; 35 (01) 25-41.
• 42 Bennett R. Management Research. Geneva: International Labour Office; 1983
• 43 Lorenzi MN, Riley TR. Organizational Aspects of Health Informatics. New York: Springer; 1995. p 157.
• 44 Lorenzi MN, Riley TR, Ball MJ, Douglas JV. Transforming Health Care Through Information. New York:: Springer; 1995. p 119.
• 45 Haux R. Health information systems – past, present, future. Int J Med Inform 2006; 75 3– 4 268-281.
• 46 Lenz R, Buessecker F, Herlofsen H, Hinrichs F, Zeiler T, Kuhn KA. Demand-driven evolution of IT systems in healthcare – a case study for improving interdisciplinary processes. Methods Inf Med 2005; 44 (01) 4-10.