Discussion Week 6

There are several steps for successful organizational change at all levels of a public health
organization. The Change must matter to those making change. A sense of ownership must be
created among the implementers of change [Williams, 1998]. For this purpose, implementers
need to recognize how the change will benefit their own work and lives. A credible, committed
internal change agent is critical for change in health care practices. Those who are in positions to
foster change can support local change agents with data and resources not locally available
supporting the internal change agent gives the agent the credibility and confidence to lead.
Change is more likely to succeed when leadership at each organizational level supports it and
when it is introduced into an environment where change is an ongoing practice [Fernandez, C. P.,
2008]. Clarity is needed about the purpose, benefits, and anticipated results of the change.
Motivating and supporting staff throughout the change process will help to maintain their
dedication and create a support network for the change agent. Clearly assigned and accepted
responsibility for implementing the change increases the chances of sustaining the change as a
part of ongoing work. The literature says that top-level leadership must be supportive for change
to succeed hence we must start where we can and start now [Williams, 1998].
Challenges
1. To engage stakeholders in thinking ahead to scale-up early in the change process.
2. To find the resources needed for scale-up.
Underlying causes of the challenges
1. Evidence of successful change may not appear until later in the process.
2. The change is viewed as simply a pilot; requirements of scale-up are not thought through.
3. There are real resource constraints [Kotter, J, 2007].
Strategies for meeting the challenges
1. Develop and carry out a monitoring plan with interim indicators and milestones, to
confirm that the change is progressing as planned [Heifetz, R, 2002].
2. Document the process, emphasizing:
- Achievement of milestones;
- Adherence to the schedule and budget;
- Unanticipated roadblocks and how the change agent and change team have
addressed them.
3. Evaluate the benefits of the change.
4. Share the documented process and benefits with stakeholders as a way of engaging them
in finding resources for scaling up.





References:

Williams, C., & Perry, C. (1998). Lessons from Project Northland: preventing alcohol problems
during adolescence. Alcohol Health And Research World, 22(2), 107-116
Fernandez, C. P. (2008). Managing the Difficult Conversation. Journal of Public Health Management and
Practice, 317-319. Senge, P. (1999). Creative Tension. Executive Excellence, 12.
Heifetz, R. A., & Linsky, M. (2002). A survival guide for leaders. Harvard Business Review,
80(6), 65-72.
Kotter, J. P. (2007). Leading change. Harvard Business Review, 85(1), 96-103.