Program:  Health Care Agency Organizational Change Initiative

Date of Report:  


I.    Purpose of the Report and Statement of the Issue

             The organizational change initiative’s intent was to move from a situation involving centralized allocation and control of services and resources to a decentralized structure with facilities loc`ated in various communities of the county and establishing an empowered partnership to service delivery.  However, the organization’s long-standing service delivery behaviors, norms, expectations and goals have not changed resulting in an unsuccessful change initiative and a dysfunctional organization.

This report analyzes and outlines the reasons for the unsuccessful organizational change initiative.  Furthermore, this report provides recommendations to get the initiative back on track.  The methods and approaches used to analyze the issues and support the recommendations are drawn from organization theory.

II.   Analysis of the Issues

  1. Insufficient Information Dissemination

The results of a study done on the initiative suggest that although much information was disseminated, it did not filter to all levels in the agency.  Insufficient information and inadequate guidance leads to confusion and a lack of understanding of frontline employees.  This further leads to service providers implementing tasks and procedures in terms of their individual interpretations, which results in inconsistent policies and procedures.

A decentralized structure involves a division of work, however, a division of work requires coordination and integration of work.  (Gulick, 1937)  There needs to be unambiguous communication so that organizational objectives and procedures reach from the top to the bottom of the entire enterprise.  Clear written procedures need to be established and disseminated to all employees.  All employees also need to receive the appropriate training on organizational goals and procedures.  This ensures that everyone in the organization is on the same page and consistent and exceptional service is delivered.

Moreover, there needs to be a feedback loop.  The systematic collection, analysis, and reporting of feedback are critical elements of decentralization, because the information can be used to verify employee understanding of organizational objectives and procedures; ensure compliance with the objectives and procedures; and guide future decisions.  If it is found that organizational goals and procedures are not being understood and/or complied with, the organization must adjust information dissemination and training procedures.

  • Diminished Decision-Making Authority of Case Workers

Though strong leadership is required to coordinate the division of work and ensure consistent service delivery, “in any practical situation the problem of organization must be approached from both top and bottom.”  (Gulick, 1937)  Moreover, the bottom-up approach is key to decentralization.  Those who implement policies at the point of contact with the organization’s target population should be given discretion and be actively involved in the planning and execution of programs, because these frontline employees understand the needs of the clients and how they will best be served.  Finally, participation will allow employees to develop a sense of ownership and accomplishment in the change initiative.  When the frontline employees are involved in the planning and execution of programs, information will be properly disseminated and resistance to change and turf issues will be combated.

  • Resistance to Change

Organizations do encounter problems during the change process; one of which is resistance to change.  Instability and uncertainty are reasons for resistance to change.  Pride of craft also leads to resistance to changing established routines.  (Merton, 1957)  However, when change is managed well, employees will see new opportunities instead of resist the change. 

The change process should include a clear and thorough statement explaining the change as well as action steps.  When employees at all levels are fully informed on and understand organizational objectives and the change initiative, “each worker will of his own accord fit his task into the whole with skill and enthusiasm.”  (Gulick, 1937)

Action steps include building the support of key groups who can gradually engage successive groups and push participation out into the organization; leading by example by behaving in a way that shows support for the change initiative; creating dissatisfaction with the current state while communicating a clear image of the benefits of the change initiative; building participation in planning and implementing change so there is understanding and a sense of ownership of the change process; relating each employees’ duties with the goals of the change initiative; rewarding behavior in support of change; providing people time and opportunity to disengage from the old; and obtaining feedback. 

  • Turf Issues

When employees are threatened they resort to protecting their turf.  The common interests in a bureaucracy and lack of internal competition, due to vocational security, leads to an internal solidarity and a defense of the informal organization whenever there is an apparent threat to the integrity of the group.  (Merton, 1957)  Lack of information and guidance, confusion, a mismanaged change process, diminished decision-making authority, and doubt for the managers’ commitment to change are all reasons that contribute to the apparent threat to the integrity of the group. 

To minimize this threat, the organization should clearly communicate the goals and procedures of the organization to all employees.  The organization should also involve frontline workers in the planning and execution of programs.  Moreover, change should be managed by clearly and thoroughly explaining the change as well as formulating action steps.  Finally, leaders must clearly define the vision of the change initiative, align employees with that vision, and ensure that their words and actions are consistent with the change agenda.

  • Doubt of Managers’ Commitment to Change

The lack of success of the initiative has led to frontline employees and local stakeholders (including clients) doubting the top managers’ commitment to change.  Effective leadership is critical in driving change.  Leaders must clearly define the vision of the change initiative, align employees with that vision, and ensure that their words and actions are consistent with the change agenda.  Employees must trust not only in the leaders official authority, but also in his or her ability to lead.  (Fayol, 1949)   

Certain functions of the executive are crucial to the change initiative, which include planning, organizing, staffing, directing, coordinating, and reporting.  (Gulick, 1937)  The executive must outline the things that need to be done for the change initiative and the methods for doing them.  The executive must then arrange duties and training of staff to accomplish the change initiative.  The executive must lead with clear instructions and actions that support the change initiative.  It is also vital that the executive interrelate the various parts of the work so that everyone is on board with the change initiative.  Finally, the executive must keep everyone informed so that everyone understands his or her role in the change initiative.

Certain management principles must also be applied, which will support the managers’ commitment to change.  (Fayol, 1949)  There must be unity in direction, which means everyone is working towards the same objective.  Employees must be fairly compensated for their efforts.  All employees must know their place in the organization and their role in the change initiative.  Employees must be given the time and opportunity to adjust to new roles and procedures.  Managers must give personnel the opportunity to show some degree of creativity and flexibility in carrying out plans and ensuring their success.  Finally, managers should ensure that there is union among the personnel so that they are all working towards a common goal.

  • Failed Partnerships

Failed partnerships were a result of many of the above issues.  The health care agency serves thousands of clients in the county and has facilities and partners in various communities.  Hence, the agency is an open system that is embedded in and dependent on its wider environment.  This means the agency must continuously adapt to changing environmental factors, and managers must recognize that all organizational decisions and actions in turn influence their environments.   (Katz & Kahn, 1966)  This also means that the agency has acquired and will continue to acquire resources from its environment; and gains social support and legitimacy from its environment.   (Pfeffer & Salancik, 1978; Meyer & Rowan, 1977)  As such, partnerships with the communities are essential to the success of the agency.

When forming partnerships, it is important to understand that the organization includes individual participants with varying preferences.  Through bargaining, stabilization and elaboration of objectives, and adjusting of agreements in response to environmental changes, partnerships and objectives can be formed.  (Cyert & March, 1959)

Moreover, building participation in planning and implementing change so there is understanding and a sense of ownership of the change process also fosters successful partnerships.  In changing conditions, there is a network structure of control, authority, and communication; knowledge and expertise may be located anywhere in the organization; there is more consultation than command; and expertise can be found externally.  (Burns & Stalker, 1961)

Finally, when linking clients or customers who wish to be interdependent, it is critical to operate in standardized ways. (Thompson, 1967)  Feedback from partners must also be obtained, because the selection, combination, and order of techniques depend on it.  (Thompson, 1967)

  • Underserved clients

The unsuccessful change initiative and dysfunctions of the organization has led to many clients bearing the burden of finding their own care.  Moreover, since communications with clients were poor, many were either unprepared or unable to proactively serve in the capacity of partner with their caseworker.  However, if the issues above are addressed with the stated recommendations, communications will improve, procedures will be more effective, employee satisfaction will increase, management will be strengthened, and partnerships will foster, all of which will result in better customer service.

III.  Conclusion and Summary of Recommendations

             The organization’s long-standing service delivery behaviors, norms, expectations and goals can change resulting in a successful change initiative if the following recommendations are followed:

  1. Clear communication and training must be established.
  2. Frontline employees should be included in the planning and execution of the change initiative.
  3. Change must be managed by clearly and thoroughly explaining the change as well as formulating action steps.
  4. Leaders should be clear as to the functions and management principles they must embody in order to support a successful change initiative.
  5. Successful partnerships should be established by forming coalitions and coalition objectives, building participation, and taking into account the environment in which the agency operates.


Burns, T., & Stalker, G. (1961). The Management of Innovation. London: Tavistock Publications.

Cyert, R. M., & March, J. G. (1959). Behavioral Theory of Organizational Objectives. Modern Organization Theory , 76-90.

Fayol, H. (1949). General and Industrial Management. London: Pitman.

Gulick, L. (1937). Notes on the Theory of Organization. (L. Gulick, & L. Urwick, Eds.) Papers on the Science of Administration , 3-34.

Katz, D., & Kahn, R. L. (1966). The Social Psychology of Organization. New York: Wiley.

Meyer, J. W., & Rowan, B. (1977). Institutionalized Organizations: Formal Structures as Myth and Ceremony. American Journal of Sociology , 83, 340-363.

Merton, R. K. (1957). Bureaucratic Structure and Personality. Social Theory and Social Structure.

Pfeffer, J., & Salancik, G. R. (1978). The External Control of Organizations: A Resource Dependence Perspective. New York: Harper & Row.

Thompson, J. D. (1967). Organizations in Action. New York: McGraw-Hill.

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