Introduction

Key Concepts of Change

14 Managing Change†
Types of Change Kellie Gibbs
Factors Affecting Change
The Change Curve
Laboratory Change Roles
How To Become an Agent of Change
Why People Resist Change
Fear • Lack of Trust • Comfort • Perception of OBJECTIVES
Need • Lack of Knowledge/Competence • Poor
Communication • Exhaustion/Saturation To define change and understand the concepts and types of change
Forms of Resistance to Change To explain the change curve and help managers deal with the human side of
Steps to Managing Change change
Prepare • Implement • Monitor • Sustain • Reevaluate To instruct the reader on how to become a change agent
Changes that Are Common Today To explore why people resist change
Looking Ahead
To identify the steps needed to manage change effectively
Paradigm Shifts in Today’s Healthcare
Industry To help the reader understand the changes and trends occurring in the
Trends and Changes healthcare arena
Competing in the Future in the To clarify the paradigm shifts occurring in the healthcare arena
Healthcare Arena To discuss survival and winning strategies for workplace changes
Summary To identify the skills needed for the future to succeed in the healthcare arena
KEY POINTS
GLOSSARY
The key to change . . . is to let go of fear.
REFERENCES
Rosanne Cash
APPENDIX

Clinical Laboratory Management, 2nd Edition
Edited by L. S. Garcia
©2014 ASM Press, Washington, DC
doi:10.1128/9781555817282.ch14
C
hange is inevitable, and as a manager or leader in today’s laboratory,
you are expected to drive and implement change. This involves taking
numerous and various challenges head-on. Change is both a challenge
and an opportunity for growth (4). Laboratory and information technology
is changing rapidly, expectations are higher than ever before, and laboratory
professionals are expected to be electricians and computer experts as well
as specialize in test methodologies. In addition, constant healthcare reform
changes, such as the invention of accountable care organizations, Medicare
payment bundling, and payment incentive programs for improved patient and
quality outcomes, are forcing laboratories to make changes to survive. Labo-
ratories need to focus on cutting costs, providing competitive services, and
decreasing excess and unnecessary laboratory testing. This requires changing
age-old protocols that are ingrained in physician and laboratory practices. As
a laboratory manager, it is imperative to encourage innovative changes and
promote modifications to meet these needs.
Change is the process of becoming something different. It is the transforma-
tion of a process, culture, or people into an alternate form. With the proper guid-
ance and implementation measures, the change or proposed changes will come
†
Some sections are revised and updated from chapter 14 by Christopher Frings in the pre-
vious edition of this Manual (reference 2a).

281
282 MANAGERIAL LEADERSHIP
with improvements that make your laboratory a better place
to work, enhance quality, and improve patient outcomes.
Although people have a desire to change and know that
change is needed, they still fear change. Therefore, you will
undoubtedly encounter resistance. Resistance to change
will come in various degrees and forms; to deal with this
resistance, you will need to change your management ap-
proach based on the situation and individuals involved.
You must develop the skills needed to encourage and guide
staff toward making the changes and even eventually wel-
coming them. You should learn to utilize the power of per-
suasion and fine-tune these skills to be able to cater to an
individual as well as a group. Lastly, learn from your expe-
riences and the experiences of others and study the subject
in order to gear your methods accordingly.
This chapter covers important questions related to
change, such as: What is change, and why is it important to
manage it? What are the key concepts of change, and how
does each fit into your workplace or laboratory? What are
the factors affecting change, and how are people affected
by the process of change? Why do people resist change?
What are the steps to managing change, and how can you
as a manager be an agent of change and help promote con-
structive changes in your laboratory?
Key Concepts of Change
There is a tremendous amount of discussion pertaining to
various theories of change. Some are old and tried, while
some are new and alternative. I have studied the various
concepts and change models and noted that there are com-
mon themes that run through them. For the purpose of
this text, I have merged and morphed a combination of
the various change concepts and models into a condensed
version. First, change may be either planned or unplanned.
Planned changes are also referred to as anticipated changes
and are intended and thought out. They are carefully im-
plemented and have usually been studied and examined to
ensure a successful outcome. Examples of planned changes
in the laboratory are transferring laboratory locations or
Figure 14.1  Key concepts of change.
doi:10.1128/9781555817282.ch14.f1
functions from one area to another, remodeling or reno-
vating, installing automation, and acquiring new equip-
ment. Planned changes often require staff training in new
tests and methodologies. Unplanned changes are changes
that are not anticipated.
There are three timing levels of change. Each one rep-
resents the intensity and the circumstances in which a
change is needed. An emergent change is made when a
pressing or important issue dictates the need. Emergent
changes are frequently unplanned, and patient safety
or quality issues are often dictators of urgent changes.
These changes are deemed absolutely necessary to resolve
an issue. Opportunity changes often result when, just as
stated, an opportunity arises. Opportunity changes can
be planned or unplanned. Sometimes these changes arise
from changes other areas have made, improvements in
equipment, or newly acquired skill sets of individuals. Evo-
lutionary change is change that just happens over time. It is
the gradual adaptation or responsiveness to change; it can
be planned but is often unplanned. Competitors are usu-
ally doing the same, and it is understood and accepted as
common practice. Figure 14.1 demonstrates the relation-
ships among these key concepts of change.
Types of Change
Change is inevitable in any organization, and in the health-
care arena the speed with which change is occurring is tre-
mendous. Recent healthcare reform policies require that we
do more with fewer resources. In order to help you with the
implementation of change, you must understand the types
of change and organize your leadership approach to fit the
goal of each type of change. The three types of change are
transactional, transitional, and transformational (11). Each
of these types of changes is respectively more complex.
Transactional change is also referred to as developmental
change. Transactional change occurs when an organization
makes improvements to stay competitive. It is a continual
process, and it should require little effort to implement this
type of change. Transactional change is the most common
 chapter 14.  Managing Change 283
type of change and is usually based on the improvement of
an existing skill, method, performance standard, or condi-
tion (1). Transactional changes usually encounter little re-
sistance because most often they are logical adjustments to
current operations and strengthen what you already have.
One example of transactional change is implementing ad-
ditional training to improve a process already in place, e.g.,
training certified phlebotomists to perform point-of-care
testing so as to allow medical technologists and medical
laboratory technicians additional time to work on more
technical or complex testing.
Transitional change is a more complex type of change
in that it replaces processes or procedures with new con-
cepts and procedures. It is designed to increase efficiency
by replacing an old process with an entirely new one. This
type of change is often referred to as a project implementa-
tion. You may incorporate new products or services and
establish appropriate start and end dates for the project’s
timeline (1). An example of a transitional change is the
implementation of new automation when the previous
process was manual, e.g., implementation of automated
cross-match when all cross-matches were previously per-
formed by hand in the blood bank.
The most complicated and most difficult type of change
to achieve is transformational change. It is a shift in the en-
tire business culture of the organization. This is the most
complex type of change because it involves the human side
of change and encounters the most resistance. Transforma-
tional change is exactly what the title states, a total transfor-
mation of the work culture, a different way of thinking, and
a change in culture. It results from a change in strategy and
results over a period of time. An example of a transforma-
tional change is the merger of two different hospitals or in-
corporation of a college or medical school into your facility
to establish an academic medical center. Figure 14.2 shows
the process of how the types of change build on each other.
Factors Affecting Change
There are three factors that affect a person’s reaction and
ability to make a change. The skill, knowledge, and mo-
tivation of the person involved determine the success or
failure of the change. The skill of the individual expected to
implement the change refers to the person’s job specifica-
tions, selection criteria, performance review, and training
needs. Knowledge refers to the individual’s understanding
of the mission or strategy of the change. Are they knowl-
edgeable about the processes or procedures, and what is
their personal development? Lastly, motivation plays a
significant role. When a person is motivated, he or she
tends to make sure that the task is accomplished on time.
What motivates each person? Are your people strategically
aligned, socially aligned, capability aligned, or empowered
to make the changes? Refer to Fig. 14.3 to see how these
factors come together to determine the success or failure
of a change.
The Change Curve
The following change curve is a modified version of the
Kubler-Ross grief curve and consists of four phases (2a, 4).
This theory describes the process in which people grieve
or react to change. While people may move more slowly
or more quickly through change, complete mastery of the
change involves transition through each of the four phases,
especially if the individual did not initiate the change. This
does not mean that every individual will move through each
phase in order. Sometimes people move back to a previous
phase or get stuck in one phase. Despite these different pat-
terns, however, one must eventually reach the commitment
stage in order to perform effectively within the changed or-
ganization (4). The more you understand people’s needs,
the better you will be able to manage change (2).
Figure 14.2  ​Types of change.
doi:10.1128/9781555817282.ch14.f2
284 MANAGERIAL LEADERSHIP

that you allow for mourning and recovery. Figure 14.4

demonstrates how productivity and morale increase and
decrease as individuals move through the different phases
of the personal change curve over time.

Laboratory Change Roles

When change transpires, it is important to recognize the
different roles encountered within the laboratory setting.
A laboratory administrator’s role is to become the change
agent and lead the change. Managing change isn’t enough;
you have to lead it (5). Laboratory managers and adminis-
trators should cultivate the vision. They must inspire others
to believe that they can change and motivate them to take
action. The laboratory manager or administrator should
Figure 14.3  ​Factors affecting change. provide mentorship and guide staff to make the change.
doi:10.1128/9781555817282.ch14.f3 Most importantly, a laboratory manager or administrator
should make expectations clear and communicate effec-
tively. A technical supervisor or bench working supervi-
Denial. Employees ignore or do not respond to the infor- sor has the role of being the implementer. As the tactical
mation or awareness of change. It doesn’t sink in right agent, he or she must execute and accomplish the mission.
away that the change is occurring and that it will affect The technical supervisor must enforce the process and ful-
them. A typical response might be, “They can’t be fill the expectations of laboratory or hospital managers or
merging our laboratory with that reference clinical lab- administrators. The technical supervisor should manage
oratory across town.” When in the denial stage, they mistakes as they occur and realign steps to ensure success.
are in withdrawal, tend to focus on the past, and avoid The general laboratory staff have the toughest job of all as
the topic as much as possible. they must change the process while maintaining the qual-
Resistance. Here strong feelings about the change emerge, ity of the present method. They are responsible for uphold-
such as anger, blame, depression, anxiety, uncertainty, ing customer expectations and guaranteeing test results. In
frustration, and self-doubt. Change is frequently addition, the general laboratory staff endure the brunt of
resisted, just because it is change. Often change is re- anxiety and stress, the burden of altering the process, and
sisted because people are fearful of the unknown. the confusion of the execution.
Exploration. During the exploration phase people ac-
knowledge the change and accept that the change is
Figure 14.4  ​Personal change curve.
necessary (4). They draw upon internal resources and
doi:10.1128/9781555817282.ch14.f4
creativity to figure out new responsibilities and to vi-
sualize our future. This can be an exciting time if they
take on change as a new adventure and a new oppor-
tunity. In this stage they have concern about details,
confusion, new ideas, and lack of focus.
Commitment. At this point people acknowledge that
the change is the norm, are motivated, and are ca-
pable of achieving success. They are able to set new
goals and make plans to reach new goals. Here they
are cooperative, are focused, and feel confident and
in control.
The longer employees stay in the denial and resistance
stages, the harder and more painful the change will be.
Try to get them through the denial and resistance stages
quickly and go on to a commitment to change. Exchang-
ing the familiar for the new, even if it is better, means the
“death” of something familiar. You need to make certain
 chapter 14.  Managing Change 285

How To Become an Agent of Change

Table 14.1 lists actions you can take to become receptive to
change (2a). When you do these things, you are no longer
part of the problem but are part of the solution.

Why People Resist Change

Why do some people have a tough time adapting to
change? Unfortunately, people dislike things they find dif-
ficult. Becoming knowledgeable about resistance, expect-
ing it, and planning for it from the start will allow you to
effectively manage objections. Managers and employees
who persistently resist change over time create measurable
impacts on a company, including decreased productivity,
negative customer satisfaction, and loss of valued employ-
ees. In some cases, excessive resistance can cause change to
fail (9). It’s not possible to be aware of all sources of resis-
tance to change, but expecting that there will be resistance Figure 14.5  ​Reasons for resistance.
to change and being prepared to manage it is a proactive doi:10.1128/9781555817282.ch14.f5
step. Recognizing behaviors that indicate possible resis-
tance will raise awareness of the need to address the con-
cerns (Fig. 14.5). new conditions competently, and they will not do well fol-
At the end of the day, all sources of resistance to change lowing the modified process (11, 12).
need to be acknowledged and people’s emotions validated.
It’s far better to anticipate objections than to spend your Lack of Trust
time putting out fires, and knowing how to overcome re- When employees doubt their leaders and question their
sistance to change is a vital part of any change manage- motives, they tend to resist change (3, 10).
ment plan (10).
Comfort
Fear People are creatures of habit and do not like a change in
People often fear the unknown. Employees may simply routine. Many employees feel connected to the old way
resist change because it is unfamiliar. They fear that the or have a personal preference and a certain way of doing
new way will not work, they may not be able to handle the things (3, 10).

Perception of Need
Table 14.1  ​Actions to become an agent of changea Some employees feel that the old/current way is good or
Get buy-in to create ownership.
is working fine. They may not understand the need for
Involve every level of staff.
change or see any benefits of the change (3, 10).
Speak from your own experiences.
Set a good example.
Lack of Knowledge/Competence
Control the rumor mill. Employees may be concerned that they do not have the
Network with other change agents. skills or knowledge to implement the changes. They may
Don’t be afraid to learn. doubt their ability to handle the change and may feel they
Be mindful of people’s weaknesses. may lose something they once had. They may have to start
Keep up the momentum. over, do not like the idea of being retrained, and feel less
Don’t fight losing battles. competent than they did with the previous way (3).
Learn to refocus rapidly.
Practice good stress management.
Poor Communication
Invent the future instead of trying to redesign the past. Employees may feel that they were not informed or con-
Finish what you start. sulted about the change. They may feel as though their
a 
The key to implementing change is to give clear and direct com-
opinion doesn’t matter or that their opinions are insignifi-
munication (8). cant (10).
286 MANAGERIAL LEADERSHIP
Exhaustion/Saturation
Employees may resist change because they are over-
whelmed by continuous change (10).
Forms of Resistance to Change
The following are different ways people resist change: (i) the
negative view (“It won’t work! We already tried that”),
(ii) apathy and indifference (“I just work here”), (iii) pet
project attitude (“Are you criticizing my plan?”), (iv) un-
conscious dissension (“Whatever the boss says . . . but it
won’t work”), (v) free translation (“We’ll implement my
variation . . . it’s better anyway”), and (vi) authoritarian ap-
proach (“You are not to reason why . . .”) (2a).
Steps to Managing Change
In today’s constantly changing environment, it is gener-
ally recognized that change is persistent. Effective strategic
leaders understand that change in the strategic environ-
ment is a continuous process (7). Applying this theory, one
must assume that the situation can almost always be im-
proved. To ensure that change is successful and continual,
the following steps should be followed in any change man-
agement scenario.
Prepare
Prepare for the change by communicating effectively.
Establish and maintain open lines of communication by
holding regular meetings and becoming as transparent as
possible. Make staff aware of the current state, and justify
the importance of the proposed change. Persuade them to
be on board with the changes. Staff is more likely to be
receptive when they are informed of the purpose of the
change. Knowing the expected positives and negatives
associated with the change can help them cope and over-
come their resistance. Motivate the staff to become excited
about the change, and convince them to buy into the proj-
ect. Design and develop a plan of action and create a sense
of urgency. Utilize global thinking and envision strategic
partnering, prepare for the unexpected, make a list of
tasks, and set realistic and acceptable milestones.
Implement
Execute and coordinate the change by delegating tasks
and assigning completion dates. Hold individuals ac-
countable for accomplishing the assigned tasks within the
agreed-upon time frames. Ensure that each phase of the
implementation occurs in the appropriate order to ensure
success of the next phase. Make the vision a reality.
Monitor
Develop a feedback process, establish key metrics, and re-
view the process. Circle back and follow up on the status
of each assignment. Are there delays? Can the delays be
overcome to meet the expected completion dates?
Sustain
Reinforce the change. Ensure that systems do not revert back
to the way they were prior to the change. Recognize people
for making the change happen and express your apprecia-
tion by word or deed. Talk about progress every chance you
get. Tell success stories about the change process, and repeat
other stories that you hear. Include the change ideals and
values when hiring and training new staff. Publicly recog-
nize key members of your original change coalition, and
make sure the rest of the staff—new and old—appreciate
the contributions made by the originators. Create plans to
replace key leaders of change as they move on. This will help
ensure that their legacy is not lost or forgotten (5).
Reevaluate
Perform an assessment of the process, and review and ana-
lyze to see if further changes are necessary. Can the new
process be improved? Brainstorm for new ideas and ask
questions.
Figure 14.6 demonstrates the cycle of steps needed to
manage change effectively.
Changes that Are Common Today
The following are changes that are common today (2a):
change in the name of your professional organization, change
in the name of your company or business, technology
changes, reengineering, merger, acquisition, divestiture,
layoffs, downsizing, startup of a new company, division
or department changes, changes in top management, cul-
ture change (new policies, values, and/or expectations),
deregulation, reorganization, serious new competitors,
changes in your company benefits, reporting to a different
manager or a different reporting structure, and promotion
to a “higher” position in the organization. Which of these
changes have you already experienced? Are you ready for
the other changes listed?
Looking Ahead
The following are some of the changes you might expect
to see in many organizations in the future (2a): more em-
ployee involvement in all levels of decision making; in-
creased emphasis on meaningful work; more responsibility
for individual employees; fewer managers; a focus on hu-
man intellectual capital as demonstrated by an investment
in training, retraining, and new skill development; an atmo-
sphere that encourages more mutual respect and trust; an
increase in the protection of employee rights; a continuing
need for workers with good communication skills; programs
(for example, flextime) that support both work and family;
 chapter 14.  Managing Change 287
better recognition of and reward for superior performance;
greater diversity in the workplace, with more women and
minorities; further graying of the workforce; a continu-
ing need for workers with specialized skills; emergence of
multi-skilled, cross-trained professionals (generalists) with
specialized skills; smaller workspace area per employee
(smaller cubicles); increased utilization of the Internet and
social media; practice of evidence-based medicine; direct
result reporting to patients; and use of surveillance tools to
maximize productivity and security and to minimize loss.
How many have you already noticed in your organization?
Paradigm Shifts in Today’s
Healthcare Industry
Paradigm shifts that are occurring in the healthcare arena
are listed in Table 14.2. Many of these are occurring in other
industries. Each industry has its unique set of paradigm
shifts; however, many share some of the same changes (2a).
Trends and Changes
Expect the expected and the unexpected (2a). Changes you
can expect in the future in the healthcare industry and many
other industries are discussed in this section. Many are
Figure 14.6  ​Steps for managing
change.
doi:10.1128/9781555817282.ch14.f6
already happening. Which changes are you ready for? What
skills do you need to develop to get ready for the others?
Trends are rapidly changing, and so are attitudes, expec-
tations, and roles. More changes are occurring, and this will
continue for years to come. Due to new healthcare reform
policies, healthcare professionals are forming more alli-
ances with those previously looked upon as competitors.
Healthcare professionals are reforming themselves and at-
tempting to collaborate and share resources before manda-
tory change is imposed. This results in the rate of change
increasing, while expectations at all levels are rising, there
are fewer managers, and costs (a very important issue) are
being reduced. Most workers are expected to increase their
personal productivity and their team’s productivity.
Medical care is being managed, which results in re-
duced test volume, cost containment, rightsizing, capitated
reimbursement, reduced reimbursement, and emphasis on
appropriateness of laboratory test selection (economic cre-
dentialing). Healthcare professionals must become better
managers of budget, personnel, self, and business. Oppor-
tunities are different, and thus different skills are required.
Changes are technology driven in addition to cost driven
and driven by legislative issues. Our environment is not
going to change to please us. Some of us are only rearrang-
ing the chairs on the deck of the Titanic!
288 MANAGERIAL LEADERSHIP

Table 14.2  ​Paradigm shift in today’s healthcare industry remedies, fueled mostly by aging baby boomers’ openness
From To to new concepts. This will not be a threat to conventional
Activity orientation Outcome orientation medicine but will be a complement to traditional medicine.
Task focus Customer focus Moore’s (Gordon Moore) law says that the number of
Illness care Health maintenance and outcomes components that can be packed on a computer chip dou-
management bles every 2 years while the price remains the same. This
Fragmented services Integrated care law has amazingly held true for more than half a century.
Competition based on price Competition based on quality This means that computer power per dollar doubles every
Competition Partnerships 24 months. Moore’s law will probably not hold true forever.
Revenue Cost The lesson to be learned from this is that personal comput-
Economics of scale Economics of coordination ers become obsolete about every 3 years due to improved
Fee for service Managed care computer technology.
Revenue from services Revenue from covered lives
Downsizing Rightsizing
Competing in the Future in the
Department focus Interdisciplinary focus
Healthcare Arena
Turf protective values Group protective values
Individuals and groups Teams committed to common Table 14.3 lists things you can do to become a master of
missions change and improve your destiny in the healthcare arena
Individual Teamwork and in other arenas (2a). Build the skills you’ll need for
Low trust and guardedness High trust and openness the future, listed in Table 14.4, to stay competitive and
Manager Leader strengthen your abilities.
Boss Mentor, facilitator, or coach Suggestion: When you are resisting change, use a rub-
Controlling others Empowering others ber band to snap out of it! Some people wear a rubber
Fixing the blame Fixing the problem band around their wrists as a self-motivator. When they
Quality control Continuous quality improvement are resisting change, they snap out of it by snapping the
Quality assurance Service excellence rubber band. The snap of the rubber band serves as a self-­
New technology Appropriate technology motivator to remind them to take action toward getting
Resisting change Viewing change as an opportunity
Reacting to change Initiating change Table 14.3  ​Actions for becoming a master of change
Get involved.
Become different.
There will be an unprecedented demand for “alterna- Be part of the solution, not part of the problem.
tive” therapies; this reflects a trend from institutional- Demonstrate your worth.
ized managed care to self-managed care. More and more Develop positive relationships.
consumers will turn to alternative therapies, such as bio- Expect and get ready for the expected.
feedback, herbs, prayer, and chiropractic, whose holistic Expect and get ready for the unexpected.
approaches often seem more natural and less intimidat- Lead the technology revolution.
ing. In 2007, adults in the United States spent $33.9 billion Keep a positive mental attitude.
out of pocket on visits to complementary and alternative Make managing change part of your job description.
medicine (CAM) practitioners and purchases of CAM Be tolerant of management mistakes.
products, classes, and materials. Nearly two-thirds of the Keep (or develop) a sense of humor. Humor is healing.
total of these out-of-pocket costs were for self-care pur- Don’t let your strengths turn into weaknesses. Refocus rapidly.
chases of CAM products, classes, and materials ($22.0 bil- Practice effective stress management. Worry is a misuse of
lion), compared with about one-third spent on practitioner imagination.
visits ($11.9 billion). Despite this emphasis on self-care Support upper management.
therapies, 38.1 million adults made an estimated 354.2 mil- Initiate or join cross-functional teams.
lion visits to practitioners of CAM. About three-quarters Invent the future rather than trying to reinvent the past.
of visits to CAM practitioners and of total out-of-pocket Look 3 to 5 years into the future.
expenditures on CAM practitioners were associated with Shape the future of your industry.
manipulative and body-based therapies. A total of 44% of Don’t constantly react to each new competitive threat as it comes. Be
all out-of-pocket expenditures for CAM, or about $14.8 proactive, not just reactive.
billion, was for the purchase of nonvitamin, nonmineral, Anticipate the evolution of the healthcare industry and build capabili-
ties now to win in the future.
natural products (6). Demand will accelerate for alternative
 chapter 14.  Managing Change 289

Table 14.4  ​Skills needed for the future variation . . . it’s better anyway”), and (vi) authoritarian
Financial management approach (“You are not to reason why . . .”).
 ​ ​Cost analysis ■■ We all go through the following four stages in respond-
 ​ ​Budgeting
 ​ ​Return on investment ing to change, whether it is a major or a minor change:
 ​ ​Break-even analysis (i) denial, (ii) resistance, (iii) exploration, and (iv) com-
Outcome assessment and analysis mitment to change.
Continuous quality improvement ■■ The steps to managing change are (i) prepare, (ii) im-
Resource management and utilization allocation plement, (iii) monitor, (iv) sustain, and (v) reevaluate.
 ​ ​Personnel
 ​ ​Materials
■■ Track trends by identifying major new trends that affect
Self-management and personal development
your workplace and its environment.
 ​ ​Setting and reaching goals
 ​ ​Time management
GLOSSARY
Change management
 ​ ​Stress management Change  ​The process of becoming something different.
 ​ ​Team building Paradigm shift  ​A change from one way of doing things to an-
 ​ ​Negotiation skills
other; often encompasses a change in an entire concept, model,
 ​ ​Presentation skills
or standard.
Informatics
 ​ ​Systems Resistance to change  ​A force active in groups and individuals
 ​ ​Reporting that limits the amount of change that occurs.
 ​ ​Telecommunications
Risk assessment and management
Knowledge of regulatory and legal issues REFERENCES
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290 MANAGERIAL LEADERSHIP
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 chapter 14.  Managing Change 291
APPENDIX 14.1  ​Case Studies of How To Overcome Resistance to Change
One example is given below for each change situation. These ex-
amples are not meant as the best or only way to deal with the situa-
tion. The examples are included to give you one way to handle each
change situation. (From reference 2a.)
CHANGE SITUATION A
Situation: Employees do not understand or have little or inac-
curate information about the problem.
Response: Provide in advance as much information as possible
about the change and why you are making the change.
Example: A new branch reference laboratory located 61 miles
from the central laboratory was opened. Initially the laboratory
was open from 8:00 a.m. until 5:30 p.m. Some of the labora-
torians worked from 8:00 a.m. to 5:00 p.m., and some worked
from 8:30 a.m. to 5:30 p.m. The laboratory has been open for 6
months; the flow of work has changed due to new clients, and
there is a need for the laboratory to be open until 6:30 p.m. There
is a need for only one laboratorian to arrive at 8:00 a.m. The work
schedule must be changed to meet the needs of the physicians
and their patients. The laboratory manager meets with all of the
employees as soon as possible after the decision is made. He in-
forms everyone that the working hours must be changed to meet
the needs of the clients and gives specific information. He gives
everyone a 30-day notice of the change in hours to allow affected
employees time to make appropriate transportation and child
care arrangements.
CHANGE SITUATION B
Situation: You do not have all of the information needed to im-
plement the change, and others have considerable power to resist.
Response: Allow the people who will be affected by the change to
participate in the decision as to what needs to be done and how
to implement the change. This could be a great team-­building
opportunity.
Example: An HMO recently purchased two hospitals in the
medical center of a large metropolitan area. The chief executive
officer and chief operating officer of the HMO don’t want to du-
plicate nonessential laboratory services. There is a lot of talk and
rumors as to when and how the duplicate services will be elimi-
nated. You appoint a team with a team leader that consists of two
individuals from each lab, an assistant administrator from each
hospital, and the medical director of both hospitals to work out
the details during the next 14 days. They are to present a written
and oral proposal of how to implement the change.
CHANGE SITUATION C
Situation: Speed is essential, and you have considerable power to
enforce your ideas.
Response: Announce the change and enforce the change with
authority, certainty, and firmness.
Example: The hospital chief executive officer, chief operating of-
ficer, and laboratory director have decided to offer point-of-care
(POC) testing in the hospital effective in 2 weeks. One labora-
torian will have to act as a troubleshooter, problem solver, and
quality control and quality assurance coordinator for the nurses
who are performing the POC testing under the central labora-
tory’s Clinical Laboratory Improvement Amendments license.
This position will be rotated weekly among four laboratorians.
Several of the laboratorians are upset about the change because
they will not be able to have the same days off as before. After
hearing complaints, the laboratory director called the four labo-
ratorians together and stated that the decision has already been
made and that it will take place in 2 weeks.
CHANGE SITUATION D
Situation: Someone will clearly lose out in the change, and they
have lots of resisting power.
Response: Negotiate for a win-win situation.
Example: Organizational changes are necessary due to the
merger of two large reference laboratories to form one central
laboratory. There were two laboratory managers (Jim Bob and
Georgia Lou), and now only one laboratory manager is needed.
Both laboratory managers have been productive, key employees
with positive attitudes and great team-building skills. The chief
operating officer talks to Jim Bob and Georgia Lou together and
separately. He lets both laboratory managers know how impor-
tant they are to the newly combined reference laboratory. Geor-
gia Lou is given the new laboratory manager position. Jim Bob is
given the job of coordinating laboratory operations between all
six satellite laboratories and the central laboratory. Each is given
a 6% raise effective immediately to let them know that the reor-
ganization is not a demotion for either person. This results in a
win-win situation for everyone.
CHANGE SITUATION E
Situation: People resist change because they are unconvinced by
the change.
Response: Help them adjust by making the change as easy and as
comfortable as possible.
Example: Refer to the example in change situation C above. One
of the laboratorians is extremely upset by the change because it will
cause hardships for her and her son. By changing her day off she will
have a problem getting her son with cystic fibrosis to the clinic each
Wednesday for therapy. The lab manager explains the situation and
repeats that POC testing is needed and the nurses will do some of
the test volume previously performed in the laboratory. The labora-
torian states that her parents will be moving to this city in 2 months
and will be able to take her son to the clinic on Wednesdays. The lab
manager makes an exception and will give this employee 2 months
to make the adjustment due to the special situation.