THE BANYAN TREE: VOLUME II - BRINGING CHANGE - ORGANIZATION DEVELOPMENT AND SOCIAL CHANGE

( By Editor : Carol Huss )

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Health Care System Applications

Over a period of 10 years (1973-84) OD was used as a major means to bring about change in hospitals by the Health Care Administration Education (HCAE) team at the Voluntary Helth Association of India (VHAI).

OD concepts were also applied at the level of socio-religious congregations and groups who were involved in hospital based or curative health care by and large (see Table 4).


Table 1
OD Intervemntions Classified by Two Independent Dimensions :
Individual - Group and Task - Process

















































Tasks vs processes Individual vs Groups Dimension
Focus on Task Issues Focus on the Individual Focus on the Group
  Role analysis technique Education : technical skill also decision making, problem solving, goal setting, and planning Technostructural changes Survey feedback Confrontation meeting
  Career planning
Grid phase 1
Team-building sessions
Intergroup activities Grid OD phases 2,3
  Some forms of job enrichment and management by objectives (MBO) Some forms of socio-technical systems
Focus on Process Issues Life Planning Survey feedback
  Process consultation with coaching and counseling of individuals. Team-building sessions Intergroup activities
  Education : group dynamics, planned change Process consultation Family T-group
  Stranger T-group Grid OD phases 2,3
  Third party peacemaking Gestalt OD
  Gridphase 1 Gestalt OD Transactional analysis  
Source : Wendell L. French. Organisation Development (new Delhi, :Prentice - Hall, India, 1983).


Table 2
Intervention Typology Based on Principal Emphasis of Intervention in Relation to Different Hypothesized Change Mechanisms























Hypothesized Change Mechanism Interventions Based Primarily on the Change Mechanism
Feedback Survey feedback
T-group
Process consultation
Organisation mirroring
Grid OD instruments
Gestalt OD
Awareness of Changing or Dysfunctional Sociocultural Norms Team-building
T-group
Inter group interface sessions
First three Phases of Grid OD
Increased Interaction and Communication Survey feedback
Inter group interface sessions
Third-party peacemaking
Organisational mirroring
Some forms of management by objectives
Team building
Technostructural changes
Sociotechnical systems
Confrontation and Working for Resolution of Differences Third-party peacemaking
Intergroup interface sessions
Coaching and counselling individuals
Confrontation meetings
Collateral orgnisations
Organisational mirroring
Gestalt OD
Education Through
(1) New Knowledge
(2) Skill practice:
Career and life planning
Team building
Goal setting, decision making, problem solving planning activities
T Group
Process consultation
Transactional analysis
Source : Ibid


Table 3





Summary of OD Interventions by the HCAE Team



  1. Personnel Department is set up and functioning with statutory policies and procedures and a personnel manager. (None existed before. There was little concept of statutory obligations given given the nature of voluntary hospitl histories).
  2. Billing Department : Controls introduced. Collections toned up.
  3. Accounts Department: Financial controls, and better, and better costing management.
  4. Pharmacy: Improved by functioning pharmacy and therapeutics committee, setting up of hospital formulary, getting unit dose up, controlling durg leakage, etc.
  5. OPD: Reorganization for easier patient flow and mutual communication.
  6. Medical Records: Reorganisation for better and relevant information. (No organised patient records existed before in many cases).
  7. Maintenance : Preventive maintenance programmes, short-term, long-term training programmes for health equipment maintenance.
  8. Inventory systems and procedures set up throughout the institution.
  9. Nursing : Training for new roles and team building. Workload studies.
  10. Manpower Requirement Studies.
  11. Top Team Management : Training for new roles, team building, role analysis negotiations.
  12. Goals, Mission : Clarification of long and short term goals, and of philosophy; socio-political analysis.
  13. Conflict resolution, process interventions, peace making.
  14. Communication systems: Organization Development Cells, Departmental Head Meetings, Joint Department meetings, efforts towards more participatory management.
  15. Governing Board : Value clarification, functional meetings, organizational restructuring and simplification.
  16. Personal Growth : Growth groups, team building exercises, etc.


Table 3 : Phases in Health Care Systems Change




























































Supporting Processes Governing Board Level        
  Pain in the organisation
Need for change experienced
Environmental pressures
Decision to improve management
Decision to seek external help Clarification of philosophy and objectives
Active role in supporting changes
Self education in hospital and related matters
Linkage with external resources
Support and reinforcement and objectives
Stock taking
Review
Long range planning
Power shared
Community represented on governing board
  Top Management Level
-Decision to send key personnel for training
Interest in problem identification
Providing accessibility of data
Openness to feedback
Good communication and support
Readiness for change
Setting aside resources for implementation
Commitment to goal
Flexibility to try new behaviour
Confidence in own resources
-Trust, support and openness increased
Risk taking
Higher self esteem
Pride in accomplishment
Creativity
Growth Phases : (1)
Personal Growth
(2)
Personal Growth
(3)
Interpersonal Growth
(4)
Organizational Growth
(5)
Community Growth
OD Phase Entry: Diagnosis Implementation Termination Self- Reviewing
Intervention change in individual management style
application of management techniques at department level
Personal change
internal-external team problem analysis
setting up action plans
agreement on norms of client consultant relationship
improvement in top management team work
Systems changes accounting, personnel materials, etc
change of leader style
creation of new functions
Change in organization climate
-owning of change
Positive attitude towards innovation particularly at the top
OD cell continues growth and diversification to cope relevantly with environment
Better service at lower cost
Community participation and involvement
Relevant Inputs Organizational diagnostic study, TA and Psychotherapy,      
  Lab methods ..............................................................................................................
    Role Analysis Technique, conflict resolution, problem solving, budgeting control systems, performance review, etc.............................................
Planning, goal setting, job redesign, cost accounting, etc.....................
Source : Carol Huss. An Approach to Health Care System Change.
(VHAI, New Delhi, 1975).

We began with an initial visit to assess readiness of the staff to be involved in such an OD effort, outlining plans and setting dates for the initial diagnostic study (which preceded such OD efforts). We would identify perssons within the organisations who would be involved in the study, and speak withthem. Then our external team would come nd work with an internal team to conduct the organizational diagnositc study. Depending on the size of the hospital, we would set the time, but usually would complete the study in a week. On the last day we would give a report to the top management, and in some hospitls, to all the staff. We had a wide range of reactions - ranging from violent rejection of us and our work, to fullscale acceptance and working through to achieve set goals. In several cases we advised closure. One hospitals did close, and after an interval of 10 years, was again reopened, with high level professionalisation, a long list of specialists,and an alarming deficit which is snowballing.

Most hospitals did improve after the study, sometimes with our help, and sometimes their own.

Examples of results of such improvements ranged from systems and procedures to decision making processes, and structural reorganisations. We ensumerate in brief in Table 3.

There are published 1-3 and unpublished studies 4 and reports 5 of these efforts (a few of the latter are accessible withthe authors).

One case study is given in Appendix 1 as an illustration.

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