The Banyan Tree: Volume II - Bringing Change - Organization Development And Social Change

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

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).
Billing Department : Controls introduced. Collections toned up.
Accounts Department: Financial controls, and better, and better costing management.
Pharmacy: Improved by functioning pharmacy and therapeutics committee, setting up of hospital formulary, getting unit dose up, controlling durg leakage, etc.
OPD: Reorganization for easier patient flow and mutual communication.
Medical Records: Reorganisation for better and relevant information. (No organised patient records existed before in many cases).
Maintenance : Preventive maintenance programmes, short-term, long-term training programmes for health equipment maintenance.
Inventory systems and procedures set up throughout the institution.
Nursing : Training for new roles and team building. Workload studies.
Manpower Requirement Studies.
Top Team Management : Training for new roles, team building, role analysis negotiations.
Goals, Mission : Clarification of long and short term goals, and of philosophy; socio-political analysis.
Conflict resolution, process interventions, peace making.
Communication systems: Organization Development Cells, Departmental Head Meetings, Joint Department meetings, efforts towards more participatory management.
Governing Board : Value clarification, functional meetings, organizational restructuring and simplification.
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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