Organisational change management framework for hospitals : a comparative case of St Mary’s, Marianhill, South Africa and St Joseph’s, Adazi-Nnukwu, Nigeria

Abstract

Change management in healthcare organisations is a complex task considering the continuous changes in global demography, technology, strategies, clinical communication, information transfer, and disease burden. The current global pandemic highlighted the need for healthcare organisations to continue implementing measures that adequately respond to health challenges towards patient satisfaction. Many organisations find it difficult to implement organisational change successfully. Unsuccessful change programmes can be attributed to the lack of employee training and development, poor leadership, inadequate communication, poor organisational culture and inadequate resources (Mosadeghrad & Ansarian, 2014). However, change programme implementation and its impact depend largely on the ability of managers to adopt and adapt the change programme techniques in their organisations. Agboola & Salawu's (2010) identified that the introduction of change produces a variety of reactions due to the intrinsic uncertainty or the alteration of employee behavioural patterns, including status quo, anxiety and lack of tolerance, amongst others. The greater the impact on the existing culture, the greater the amount of resistance likely to emerge and the more difficult it will be to implement change. The study of Organisational Development (OD) can serve as a learning paradigm for academic research by enhancing student knowledge about how change management can enable hospitals to create effective responses to changes. The main purpose of this study was to explore organisational change management practices in hospitals in Nigeria and South Africa and proposed a conceptual framework for the change management process for hospitals in a developing context. Employees are one of the most critical elements in any organisational change. Research objectives guided this study to determine the influence of driving forces of change on employee performance in St Mary's Hospital, Marianhill and St Joseph's Hospital, Adazi-Nnukwu; to examine the impact of organisation culture on the practical implementation of change in St Mary's Hospital, Marianhill and St Joseph's Hospital, Adazi-Nnukwu; to determine the influence of practical implementation of change on patient satisfaction in St Mary's Hospital, Marianhill and St Joseph's Hospital, Adazi-Nnukwu; and to establish if drivers of change influence resistance to change during the implementation process in St Mary's Hospital, Marianhill and St Joseph's Hospital, Adazi-Nnukwu. This study provided information on resisting forces and stakeholder attitudes towards the change. And thus, assisted in restructuring the health system for greater efficiency through structural reforms that bring healthcare closer to the people, foster greater accountability and promote community participation. A case study research design was adopted for this study. An explanatory mixed-method approach was adopted with the observed hospitals. The target population and sampling frame were the employees and management from different organisational levels at both hospitals. The total number of employees and final sample size for the study was 132 for St Joseph's Hospital and 150 for St Mary's Hospital. The researcher designed two sets of questionnaires for all employees, a survey for quantitative and an open-ended questionnaire for qualitative. The Statistical Package for Social Sciences (SPSS) 28.0 and NVivo 12 were used to analyse the data. The analysis results for objectives one, two, three and four revealed a significant relationship between drivers of organisational change and employee performance. Organisational culture significantly impacted the practical implementation of change. Practical implementation of change showed a significant relationship with patient satisfaction. However, a non-significant association was found between drivers of change and resistance to change. The study found that both hospitals were successful in their change programmes. This can be attributed to proper employee training and development, good leadership, effective communication, strong organisational culture and adequate resources. Technology and organisational policy have been documented as key drivers of organisational change and performance. The study recommends that the management of the two healthcare organisations continue to implement technological changes with appropriate and required training. Management should continue to improve the adopted communication system, participative leadership and motivation system to enhance the implementation of change and promote team-building exercises to improve staff attitudes.