Change Management Proposal for Parkway

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The purpose of my report today is to present the findings about the problems identified in Parkway, the proposed changes and ways to overcome related resistances as well as a stress management plan aimed at developing a conducive environment for Parkway to pursue its long-term growth objectives.

Parkway nursing care is dealing with large changes just like other organizations. The firm believes in innovation and competitive advantage can be achieved through maximizing human capital, the very reason why there is a need for the company to strategy to sustain its competitiveness in the growing global market.

Leadership and Management are the very keys that dictate the success or failure of a team or an organization. It is due to the fact that these elements serve as the cohesive force that drives and guides the members to the ways and means in reaching the goals and objectives of the organization.

In fact, as one of the best care facilities in the region, Parkway want to retain good position in growing nursing home industry, and continue expanding rapidly. It had more pressure than before.

With the problem facing company, the Board of Directors of Parkway need to understand why causes these problems and how to solve them, thereby reach to company growth and profit for now and future.

2.0 Survey Results

Figure 1. Survey Result of Parkway



Injuries per Staff Member

Incidents Per Patient

Certified Absences Per Staff

Other Absences Per Staff

Turnover Rate







































































Source: Internal Survey

The tabulated result showed that there were many problems with the staff and patients. Due to increase in patient population annually, problems also increased. In the past, Parkway had good reputation for service, but now the Board of Directors just focus on patient numbers for rapid expansion.

According to Hofstede's model, there are two types of time orientation, long-term orientation vs short-term orientation. Long-term orientation emphasizes the future, thrift, and persistence. Short-term orientation emphasizes the present and the here and now.

If Parkway's management just focuses on filling beds, there should be short-term increase in income. However if nursing homes do not have relevant strategy to support it, having more patients will lead to more problems. In addition, the company should be concerned with the welfare not only of its patients but also its staff. In long-term orientation, there would be unsatisfied patients resulting in negative image and will be detrimental to achieve long-term goals.

3.0 Problems Identification

3.1 Staffing

Many staff complained that the schedule was not flexible. They had no time to do what they need to do. Especially, there are a lot of single parents or primary caregivers of their children, they have more childcare responsibilities. Company should have plan that help them deal with emergency absence. It would be let staff work better, and feel happier.

Management need to keep positions filled because of more patients, while the government does not care staffing level, and management do not select applicant, just focus on keep position filled. So some new guys is hired, even they have no basic job skills and any caring knowledge.

As we can see, most of the new staff does not have adequate training or even basic knowledge on how to care of the patients, this only result to more stress and confusion to patients and at work. Meanwhile new health care standards are raised and the development of technology, senior staff need study new skill and knowledge, such as how to use electronic documentation.

Company needs to provide vocational training to staff. The company should spend more time, money, and resources to making sure that they will have adequate training before they are given responsibilities on how to handle patients. By having a well trained staff the company can be assured of excellence and value with work.

Physical Demands

There are more injuries because of back strain from lifting patients in Parkway. Some times patients would be injured with nurse together. More injuries will create more absences. This means that company need to spend more on medical fees, and need to hire temporary staff do their work. This will increase costs and decrease profit. Furthermore, if some staff cannot endure it, they will consider looking for another job. As a result, company will lose experienced staff.

Company can install high tech equipment that can help lift patients, thus reduced the labor intensity, while encourage employees do more exercise, this will improvement of their health.


Nowadays the government is subjecting nursing homes to greater scrutiny following reported cases of patient abuse and billing fraud. Government regulations on health care reporting require that documentation be made in a form that will avoid tampering to conceal the abuse. On the other hand, there is a need for a better way to get the information across shifts. Hence company needs to use specialized software systems for electronic documentation, and then teach staff how to use it. Every staff must learn how to use it, regardless of age.

Focus on Filling Beds

Since 1993, the venture capitalist Robert Quine had invested and expanded Parkway nursing homes rapidly. The company has 220 nursing homes in southwestern United States with an average of 115 beds per facility. The employees of Parkway total at 30,000.

Expansion need more input just like as an experienced nurse, equipment, material and money, while shareholder need more return. Meanwhile, Parkway has to tighten their budget because federal government wants to cut Medicare expenses.

Consequently, there is a need for more income and that means more patients. The marketing strategy must be aggressive to fill in the beds. The marketing department of Parkway must utilise a variety of methods to attract patients. In addition, company must ensure that patients can get excellent care and greater satisfaction which will further cultivate patients' loyalty.

4.0 Change Management Strategy

Forms of Resistance

No company today is in a particularly stable environment. In the age of worldwide globalization and growing competition many companies must sacrifice large parts of their secure traditions in order to remain sustainable in the future. This change is the

result of many factors.

EXHIBIT 4-1-1 Forces for Change

Nature of the



Economic shocks


Social Trends






Source: Self-created

Innovation is imperative under such circumstance. However, most employees see change as threatening that's why they are afraid to change even though they need to. Exhibit 4-1-2 summarizes the major forces for resistance to change, categorized by individual and organizational sources.


Sources of Resistance to Change

Individual Sources Organizational Sources

·Habit ·Structural inertia

·Security ·limited focus of change

·Economic factors ·Group inertia

·Fear of the unknown ·Threat to expertise

·Selective information processing ·Threat to established power


·Threat to established resource


Source: G. P. Audia & S. B.Rrion (2007)

The most common forms of resistance have two types, Overt and Immediate and, Implicit and Deferred. The former involves voicing complaints and engaging in job actions. The latter major manifestation modes has loss of employee loyalty and motivation, increased errors or mistakes, increased absenteeism, and deferred resistance clouds the link between source and reaction.

4.2 Resistances in Parkway

When Parkway wants to change, there are resistances from staff because of some reasons.

First, employees are accustomed to the existing way of working and so do not wish to change status quo too much. They are so used to it that they are afraid of making changes because they know it will be difficult and they are in fear that this change might lead them to lose their jobs.

Second, they are concerned that they will be working with new people. This means a lot of adjustment is required that will only increase their workload. Some of the new staff do not have job skills, and need training and assistance. Experienced nurses do not want to train new staff, even if they want to do it, they just do not have the time.

In addition, senior staff does not want to learn new knowledge due to the belief that high-technology equipment might replace them at work. On the other hand, they are also afraid that advanced software systems will expose mistakes that they cannot alter and cover up.

Ultimately, company management set some new targets and policies, but they are not sure whether it can be understood and fully implemented by staff. Some staff is scared of change because they do not know why they need to do it and how they can do it.

For various reasons, the staff resists innovation. In overt and immediate way, some concrete behavior like feigning illness, slowing work, sabotage, breaking tools, bed manner for patient, and so on. In implicit and deferred way, most of the time staff will be absent and lose engagement and loyalty at work. However any resistance would to do a lot of negative effects, and go against corporate development program. Management need try to overcoming it.

4.3 Overcoming the Resistance

When there is change, resistance is inevitable. Nevertheless it is possible to overcome this resistance. Kotter's Eight-step Plan can help management to deal with resistance to change.

4.3.1 Step One: Create urgency

In this step, company needs to establish a sense of urgency by creating a compelling reason to show what potential threats in company to staff. Company should hold an emergency meeting to inform staff why Parkway needs to make changes. What good does it do for company and staff? If not innovate, what will happen?

4.3.2 Step Two: Form a powerful coalition

In this step, company needs to form a coalition with enough power to lead the change. The Board of Directors should find the true leaders in company, and get an emotional commitment from this group. The member of the group must come from different departments and levels.

4.3.3 Step Three: Create a new vision

In this step, company needs to create a new vision to direct the change and strategies for achieving this. The Board of Directors' can create a new vision---"Growth & profit for now and future", while ensure coalition group can describe it within 5 minutes, and practice it whenever.

4.3.4 Step Four: Communicate the vision

In this step, company needs to communicate the vision throughout the organization. The Board of Directors must talk about new vision frequently, and utilize to every aspect. In addition, company can set up a model to lead others.

4.3.5 Step Five: Empower others by removing barriers

In this step, company need to empower others to act on the vision by removing barriers to change and encouraging risk taking and creative problem solving. Identify or hire powerful leaders who can deliver the change and help remove barriers (human or otherwise). Meanwhile company can also acknowledge or reward people with contributions to change.

4.3.6 Step Six: Create and reward short-term "wins"

In this step, company need to plan for, create, and reward short-term "wins" that move the organization toward the new vision. At first, The Board of Directors can seek for a sure-fire project and insure it is successful, and then reward the people who help to reach it.

4.3.7 Step Seven: Consolidate, reassess, and adjust

In this step, company need to consolidate improvements, reassess changes, and make necessary adjustments in the new programs. Quick change is not real victory company needs to focus and be consistent on long term goals to achieve change.

4.4.8 Step Eight: Reinforce the changes

Finally for the change to become a success it needs to become the core values of the company. Management should make sure that changes can be seen in every aspect of the organization; they should encourage leaders to talk about the progress achieved by these changes and include them when hiring new staff and should openly recognize the people who are responsible to help make these changes.

In order to proactively address the resistance and effectively implement the management reform, the management must find the ways and means to address the concerns of its personnel most especially on the area of work time flexibility, skills enhancement programs, additional incentives, reward systems, maximizing safety and implementation of motivational programs.

According to the interactions view of conflict, conflict is not only a positive force in a group but that it is absolutely necessary for a group to perform effectively. It does not mean that all conflicts are good. Low-to-moderate levels of task conflict and Low levels of process conflict are functional, but relationship conflict almost always dysfunctional. Company and employees of Parkway can work together to negotiate, and seeking for a mutually acceptable solution to reach win-win.

Last but not least, Parkway management can not change everything at all simultaneously; doing this will lead to more resistance. There must be several steps. In Parkway, staffing problem is an urgency in short-term, it must dealt with immediately. Physical demands and documentation problems will take time because the company still needs order new machine and invite experts to design specialized software systems, and then educate staff how to use it. About filling beds problem, the solution needs to be appropriate, the company has to be ready with the resources will need excellent quality service and strategy to welcome more patients.

5.0 Implementation

5.1 Hierarchy of Needs Theory

Maslow hypothesized that there are a hierarchy of five needs within every human being. The individual will try to meet the lower-lever needs before moving on to higher-level needs.

EXHIBIT 5-1-1 Maslow's Hierarchy of Needs

Source: Kevin (2008)

5.1.1 Physiological Needs

In Parkway nursing home, the first basic level that must be satisfied is that of wages. Niecey Wilson (one of Parkway's staff) said it was the best-paid job that she can get.

5.1.2 Safety Needs

When staff have met the basic survival needs (satisfied of wages), they seek safety on the job. This involves physical and mental safety. Physical safety is not good in here. Most of the time staff needs to do overtime work and take on more patients.

On the other hand, mental safety is also not assured in here. The physical pain, patients that are demanding, and schedule that is not flexible creates more stress.

Unhappy employees are less productive and more likely to have higher absent rates; on the other hand, increases in job satisfaction lead to increases in employee morale, which lead to increased employee productivity and customer retention.

If the Board of Directors of Parkway ignores this appearance, this must be jeopardizing the board's profit target and long-term expansion plan for the company. The directors must be taking care of staff health and mental needs.

Professional Training is also important in this level, whether new or senior staff. Company needs to provide vocational training to staff. The company should spend more time, money, and resources to making sure that they will have adequate training before they are given responsibilities on how to handle patients. By having a well trained staff the company can be assured of excellence and value with work.

5.1.3 Social Belonging Needs

The third level is seeking social belongingness in the workplace. Some people prefer emotional needs more than physiological needs.

Staff wants to have a pleasant working relationship with colleagues and they like to look for a status that fit themselves and feel comfortable. Everyone wants to become one of group member that they are interested.

5.1.4 Self-Esteem Needs

Staff hopes they can have the stable social status; they want their ability and achievements to be acknowledged by co-workers, peers, and others in the hierarchy. If company can do something about this demand, employees will have confidence in themselves and will be enthusiastic about their work. Company can go through the individual's successful performance appraisals, incentives, rewards received and recognitions obtained to enhance staff's self-confidence, and satisfy their self-esteem needs.

In fact, the staff thinks their perspectives are ignored by management, and their point of view gets lost. Therefore management needs to do some ways to hear their suggestions, try to let them feel welcome, wanted, respected and valued in company.

5.1.5 Self-actualization

This is the top level of needs. In this level, company needs to encourage staff to develop their potential, to learn new things, to take risks, and to feel even more confident in what one does. As the individual learns, and grows in the work environment Maslow suggests that, 'Duty becomes pleasure and pleasure is merged with duty' (2000, p. 25).

5.2 Creating a Leadership Strategy

The board of directors' wants to re-energize the workforce, and come through the change. There needs create a capable leadership to take the organization forward. The center for creative leadership has been studying leaders and leadership for nearly 40 years and has recently come to an important conclusion: Leadership begins with individuals in leadership positions, but it does not end there. The research showed it was a collective action by some leaders (formal or informal). A good leadership strategy needs to consider a lot of factors.


The Factors of Leadership Strategy

The quantity of leaders needed, as indicated by current and projected formal

leadership positions depicted on an organization chart (number, level, location,

function, business unit, reporting relationships, etc.)

The qualities desired in selection (demographics, diversity, background,

experience level)

C. The skills and behavior that are needed to implement the business strategy and

create the desired culture(skills, competencies, knowledge base)

The collective leadership capabilities of leaders acting together in groups and

across boundaries to implement strategies, solve problems, respond to threats,

adapt to change, support innovation, etc.

The desired leadership culture, including the leadership practices in use, such as

collaboration across boundaries, engagement of employees, accepting

responsibility for outcomes, creating opportunities for others to lead, developing

other leaders, learning how to learn, etc.

Source: The center for creative leadership, 2009.

When company wants to create a leadership strategy, they need to review the business strategy for implications for the new leadership requirements at first step. The driver of the strategy is the critical choices for leader how to give organization positioning that manipulate SWOT. For example, one of key driver of Parkway is becoming more customers-focused; hence before company create strategy, it must understand customer experience and the different needs of customers, and so on.

Next, the leadership strategy implication must be sure that the individual leader and the collective leadership of the organization are ready to carry out the foremost strategy about the key diver.

Ultimately, developing leadership strategy need to assess current leadership situation and compare to the desired future. The term of assessment and data collection is the most "heavy lifting" in this step.

5.3 Recommended leadership style

There are two contemporary leadership can apply in the Parkway: charismatic leadership and transformational leadership.

First, they must try to create charismatic leadership. Max Weber defined charisma (from the Greek for "gift") as "a certain quality of an individual personality, by virtue of which he or she is set apart from ordinary people and treated as endowed with supernatural, superhuman, or at least specifically exceptional powers or qualities." Moreover, they can try to influence employees by a four-step process.

Articulate a Vision


Create a Vision Statement


Create a mew set of Values


Demonstrate the Vision.

Next, the Board of Directors requires establishing transformational atmosphere in company. It will inspire employees to transcend their self-interests for the good of organization. They can provide vision and sense of mission further, while setting reasonable goals and fair salary and motivation system. Intellectual stimulation and individualized consideration are also important.

Finally, the Board of Directors needs to let employee trust company, and produce sense of attribution. In organizations, trust and attitudes are important for their behavioral component.

5.4 Leader Behaviors of Home Directors

As nursing home directors, they play a very significant role in order to achieve sustainable success. They should have several characteristic, for instance, can create vision and articulate it, can undertake personal risk, sensitivity and had unconventional behavior. Furthermore, they must have capability on planning the strategy of the company, and finding and creating effective leader.

Home directors should realize that the goal established under incentive plan will result to a better performance of employees and staff and can shape organization culture. Management should pay attention to the effective implementation which requires absolute and successful means of communication that includes scheduling employees and employers meeting to present and talk about incentive plan and how it will work. Meanwhile they need to develop a habit of openness towards feedback from others in order to grow further.

They should empower middle management to administrate daily routine to ensure employees produce superb service to the customers, the company must always give importance on their Human Resource Departments' significant role in the empowerment of their employees.

5.5 Leadership Strategy of Supervisors

As nurse supervisors, they need to know how to prioritize, have excellent time management skills and can do planning and delegate. They should take delight in training new staff and help others.

They need to have an in-depth understanding of human psycho-emotional dynamics as it undergoes aging. Fulfilling the duty in this field requires deep professional knowledge, passion and pro-active attitude towards the elderly. Recreation department, its functions and responsibilities are designed to prolong the life, foster the quality of life, physical and psycho-emotional well-being of the elderly residents. In the field of assisting and organizing in recreational activities it is very challenging and requires the combination of psychology, extreme patients, respect, professionalism and understanding in order to succeed in social service.

6.0 Job Stress in Parkway

6.1 Sources of Stress

In general, the source of job stress has three factors, environmental factors, organizational factors and personal Factors.


Sources of Stress

Environmental Factors

Economic uncertainties of the business cycle

Political uncertainties of political systems

Technological uncertainties of technical innovations

Organizational Factors

Task demands related to the job

Role demands of functioning in an organization

Interpersonal demands created by other employees

Personal Factors

Family and personal relationships

Economic problems from exceeding earning capacity

Personality problems arising from basic disposition

Source: Self-created

6.2 Actions Required

Inflexible workload is the major source of job stress in Parkway due to the fact that providing healthcare to the patients in such kind of scheduling would make the employees feel burn out and less motivated. Strict and unfriendly atmosphere also contributes to the job stress, plus the automation where their job objectives and schedules are strictly defined while not considering the human factor and level of stress associated with it. As it also aggravates numerous injuries incurred in serving the elderly patients caused by lack of enough manpower or assistance, training and necessary equipments.

The perception of being restricted and tight management system can be the very sources of job stress as employees have innate desire to work in a freer and friendly workplace. The organization must take away all the negative thoughts or ideas of the staff in order for them to have a stress free work environment.

Parkway must also implement management strategies that induce job satisfaction, sense of recognition, motivation and compassion in order to make its personnel to become superb in providing healthcare service to their patients. Aside from creating management policies that would make the personnel feel an organizational atmosphere that would make eliminate the feeling of discontent, pressure and burden in complying their duties and responsibilities as healthcare provider.

6.3 Stress Management Plan

Scientific Management by Frederick Taylor sees managers and employees are under an enforced standardization of methods, enforced adoption of the best implements and working conditions, and enforced cooperation that this faster work can be assured. And the duty of enforcing the adoption of standards and enforcing this cooperation rests with management alone. (Montgomery, 1989, p229).

In this theory the employees are supposed to be helpless of understanding to what they are doing in the organization even to the simplest task assign to them so it is the responsibility of the managers or the management itself to let its employees comprehend their task or functions in the organization. It also asserts the importance of time and motion as the quantitative means to measure workers performance. Management must "Detailed instruction and supervision of each worker in the performance of that worker's discrete task" (Kanigel, 1997, p.250).

Planning to reduce stress and fosters positive attitude, creativity, racial or ethnic tolerance, personal growth, workshops and seminars that improves skills on the company must be taken much consideration so that it would generate empowerment to the diverse employee to avoid stress. The process of learning how to best motivate employees is long but rewarding. And employee motivation is one of the greatest factors that influence the business ability to generate revenue, it's important to know how to motivate the people working for the company in the most effective way. Highly motivated employees enhance excellent performance and productivity wherein total customer satisfaction can be achieved and sustainable success for the company is realized.

The company must make their organization as a learning institution wherein it must focus on people development by investing on programs that enhances or develop competitive skills, professional growth, leadership programs, team building programs, and workshops designed to improve or empower the employees. Organizations who reached the epitome of success are always intertwined with strong ethical values. The said values are the very source of their core strength composed of people who have emotional and moral intelligence that work as a catalyst of their organization integrity, drive to succeed, and organizational harmony. So, Parkway must also imitate these organizational values. Consequently, in doing such strategy would create a very friendly organizational and workplace atmosphere that stimulate professional and interpersonal growth and make the personnel more service oriented.

The Parkway employees are the internal customers of Parkway wherein the management must find the ways and means to satisfy and motivate them in order to make the latter more effective in complying with their job objectives and attaining organizational goals to be more competitive.

7.0 Conclusion

As one of biggest in the southwestern United State, Parkway nursing care should to foster strengths and circumvent weaknesses, setting highest goals which employees will commit. Meanwhile, company need to establish a specialized crew management team and make a series of effective management policies and nursing training systems. In addition, they also need to cares employees life, enhance the cohesive affinity of the attributive feeling of employees and enterprise. Thereby, staff member can make the self-conscious value standard with the enterprise together; provide more superior service for the patients.

Company should realize that there are not effective for the short-term, it is important to make continuous efforts to ensure that change a solid place in organization's culture. Meanwhile, after a series of reform, there may suffering from short-term profit, but there is no doubt it would be better in long-term, in the future of Parkway.