Managing CHANGE

Jean B. Ganub, RPh

There is nothing more difficult to take in hand

more perilous to conduct or more uncertain in the
success than to take the lead in the introduction of
a new order of things
—Niccolo Machievelli

Pharmacy Management: Essentials for all Practice Setting ⁕ Mc Graw Hill Professional
Scenario
The pharmacy manager, Dianne Watts, was away on long-term sick
leave. In her absence, Maureen Wright assumed duties as pharmacy
manager until Dianne’s return. Maureen, who is also a non-
pharmacist, has been a relief manager for several years. Within a
week of assuming duties, she announced several changes that she
intended to make. Shelving of bags dispensed medications was done
by healthcare assistants as and when time permitted, leaving time for
dispensers to do their work uninterrupted. Dispensers were made
responsible for shelving. Maureen instructed the responsible
pharmacist to perform six medicine use reviews (MURs) per week.
Waiting time, she said, was too high and she wanted that reduced by
25%. She set an arbitrary target for signing up patients for the repeat
dispensing service. There was no consultation on these matters with
anybody in the pharmacy. Because there was no employee
participation, the staff were extremely disappointed with the manner
in which the changes were introduced. When the staff protested, her
reply was: “Unless these changes are made, you’ll have to look
elsewhere for jobs.”
Definitions
Change: The process of effectively managing the
transformation of a business to improve the way it
works in order to meet the challenges imposed by
the organization and the external environment.
Change management: “The coordination of a
structured period of transition from situation A to
situation B in order to achieve lasting change within
an organisation” (Connelly, 2008).
Triggers
Changes may be triggered by a multitude of factors
both within and outside the organization. These
changes can be accomplished by
 Improving job design, skills, and responsibilities
 Having an innovative or broader range of products and
services
 Improving the infrastructure, such as buildings, factories,
and machinery
 Enhancing information technology
 Modifying and improving processes and procedures
 Reducing the cost of operations
 Enhancing the skill base
 Improving customer service
 Altering the organizational structure
History of Changes
During the past 200 years or so, the globally traditional
society has transformed into an industrial society. We have
taken for granted several changes that have taken place
during this period, such as

 Proliferation of factories
 Discovery of new medicines resulting in longer life
expectancy
 Better disease control
 Increase in global population
 Improved and new modes of communication
 Developments in information technology
Three components of change
Scope
-Changes occur at three levels: (1) organizational
level, (2) individual level, and (3) group level.
At the organizational level, changes affect working
conditions, job divisions, training and experience,
and hierarchical divisions
-Changes that affect job security, motivation,
challenges, and advancement opportunities occur at
the individual level. Group level changes affect the
norms, cohesiveness, role relationships, and
interpersonal relations.
Three components of change
Depth
-There are many ways to categorize change,
depending upon the extent of the change and
whether it is top down or bottom up.

-Three types of change are commonly described in

terms of the magnitude of intended change: (1)
developmental, (2) unplanned, and (3)
planned
Three components of change
Duration
-The time needed to accomplish the change
depends upon the scope and depth of the intended
change
-Short-duration changes require the utilization of much-
needed resources rapidly. Furthermore, the skill base may not
be adequate to accomplish the change. The level of resistance
among co-workers is highest with short-duration changes
-Intermediate-duration changes require months to
accomplish the goals. Upgrading dispensers to obtain
recognized qualifications requires months of hard work.
-Long-term changes have a higher risk of not achieving the
goals because of the complexity of the changes and the need
to tie up resources for long periods
Methods
 Structural
of Achieving change
-refers to the reorganization of the organization structure to maximize
efficiency and performance. This may also include mergers, acquisitions,
consolidation, and diversifying the operations.
 Cross Cutting

-When cost-cutting changes are implemented, nonessential activities are

eliminated. Layoffs usually occur. Rota may be rearranged to reduce
overtime. Pharmacists may be pressured by the management to reduce
waiting times.
 Process

-All business operations are reviewed with a view to reduce costs,

improve efficiency and reliability, and achieve faster operations. Standard
operating procedures (SOPs) may be reviewed to improve all dispensary
activities.
 Cultural

-These changes affect the human aspect of the organization and activities
between the management and the employees. It involves a shift from an
autocratic style of management to a participative style of management.
This is the most difficult change to achieve.
Resistance to Change
There are seven possible sources of resistance to
change (Longest, 1984).
 Insecurity and Fear
 Social Issues
 Economic Issues
 Stability
 Impact on Business Units Organization
 Inconvenience
 Unions
Overcoming resistance to
Change
Management issues:
 Encourage ownership by those affected by the change.
 Demonstrate total commitment to the project from top
management.
 Involve those affected by the change in decision making.
 Demonstrate empathy to those who oppose the change and
dispel their fears.
 Clarify all aspects of the change to prevent misinterpretation
and misunderstanding.
 Promote trust and confidence in the relationships among
individuals.
 Have a flexible approach to the change process and be
prepared to make amends as and when necessary.
Overcoming resistance to
Change
Issues relating to the change:
 Change should be perceived as reducing the current
problems.
 Change should not bring about a departure from currently
held values and ideals.
 Change should pose new challenges to the employees.
 Change should have the support of all individuals at all
levels.

People issues:
 Job security and employees’ autonomy should not be
threatened by the intended change.
Why Change Management Fails
 No sense of urgency
 Not establishing a guiding coalition.
 Lack of vision.
 Lack of communication.
 Not removing the obstacles.
 Not creating short-term wins.
 Celebrating success too soon.
 Not integrating the change into the corporate culture
Revisiting Scenario
 Maureen’s management of changes is obviously
flawed. The proposed changes have not been
discussed with the responsible pharmacist or the
dispensers, who could make a valuable
contribution to the proposed changes. Arbitrary
targets have been set without consultation. Her
threatening behavior has made the situation
worse. A recommended plan to reduce waiting
times is shown in Table 1
 Changes made without the participation of those
affected by the change are ineffective and
temporary. If the targets are unrealistic, a state of
confusion will prevail in the workplace.