Introduction

A static organisational environment potentially hinders not only organisational development but also development of individual professional practice. Therefore, periodic changes and improvements are constant can essential requirements for both organisations and professionals to survive and remain competitive in the modern, highly volatile global economy. On one hand, organisational changes and improvements have been shown to eliminate inefficiencies and redundancies while streamlining business processes (Lozano et al 2015, p. 206). On the other hand, however, such changes are often accompanied by negative consequences such as employee resistance, deteriorating work climates, high (and typically costly) employee turnover and failure to achieve organisational goals. This paper will take into cognisance that organisations are regularly challenged and informed by forces of change and continuous improvements and, with focus on nursing, consider the implications to healthcare organisations. It will further provide evidence-based rationale for a strategy for the organisations to grow and sustain progressive and contextually relevant improvements basing on Lewin’s theory of change.

Building the capacity of healthcare institutions to reflect global changes in systems and communities is a critical action area for addressing public health challenges in the modern world (Batras 2016, p. 232). At the 7th and 8th Global Conference on Health Promotion in, respectively, Nairobi, Kenya and Helsinki, Finland, the significance of creating sustainable institutional infrastructure, skills and capacity to effectively implement health development strategies was emphasised. The implication of the statements from the conferences on healthcare organisations is that a sophisticated understanding of the dynamics of organisational processes and organisational change are critical for the achievement of successful health promotional initiatives (Batras 2016, p. 231). However, while the organisational leadership and management might have such sophisticated understanding of the dynamics of organisational processes and change, implementing planned changes as informed by periodic internal and external forces or the need for continuous change presents significant challenges. While different researchers have different perspective of the challenges based on the industry in question, there is general consensus that there is need to clearly identify the targets of change and effectively strategise on the implementation process (Olins 2017, p. 69). The significance of this approach is that poorly managed organisational change will give rise to employee resistance and the organisation will not be able to seamlessly implement the much needed changes.

On one hand, change is acknowledged as a critical necessity for any organisation. On the other hand, it is also imperative to note that it requires adjustment not only from the organisation in terms of time and money but also from the human resources that must adjust to the changing workplace (Cullen et al 2014, p. 274). According to Bolton and Foxon (2015, p. 541), the employees must not only draw from their personal resource banks but also invest both physical and cognitive energy to adjust their behaviour, learn new skills and feel and think differently. Each of the organisational changes made with the objective of improving organisational performance has significant impacts that need to be managed, failure of which such changes might be counterproductive. The most sough-after changes include shifting to superior technical systems, implementing new/improved work schedules and moving to better benefit plans (Dawson & Andriopoulos 2014, p. 17). However, the cumulative impacts such changes have on employees affect the organisation in both positive and negative ways with regards to achieving organisational goals. Hayes (2014, p. 44) argues that the link between the employees’ perception of changes and how they impact on the organisation arises from the fact that human resources are the most significant resource in any organisation.

From the argument by Hayes (2014), it is evident that changes perceived by the employees as negative will further drain resources and make it more difficult for them and the organisation to implement and cope with them (the changes). An example is given by Manojlovich and Ketefian (2016, p. 104) of a new nursing leader who micromanages direct reports, effective decreasing the ability nurses had previously to make independent decisions. While this may be viewed as injurious to the nurses’ personal and professional development, it has more serious negative impacts on the organisation. In explanation, Berta et al (2015, p. 141) assert that such negative changes not only deplete the nurses’ energy but also add to stress since resources gained from the change do not match or offset the required resource investment. The ultimate consequence is that nurses will not draw job satisfaction from their work; rather, they will be exposed to the risk of burnout. Burnt-out nurses are not only a hazard to the objective of delivering optimised care to patients but also a risk to the reputation of the organisation and their own wellbeing. There is sufficient evidence showing that organisational change and job satisfaction are closely related. For instance, low job satisfaction among nurses is associated with an increase in workload after changes in job schedule and poor workplace relationships (Duncan et al 2016, p. 314).

From the foregoing, the most important consideration to be made before implementing organisation change is the concept of employee resistance. When employees resist change, the organisation cannot work towards achieving its common organisational goals. The explanation given is that when employees are unwilling to accept change or are not involved in the change process, it will most probably fail (Lozano et al 2015, p. 209). Therefore, for the organisation, it is imperative to note that employees will typically resist change because of their fear or uncertainties, which include the fear of being rendered redundant or having to assume additional responsibilities that they are either ill-equipped or ill-qualified to handle. The implication to the organisation is that some employees might sabotage the planned change while others may seek employment elsewhere (Cullen et al 2014, p. 276). While the conservative human nature seeks to maintain the status quo, it is imperative for the organisation to communicate the need and intended outcome of the planned change. Thus, the organisational leadership and management must acknowledge that employees are a critical stakeholder group and are concerned about how changes in the workplace affect them. Studies have shown that intentions to quit during organisational change are predicted by employees’ perceptions of decreased opportunities for promotions, poor or nonexistent communication and low-decision latitude (Dawson & Andriopoulos 2014, p. 93).

While all organisational changes are designed to improve operations, it is also imperative to note that poorly managed changes can achieve the opposite of what they were intended to (Berta et al 2015, p. 145). On the contrary, changes perceived by employees as positive increase their access to resources to carry out their roles. For example, Berta et al (2015, p. 145) note that a new knowledge management system will provide more autonomy to employees and save organisation time if provides them with greater and improved access to information. Positive changes effectively reduce stress among employees since the resources gained from such changes offset their (employees’) resource investment (Berta et al 2015, p. 145). It follows, therefore, that organisations must acknowledge all changes necessitate investment and cumulative costs of change must be recognised. It is imperative that the agents of change initiatives that fit within their organisational context by making sure that such initiatives accommodate the organisation’s needs. Therefore, for the healthcare institutions, this may mean the modification of aspects of the organisational context, either externally or internally, by health promotion practitioners in order to realise an optimal fit between health intervention goals and organisational goals (Batras et al 2016, p. 34).

Several evidence-based strategies can be used to enable organisations and professionals to grow and sustain progressive and contextually relevant improvements. However, the most critical aspect of such strategies is being sensitive to the impacts of change on human resources because they are the ones that ultimately determine organisational success (Olins 2017, p. 53). It has been noted that the conservative human nature seeks to maintain the status quo, which Lewin’s theory of change describes as the product of forces in the social environment responsible for the behaviour of individuals at any point in time (Bolton and Foxon 2015, p. 549). Change initiatives, therefore, must first destabilise the status quo and then implement the planned change before re-stabilising the environment. What this means for the organisation is that appropriate conditions must be created for the planned changes to occur sustainably through experimental group processes until the most appropriate and relevant fit is found. In healthcare organisations, it is possible to maximise effectiveness, efficiency and sustainability by incorporating organisational change as a key element of health promotion practice (Dawson & Andriopoulos 2014, p. 14).

Lewin’s theory of change has been shown by evidence to be a practical approach to implement organisational changes. According to (Dawson & Andriopoulos 2014, p. 18), changes are inadvertently short-lived in the wake of setbacks, hence the significance of Lewin’s theory of change in anticipating such setbacks. In the unfreezing stage, the organisational leadership and management will create dissatisfaction with the status quo. This can be achieved through benchmarking against other high-performing organisations and clearly communicating to the employees the potential benefits of the planned change as opposed to focusing on the potential negative of the process itself (Duncan et al 2016, p. 315). Then, the changing stage will involve implementing and trialing the change, which entails not only research and action but also learning. The actions in the moving stage necessarily involve the redesigning of roles, relationships and responsibilities, which are the most significant contributory factors towards employees’ resistance to change. However, the resistance can effectively be overcome through adequate training, up-skilling, removing resisters and promoting supporters. The final stage, refreezing, entails realigning organisational policies, practices, norms and culture such that the continuation of the implemented change is supported. That way, sustainability is achieved (Cullen et al 2014, p. 270).

According to Olins (2017, p. 41), the unfreezing stage of change implementation is the most significant yet the most challenging because it involves, on one hand, identifying wrong practices of the past and, on the other hand, unlearning such wrong practices. The rationale given for this argument is that most practices, whether right or wrong, are usually engrained in the organisational culture (Olins 2017, p. 42). However, employee acceptance is the most critical success indicator in the unfreezing stage, hence the need for the organisation to communicate the need and intended outcome of the planned change before embarking on the process. At this point, it is imperative to note that employees will be required to adapt to many other unforeseen changes beyond those the organisational leadership and management identified and planned for.

Therefore, any planned change must be prioritised, sequenced and coordinated throughout the organisation in order to minimise the cumulative cost of change to the human resources (Cullen et al 2014, p. 271). On one hand, the organisation must acknowledge that their human resources are neither universally resistant to change neither are higher levels of change uniformly perceived as negative. On the other hand, however, the leadership and management must understand the entire scope of change initiatives, which includes the unplanned changes that impact on employees and, ultimately, organisational performance (Dawson & Andriopoulos 2014). Therefore, it must be ensured that employees perceive change as positive in order to feel that such changes impact positively on their current resource pool. Open communication that provides room for feedback, as argued by Batras et al (2016, p. 34), is the most important way of ensuring that planned changes are perceived positively.

An inwards mindset has the potential to blind persons in positions of authority to the capabilities of their followers and subjects. Consequently, there is a tendency to dictate the way they work typically by using manipulation and coercion to “invite” them to change rather than allowing them to use their own intuition, initiative and creativity to contextualise the planned change. Olins (2017, p. 58) agrees with Batras et al (2016, p. 34) that employees feel appreciated when they are made part of the planning process and allowed to contribute their opinions. This way, they are more likely to accept, support and embrace the changes, which will work positively towards achieving organisational goals. A crucial starting point in this context would involve understanding the employees’ needs, objectives and challenges as opposed to simply telling them what they are required to do and the results they have to deliver in implementing the planned changes (Lozano et al 2015, p. 207). It is, therefore, imperative to describe to the employees what is going to happen, explain to them why the changes are necessary, allow their contributions by creating feedback paths and involve as many of them in as many ways as possible.

In conclusion, organisational change is a constant requirement that ensures entities remain relevant in the dynamic business world. On one hand, all changes are implemented to improve efficiency and effectiveness while reducing redundancies and wastefulness. However, there are both positive and negative implications for the organisation whenever such changes are planned and implemented. The most notable one is employee resistance, which potentially hinders the seamless implementation of the changes and the achievement of organisational goals. Lewin’s theory of change has been identified as the most appropriate model to implement organisational change, while communication is the most important aspect of the approach to implementing change.