Internal and External Forces and Change

Within the business world, there are different theories of effective change implementation. The corporation this research focuses on is Duke University Children’s Hospital, which is highlighted in the textbook. The topic of the research paper will focus on the process of implementing change within the hospital. Implementing change within organizations is very relevant to this course. Not only is the course called Leading Organization Change, but the topics we have been focusing on revolve around methods of implementing change. With changes, organizations need to take steps to fully plan the change in order to ensure a smooth transition and acceptance (Spector, 2013).

Research will show how Duke University Children’s Hospital assessed the internal and external forces that impacted the change and how they assessed if the organization was ready for change.

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Also, research will show what model and strategies were used during the organizational change along with an analysis of whether resistance to the change occurred and if so, how it was dealt with.

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Finally, I will strategize how to handle leading group changes within a similar context.

Often times, financial crises spurs change in organizations. This was the case for Duke University Children’s Hospital. An assessment was made by the key administrators that showed how dire their financial situation truly was due to various reasons. This resulted in the pending elimination of programs and reduced services. Additionally, sales productivity had dramatically fallen as well as patient and staff satisfaction reaching its lowest point. These negative factors caused the hospital to make an assessment that they were ready for change. Change was the only thing that would keep their doors open to the public and Meliones knew that once people understood the situation more fully, change would be a goal on all of the staff’s minds. The first step Meliones took was to diagnose what the root causes of the financial crisis was with the staff (Spector, 2013). By creating a sense of urgency around the need for change to a wide variety of staff members, the change implementation process started out on the right path (Russell, 2013). One problem they immediately noticed was that each group of employees (accountants, administrators, clinicians, etc.) was working towards individual goals instead of understanding what the goals of the organization were.

This assessment of internal forces that could impact the change led the staff to understand that it was essential to create a sense of shared responsibility for the organization’s performance as well as changing the previous patterns of behavior. The hospital’s chief medical director, Jon Meliones, realized that these problems could not be addressed by the chief executive officer and chief operation officer alone. These problems needed the combined efforts of all administrators and clinicians in order to successfully come out of the negative place they found themselves in. Meliones, the chief nurse executive, and the nurse managers decided on a tactic that brought together the connection between financial performance and excellence of the health care provided to patients. Under their planned strategic renewal, both financial performance and excellent patient care would be dual focuses. During the shared diagnosis stage, the wide spectrum of employees was educated in the external forces their hospital was up against financially. They realized that because the external forces would most likely not change, changes needed to be made primarily internally (Spector, 2013).

Next, implementation moved to the pediatric intensive care unit. It was crucial that new behaviors became operationalized by the redesign of roles, relationships, and responsibilities. The team was able to redesign how every member (doctors, nurses, medical staff, accountants, etc.) would perform their tasks. This redesign was done alongside the members in order to get input. There was a decision to use the balanced scorecard measurement tool once they got to the stage where measurements could be utilized. This measurement tool utilized measurements of many things such as customer satisfaction, financial outcomes, processes of the business internally, and the learning/growing abilities of the organization. These measurements were done in hopes to aide in the reinforcement of all new behaviors that were expected. Because of these new tactics, within three years, the hospital began making a profit again (Spector, 2013).

What was crucial to the success of Meliones and his team was the sequence they chose to take during the intervention. First, Meliones kept the staff involved by facilitating a shared diagnosis process which helped find the root of the hospital’s financial issues. The process of unfreezing is important because this is when group members become dissatisfied with current performance or situations. Because Meliones used this approach instead of lecturing the employees on how to change, the employees were given the opportunity to learn and they felt more involved. This allowed the process of formulating an appropriate response to the issues be a group effort as opposed to Meliones coming up with a plan on his own that may have been resisted. The way to overcome defensiveness, when employees resist change, is to get broad-based participation. The shared diagnosis approach surfaced the connection between their financial performance versus behavior patterns and brought agreement among employees about what needs to change. Of course, Meliones could have chosen the approach of presenting to the employees all that was wrong and what the new plan would be, including the balanced scorecard.

This would have made the unfreezing stage nearly impossible to accomplish if this approach had been taken. Second, he formulated a cross-functional team made of many different positions. This team had a goal to decide the best way to provide excellent customer service for their patients as well as perform well financially. By using the approach of task alignment, Meliones spurred the organization to focus not only on how the staff could work better together, but a dual focus on excellent patient care and financial performance. It was crucial at this stage to get employees to understand how their roles must interact and rely on other roles within the hospital to be successful. This involved educating all employees about the organization as a whole to give everyone a broad perspective and understanding. Third, Meliones began implementing the changes needed specifically in the pediatric intensive care unit. Fourth, every unit member had a redesign of roles, relationships, and responsibilities. The last step involved using the balanced scorecard system to reinforce the new behaviors within the organization. This sequence was done for each unit within the organization and as a result, the hospital completely changed their downward trajectory within three years (Spector, 2013).

After seeing the success that Duke Children’s Hospital experienced in their strategies, I would take the same approach if I were expected to lead group change in a similar situation. Within the process of shared diagnosis, a shared commitment to the ideas and action plans is incredibly valuable. When people come together, they stimulate, motivate, and inspire each other to bring forward the best ideas (Fullan, 2001). By involving many employees in the process, the positive effect is that they naturally will have a clear understanding of how the necessary changes will actually benefit the organization (Nguyen, 2010).

Fullan, M. (2001). Leading in a culture of change (1st ed.). San Francisco, California: Jossey-Bass. Nguyen, S. (2010). Implementing change and overcoming resistance. Workplace Psychology. Retrieved from Russell, J. (2013). How to create change in the workplace. The Washington Post. Retrieved from Spector, B. (2013). Implementing organizational change (3rd ed.). Upper Saddle River, New Jersey: Prentice Hall.

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Internal and External Forces and Change. (2016, May 08). Retrieved from

Internal and External Forces and Change

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