Month: February 2024

External scan: How digital change is addressed by leaders

Realities of managing and leading change in healthcare

In preparation for this assignment, I reflected on unit readings, the perspectives offered in the Voices of Leadership audio recordings, discussion in our synchronous sessions, what fellow learners have shared about leading and managing change, and my own experiences with change, past and present. Given that I work in the healthcare sector, I was interested to find the synthesis of theories and models offered by Antwi and Kale (2014). I found this reading reflected the pragmatic realities of leading and managing change in healthcare, specifically, the very slow speed at which change happens, and the high degree of decentralization in health organizations, which can make alignment of purpose and vision all the more challenging.

In the context of leading a digital learning initiative, I was really pleased to come across the audio interview of Christy Boyce, a Virtual Care Learning Consultant with the Fraser Health Authority. I agree with her comments about what the key drivers of adoption of a digital learning initiative are. She emphasizes keeping design as simple as possible to discourage steep learning curves and rejection by users. She also underscored digital literacy and competency among employees in the health care system. I found this point to be exceptionally relevant in my own context, as leading a digital learning initiative (when digital competency is low) has real consequences for even the best-resourced or managed plans. In this aspect, this signals to me that training and upskilling opportunities for employees have to be part of the planning and implementation of a digital learning initiative. Christy Boyce also references the ADKAR model of change management in her interview, and recommends that change initiatives have change management practices embedded early, rather than as an afterthought. This signalled to me a reminder that even though leading a digital learning initiative can be overshadowed by technology, the foundation of a change process still needs rigour and oversight.

The models and theories

In terms of the change models and theories, Antwi and Kale’s review of the literature summed up the most common elements that appear in healthcare change initiatives. These are: environmental circumstances, power dynamics, organizational harmony, organizational capacity, nature of change, and process of change. When I reviewed these elements, I could relate to my own experiences in healthcare. In particular, in recent years, when health human resource shortages have depleted organizational capacity in many ways, the appetite for change among employees can have significant influence on the success of a change initiative. Thus, any digital learning initiative in health must have some way to mitigate the change fatigue that is already high in our organizations. Further, in this same reading, I found the description of Lewin’s three-step model for change to be very salient in the context of introducing and sustaining a digital initiative in healthcare. This sector is not known for being particularly agile, nor does it embrace risk, for obvious reasons. Introducing change (especially when it involves disruption, learning new skills, and abandoning familiar practices), requires approaches that address group dynamics in order to gain momentum to start and sustain a change. I relate to this model, in the context of a digital learning initiative in healthcare.

What about the leaders?

As for the role of leaders in change, two articles, respectively, capture some key findings that reflect how I see the role of leaders in a digital learning initiative. Khan (2017) states that “adaptive leadership challenges beliefs, values, and norms” and that “it creates follower motivation”. These are key facets in leading any change, but especially in a digital learning context, a leader must have not only subject matter credibility, but also a skill with inspiring a vision that is attractive and inspirational. Similarly, O’Toole (2008) writes that in reviewing a number of historical leaders who have common and unique leadership characteristics, the attribute that is most salient is that their actions “are based on helping their followers realize their true needs”. These are the hallmarks of skilled leaders who understand the drivers – and sustainment – of change.

So much to choose from, and yet…

During this time I have been struck by how varied and diverse the approaches are to leading and managing change – reactive vs. proactive, top-down vs. bottom-up, taking into account user experience and feedback vs. non-negotiable directives from domain experts, and iterative approaches vs. waterfall methodology. It’s clear from the readings that change management and leadership theories abound in the literature. They are even written for specific contexts and sectors such as higher education and healthcare. Yet in our conversations in this course, we all seem to be able to offer at least one personal experience of living through (or even being responsible for) a work-related change that could have greatly benefitted from some change management methodology, and/or transformational leadership. I’m interested to see if by the end of the course, if any of us feel more confident about our own understanding and application of leading and managing change in a digital learning context – I hope so.

References:

Antwi, M., & Kale, M. (2014). Change management in healthcare: literature review. Monieson Centre for Business Research in Healthcare, Queen’s University, Ottawa, Ontario: Canadian Electronic Library.

Boyce, Christy. (n.d.). Voices of Leadership. Royal Roads University. https://malat-coursesite.royalroads.ca/lrnt525/schedule/voices/

Khan, N. (2017). Adaptive or transactional leadership in current higher education: A brief comparison. International Review of Research in Open and Distributed Learning, 18(3), 178-183.

O’Toole, J. (2008). Notes toward a definition of values-based leadership. The Journal of Values-Based Leadership, 1(1), 10.

Reflections on leadership

A boss has the title, a leader has the people.

Simon Sinek

The overall topic of leadership in digital learning environments is one that’s fascinating to me. There’s an endless number of books and papers that have been written about the topic, each trying to define, describe, instruct, inspire, and shape what leadership is. This topic is also personal to me. I have been on the receiving end of what I would describe as exceptionally horrible leadership and have wondered how people can become leaders without ostensibly any skill or knowledge of what it means to lead. Perhaps that’s part of what makes this topic so complex and worth ongoing inquiry and study. What or who defines good, effective leadership? Is there a common evaluation or threshold to meet? And is it possible that good leadership in one type of situation or environment would not succeed in another?

In our Unit 1 exercise where we ranked attributes of good leaders, I naturally gravitated to the lens of “What do I need in a leader in order for me to be successful?” This influenced the order of the attributes which I prioritized. For example, my top five attributes (from number five to number one), were fair-minded, inspiring, caring, dependable, and supportive. I see leadership as being fundamentally relational to other people. While it is true that managing or leading change often involves systems, resources, technology, and infrastructure, all of these building blocks of change require people to support an end outcome. And if a leader doesn’t earn the trust of people, and inspire a common vision, then the required systems for change have little chance of succeeding.

According to Latchem & Hanna (2001), “tomorrow’s leaders need to be capable of handling dynamic agendas of possibilities and see the future as discoverable rather than predictable” (p. 60). This is especially true of leading a digital learning initiative when those attempting to lead must conceive a vision that others don’t yet see, or believe in. Drawing on my own experiences working in the public sector, the best intentioned strategic plan almost always requires a certain amount of flexibility to adapt to changing, dynamic conditions. Thus, a leader working in a digital learning environment is constantly balancing loyalty to advancing a common vision, at the same time allowing for new information and situational context to influence their decisions and thinking.

To be a digital leader requires a particular lens and clarity on what one’s personal role is in setting a direction and vision, and also a self-awareness of barriers and challenges to inspiring that same vision in other people. In my sector, there is a high aversion to risk and a general cynicism when it comes to change. Therefore, before initiating change, it would be wise to have an awareness and some empathy to understand the root causes of this risk-aversion and resistance. In my organization, technology initiatives such as electronic health records, have unfortunately been documented to be mismanaged, poorly documented, lacking buy-in from staff, cumbersome, and inefficient. Therefore, those planning future digital initiatives can learn a lot from past experiences and make efforts to avoid similar outcomes. Unfortunately, because of high-profile examples of poorly managed digital initiatives in the public sector, those leading digital initiatives must attain a high degree of confidence in stakeholders in order to build positive momentum.

References:

Latchem, C. R., & Hanna, D. E. (Eds.). (2001). Leadership for 21st century learning: Global perspectives from educational innovators. Psychology Press.