Applying change theories on the implementation of an ambulance despatch system

Applying change theories on the implementation of an ambulance despatch system 1. INTRODUCTION Change is inevitable and to enhance the efficiency of the services that a company offers, change is very necessary. The world is changing everyday. This is attributed to the advancement in technology, globalisation in addition to many other factors. There is an incentive for all business and economic institution to change in order to benefit from the advancement in information technology. This is one of the factors that motivated the Metropolitan Ambulance Service (MAS) in Melbourne to implement a state of the art emergency despatch and communication system in 1994. In the late 1980s, the MAS received criticism based on poor ambulance response times(Darren,2004).In an average day, MAS ambulances attends to more than 600 medical emergencies and are also involved in transporting around 400 patients(Darren, 2004). Therefore, the decision to improve previous system as a result of delays is acceptable and necessary to provide a timely, appropriate, and professional response to all calls f or emergency assistance (Darren, 2004). However, the underlying decision to implement this system and the strategies utilised to implement this information system affected the efficiency to deliver desired services. The new CEO, John Farmer, intended to change the way the MAS operated through the utilisation of computer technology in two areas: management of emergency calls and management of finances (Darren, 2004). This decision in conjunction with politics and other strategies were the catalyst for the failure to implement change in the MAS. This paper is set to analyse the case study written by Prof Darren Dalcher in 2004 (Emergency: Implementing an Ambulance Despatch System).The case study highlights the story of the problematic implementation of a computerised despatch system for the Metropolitan Ambulance Service (MAS) in Melbourne, Australia(Darren, 2004). The aim of this paper to analyse how information system implementation approaches, resistance theories and change theories such as Lewins Three Step Change Theor y, Lippits phases of change Theory and the Social Cognitive Theory can be applied to the case study to bring about necessary changes. 2.LITERATURE REVIEW The literature review is divided into 3 sections. The first section explains the four approaches designed for implementing I.T systems. The second section explains resistance theories. The third section explains change theories. 2.1 There are four approaches available for implementing an I.T information system. These approaches include 2.1.1 Plunge approach: The plunge approach means implementing a system in an urgent fashion, by ending the previous system at a particular day and starting the new system the next day. This approach minimises transition cost and operation cost. However, the plunge approach is risky and could easily lead to system failure. (Efraim Linda, 2010, p 533) 2.1.2 Parallel approach: The parallel approach means operating the old and the new system at the same time. Although the parallel approach is costly to operate, it is beneficial in the long run because major problems about the new system would have been identified and solved. If the new system fails, the old system acts as a backup for achieving the corporate goal. (Efraim Linda, 2010, p 533) 2.1.3 Pilot approach: The pilot system means operating the new system in another geographical area or a specific branch of the organisation in study. Conducting the pilot study to examine the impact of change will avoid unseen complications (Anderson,1985). 2.1.4 The phased approach: The phased approach is applicable to both parallel and plunge approach. It focuses on implementing every module or version of the system as it is developed and tested. Efraim Linda, 2010, p 533).The cost of application varies with the methodology. (Efraim Linda, 2010, p 533) 2.2 Resistance theories: 2.2.1 The people oriented theory: The people-oriented theory suggests that resistance to systems is created by factors internal to users as individuals or groups.( James, Waleed, and Gary (1999)). Gardner, Dukes and Discenza (1993) supports the notion that certain characteristics (e.g., age, gender) as well as varying background, value and belief systems contribute to an individuals attitude towards technology. 2.2.2 The system oriented theory The system-oriented theory posits that resistance is induced externally by factors inherent in the design of the system or the technology being used (James, Waleed, and Gary (1999).Such factors include user interface and other systems characteristics (e.g., realization of requirements, performance, reliability, and the degree of centralization, distribution, or decentralization)( James, Waleed, and Gary (1999). 2.2.3 The Interaction oriented theory: The interaction theory explains that systems acquire different political and social meaning in different settings and that different users perceive the effects of the same system differently ( James, Waleed, and Gary ,1999). Resistance may, for example, manifest itself as a result of shifting power relationships (James, Waleed, and Gary ,1999). 2.3The change theories 2.3.1 Kurt Lewins planned change: The Lewins planned change theory argues that planned change occurs by design where each and every process is planned. This is as opposed to spontaneous change or change by accident. The status quo is disrupted and results into some imbalance of forces. The two forces that are mostly present are the driving force and the restraining force. The driving force acts as a motivator in motion towards a positive direction or a goal that has been set. The restraining force opposes the movement towards a destined goal. When the opposing forces are overcome, another equilibrium position is reached (Bessie, 2003: p.167). The three phases that are identified include: unfreezing the status quo, attaining a new state (moving) and refreezing to make the change permanent. The first steps are informing stakeholders of the required change and agree on the importance of the change. According to Miller (1982) one of the most difficult tasks is getting people to accept a change. Change is challenging and the stakeholders or users may feel as if they have lost control of everything but it is important to encourage them. The individuals will then take time to implement the real change. This might take quite sometime but the process should be gradual. Freezing makes the process to stabilize and the process can now be implemented into the system. 2.3.2 Lippits Phases of Change Theory In Lippits Phases of Change Theory, an extension of the Lewins Change Theory is done. Seven steps are developed that focus more on the change agent than on the change itself. This involves exchange of information throughout the process. The change begins by a diagnosis of the problem and then checking the motivation that the change will bring and the capacity of the change to make a difference from the current situation. The change agent should also be examined so as to decide if the necessary capacity that is required is available (Alicia, 2004: p.1). The strategies that will be used to accomplish the change are chosen and each agent of change is assigned and alerted of the changes that are expected from his part. Experts and facilitators may be required at this stage and may be part of the change agents. The institution implementing the change should ensure that the change is maintained. This can be achieved by efficient communication, coordination and feedback on every activity th at takes place. When the change has been implemented and the employees have adopted the new culture, the change agent can now withdraw from the process. 2.3.3 Social cognitive theory: According to the social cognitive theory, individuals can change their behaviours depending on the environmental factors that surround them, the personal factors of the individuals and the attributes of the behaviour itself. The individuals must believe that they have the capacity to perform the new behaviour and they must also see the importance of adopting the new behaviour. If the individuals see the consequences of the behaviour to be positive, they will be willing to adopt the new behaviour and vice versa. This means that social learning will take place where the individuals can perceive the positive expectations to outdo the negative expectations (Alicia, 2004: p.1). If the individuals can visualize the positive benefits and see the importance of the change, they are likely to be motivated and to have more morale to carry out the changes in the behaviour. Self-efficacy is the most important aspect in this process and can be increased by: giving clear instructions that will allo w the change to be achieved, providing proper training that will enable the individuals to develop the skills required for the change to be achieved and trying to model the desired behaviour. 3. Analysis of the Case Study The MAS was established at the end of the nineteenth century. The aim was to offer emergency medical transport especially in transporting patients in critical conditions to hospitals as fast as possible. They offer first aid services to individuals that require the first aid services as they move them to places where they can be attended to. They provide first aid education to the public for free and in addition, they provide special facilities that can be used by individuals who require these special transport services in order to get to the hospital. In the late 1980s, MAS experienced intense criticism with the press analysing major events where the companys response to calls was very poor. The private sector had also tried to become very active and had started actively competing with the MAS. The financial status of the MAS had also been very poor. The service was recording losses every year. The relationship that existed between MAS management and the ambulance unions was not good. Many strikes, mistrust and tensions had always prevailed in the region and the media produced some articles on how the ambulance had been inadequate in dealing with some cases. In 1992, it was found that MAS was using some systems that were not integrated in terms of technology. As a result, the new government which was elected was concerned with the way the service was using the finances that the government had allocated to it. A review that was formed in 1992 to address the issue concluded that the MAS should restructure its management and structu re so that it could focus on improved technological systems so that the dispatch of ambulances could be strengthened. A John farmer was elected as the CEO and he wanted to use computer technology in managing emergency calls and in the management of finances. X-consultants were given the contract for providing the emergency system and were offered about $A32 million by the Victoria State Government. In 1994, the media produced records of delays by the company and the deaths that occurred as a result of those delays (Darren, 2004: p.1). The implementation strategy was flawed from the start because stakeholder had different objectives. The means the government was more focussed on reducing cost than employing the right agent for the project. The X-consultants agreed to an unrealistic timeframe in which to introduce the system (Darren, 2004). Implementation was scheduled to proceed in a Big Bang manner, with a switch over to the full system scheduled for 24 August 1995(Darren, 2004). The timeframe was obviously too short for the information system to be developed, tested and reviewed for further corrections. The fixed deadline imposed by the clients, without negotiation, became a major constraint on the project and proved to be a difficult hurdle for X-consultants (Darren, 2004). The CEO decided to use the plunge approach in implementing the new system in order to reduce cost. The methodology backfired and resulted into the failure of the new system. Other approaches such as parallel, pilot and phased approach should have been considered. Although these other approaches will not necessary minimise cost, the pace of the system implementation would have allowed for adjustment period to the new system (Zuboff, 1988). By May 1995, it became clear that X-consultants were unable to meet contract deadlines, while the media uncovered evidence of frequent system shut downs. (Darren, 2004). MAS officers began complaining to X-consultants and a heated row developed between the two organisations. (Darren, 2004).The obvious truth was that the ambulance union would have liked their members to do the despatching, rather than non-paramedic X-consultants civilians. (Darren 2004).This means the importance of the change has not been properly communicated. Resistance had developed within the organisation because MAS was not consulted about the need for change. The change was enacted by force instead by consultation from the stakeholders and users. The trade unions were ignored instead of been consulted to process change. The government and the CEO did not recognise the inability of sophisticated technology to overcome human and organisational issues(Darren, 2004). The government in conjunction with the CEO should have appropriate strategies to promote acceptance of the information system. They should have Involve employees in development of new systems to encourage a feeling of ownership (Mumford, 1979). Open lines of communication between employees and management should have been established (Land, 1992).The employees should be provided with information regarding system changes to preserve ownership (Jager, 1994). Morale-boosting activities should have been initiated, for example, company parties and newsletters, to promote community (Nord and Tucker, 1987). Standards could have been documented so new procedures are easy to learn and reference (Nord and Tucker, 1987). The CEO should have established in advance the demarcations of authority that will exist following changeover to clarify role definitions (Martinsons and Chong,1999). The CEO could have upgrade work environment following change e.g. more space and design for comfort, to improve atmosphere (Swanson, 1988). Job titles could have been altered to reflect increased responsibility to clarify job roles (Rivard, 1984). Show sympathy and be receptive to complaints following conversion to maintain user contact and trust ( Nord and Tucker,1987). Conduct orientation sessions to prepare for change (Rivard, 1984).Give job counselling to help users adjust (Holmes and Holmes, 1970). Organize group therapy to help users adjust (Hussain and Hussain, 1984). Retrain employees to be effective users of the new system (Aggarwal, 1998) According to Lewins planned theory, the first process that ought to have been discussed was if the change to privatise and outsource the emergency despatch system was necessary. If it was found to be necessary, the process of convincing the MAS of the importance of the change would begin. This would have taken sometime but at the end of the day, the individuals would have been convinced and would have embraced the need for change. The next process would have been identifying the driving forces and the restraining forces. When all these are identified, the goals that are destined are identified (Bessie, 2003: p.168). This will help in identifying the methods that will be used in achieving the corporate goals. The government together with the MAS could have sat down and negotiated on the requirements that would result in efficient distribution of the emergency services. Different companies that would have supplied the requirements would have been identified and the best one chosen. Th e barriers towards achieving these goals would also have been evaluated and ways of overcoming them designed. In unfreezing the status quo, the management together with some government officials will think of the specific areas that need change and these areas will eventually be destabilized. This will call for some processes that will involve the planned changes. The time that will be taken to establish the change may also be noted so that people may work and dedicate their efforts towards achieving the greater goal (Bessie, 2003: p.313). Much resistance should be expected as usual since some individuals will view the change as being stressful and may seem to lose focus. Reaching the equilibrium is not that easy and every member should be determined to make a change. This way, it will take less time to reach the destined goal. In dispatching the system, resistance is one of the expectations as individuals are not trained in working with computers and especially in the new software. The best training should be given to employees to ensure that they are confident in working with the new system. Appropriate software also ought to be developed so that there is no confusion in the software. The Lippits Phases of Change Theory could also have been used to address the issues that existed in the case study. Before taking any action, the government ought to have taken sometime to sit down with the MAS and see if there was a way that the problem could have been solved by making some changes. The first necessary process could have been diagnosing the problem and knowing why there were delays in releasing the ambulances that led to the death of many people. If a change was deemed fit for the process such as the proposed use of computers in call taking, the motivation and capacity for change could have been necessary before implementing it. Some agents like facilitators and experts could have been identified to help in the process of change. Determination of the capacity of the change agent to attain the required change is also necessary when using the Lippits Phases of Change Theory (Alicia, 2004: p.1). The power, stamina and commitment to change are important and therefore, the company should be very keen in selecting the change agents. The strategies that were to be used to help accomplish the change could have been identified and the change agents assigned the roles that they should play in the process. Proper communication between the change agents and the members of the company is necessary as it will allow the members to get the details about the change. 4. 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