30. Managing in a Changing System: VHA Managers’ Perceptions of Organizational Change
VA Parker, CHQOER; MP Charns, MDRC
Objectives: Since 1996, the VHA has been the target of a large-scale organizational change effort originated under Dr. Kizer’s leadership. Theory suggests that such change is difficult to effect, and may generate a great deal of activity without any real change in organizational processes. We sought to understand managers’ perceptions of the change process and specifically, to identify what managers perceived as the key developments indicating that enduring changes were actually being effected.
Methods: As part of the study plan, site visits were conducted to 10 VISNs in summer and fall 1999. Selection criteria included either a) VISNs that had not been visited since 1997 and were not aggressively implementing service line structures (5) or b) VISNS that were aggressively implementing clinical service line structures (5). 152 semi-structured interviews were conducted with individuals in specific management roles. Interviews were conducted by two researchers, one of whom took notes during the interview. Among the questions, respondents were asked to identify and describe any key developments, not just those relating to service lines, in their VISNs and/or facilities during the past year. Using a constant comparative coding process, responses to this question were coded into eight categories representing differing perceptions of important developments in the change process.
Results: Of the 135 responses available for analysis (17 respondents were not asked this question), 10 reported that there were either no key developments or only incremental changes during the previous year. Among the remaining interviews, seven categories of change developments (followed by examples) emerged through the coding process: changes in financial resources/budget processes and their effects (e.g. the decentralization of budget authority); changes in clinical care delivery (e.g.improved access through additional sites/services); external factors that impeded or accelerated internal change (e.g. preparation for NCQA network accreditation); changes in management practices (e.g. the use of performance measures); significant changes in managerial personnel (e.g. replacing of facility directors); changes in management structure (e.g. reorganization by clinical service lines); and aspects of the change process itself (e.g. the extent of resistance to change). Within each category, there were attributions of both positive and negative effects associated with a particular development. Details of each category and illustrative quotes will be presented.
Conclusions: The majority of respondents reported developments that provide tangible evidence of organizational change within the VHA system. The type of development reported varied, as did views of whether or not the change was an improvement over previous practice. The results suggest that the organizational change effort in VHA is in fact affecting the infrastructure for managing and delivering clinical care.
Impact: This detailed descriptive understanding of how managers in the VHA system have experienced the change process thus far can assist policy makers and senior managers in the VHA system in effectively designing continued organizational change efforts.