New Hire Orientation Program at Nightingale Home Care Inc. has been designed to implement organizational challenges that are currently present in the local market. Due to internal struggles, turnover rates have been increasing and reducing the quality of service and patient outcomes. It is recommended that a transformational leader be selected and follow Kotter's organization change model to address the issues that are present. In the past two years, the organization has been experiencing increased turnover rates and losing key clinical staff members (RN's, PT's, and OT's). The competition within the home health community has also led to difficulty in recruiting experienced clinician. This trend has made the ability to maintain operational quality standards difficult and has reduced patient outcomes on a variety of key metrics. The organization has determined the key roles in the organization that the that a New Hire Orientation Project should address and a plan for implementing organizational change is detailed using Kotter's model.

Analysis

In order to fully scrutinize the fundamental reasons why the organization would be resistant to change, the staff's perspective must be fully understood along with the traditional change leadership. Any major changes can be scary for any member of an organization and people tend to not like uncertainty in regards to their future, and people can resist these changes in a variety of ways, including subconscious ways. One of the most important ways to address some obstacles can be mitigated is through effective communication.

The objectives of the strategic change are often communicated through a variety of channels so that they can be understood in full. However, if there is resistance to change then these messages can often be misconstrued or simply ignored. Therefore, fostering an effective communication strategy is a critical component of the strategic plan is a necessary ingredient and it must focus on the objections to change that might arise. Most changes can be successfully addressed with communication so that the staff is comfortable with need for organizational change.

Furthermore, being able to recruit a transformational leader to help initiate the project has also been identified as an advantageous idea because research has indicated that this can also serve as a critical success factor (Carter, Armenakis, Feild, & Mossholder, 2012). Transformational leadership has been called one of the most effective among the various theories of leadership (Judge & Bono, 2000). There have also been three factors regarding change that have been explored in health care organizations which include the level of agreement with the new strategy, leaders' actions, and the groups' general orientation towards change (Caldwell, Chatman, O'Reily, Ormiston, & Lapiz, 2008). These factors can predict the success of a strategic change and each of these factors can be designed before the strategic plan change is close to implementation.

It is recommended that a New Hire Orientation Project be implemented to address the challenges:

Reduce Costs

Increase Employee Retention

Increase Productivity

Improve Employee and Patient Outcomes

Produce Employee and Patient Satisfaction

Meets the Organization's Needs and Regulatory Requirements

Practices the Organization's Mission, Vision, and Values

New Hire Orientation Project is presented with many obstacles, both human and non-human. This activity focuses on the obstacles or challenges related to the nonhuman obstacles which are:

Budgetary Constraints -- Too expensive

Timelines and Deadline Constraints -- Takes too much time to implement

Technology Limitations and Constraints -- Difficult to implement to switch from Allscripts to a new EHR system.

The adoption of the new concepts, philosophies, and techniques does not happen quickly nor does it happen naturally but the effects of solid efforts, trial and error will the adoption of change succeed. It is key to identify this point and to make concerted efforts to develop and cultivate pertinent information that is accurate, understandable and to the point so to ensure the needed information influences the people who use it. A comprehensive range of skills are required to lead the effective management of this project and result in innovation and change. Strategies the organization will offer to keep qualified clinical staff:

1. Improved onboarding program

2. Continuing education and advancement in education such as earning BSN, MSN

3. Referral fee $1,000 given to the referral source and $1,500 to the newly hired employee. This will be given to both referral source and new employee in increments through the first year of hire.

4. Opportunities for advancements in both clinical and administrative areas of the organization

5. Comprehensive onboarding program with evaluations: 60 days, 90 days, and annually with up to 15% to 20% increase (annually) in salary.

Change Theory

The organization's has considered change theories such as Kurt Lewin's Change Management Model- Unfreeze, change, freeze. Another change model was selected...

Since the stakeholders are ultimately responsible for making the change, making a comprehensive effort to give them all the tools, motivation, and support they need to institute the change is sufficient to drive the change. Once the stakeholders are onboard with the change management plan, the implementation of the actual change is very easy (Green, 2007).
This model strives to overcome any behavioral challenges that are held by the stakeholders and effectively meet the needs of the changing environment. John Kotter and Dan Cohen identify "The Eight Stages of Successful Large Scale Change" in which leadership is an important aspect of change (Green, 2007). Leadership is one of the critical success factors and there are a variety of tools that leaders can use such as setting a vision.

Figure 1 - Kotter's Change Management Model (Klein, 2011)

There are many change models that can be followed to facilitate the organizational change and Kotter's eight step process is recommended as a guide to implementing the organizational change. An organized approach can not only help build a sense of urgency but can also facilitate the organizational change through its various stages (Shirey, 2011).

The eight steps in this model are:

1. Create and increase the urgency for change.

2. A team is built to work for the campaign on change

3. Create the vision for change.

4. Communicate the need for change.

5. Empower staff with the ability to change.

6. Create short-term goals.

7. Stay persistent.

8. Make the change permanent

Each of these models can be relevant to planning for different types of organizational changes and can be used as templates to that end. The Kotter's 8 Step Change Model can also be used in conjunction with other planning efforts. Since the model focuses on preparing the employees and stakeholders for change and not the actual change. The idea behind Kotter's model is that if you support and prepare the stakeholders and employees thoroughly then they are more likely to institute the change comprehensively, then the actual implementation of the change is relatively simple. This model can foster motivation from within the organization to make the proposed changes and employee satisfaction is a key metric in this situation. However, any organizational change can be used to design a change management plan can be designed for the proposed change.

Communication Plan

New Hire Orientation Program at Nightingale Home Care Inc. has determined that these are the organizational roles that need realignment with the new vision and support the project in regards to onboarding new members.

1. Administrator- leader that decides major issues and plans of the organization and makes certain they align with its mission, vision, values, and achieve goals. Involved in interviewing and hiring process, financial decisions. Sits on the board.

2. Director of Clinical Patient Services (DCPS)- managerial role in a healthcare environment. Demonstrated skills in administrative performance, including expertise in written/oral communication, supervision of staff, documentation requirements, service coordination and case management. Comprehensive knowledge of nursing practice, applicable rules and regulations and industry standards pertaining to home health care.

3. Clinical Nurse Manager- primary duties are evaluating the performance of staff nurses, providing feedback and mentoring, developing education programs, contributing to staff professional development, interviewing and hiring nurses and medical staff, developing departmental budgets, and maintaining inventory of medicines, equipment and supplies. Clinical nurse managers may also speak on behalf of their nursing staff when upper management is making decisions that affect the nursing unit. In this situation, clinical nurse managers serve as a representative and promote the best interests of their staff and the patients that they care for.

4. Operations Supervisor- responsible and assists with hiring, interviewing and onboarding process, manages quality assurance staff, documentation education to nurses and therapists, and social worker, assists IT with EHR system, upgrades, updates, changes, makes sure that the EHR follows Medicare and JCAHO regulations and requirements

5. Human Resources Manager- manages all hiring and firing issues, benefits, manages staff personnel records, billing insurances (medi-caid medi-care, HMOs and PPOs), manages staff medical records and updating personnel staff yearly. Assists with interview, hiring process.

Works Cited

Caldwell, D., Chatman, J., O'Reily, C., Ormiston, M., & Lapiz, M. (2008). Implementing strategic change in a health care system: The importance of leadership and change readiness. Health Care Management Review, 124-133.

Carter, M., Armenakis, A., Feild, H., & Mossholder, K. (2012). Transformational leadership, relationship quality, and…