Implementation of a System of Improvements in the Management of Changes in Healthcare Facilities - Barrier Analysis

In the current economic situation, healthcare facilities pay
special attention to the environment and its signals...


Introduction
In the current economic situation, healthcare facilities pay special attention to the environment and its signals. They are forced to constantly learn and systematically and quickly act to meet the challenges of public health [1]. Overestimating the resources of innovations is a condition of functioning and development in conditions of increasing health problems [2]. Organizational factors, i.e. human capital. What's more, the role of the latter factors increases significantly in the age of the knowledge-based economy, in which the focus on building enterprise value has been directed at the intangible sources of creating enterprise value, from human capital as the main component. Therefore, an increasing group of researchers is focusing on human aspects of stimulating change, also highlighting the importance strategies, practices and procedures in their creation [6][7][8]. An important role in this process is played by the personnel function, commitment of leaders, flexible structures enabling quick redirection of time to innovative activities.
Supporting innovation based on personal practices may include the following activities [9]:  Employees submitted many ideas, but they were not rated well by the Board, because they were not professionally prepared in the form of projects. As a result, no winner was selected, and employees felt "cheated" because the ideas were thrown in the trash. From that moment the competition was not repeated [...] ".
The change gives employees fears, resistance, a sense of uncertainty, raises threats that are the basis of substantive and emotional conflicts [12]. Resistance is widespread and unavoidable.
It appears primarily when changes are introduced without the participation of the persons they concern. Limit resistance may consist of influencing its causes or supporting attitudes conducive to change. These include communication aimed at education and reducing uncertainty, learning and understanding the causes resistance and giving support, engaging employees in work, consulting and taking their opinions into account.It is also worth considering that in every social system, which is the organization of healthcare, there will be different attitudes towards change.
Identifying the so-called change agents and opponents. Opponents Change agents are people who see problems and are able to convince the group to fight them. R. Luecke [13] points out that: 1) Change agents are (not necessarily formal) leaders thanks to their own ideas, 2) They can "think differently" and thus may be disliked by management, 3) Often have extraordinary experience, so they can see the world through a different lens.
B. Spector [14] indicates that the leverage that gives you the chance to achieve your progress is employee involvement. Schaufeli, et al. [15] note that commitment is a positive, work-related state of

Research Methodology
The aim of the study was to identify factors that would motivate hospital staff to report improvements and increase their commitment to work. To this end, it was also necessary to identify barriers to such behavior in the organization. Conducted research coincided with the conducted hospital changes that aimed to increase activity and employee involvement, with particular emphasis on medical workers.The selection criterion was therefore purposeful. The research was conducted in the third quarter of 2019 using the survey method and partially structured interview.
The survey questionnaire used for the research was created as part of the grant research conducted by the author. 106 respondents participated in this part of the survey (56% women and 44% men.
50% of respondents medical professionals, 26% -specialists, 5% -managers, 19% -administrative employees. The research was supplemented with a series of interviews with specialist doctors (11 people) and nurses (12 people) -mainly ward nurses. In interviews it took participation of 5 women and 6 men.The interviews were recorded with the consent of the participants. In the further part of the research, the interviews were transcribed as well as data analysis and conclusions were drawn.

Results Obtained in Quantitative Research
Based on the results of the research, it can be assumed that the

Results Obtained Based on Interviews with Medical Workers
The study identifies seven barriers to changes (kaizens) by medical staff: Restrictions Resulting from Employee Beliefs: Employees are not sure of the value of their ideas (n = 9). They think that these are small things that improve work, have no value for the organization.
They often improve their work and use this improvement, but they do not perceive this solution something that could be introduced on a larger scale: "we are not sure. We can ask the man who made this it occupies. Clear evaluation criteria could be useful. " In addition, employees emphasize that it is much easier to make improvements for themselves, even sharing the proposed change, than to fill in the laborious documents necessary for formal notification of a change: "I am very pleased with the facilities I have introduced. I have more time; I can do the rest of the job more properly. This makes work easier. Everyone watches over their norms".They emphasize (n = 4) that some of the improvements concern the style of work and do not have to answer everyone, fearing that one of the colleagues may be forced to change the way they work as a result of submitting their idea.
Failure to Notice Benefits for Themselves, or Even Fear of an Increased Number of Duties:Several employees claim that they initially submitted ideas, but many of them withdrew because it is labor-intensive and the salary for ideas is small. In addition, there is a high probability that reporting the improvement will result in increased obligations. It happened that the employee who reported the improvement, he became the object of retaliation of his colleagues, including "why should we do such harm, we have introduced improvements and we have increased the amount of work." Employees emphasize that "ideas are implemented, but they do not work on the person who invented them".    Also, the scale of participation in preparing changes is small ( Figure   3).

Opinions on Changes After Introducing Them
The functioning of the changes after their introduction, otherwise known as their "freezing" is also a stage requiring special diligence and regularity in observing its course. It should be remembered that the process of changes in the examined health care organizations was initiated in order to improve their economic and organizational condition. Opinions about these changes turned out to be critical.

Perception of Depth of Changes
Research results indicate that the scope of implemented changes in the organization in the perception of their participants turned out to be diverse. Also, their depth was not assessed equally.
For 34% of respondents, the changes carried out so far are of little importance, slightly less -30% of respondents believe that the changes were only apparent, not insignificant. Only 27% of respondents assess changes as appropriate. In turn, only 9% of respondents assess that the changes were profound (Figure 4). In turn, in the management's assessment, an identical percentage distribution of responses appears for the statement that the changes are apparent (27.7%) and that they are deep (27.7%) - Table 1. Administrative staff are the most critical towards changes.
People from this occupational flu more often than representatives of other groups believe that the changes are not significant or apparent (89.6% of responses). Nurses are also critical of the changes. However, doctors more often emphasize that the changes are apparent (37.0%). None of the people in this professional category assessed the changes as appropriate (Table 1).   Table   2).

Assessment of People Introducing Changes
Opinions on those introducing changes are clearly oriented towards negative assessment. Over 40% of the respondents gave a negative assessment to these people. In contrast, 42% decided not to speak on this subject.
Only 15% of respondents indicate confidence in change managers. This is particularly worrying, because it depends on them to a large extent whether the changes will be accepted and whether the participants of the change will want to be actively involved in their implementation.Lack of trust in people who introduce changes and "escape" from the answer can be seen also in the case of analyzing the opinions of respondents in terms of seniority in healthcare organization ( Table 3). The analysis shows a lack of trust, most often people with 11 to 20 years of experience express this opinion and over 30 years of service. In addition, people with more than 30 years of experience ignore the possibility of answering: small and high confidence in those introducing changes.
It should also be emphasized that in the opinion of more than