There are 50 respite beds available within Fraser Health with an occupancy rate of 80%. The loss in dollars of unused resources is 20% of 50 which is 10 beds. At this rate the financial loss is 10 beds times 365 days per year which is a loss of 3650 days per year times the amount paid for each bed which is $130. The total loss per year is $475, 500 in the form of unused resources that are being paid for by Fraser Health.
Assuming an occupancy improvement by four beds multiplied by 365 days times $130 the improved flow will equal $189,800. Investment required is $167,200 and will not be discounted as it is an outflow now and not in the future. Assuming a 10% return on investment $189,800 x 0.909 equals $172,528.2. Present value of inflow in year one would be $172,528.2 minus initial investment which is $167,200 which leaves a net present value of investment as $5328.2.
The investment required is $167,200 and cash inflow recouping is sensitive to the rate of occupancy and the rate of cost of the bed. If occupancy rates drop lower than the current 80% even by less than one percent the investment will have been a poor investment as it would not have achieved the goal which is to improve occupancy above 80% (MFEP, 2007). The system will provide reports which will provide utilization of each bed by facility and geographical area thus decisions can be made regarding changes in increasing, decreasing or moving beds based on these reports to further improve occupancy. A change in the rate paid for beds is another variable which could impact cash flow, the assumption is the cost will go up not down.
The enhancement of the existing website by adding the respite information can support an improvement in the occupancy rates of the residential respite beds. The site already has the infrastructure in place thus there is no additional cost. The cost of taking photos of the 11 facilities with respite beds at the current rate of $160 per facility is $1760. The cost of staff time involved in the write up, editing and review of content is $95 times 10 hours which equals $950.
The total cost of the enhancement would be $2710. The site is already being maintained and thus there will be no additional costs. Due to the limited risk involved in this project a sensitivity analysis and assumptions regarding analysis will not be made. A change management plan is also not required for this change as the site exists and stakeholders are already aware and using the site, this will be an addition. The addition will be communicated via the website itself and via staff newsletters and email.
The quantitative business metric used to measure the performance of the process improvement is the occupancy rates of the respite beds. The benchmark used will be that used for all residential beds which is 99% occupancy. Return on investment will also be considered. Qualitative business indicators of success will also be measured via caregiver and employee satisfaction surveys that will be developed and conducted.
The project metrics used to measure project success will be the time, cost and technical performance. The project will be completed on time. The vendor will deliver the product on or before the target date. The training will be completed on time. Cost will be at or below the estimated cost. The software will meet design and performance specifications. A review of the project will be done with the executive sponsor to determine her satisfaction with the project. A review of the process will also be done with the project team to determine their satisfaction with the process (Bennigson, 1971).
Fraser Health has all of the hardware and most of the software required by both solutions. Use cases aid in system analysis and design processes by involving the end users early on in the process in a non-technical way, thus assuring success. Considering the impact of a solution on all stakeholders, evaluating and mitigating business and security risks are important steps in any project and have been considered in this project. A clear financial plan must be developed to determine the appropriateness of the investment and performance measured by the use of metrics, both have been covered.
Models and Theories of Change Review
In this section the following five models and theories of change will be discussed for validity and utility: The Generic Change Model; Lewin's Change Model; Kotter's Eight-Step Model; Bridges' Change Model; and Coghlan and McAuliffe's Model of Large System Change. The human implications of major organizational change, focusing on change that result from the implementation of new technology will be explained. The critical success factors for organizational change from the perspective of managing people will be analyzed. The human implications of the technological changes proposed in the 18 week project will be described, and how the five models and theories selected may be used to address the human implications identified.
Five Models or Theories of Change: Validity and Utility The Generic Change Model The Generic Change Model is proposed by Jay and Smith (1996) state it is vital to focus on change management when implementing a new information system. The model the two authors recommend is mapped onto a typical systems development life-cycle model. Jay and Smith (1996) state this model is the best one to use when change is related to implementing a new information system, as it provides managers with the essential steps required to ensure effective change management throughout the process. The model consists of the following four phases: orientation; preparation; implementation; and support.
The orientation stage is where an understanding of the motivation of change is searched for, and a change strategy is developed. The preparation stage involves analyzing the environment, announcing the change direction, developing a change work-plan, ensuring change readiness and providing a common direction. During the implementation phase; the computer system is being designed and developed, system testing occurs, procedures are developed, training takes place, and the system is rolled out.
The support phase is the last phase and includes stabilizing or reinforcing the change, evaluating the system's effectiveness and ensuring the new state remains permanent (Jay & Smith, 1996). This model is valid and useful for use in any technology initiative as it links with the Systems Development Life Cycle and provides change agents clear steps to follow to manage the human aspects of change.
Lewin's Change Model Levasseur (2001) recommends using Lewin's Change Model when introducing new technology. Levasseur (2001) states most failures when introducing new technology occur because of lack of effective communication and failure to involve stakeholders early in the process. He states this failure creates barriers that are difficult to overcome later in the change process. Following the first step of Lewin's Model helps minimize barriers to change and increase the chance of success (Levasseur, 2001). The second stage, the change stage needs continued support and teamwork to maintain momentum.
The third stage is the refreezing stage in which the change agent works with the appropriate stakeholders in the organization to install, test, debug, use, measure, and enhance the new system (Levasseur, 2001). The change agent needs to be involved until old behaviors are replaced with the new ones. The challenge with Lewin's model does not provide change agents detailed steps to follow however, the model is clear in terms of the major steps that must be followed for change to be successfully implemented (Levasseur, 2001). Lewin's Model is valid and useful as it takes into account the human implications of a change initiative.
Kotter's Eight-Step Model Kotter developed his model as a way of avoiding major errors in the change process after he learned that a majority of change efforts fail (Mento, Jones, & Dirndorfer, 2002). Kotter identified through his study of 100 companies, eight critical stages required for successful change management. The stages are: establishing a sense of urgency; forming a powerful guiding coalition; creating a vision; communicating the vision; empowering others to act on the vision; planning for and creating short-term wins; consolidating improvements and producing still more change; and institutionalizing new approaches (Kotter, 1998). Kotter believes that mismanaging any of the steps can undermine even a well conceived vision. Kotter's Model is valid and useful as it provides more detail on what steps change agents need to take to successfully manage change.
Bridges' Change Model Dulaney and Stanley (2005) used the three phases of the Bridges' Change Model, the ending, the neutral zone; and the new beginning, to bring about organizational change in their healthcare organization. The goal was to change the way in which addiction services were being provided thus requiring a change in staff behavior. The authors faced a number of challenges through the process but were successful in transitioning the staff to the new processes. Bridges' Change Model is a popular model when managing an individual's transitional journey, in this case it was also used successfully in organizational transition (Dulaney & Stanley).
Coghlan and McAuliffe Model of Large System Change The Coghlan and McAuliffe Model of Large System Change has been used in Ireland for healthcare reorganization (O'Shea, McAuliffe, & Wyness, 2007). Coghlan and McAuliffe according to O'Shea et al. believe health organizations are open systems and therefore, issues, events, forces, and incidents cannot be viewed in isolation but seen as interconnected, interdependent components of a complex entity when making change.
The model consists of the following five phases; determine the need for change, define the desired future state, assess the present in terms of the desired future to determine the changes to be made, implement the change and manage the transition, and consolidate and sustain change. O'Shea et al. in a retrospective analysis was able to show that this model was successfully used to re-organize regional orthopedic services in Ireland.