Determine the major driving and restraining forces for change at Ambrose Health and strategies for dealing with these.


You have been appointed as the Director of Clinical Services at a large (600 bed) metropolitan hospital – Ambrose Health. You are younger than the previous incumbent, being only 30 years of age and better qualified, having just completed a Master of Health Service Management and enrolled in a doctoral program. Most of your experience has been in smaller hospitals outside the metropolitan area. The executive management team made it clear to you at interview that they were interested in effecting change throughout the Clinical Services Division, which is why they were seeking an external appointment to the position. In particular, they were seeking an individual who could establish a cohesive and productive working team.
Shortly after commencing in the position it becomes obvious that much of what is achieved is as a result of ‘who you know’. There are many instances when the usual communication channels or procedures are not followed because of ‘system failures’ which have never been brought to anyone’s attention. When running short of stock medications, for example, many nurses contact the nursing unit manager of the medical ward as she has a ‘contact’ in the pharmacy, rather than working through appropriate channels to correct the problem. Patients in the Coronary Care Unit are routinely admitted directly to the unit rather than through the Admissions Office because it is a slow and tedious process.
When you ask why these problems have never been addressed formally, the nursing unit manager of the medical ward tells you “It has always been this way. I am a very experienced health professional – I know the system and how to get around it to get what I need to do the job properly. I see no reason to change things when I think the system is working well.”

Questions to be answered (maximum of 750 words):
1. Propose three personal goals that will guide you in effecting change throughout the Clinical Services Division of Ambrose Health within the first six months.
2. Determine the major driving and restraining forces for change at Ambrose Health and strategies for dealing with these.
3. Determine relevant strategies for initiating change and methods of unfreezing and refreezing.
4. Propose how you would respond to the nursing unit manager of the medical ward who expressed the comments in the last paragraph – your exact words are required.
5. Predict your chance (as a percentage) of implementing successful change in this organisation in the next two years and justify why.
You have recently been appointed (in a voluntary capacity) to lead the medical services in a
volunteer organisation which provides first aid services at a range of sporting events. The position has been vacant for two years and perhaps as a consequence, medical staff numbers have fallen, there are very few policies to guide the volunteers and virtually all protocols have not been updated for over ten years. The director responsible for all volunteers is and has been running the organisation to suit his own needs, which at times are in conflict with accepted medical practice. The administration of drugs during cardiac arrest procedures by medical officers, for example, has been discouraged because lay members of the organisation are unable to participate in this activity. He has often described the medical staff as being ‘elitist’ and ‘arrogant’ and does not like it when they try to ‘bamboozle him with scientific information’. Despite being committed to assisting injured players at sporting events, morale is low amongst the medical staff volunteers who are now looking to you for leadership in this organisation.
The organisation is well established and hierarchical. There are over 2000 volunteers of whom less than 100 are medical staff and there are approximately 150 nurses. A range of commercial providers is increasingly competing for contracts that your organisation has traditionally held.
Questions to be answered (maximum of 750 words):
Determine the difficulties facing this organisation.




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