Ch13,

Burke: Because organization change and development practices in the early days of the field (19501960s) in the United States and United Kingdom were conducted predominantly in business-industrial organizations, the applicability of that earlier work may have established a strong precedence for how change efforts should be done. That precedence could be described as following the overall sequence of Lewins unfreeze, change, and refreeze, in general, and more particularly conducting attempts to support (a) more open communication regardless of level, (b) more employee involvement in the decision-making process, that is, including them in the decisions that directly affect their work, (c) increased teamwork, and (d) initiatives that provide vision and clear direction for the future.

Yet when considering the change cases reported in this chapter, all of them, whether in health care or government, quite appropriately used the thinking and practice of organization change and development from the past and from business-industrial organizations. So it would appear that the process of effective change that we have known and practiced for many years is applicable beyond business-industrial organizations. Possible modifications of this conclusion should be considered, depending on how loosely coupled the organization we are attempting to change.not necessarily whether the organization is in health care or government. The conclusion I am presenting, therefore, is that the process of change (i.e., how we bring about the change) should remain the same, but the what will differ. And that what concerns power and control. Besides conducting surveys, resolving conflict between groups and functions, team building, and so forth, our overriding goal in health care is likely to be focusing on the conflict between professional loyalty and allegiance to the organizations administrative requirements and helping those directly involved, doctors and nurses, deal with that conflict. In government the conflict we as change consultants need to help with is long-term versus short-term goals.

But what if our organization of interest is the U.S. Department of Veterans Affairs (VA)? It is both a health care and government organization. The VA is attempting a massive change due to incredible need. It has been a broken system for quite some time, and changing it for the better will take quite some time. The VA is (a) huge, with more than 300,000 employees nationwide (e.g., its the largest employer and trainer of clinical and counseling psychologists); (b) complex, providing most of the wide range of health care for U.S. veterans; and (c) bureaucratic, with layers upon layers of administration. The VA may be the most difficult organization on the planet to change.¹

1. In 2014 Congress passed the Veterans Access, Choice, and Accountability Act. A part of this legislation required that a study be conducted to assess the current capabilities, problems, and issues of the VA. The prime contractor conducting this study from mid-2014 through September 2015 was the Mitre Corporation. Because the study needed to be done comprehensively yet quickly, Mitre subcontracted with McKinsey, Grant Thornton, and the RAND Corporation to provide assistance and expertise. Mitre also established a blue-ribbon panel of independent experts to provide overall evaluation of the study. I was a member of that panel, and my information came from that oversight activity.

Change for the VA, which continues to the present, has been considered from practically every possible perspective and potentialcarve it into more manageable units, make it a private corporation, decentralize the structure, establish a more limited mission and give veterans more choice from the private sector regarding their health needs, and so on. In any case, and finally regarding change, it may be best to concentrate a change effort at this stage on one critical component of the VA instead of the entire system, such as the clinics (not the hospitals for now) that provide outpatient care. And not so incidentally, it may be that the head of the VA needs to be a physician, not a military general or admiral and not a former business executive. Respect from followers for their leader is no doubt linked to expertise in both health care and government. Whom followers give power to is of utmost importance.

Question: Chapter 13 discusses health care and government organizations. Choose one of the following statements that you most agree with and tell us why you picked that statement?

A. Burke should have expanded this chapter. B. Burke devoted just the right amount to covey his message about nonprofit organizations. C. While important to address, Burke could have provided the key points in less pages.