- Introduction
To the casual observer or novices in management and leadership science, an organisation can only go as far as the vastness of financial and resources vault is. This kind of an untrained thought remains popular in the business, public, private and corporate sectors but is most responsible for inchoate strategies and organisational failure. This is because, no sooner is this thought bought than for organisational management and strategists wrongly surmise that the key to organisational or entrepreneurial success is having an immense pool of resources. However, the fact of the matter is contrary, since organisational success is a culmination of critical application of leadership and management skills and that the success of an organisation may rise or fall on the application of leadership and management. The downward surge of better placed organisations such as Enron underscores the extent to which the disregard for values enshrined in leadership and management can visit devastating effects on any firm or corporate entity, its size and revenue base notwithstanding. Again, the growth and progress of organisations from humble beginnings [miniature pool of finances, human resources and infrastructure] is a testament of the extent to which sound leadership and management go a long way to guarantee ultimate success and stability, ditto Mayo Clinics.
The extent to which leadership and management skills are important to an organisation is well understood in light of organisational change. The need for leadership and organisational change is appreciated in the fact that an organisation is at its most critical and fragile stage during the transitional stage, yet transition is totally unavoidable in organisational life. This is because, like any other form of change, organisational change is inevitable due to changes in the market, forces of demand and supply and government policies, employment and company laws and matters such as corporate social responsibility. This also means that leadership and management are equally indispensible values in organisational change, due to the need to manage or resist transition. In the event that a healthcare institution is intent on installing HER systems, it is obvious that there will be major organisational changes and this will automatically require the input of the management and leadership in the organisation. The veracity of the sacrosanct nature and importance of leadership and management in organisational change is to be best understood in the discourse which ensues forthwith.
- Background
With the breakthroughs in technology, specifically in the two related fields, healthcare services provision and information and technology (IT), there are measures that have been made to integrate healthcare services provision and IT modules. It is against this backdrop that most hospitals and healthcare services institutions have opted for the use of EHR, fully known as electronic health record. EHR is both a digitised and digital version of healthcare client or patient’s paper chart. HER records and platforms are patient-centered and time-specific records that avail information securely and readily to authorised users only. The import of this is that during treatment, admission, discharging or billing of the client, the patient’s information can easily and instantly be retrieved from the database. The same is also an advantage in that only authorised users are allowed access into EHR database. This means that cases of an individual’s information being leaked to a third party are totally eradicated, with the advent and use of EHR platform.
The advantages immediately above are guaranteed by the fact that EHR systems mainly occur in two formats: mobile applications and web portals. The existence of the two portals ensures that people [specifically authorised users] can access the target database through an array of channels, and at the user’s point of convenience. It is also worth noting that EHR is important in ensuring time-saving and the use of the least amount of energy. This is because EHR systems allow users to access their platforms from different channels and in varying contexts such as self-management programmes such as lifestyle illnesses such as diabetes.
While the gains that accompany the domestication and use of EHR in any given healthcare institution are more readily pronounced, it is given that organisational challenges sprout from the use of EHR platforms and technology. This tendency does not indicate an inherent lack on the side of EHR. On the contrary, these challenges may stem from the failure to accord the organisation sound leadership and management skills at the time of transition from manual recordkeeping to EHR system.
The crux of the matter at hand is that while the use of EHR may greatly benefit an organisation, yet an inchoate or hurried-through installation and adoption of the same platform can have far reaching impacts. It is against this backdrop that the need to tinker the installation of EHR digital platform with sound leadership and management strategies becomes indispensable. This is because sound leadership will help in determining the extent of the changes that should be ratified in the wake of implementing the EHR platform. This is because, it is leaders who are tasked with the responsibility of setting the goals, challenging the status quo and giving new directions to the rank and file of the organisation, at one end.
At the other end, it is the responsibility of managers to preserve the status quo. This task, managers do by managing the different teams in the organisation or different teams working on a given project, specialising on adherence to standard, managing individuals across boundaries that have been established and organising, directing and issuing directives that are needed to help in the attainment of a set task. The import of this is that even in the establishment and installation of EHR, it will be needful to have the organisation tamper the operations of the manager and leader so as to have a balanced approach in the ratification and installation of EHR. The absence of leadership during the installation of EHR will subject the organisation to stagnation, as there will also be a dearth in challenges on the status quo. The flipside to this is that the absence of managers will lead to an incompetent or inchoate implementation of changes and progressive policies. This is because it is managers who maintain status quo, in order to guaranteed stability and continuity.
- Methodology
The research paper is mainly considering secondary sources for use. The use of secondary sources is informed by the fact that they are readily accessible and cheaper to access. Primary sources of information in this case would demand laborious exercises and undertaking such as conducting interviews and questionnaires, fieldwork, travel, tabulation and compilation of the information received. These efforts would definitely consume a lot of time and require higher amounts of funding. The timeframe provided for the research study is too narrow to accommodate the gathering, interpretation, tabulation and compilation of the research information. The same also applies to the size of funding allocated for the study.
Given that the research study factors secondary [sources of] data, it is also in order that the research will also carry on biasness for qualitative data. The data being used will be more qualitative than quantitative, though quantitative data are also used to underscore points that are considered chief in the discussion.
The main sources of data for this research study are peer-reviewed journals. These are journal articles wherein a board of scholarly reviewers on a specific subject area reviews them same for adherence to editorial standards and quality of research, as a prerequisite for the acceptance of the research. This means that the materials being used as sources for the research study are of high quality by the virtue of having been vetted by field in a particular field, for both importance and quality. In view of this fact, it will still be important to state that the journal articles being used are strictly scholarly journals. Some of the scholars whose journal articles have been used include Hewitt, Chreim and Forster on the one hand and Hewitt and Chreim, on the other.
- Results
The study findings show clearly that patients are more satisfied and best treated when the administration of medical and healthcare attention is integrated with technological advancement, yet during the installation of technological provisions organisations are almost always accosted with intra-organisational tension and apprehension (over the fear of retrenchment), sabotage and non-cooperation. It is for this reason that calls for sound leadership and skilful are real in the quest to bring technological changes in any institution or establishment.
- Discussion
This section is of great importance in this study since it analyses the thoughts, theories and theoretical frameworks that have been put down and are thus relevant to the study.
The role of managers and leaders in organisational change:
Apart from the aforementioned factors, technological changes or advancements may compel an organisation to make far-reaching changes that may require restructuring of the scope of organisational operations, the organisation’s chain of command, flow of communication and organisational tradition and both long-term and short-term organisational strategies. In this regard, it is clear that irrespective of the change in organisational operations, leadership and management play a critical role in consolidating the interests, operations and continuity and stability of the organisation. The gravity of the matter is understood in light of the new to install a new EHR system in a hospital, as shall be seen in the study.
From the information provided, it is clear that there are measures that need to be made so as to ensure that leadership of change be structured to help facilitate acceptance and implementation of the new technology. One of the moves that leadership should engage to ensure an effective acceptance and implementation of EHR technology is by first understanding the role of the aforementioned strategy. The leader and the manager should also understand the number of employees who carry out the tasks that are commensurate with those of the EHR platform (Abramson, McGinnis & Kaushal, 2014, pp. 361 – 372).
In light of the foregoing, one can readily agree with Mills, Vavroch, Bahensky and Ward (2010, p. 1) in saying that it is needed that both the leader and the manager appreciate the extent to which EHR will usurp the duties and roles of employees in the organisation. From this point, the management should work hand in hand with the leaders of the organisation to ensure that the installation of EHR should be done in peace meals and in phases so as to stave off cases of massive job losses. At the same time, consultations should be made with the leadership of the organisation so that the need to stave off massive job losses does not relegate the organisation to the status quo, while the organisation’s competitors engage EHR at a break-neck pace.
According to Wu, Chen and Greenes (2009, pp. 71 – 82) and Otto and Nevo, (2013, pp. 165 – 182), it is therefore in order that the managers and leaders of the organisations hold spates of consultative meetings to settle on the phases in which EHR platform will be executed. It is in these meetings that concessions should be settled upon and determined and the timeframe in which the concessions will be executed determined. The departments, sections and specific offices and employees that are to be affected by the endorsement of the new technology should be determined.
In the course of this action, Amanda, Thorpe and Gavin (2008, pp. 730 – 736) point out that it is important for both the leadership and management of the organisation to determine the yardsticks that will be used to lay off employees who have been rendered redundant by EHR. In this light, the panel will determine factors such as: offices which have roles superimposed over the EHR platform and occupants of the office; alternative qualifications that occupants of the offices may have; and the urgency of the impending ratification and domestication of EHR platform, before the ratification of the chosen technology.
It is from the above development that the leadership and management should establish the manner in which the EHR platform is to be installed. According to Schreiber (2013, p. 14) and Tripp (2013, p. 28), this is important since, even in the ratification of the new platform, there will be a need to observe ethics so that there is an aspect of continuity and stability within the organisation. It will be important that the managers and leaders determine the number of offices that will be affected. The management and the leadership of the organisation will also determine the offices that will be merged or/ and made defunct because of being obsolete.
Just as is elaborated upon by Lorenzi, Kouroubali, Detmer and Bloomrosen (2009, pp. 15), this will need a restructuring of the healthcare services provision organisational hierarchy in order to ensure that even in the face of change, there are still structures that guarantee continuity and stability. The manner in which power flows hierarchically downwards to different offices is to be re-determined. The same applies to the flow of communication. Information is to flow from up downwards and vice versa, is directed by the arrow of organisational hierarchy.
According to Menaker (2009, p. 339), it is also important that the restructuring will also touch on the issuance of remunerations. Officers who will have been retained because of extra skills will have to be given a slight raise, since they are applying more skills to the organisations. Even in the face of the restructuring, it will be necessary that the organisation preserves skilled remnants who will maintain the database. McAdams (2005, p. 12) and Murphy (2011, pp. 25) state that the need for this measure is underpinned by the need for a separate hardcopy system which runs alongside the digitised and electronic EHR platform. This is because, it is always important to have a backup system that is the hardcopy, non-computerised database running alongside the computerised one; the EHR platform. In the event of collapse, high-level maintenance, infiltration or malfunction of the EHR platform or system, there can be a return to the hardcopy or hard files, albeit in a temporary manner.
Theories or Theoretical Frameworks Which Guide the Implementation of EHR Platform Vis-À-Vis Leadership and Management
It is a fact that even as leaders and management of the organisation come together to ensure the successful installation of EHR platform, theoretical frameworks and theories will still guide the same exercise.
In the first instance, McCullough, Zimmerman, Bell and Rodriguez (2015, pp. 20 – E28) contend that it is important to appreciate the fact that ethical and philosophical theories will crop up. This inevitability will be necessitated by the fact that human life is involved in the entire exercise. At the heart of the matter are medical or healthcare records which need to be fortified with greater degree of accessibility, privacy and reliability. Ludwick and Doucette (2009, pp. 22 – 31) elaborate that the records contain everything about the patient, including his financial capacity, the degree to which the client has met his financial obligations, personal details and updated information on the health of the patient. It is obvious that the ratification and use of EHR platform comes with serious ethical issues.
One other factor that underscores the reality of ethical issues and underpinnings of the implementation of EHR platform is the fact that they will be manned by human beings. Similarly, it is worth noting that the introduction and use of the EHR platform will be instrumental in edging out some of the employees out of the organisation. According to Ghazisaeedi, Mohammadzadeh & Safdari (2014, pp. 419), some of the employees who may be rendered redundant include clerks, data and file managers. It is therefore in order that the move to install EHR platform is underscored by the need to do so, to the most minimal amount of detriment (ditto, downsizing) to employees possible. The same is also to be done in such a way that the use of EHR platform does not infringe on the patient’s rights such as the right to privacy.
In light of the immediately foregoing, it is important to appreciate some of the ethical schools of thoughts and philosophies. DeFrancesco (2014, p. 186) specifically espouses utilitarian ideals when he contends that as long as the ratification of EHR platform in the organisation and healthcare sectors benefit the highest number of people, then it follows that there are no qualms or reservations that should follow the implementation of the same. In this case, leaders should not have reservations in installing the digital platform, in so far as the number of the beneficiaries will outnumber the number of those who were shortchanged by the installation of the EHR platform.
Wu, Chen and Greenes (2009, pp. 71 – 82) on the converse argue in favour of deontological philosophy. This argument, he propounds by arguing that as long as the implementation and installation of EHR platform is done within the confines of office duty, then there will be nothing amiss with the move. In this respect, there will be nothing wrong with move to install EHR platform even if it will cost many of their jobs. Given that the move will have been arrived at in decision-making, then it is legitimate to install and domesticate EHR platform, the number of losses registered at personal level, that notwithstanding.
Salim and Lipschultz (2015, p. 60) on the other hand espouse consequentialism by arguing that so long as the results of embracing the new technology will be positive, then there is nothing wrong with the proposed or the anticipated policy. This is because, the main concern is the stability and continuity and success of the organisation and matters such as downsizing may therefore be considered as being somewhat too peripheral to derail the steps that the organisation needs to take.
Nevertheless, from a personal standpoint, the presentation above is amiss because an organisation is the summation of a complex whole. It is therefore impossible for an organisation to remain effective as long as it disregards the welfare of employees. In any case, even if an organisation should get away with the consequentialist way of establishing the EHR platform, yet it will eventually have to contend with negative corporate or public image.
There are also those such as Fatih and Ahmet (2014, p. 155) and Gluskin, Mavinkurve and Varma (2014, p. 16) who contend that the domestication of EHR platform should be informed and underpinned by the values and ideals captured or enshrined in virtue ethics. In virtue ethics, the quality of an action or a character is the very determiner of what is moral and/or otherwise. This school of thought descends from Aristotelian ethics and is thought to be the very incarnation of Aristotelian and Nichomechean ethics. In this school of thought, the highest moral god or virtue is the possession of specific traits and characteristics at the time of implementing the EHR platform. From a personal standpoint, it is important that both the leadership and management of the healthcare services provider or organisation pay heed to virtue ethics, in lieu of restricting attention to utilitarianism and doing right or wrong out of the requirements of the law or duty.
This above is because, pegging the morality of an action to the highest number of people or beneficiaries can be wrong since world history is replete with cases where the majority have been wrong. It is also amiss or misleading to peg an action and its morality on the sense or guidance of duty and/or law simply because offices may have maladroit policies. The same may also be the case with laws. In fact, man ought to transcend the prescriptive limits of the law and seek the ultimate good in his quest for the right choice.
According to Chreim (2015, pp. 517-19), the import of leadership-as-practice and leadership perspectives in the ratification of new technological platforms cannot be sidestepped. To Chreim, attention should be accorded to members of leadership teams which traditionally happen to be two. The first leadership team relates to the acquired organisation, while the other, the organisation doing the acquisition. Both organisations and leadership divides are to work towards the integration of practices (such as the new digital EHR platform) in the attempt at integrating organisational practices and redefining and redistribution of leadership roles.
Chreim, et al (2010, pp. 187-199) continue that even in the face of the expectations towards the achievements of redistributed leadership, the new or emerging configurations that vary across organisations and comprise distributed leaderlessness, distributed leadership, non-distributed leadership and overlapping leadership. According to Chreim, the configurations have their underpinnings in relational practices, members’ framings, and the non-exercising or exercising role of the agency. Chreim proposes ideas of leadership surpluses and deficits, in light of the configurations of organisational management. He also explores the ambiguous gaps of leadership and how such gaps come about and how the gaps compound into how leadership models may vary in degree and in light of conflict tractability. According to Chreim, during transitioning, it is important that the gaps in distributed leadership are sealed to ward off excesses and anomalies such as superimposition of duties, duplication of roles and offices and incongruence in organisational communication and power flow.
In the article, Fix and Forget or Repair and Report: Tensions at the Front Line of Incident Reporting in Patient Safety, Hewitt and Chreim (2015, pp. 303-310) are categorical that in many instances, medical practitioners and administrators are faced with several problems that can be resolved pronto, in the event that competent leadership and management skills are ably integrated with technological advancements such as the EHR platform. Hewitt and Chreim contend that in most instances, when faced with technical problems, physicians and medical practitioners prefer fixing and forgetting.
According to DeVore and Figlioli (2010, pp. 664 – 667) and Reza, Marjan and Mohamad (2015, p. 102), this above is especially the case when the problems being faced are the ones the doctors deem fixable to them. These problems or situations include: handling cases with near misses simply because the physicians surmised that they are fixable without harming the patient; the prioritisation of the solving of the problems that accost the safety of the patients, even in the face of the fact that the problems are unique and one-time event; and the re-encountering of recurring problems which may have been categorised as routine and inevitable events.
According to Hewitt and Chreim (2015, pp. 303-310) and Eric, Menachemi and Thad (2006, pp. 106 – 112), it is through the effective and skilful integration of leadership and management skills in organisational leadership or management that the most effective and appropriate technological tool or platform can be identified and applied for the betterment of quality healthcare services provision. The import of the foregoing is that aside from the implementation of EHR platform, measures should be taken to have healthcare services find it easier to prioritise reporting, in the event that safety concerns arise and need fixing. Good leadership and management teams will appreciate the fact that fixing and forgetting problems of patient safety that have been encountered may not be as patient-centered as fixing and reporting. It is only through fixing and reporting that patient safety can best be enhanced.
In the peer-reviewed journal article titled, Transforming New Ideas into Practice: An Activity Based Perspective on the Institutionalization of Practices, Reay, Chreim, Golden-Biddle, Goodrick, Williams and Casebeer, Pablo and Hinings are of the persuasion that it is through sound leadership and management skills that there can be a development of activity-oriented process models that can facilitate the transformation of ideas into barefaced practice. This transformation can be achieved through the revival of attention to the sacrosanct nature of habitualisation as an important component of institutionalisation. In this argument, Reay, Chreim and others key on micro-level perspectives that can be used to learn and comprehend successive intra-organisational activities and processes as the avenue through which the aforementioned ideas are translated into newer workplace activities.
According to Reay, Chreim and others (2013, pp. 963-990), it is through sound leadership and management that efforts to transform the ideas and activities of the organisation are best carried out through interdisciplinary frameworks, and into new day-to-day practices that are to be exacted over a six-year timeframe. Reay, Chreim and others contend that it is through sound leadership and effective management skills that the policy makers of the organisation are to engage in the de-habitualisation and re-habitualisation of behaviours that organisational behaviour, culture and activities can be re-engineered to both macro and micro-levels. In this light, de-habitualisation and re-habitualisation of organisational behaviour should be included in the effort to introduce and install the EHR platform.
In the article, Role construction and boundaries in inter-professional primary health care teams: a qualitative study, MacNaughton, Chreim and Bourgeault (2013, p. 486) are of the persuasion that in the face of implementing radical measures such as installing the EHR platform, it is important that there be autonomy as a salient feature of inter-professional functioning of organisational teams. MacNaughton, Chreim and Bourgeault are convinced that even if the suggestion may seem counter-intuitive, it is key in empowering organisational team members and enhancing collaborative interactions. The same would be instrumental in averting power struggles which may ensue during the implementation stage since the roles that different professionals within the organisations are supposed to discharge will have been specialised and differentiated. The same will also help lessen the amount of work that is to be shouldered by every team member.
Again, Chreim, Janz and Dastmalchian in the peer-reviewed journal article, Change Agency in a Primary Health Care Context, are of the of the standpoint that what is needed to facilitate positive and transformational change that should ensure clinical improvement should be inclusive of operational leaders acting within the practices and auspices of the organisation and the vision for transformation. It is for this reason that before the installation of the EHR platform, there should be an active attempt by the management and leaders of the organisation to discuss and consult and form a consensus with the rank and file of the organisation. Any recourse to this approach will expose the organisation and its project to internal sabotage and division.
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