This document summarizes a presentation on organizational culture and change in healthcare facilities. It discusses how organizational culture influences staff and functions. It defines organizational culture and examines its effects. Change management is introduced as a systematic approach to managing transitions. Models of organizational change and people's reactions to change are presented. German healthcare systems and the influence of ownership type on organizational culture are reviewed. Success factors for change initiatives in healthcare like leadership, communication, and staff involvement are identified.

1. Wissen durch Praxis stärkt
Faculty 4: Health and Social Work
Slide 1 29 November 2018
Organisational Culture and Change
How the culture of an organisation
influences it´s staff and functions
Prof. Dr. Michaela Röber
Professor for nursing sciences and clinical care
Prof. Dr. Michaela Röber

2. Content
1. Organisational culture and change management
2. Organisational culture and Change in German health care facilities
3. People & Change in healthcare facilities: Success factors
4. Conclusion
Slide 2 Prof. Dr. Michaela Röber 29 November 2018

3. Content
1. Organisational culture and change management
2. Organisational culture and Change in German health care facilities
3. People & Change in healthcare facilities: Success factors
4. Conclusion
Slide 3 Prof. Dr. Michaela Röber 29 November 2018

4. Organisational culture
4 Prof. Dr. Michaela Röber 29 November 2018
Fundamental beliefs
(non-observable / unconscious /
emotional / based on experiences)
• Assumptions
• Perceptions
• Thoughts
• Feelings
Artefacts, Norms and values
(observable)
• Commitment towards staff and public
• Tradition
Source (picture): https://www.sinus-art.com/120x80cm-wasser-eisberg-natur-unterwasser, Stand 14.11.2018.

5. Effects of organisational culture
5 Prof. Dr. Michaela Röber
Goal orientation (compass
effect)
Anticipative problem solution
Smooth communication
Quick decision-making
Motivation and team spirit
Stability
Tendency to lock up
Tendency to inertia
Blocking new orientations
("we've always done that")
Collective defense attitude
Building emotional barriers
Lack of flexibility
29 November 2018

6. Change Management
• Systematic approach to dealing with a transition or transformation of an
organization's goals, processes or technologies
• Purpose: Implementation of strategies for effecting change, controlling change and
helping people to adapt to change
• Systematic approach for helping individuals impacted by "the change" be successful
by building support, addressing resistance and developing the required knowledge
and ability to implement the change (managing the people side of the change)
Slide 6 Prof. Dr. Michaela Röber 29 November 2018
?
Sources (pictures): https://www.westwingnow.de/rattan-stuhl-ko-lanta-59331.html, https://www.furnissimo.de/stuhl-patchwork-bunt-2er-set-sit4717-30, Stand 14.11.2018;

7. Spheres of influence for change
management
7 Prof. Dr. Michaela Röber 29 November 2018
Direct and indirect
sphere of influence
Source (picture): https://www.sinus-art.com/120x80cm-wasser-eisberg-natur-unterwasser, Stand 14.11.2018.

8. People´s reaction on change (1)
8 Prof. Dr. Michaela Röber 29 November 2018
Source: https://www.torbenrick.eu/blog/change-management/change-management-comic-strips, 16.10.2017.

9. People´s reaction on change (2)
9 Prof. Dr. Michaela Röber 29 November 2018
Source: In Anlehnung an Vahs, Dietmar, Organisation. Ein Lehr- und Managementbuch, 8. Aufl., 2012, S. 368, vgl. auch Streich, 1997, p. 243.
Shock
Surprise or shock
at the event
Denial
Disbelief, looking for evidence
that it isn´t true
Integration
Changes integrated a
renewed individual
Experiment
Initial engagement with
the new situation
Decision
Learning how to work
in the new situation;
feeling more positive
Frustration
Recognition that
things are different;
sometimes angry
Depression
Low mood; lacking in energy
Morale and
competence
Time
Information Communikation Training Coaching Mentoring

10. Content
1. Organisational culture and change management
2. Organisational culture and Change in German health care facilities
3. People & Change in healthcare facilities: Success factors
4. Conclusion
Slide 10 Prof. Dr. Michaela Röber 29 November 2018

11. • Multi-professional teams
• Expert-organization
• Job satisfaction
• Support for innovations
• Interfaces between healthcare sectors
• Collaboration / cooperation / mergers of health care institutions
 Many projects fail!
Importance of organisational culture
in healthcare?
11 Prof. Dr. Michaela Röber 29 November 2018

12. Germany and Hessia….
Slide 12 Prof. Dr. Michaela Röber 29 November 2018
Source: xxx.

13. 61
265
334
Komm.
Liga
Private
Outpatient nursing services in Germany
by ownership (example: Hessia)
Slide 13 Prof. Dr. Michaela Röber 29 November 2018
Source: Statistisches Bundesamt; 2015
33
815
265
1995 2015
9 %
40 %
61 %
3 %
23,8 %
73 %
660 services 1117 services
Non-profit
Public
Private

14. Number of patients of nursing services
in Germany (size and growth rate)
Slide 14 Prof. Dr. Michaela Röber 29 November 2018
Source: https://www.pflegemarkt.com/2017/02/27/anzahl-ambulante-pflegedienste-in-deutschland/, Stand 10.11.2018.
Growth rate in %Number of services
Size by number of clients

15. Organisational culture and ownership
in German healthcare facilities
15 Prof. Dr. Michaela Röber 29 November 2018
Public
Non-
Profit
Degree of risk taking
Degreeofstafforientation
Private
• Private owners due to their
livelihood market-oriented
• Non-profit owners ecclesiastic
and charitable (specific history
with other legal and statutory
framework)
• Public owners (cities, municipals,
federal states) focus on ensuring
regional healthcare
High
Low

16. Content
1. Organisational culture and change management
2. Organisational culture and Change in German health care facilities
3. People & Change in healthcare facilities: Success factors
4. Conclusion
Slide 16 Prof. Dr. Michaela Röber 29 November 2018

17. Stage Model of change
17 Prof. Dr. Michaela Röber 29 November 2018
Goal orientation / vision for change
Motivation to
start change
(Unfreezing)
Managing people
and change
(Move)
Making people live
with new framework
(Refreezing)
Quelle: In Anlehnung an Lauer, Thomas, Change Management, Grundlagen und Erfolgsfaktoren, 2. Aufl., S. 70 ff., (pictures): https://www.westwingnow.de/rattan-stuhl-ko-lanta-59331.html,
https://www.furnissimo.de/stuhl-patchwork-bunt-2er-set-sit4717-30, Stand 14.11.2018.

18. What is the history of our facility?
What is the way of making organisational decisions?
What is the staff´s reaction to organisational changes?
What factors are relevant in terms of rearranging the
organisation (e.g. patients, staff, strategy, technology,
level of digitization)
Does the staff have certain routines to bridge the gap
of organisational problems?
Change Management is very complex and
has to consider a variety of challenges…
18 Prof. Dr. Michaela Röber 29 November 2018

19. Means to overcome resistance
• Transparent Change Processes -> Information and Communication
• Participation of staff and Joint Decision Making (Better "Change" than “Beind
changed")
• Create confidence
• Create acceptance by taking small steps
• Stability and security / consideration of long-term work and social relations
• Support measures: e.g. qualification of the people affected through training and
coaching
• Creating "quick wins“
• Rapid stabilization of changes
19 Prof. Dr. Michaela Röber 29 November 2018

20. Selected success factors of change
20 Prof. Dr. Michaela Röber 29 November 2018
Cooperative
leadership
(nurses, doctors,
administration)
Joint
vision
Involvement
of all parties
affected
Communi-
cation
Re-
education
Project
organisation

21. Content
1. Organisational culture and change management
2. Organisational culture and Change in German health care facilities
3. People & Change in healthcare facilities: Success factors
4. Conclusion
Slide 21 Prof. Dr. Michaela Röber 29 November 2018

22. Consequences for change management
in healthcare
• Designing change and always is a huge challenge especially for healthcare
organisations
• Decision makers have to deal with change in addition to their everyday tasks
• Successful change = sum of systematic, targeted work and creative search for
possible solutions
22 Prof. Dr. Michaela Röber 29 November 2018
Creativity
Hard factors
• Strategy
• Organisation
• Systems
Soft factors
• People
• Organisational
culture
+/-=
Success of change

23. 23 Prof. Dr. Michaela Röber 29 November 2018
Source: https://me.me/i/lm-sure-glad-the-hole-isnt-in-our-end-none-19532380, Stand 14.11.2018.

24. Wissen durch Praxis stärkt
THANK YOU
for
YOUR ATTENTION…
Slide 24 29 November 2018Prof. Dr. Michaela Röber

25. 25
• Verbesserung der Pflegeinfrastruktur und Pflegequalität durch Markt
und Wettbewerb?
• Mit Einführung der Pflegeversicherung gesetzlich verankerte
Gleichstellung von gemeinnützigen und privat-gewerblichen Trägern
von Pflegeeinrichtungen
• Rechtsanspruch auf Abschluss von Versorgungsverträgen und damit
Zugang zum „Pflegemarkt“ unabhängig vom konkret vorliegenden
Bedarf.
• „…damit soll ein geschlossener Markt der zugelassenen
Einrichtungen verhindert, neuen innovativen Anbietern der Zugang
zum Pflegemarkt offen gehalten werden und der Wettbewerb unter
den Einrichtungen gefördert werden…“ (Deutscher Bundestag,
1993)
Prof. Dr. Michaela Röber 29 November 2018

26. Development of number of inpatient
home care units by ownership
Slide 26 Prof. Dr. Michaela Röber 29 November 2018
Source: Gesellschaft für Wirtschaftliche Strukturforschung (Hrsg.), Struktur des Pflegemarktes in Deutschland und Potentiale seiner Entwicklung. Kurzfassung der Studie im Auftrag des
Bundesministeriums für Wirtschaft und Energie, p. 8, https://www.gws-os.com/discussionpapers/Kurzfassung_ProjNr_019_16.pdf, Date: 06.11.2018..
Numberofhomecareunits
Estimation
Private PublicNonprofit