Change Management


Change is an organizational process that will in most cases be met with resistance from various organizational stakeholders. Resistance or ambivalence to change is usually caused by the fear of the unknown, employees will resist change because they fear that the change may have negative implications to their working climate. For instance, in this case where a hospital seeks to move from a manual system to an electronic system, the employees may have ambivalence to change basing their fears on the idea that the automated system could lead to many tasks being done by machines, hence resulting into retrenchment of some of the employees. For change to be successful, various measures and controls must be put in place to foster effectiveness of the change process. For instance, organizations should use the force field analysis to establish forces for and against the change process so as to alleviate the forces against and strengthen the forces for the change process. This paper will carry out an in-depth analysis of the Cerner system and how an organization can effectively transition from a manual system to an electronic system.

History and current state of the Cerner System

Cerner system refers to an automation process where organizations transition from manual systems to electronic systems. The change involves organizations departing from paper work and embracing electronic health records. Cerner system was founded in 1979 and has developed through the years (Kullar, Goff, Schulz, Fox & Rose 2013). When it was founded, the Cerner system was concerned with development of Health Network Architecture (HNA) and integrated IT systems for automation of healthcare process, the system has developed significantly since its inception. In 1997, the HNA system was improved to Cerner millennium which is an architecture that incorporates all automation software in one package. Currently, the Cerner system includes products such as PowerChart and millennium e-booking (Kullar, Goff, Schulz, Fox & Rose 2013). To embrace the Cerner system, organization need to put in place the relevant controls that would make the change effective. For instance, there should be field analysis meant to increase the forces that support the transition and alleviate those against the change such as alleviating employees’ ambivalences and making them embrace the change (Appelbaum, Habashy, Malo & Shafiq 2012). The employees should also be trained on the use of the system so that they can operate effectively using the new system. Therefore, transitioning into the Cerner system should never be an abrupt process, but should be a step-by-step process if the transition is to be effective (Garvin 2012)

Kotter's eight steps of effective change management

The first step towards embracing a Cerner system should be creating a sense of urgency (Appelbaum, Habashy, Malo & Shafiq 2012). This step involves creating a scenario to make employees see the relevancy of the change process (Cummings & Worley 2014). At this step, the organization should carry out sensitization programs to inform the employees of the advantages that will be sustained as a result of embracing an electronic system of operations and the shortcomings of using the traditional manual systems. For instance one of the advantages of using electronic systems is that the possibility of human error is alleviated (Appelbaum, Habashy, Malo & Shafiq 2012). In this step, the hospital also needs to deal with the ambivalences that employees may have; the employees may feel that the electronic system is coming to replace them and hence may possess eminent resistance to the change process (Beischel & Davis 2014). The organization should indicate to the employees that the electronic system is meant to improve efficiency of the hospital as a whole and not retrenching any of the staff members. Creating a sense of urgency provides a platform from which the change process can take off, it makes all the organizational stakeholders see the need for change and makes the change process attract collective support from organizational stakeholders (Appelbaum, Habashy, Malo & Shafiq 2012).

After creating a sense of urgency, the second step in the change process should be building a guiding coalition which should as steers of the change process (Beischel & Davis 2014). Organizational change is a complex process which is hard to effect through individual effort; as such the change should be effected through collective effort that can only be achieved through creating a change team (Appelbaum, Habashy, Malo & Shafiq 2012). In the case of transitioning from a manual system to an electronic system, the change team should comprise individuals with know-how and experience in change management as well as experience in the operations of electronic health systems (Kullar, Goff, Schulz, Fox & Rose 2013). The guiding coalition acts as a catalyst to the change process because they set a framework which other employees are expected to follow for the change to be realized. Creating a change team increases the effectiveness of the change process as the different individuals in the team would contribute diverse ideas as to how the change can be actualized (Cummings & Worley 2014). In addition, having individuals with experience in Cerner system would create high chances of the change to be realized as the individuals would contribute important insights on how the Cerner system could be designed in order to provide maximum benefits to the organization (Appelbaum, Habashy, Malo & Shafiq 2012). Having a change team provides a more favorable environment for the change to be rolled out as it ensures that there is a wide pool of ideas that the organization can capitalize on to foster more effectiveness for the change process (Van de Ven & Sun 2011).

The third step in a quest to embracing Cerner system by a hospital should be the formation of future strategic visions and initiatives (Appelbaum, Habashy, Malo & Shafiq 2012). This step should involve the change team asking the question of where the change is likely to take the organization in the future. Setting a strategic vision sets out a blueprint in the change process (Beischel & Davis 2014). It creates increased fervor by the whole organization to change as it provides a clear picture of the benefits that are likely to be realized out of the Cerner systems (Farkas 2013). The formation of the strategic vision should be very realistic; the visions should not be too ambitious, but should also provide a challenge to the organization. Providing initiatives for the change also acts as a substantial driving force for the change process (Cummings & Worley 2014). The organization should provide initiatives that would offer mutual benefits both to the employees and the organization; for instance, offering free training on the use of the electronic system for the employees would serve as an encouragement to the employees to embrace the change process (Farkas 2013). Setting out future visions for the change process creates a commitment among all organizational stakeholders who will be affected by the change process to be more committed as there are precise goals and a timeline for achievement of the future prospects as a result of embracing the new system of operations (Appelbaum, Habashy, Malo & Shafiq 2012).

After setting the strategic vision and initiatives for the change process, the next step should be enlisting a volunteer army of people who are ready and willing to drive the change process (Appelbaum, Habashy, Malo & Shafiq 2012). This step involves selection of organizational stakeholders who express high interest in driving the change forward after realizing the feasibility of the change process. The army should comprise of individuals from all levels of the organization as well as external stakeholders who are affected by the organization’s operations (Farkas 2013). The army of volunteers would create an even greater possibility of the anticipated change to be realized. The volunteers provide an example to other organizational members who may still be stuck with ambivalences to change to join the change team (Beischel & Davis 2014). Also having an army of supporters cuts down to zero the chances change process being rejected. The fifth step in the quest to implement the Cerner system should be enabling action to realize the anticipated change by removing any imminent barriers (Garvin 2012). This step should involve creating an enabling environment for the change to be realized; at this step the organization should iron out any traces ambivalences to change that employees could still be having about the issue of embracing the electronic system (Cummings & Worley 2014). The step should also involve creating a platform for the electronic system rollover such as the acquisition of the relevant infrastructure to be used by the Cerner system (Appelbaum, Habashy, Malo & Shafiq 2012).

The sixth step of the change process should be the generation of short-term wins for the change implementation process (Appelbaum, Habashy, Malo & Shafiq 2012). Short-term wins provides an assessment of whether the change is taking a course to success or not. This step provides a platform for the evaluation of the change implementation process. Achievement of short-term wins provides an impetus towards achievement of long-term goals and the realization of change and changeability for the Cerner system (Garvin 2012). The seventh step for effective Cerner system rollover should be sustaining acceleration for effective implementation of the change process. This step should involve taking measures that would actualize the change such as the employment of professionals and train employees who will foster the realization of the vision for the change process (Farkas 2013). The last step should be institutionalization of the change; this involves making the change part and parcel of the organization such as establishing frameworks for future improvements to the system to avoid obsolescence (Appelbaum, Habashy, Malo & Shafiq 2012).

Force field analysis

For effective rollover from a manual system to the electronic system, the change team should also carry out a force field analysis about the change process (Beischel & Davis 2014). This process should involve establishing forces for and against the embrace of the Cerner system (Cummings & Worley 2014). The core purpose of carrying out the force field analysis should be to minimize the anti-change forces and strengthening the for-change process (Farkas 2013). For instance, some forces against implementation of the change would be the ambivalences that employees would have regarding the change; the change team should alleviate this force by reassuring the employees that the change would bring good rather than devastation (Farkas 2013). Alleviating the negative forces would lead to the strengthening of forces that support them change such as achieving more efficiency in the hospital operations that would lead to reduced costs of operation. Carrying out a force field analysis would play a significant role in ensuring effectiveness of the change process (Garvin 2012).

The change house model

For effective change from manual to an electronic system of operations, the hospital should also employ the change house model which would provide a picture of positions held by different stakeholders regarding implementation of the change process (Michie van Stralen & West 2011). The change team can then know which measures to take to align the positions for overall good of the organization. Some employees could resist the change on the basis of being contented with the current situation. The organization should carry out a campaign to change the views of such employees by indicating the significant benefits that would accrue from embracing the Cerner system as compared to the traditional manual system (Farkas 2013). Other employees could resist implementation of the Cerner system just in denial and defense of the existing status quo, the organization should be able to convince such employees that the change would improve the status quo and bring more returns both to the organization and the employees (Garvin 2012). On the other hand other employees would support the change arguing that it would bring renewal and reinvigorate their contributions to the organization; such employees should be encouraged by indicating to them the actual benefits that the systems change would bring to the collective organization (Garvin 2012). Lastly employees could be willing to accept the change but still have confusions about implications that could accrue from the change process; for such employees, the organization should carry out a campaign indicating the benefits that would be realized as a result of using the electronic system as compared to the manual system (Van de Ven & Sun 2011).


It is evident that changing from a manual system to an electronic system in hospital operations would not be a smooth process, the process would face hurdles such as some organizational stakeholders resisting the change as a result of the ambivalences they may have regarding the change. For this reason, the organization should apply different models of change to achieve smooth transition from the manual to the electronic system of operations. Incorporating different models of change would crucial in providing greater effectiveness in the change process. For instance, the Kotter's eight step model provides a step-by-step process that would lead to the eventual institutionalization of the change. The change house model would enable the organization to establish the different positions held by employees in regard to the change process and establish measures to align the different positions to the organization's goals. Moreover the force field model would provide forces for and against the change and as such enable the organization strengthen the forces for change and alleviate the forces against the change process.


Appelbaum, SH, Habashy, S, Malo, JL & Shafiq, H 2012, "Back to the future: revisiting Kotter's 1996 change model. Journal of Management Development, Vol. 31, no. 8, pp 764-782.

Beischel, KP & Davis, DS 2014, "A Time for Change: QSENizing the Curriculum." Nurse educator, Vol. 39, no. 2, pp 65-71.

Cummings, T & Worley C 2014, Organization development and change. Cengage Learning, USA. and sustaining a culture of assessment: best practices for change leadership." Reference services review, Vol. 41, no.1, pp 13-31.

Farkas, MG 2013, "Building

Garvin, DA 2012, "The processes of organization and management." Sloan management review, 39.

Kullar, R, Goff, DA, Schulz, LT, Fox, BC, & Rose, WE 2013, The epic challenge of optimizing antimicrobial stewardship: the role of electronic medical records and technology. Clinical infectious diseases, Vol. 57, no. 7, pp 1005-1013.

Michie, S, van Stralen, MM & West, R 2011, "The behaviour change wheel: a new method for characterising and designing behaviour change interventions." Implementation Science, Vol. 6, no. 1, pp 42.

Van de Ven, AH, & Sun, K 2011, "Breakdowns in implementing models of organization change. The Academy of Management Perspectives, Vol. 25, no. 3, pp 58-74.