Organizational and Change Theory

Organizationaland Change Theory

Organizationaland Change Theory

Emergencydepartment (ED) is critical for patients with chronic illnesses.However, its effectiveness depends on the type of triage process thatis used to identify the clients who need immediate care. Adoptingreforms that can enhance efficiency in service delivery in the ED canreduce the waiting time. This paper will provide the analysis ofchange in the hospital’s triage process and make suggestions thatcould facilitate effective reforms.

Organizationand Change Management: Reforms on the Triage Process

Arecent adjustment in the patient triage practices in the ED wasmanaged effectively by applying the Lewis theory of changemanagement. The process of managing the entire process of changeoccurred in three stages. During the first stage, unfreezing, thedepartment prepared the stakeholders for the anticipated change. TheED communicated to the workers about the key factors (such as thelack of efficiency in prioritizing emergency cases) that created theneed for a change in the triage practices. Prior to the new changes,the ED technician was given the responsibility of assessing patientsand giving them immediate placement. The technician sent patients forimmediate placement to the nurse for medical screening examination(MSE) that took 12-18 minutes. Patients were then sent to theregistration clerk, back to the waiting room, to the second nurse,and finally to the physician. Non-critical clients experienced a lotof delays.

Afterconvincing the stakeholders about the need to change the ineffectivetriage process, ED went into the second phase of the actualimplementation of reforms. ED informed the stakeholders (includingthe health care providers) about the potential benefits of the newtriage process in order to enlist their support and shorten thechange curve. One of the key changes that ED adopted include thephysical rearrangement of the facility, where the triage nurse andthe clerk were placed closer in order to ensure that initialassessment and registration of patients occur simultaneously. Inaddition, the new triage process allowed the nurse to perform apartial registration for patients with emergency cases, where fullregistration could be done after seeing the physician.

Inthe last stage of change management, ED focused in entrenching thenew triage system and making it part of the department’s culture.This phase, which is known as refreezing under the Lewin’s theory,involved the development of a new flowchart and floor plan. Thepurpose of the refreezing stage was to help the ED institutionalizingand internalize the new reforms. Currently, health care providers andpatients are in the process of developing the sense of stability inorder to adapt to the new reforms on triage process.

Makingthe Change More Effective

Theuse of chaos theory can ensure that the changes implemented in thetriage process are effective. The chaos theory holds that anorganization is made up of a system that is non-linear in terms ofexistence and design (Cordon, 2013). There are two factors that canenhance the effectiveness of the ongoing changes. First, a high levelof engagement of all stakeholders in the process of planning as wellas implementation of the change will reduce resistance (Markos &ampSridevi, 2010). For example, the staff at the ED should engage themembers of staff from other departments, especially those that workin collaboration with the emergency department. Based on theperspective of the chaos theory, the organization is non-linear whichimplies that a decision made by one department will affect otherunits (Markos &amp Sridevi, 2010). Apart from reducing the risk ofresistance from the members of staff who are expected to implementreforms, the process of engagement will establish the connectionbetween change and the people. This is because people who take partin the process of establishing a plan for change develop the sense ofownership, which makes them feel as part of the change.

Secondly,the ED should develop a monitoring and evaluation plan in order toassess the effectiveness of the changes and facilitate continuousreforms. Chaos theory holds that an organization can never attain alasting change (Cordon, 2013). This implies that ED should embark onthe process of reforms from time-to-time, instead of refreezing thedepartment. The processes of monitoring and evaluation facilitate theidentification of areas that require some adjustments (Tache, 2011).The reforms made in triage process should not be considered as theend, but the ED should take them as the means to an end. The EDshould continue screening the triage process and adjust the system assoon as the need arises in order to keep it effective at all times.


Waitingtime in the emergency department can be reduced by adopting thenecessary changes in the triage process. The Lewin’s theory canfacilitate an effective management of the ongoing changes in thetriage procedures. The application of the chaos theory indicates thatthe emergency department should increase the level of stakeholders’engagement in order to minimize resistance and establish the linkbetween change and people. The chaos theory also requires the ED toconsider change as an ongoing process, instead of refreezing thedepartment.


Cordon,P. (2013). System theories: An overview of various system theoriesand its application in healthcare. AmericanJournal of Systems Science,2 (1), 13-22.

Markos,S. &amp Sridevi, M. (2010). Employee engagement: The key toimproving performance. InternationalJournal of Business and Management,5 (12), 89-96.

Tache,F. (2011). Developing an integrated monitoring and evaluation flowfor sustainable investment projects. EconomiaSeria Management,14 (2), 380-391.