A Healthy Change Process

A Healthy Change Process

The influence of the change approach enacted for the introduction of Integral Health Management (IHM) on the employees’ commitment to IHM and the success of the introduction of IHM.

Master thesis, MscBA, specialization Change Management University of Groningen, Faculty of Economics and Business

1 October 2012 PAULIEN PATHUIS Barbershopdreef 4 3845 DP HARDERWIJK tel.: +31 (0)6-28086917 E-mail: paulienpathuis@gmail.com Student number: 2044986

First supervisor/ university Dr. K. S. Prins

Second supervisor/ university Dr. B.J.M. Emans

A Healthy Change Process

The influence of the change approach enacted for the introduction of Integral Health Management (IHM) on the employees’ commitment to IHM and the success of the introduction of IHM.

“Man cannot discover new oceans unless he has the courage to lose sight of the shore”. ∼ Andre Gide

“People don't resist change. They resist being changed.” ∼ Peter Senge

Acknowledgement: During the writing of this research the following people have been a great support. Firstly I would like to thank Karin Prins and Ben Emans from the University of Groningen who provided me with helpful feedback. Additionally I would like to thank Deltion College, the Human Resource Development department and in particular Henk Achtereekte and Monique Mijsbergh for their openness and the opportunity to conduct this research. Moreover I want to thank Monique for her guidance, feedback and help on my thesis.

ABSTRACT

The central question of this research relates to the introduction of Integral Health Management (IHM) in organizations; it is about the relationship between the type of change approach that is enacted on the one hand, and the employees’ commitment to the introduction of IHM and the success of the introduction of IHM on the other hand. For investigating this relationship a case study was conducted in a large educational organization, by means of semi-structured interviews. This case study confirmed a positive relationship between the enacted change approach, the level of commitment and the success of the change. The success of IHM is limited. This is caused by a low level of commitment of stakeholders to the introduction of IHM. This low level of commitment results from a low level of a sense of urgency, a lack of power of the guiding coalition, a low quality of communication, a low level of empowerment and a small amount of short-term wins.

This research recommends to approach the (further) introduction of IHM in an integral way, which means that all levels of the organization are synergetically involved, driven by a vision and guided by an integral team with participating members of all levels of the organization. Moreover, since health management is a ‘soft-topic’, often with long-term effects that are hard to measure, it is an organizational topic that holds not much urgency on its own accord. Therefore the change approach should amplify the awareness amongst stakeholders of the importance, need and benefits of integral health management and their own role in it.

Keywords: Integral Health Management, Change Process, Change Success, Commitment to Change, Sense of Urgency, Guiding Coalition, Communication, Participation and Short-Term Wins

Research Theme: Organizational Change Supervisor University: Dr. K.S. Prins

TABLE OF CONTENT ABSTRACT 3

1.3 Integral Health Management 7

1.4 The Shift to Integral Health Management 7

1.5 The Process of Change 8

1.6 Research Question 9

4.2 Commitment to the Change 24

4.3 Sense of Urgency 25

4.4 Power of the Guiding Coalition 27

4.5 Communication 28

4.6 Empowerment 29

4.7 Short-Term Wins 31

5.CONCLUSION &DISCUSSION 32

5.1 Conclusions 32

5.2 Discussion 33

5.3 Practical Implications 35

5.4 Recommendations for Deltion College 35

5.5 Limitations and further research 37

APPENDIX 1 43

Organizational Chart Deltion 43

APPENDIX 2 44

Kotter’s Eight-Stage Process model 44

APPENDIX 3 45

1. INTRODUCTION

The process of organizational change receives a great deal of attention in scientific literature and daily organizational management. Researchers and managers agree on the difficulty of managing change and the failure of change initiatives often due to errors in the change process (Kotter, 1995). Academic research proposes models to change that are focused to delineate resistance to change, and it examines management characteristics that enhance change management. Organizations are searching for prescriptions for action in the knowledge provided by research (Briner, Denyer & Rousseau, 2009) and are struggling with the best way of coping with the fast moving day-to-day business that requires rapid responses to unforeseen changes. Nowadays, in the public sector especially, demographic (e.g. aging workforce) and economic developments (e.g. tight labour market) require organizations to change and develop. This research presents the examination of a research model based on scientific literature and a case study on the topic of managing change at Deltion College (from hereon Deltion), an educative organization. The main objective of this research is to determine the influence of a particular change process on the success of the introduction of Integral Health Management.

1.1 Management Question

The explored change process at Deltion considers the implementation of Integral Health Management (IHM) in the organization. This change is initiated in 2010 and commenced in the spring of 2011. The organization wants to examine how their enacted approach has influenced the success of the change process so far, and how they can improve their change approach to enhance the chance of a successful further implementation of IHM. The objective of the Human Resource Development (HRD) manager is to obtain more support and desired behaviour of the management for the execution of IHM. The objectives of the HRD manager provide the management question for this research and incite the study to offer an advice on how to improve the change approach and enhance the success of the further implementation of IHM.

1.2 The Organization

environment where they can exceed and show the best of themselves: ‘We create a working environment that challenges people and offers opportunities for initiatives and creativity, a place where employees can develop in their profession and continuously learn from each other’ (Deltion College, 2011).

1.3 Integral Health Management

The improvement of the health and well being of employees is a theme that becomes increasingly important for organizations. Due to demographic and economic developments (aging workforce, financial crisis) organizations are faced with the increasing costs of curative health management, and they are forced to develop more preventive policies and practices. Moreover the trend of Corporate Social Responsibility (CSR) requires organizations to adapt their policies, processes and working conditions. Zwetsloot & Pot (2004) describe Integral Health Management (IHM) as an approach that helps organizations to manage the effects of health on business and vice versa, so that the health of both the employees and the company can be fostered. ‘The IHM approach distinguishes seven tracks of development: (1) health as a strategic company interest; (2) the realization of a healthy primary process; (3) a safe and sound physical (work) environment; (4) an inspiring social (work) environment; (5) vital people; (6) a sound relationship with the immediate organizational environment and local community, and (7) healthy products and/or services. The inter-relationships between the seven development lines are essential for combining an improvement of the business impact on health with a strategic interest of companies and organizations’ (Zwetsloot & Pot, 2004).

1.4 The Shift to Integral Health Management

The organization directed efforts to health and safety before the implementation of IHM; however, these consisted of separate initiatives, like offering reduction at sports facilities, risk inventory and support with absenteeism. IHM takes the organization a step further since it is the strengthening of the cohesion, connection and expansion of the policies and efforts that were done previously. The implementation of IHM for Deltion consists of improvements in work characteristics, as for example, job design, job content and work environment, as well as a change in attitude and behaviour of employees and management. The success of IHM requires intrinsic motivating and ownership by the management combined with a supporting culture. These requirements provide the conditions for effective interventions. In order to achieve the organizational objectives a number aims have been specified for IHM:

• Better management of health, and increase of the effectiveness and efficiency of activities in the area of the Working Conditions Act and Human Resource Development;

• A more vital organization that enhances innovation in work practices and reduces absenteeism;

• Enhanced involvement and engagement of employees; • A reduction of costs associated with health;

• A better image of the organization.

However, the key objective and challenge of the introduction of IHM is the required cultural change. The organization seeks for a new way of dealing with health and employability of the workforce; a policy-change that focuses on the shared responsibility of employer and employee, prevention of absence and an open dialogue concerning health and vitality.

1.5 The Process of Change

Doubtless every change initiative will be undertaken with the objective to achieve successful change. Scientific literature extensively defines factors that can contribute or inhibit the achievement of that objective and a number of models are suggested for the process of realising successful change. Some of the most commonly used models are the Eight-Stage Process Model of Kotter (1996), Theory E and O of Beer & Nohria (2000) and the Approaches to Change of Kanter, Stein & Jick (1992). These models describe a way in which a change should be undertaken to ensure its success, thus the change process as the key to successful change.

purpose for change, 2) Participative leadership style and importance of dialogue, 3) Focus on change in culture, 4) Non-programmatic and emergent change efforts, and 5) Less emphasis on financial incentives as a driver for change. Within this type of change emphasis is placed on the development of emotional commitment by employees, which in turn will lead to improved involvement by the organization and its overall performance (Beer & Nohria, 2000). Learning capabilities are essential to create that commitment (Senge, Kleiner, Roberts, Ross, Roth, & Smith, 1999).

The highly influential Eight-Stage Process model (appendix 2) for successful organizational transformations of Kotter (1996) also fits within the emergent types of organizational change. Although the model suggested by Kotter (1996) seems to be prescriptive rather than emergent, the model is limited to a description of process steps. The content of the change is not by definition set at the start of the change. This makes it possible to use this eight-stage model to form the base for this research on an emergent change process.

1.6 Research Question

The central question to be addressed in this research relates to the introduction of IHM in organizations; it is about the relationship between the type of change approach that is enacted on the one hand, and the employees’ commitment to the introduction of IHM and the success of the introduction of IHM on the other hand. While this research is focused on the implementation of Integral Health Management, it implies an emergent change process comprising a change of the organizational culture.

The Eight-Stage Process model of Kotter (1996) serves as the backbone of the change approach. However, the independent variables of this research comprise not all the eight-stages presented by Kotter. The last two stages of the model embody change process steps that need to be taken when the implementation is (almost) finalized and changes need to be institutionalized. Since the introduction of IHM has not reached these phases yet, only the first six stages of the model are included in the research variables. Moreover, the selected research variables that describe the change approach in this research are broadly based upon the model of Kotter (1995), and are not completely identical.

Since the eight-stage process model suggests a strict and sequential change process and the change process at Deltion has not been initiated according to this process model, it is illogical to measure it in these strict terms. The aim of this research is to explore how the steps have influenced the commitment to change and thereby the success of the change, not intentionally to examine the precise influence of the sequence of the steps.

the Guiding Coalition, 3) Quality of Communication, 4) Level of Empowerment and 5) the Amount of Short-Term Wins.

The central research question:

How does the change process influence the level of commitment to the change, and thereby the success of the introduction of IHM?

1.7 Readers Guide

2. THEORY

The first chapter described the motives for this research, the management question and the derived research question. The structure of this chapter allows for the discussion of the research variables including the dependent variables, Change Success and Commitment to Change, followed by a description of the selected independent variables; Level of the Sense of Urgency, Power of the Guiding Coalition, Quality of Communication, Level of Empowerment and the Amount of Short-Term Wins.

2.1 Change Success

In order to be able to assess which and how factors have influenced the change success, success of the change has to be defined. The Oxford dictionary1 _{defines success as ‘the accomplishment of an} aim or purpose’. Since a change initiative is often undertaken as a project, its success can also be defined by the definition of success from a project management perspective. Pinto (2010) describes four criteria that normally determine project success: time, cost, performance and client acceptance. A successful project is delivered within the set timeframe and budget, according its specifications, and satisfies the clients needs. The above two descriptions of success assume that the goals, aim and purpose of the change are known before the change starts. Palmer, Dunford and Akin (2009) offer a more holistic definition of change success by describing three possible change outcomes; intended, partially intended and unintended. An intended outcome is the result of prior intentions by actions of change managers. In this case success means that the intended outcomes of the change are achieved. Partially intended change outcomes refer to a partial achievement of intentions, depending on the change managers’ characteristics. Unintended change outcomes imply that managers face great difficulty in achieving intended change outcomes because of the variety of internal and external forces that inhibit the managers from their desired outcomes or lead to unintended outcomes. In this view, success of the change cannot be derived from the degree to which intended outcomes are achieved. This is in accordance with Cummings and Worley (2008) who state that goals are not always predefined at the start of an organizational change initiative, which also implies that the definition of change success not solely depends on the degree to which goals or aims are met. Moreover, Price & Chahal (2006) argue that besides the adaption of new processes and structures, the extent to which the organizational culture supports these new systems is an important criterion for successful change.

From the above-presented opinions about change success this research uses a combined definition; the change process is considered successful when the predefined goals are met and the opinion and satisfaction of key figures from the change initiative is positive.

2.2 Commitment to Change

Numerous studies have argued that change efforts often fail as a result of underestimating the importance of the role of individuals in change efforts. (Armenakis, Harris & Mossholder, 1993; George & Jones, 2001). Since organizations act and change through their members, and every form of change depends on learning and learning starts with individual change (Schein, 1985a), successful change can only remain if organizational members adapt their on-the-job behaviour (Jones, Jimmieson & Griffiths, 2005). Therefore, the commitment to change by top management and employees affected by the change has been proven to be crucial to a change program’s success; change programs with a high level of commitment of executives and employees are more likely to succeed (Sirkin, Keenan & Jackson, 2005).

The concept of commitment to change is by defined by numerous researchers. Herscovitch & Meyer (2002), for example, define commitment as ‘a force (mind-set) that binds an individual to a course of action deemed necessary for the successful implementation of a change initiative’. According to Jaros (2007) a high level of commitment of stakeholders reflects a state in which people are aware of the need for change and are empowered and motivated to implement it. Other definitions of commitment include proactive behavioural and the intention to support and work toward the change initiative (Fedor, Caldwell & Herold, 2006; Herold, Fedor & Caldwell, 2007; Herscovitch & Meyer, 2002; Choi, 2011). According to Coatsee (1999) commitment to change reflects a state in which employees are made aware of a change, have the skills, and are empowered and motivated to implement change. Other models of commitment to change presented in literature reflect a kind of attachment and involvement in the change project. This involvement results from the awareness to change (need for change), a combination of motivational factors and the mental and physical ability to work on behalf of the change (Coatsee, 1999; Herscovitch and Meyer, 2002; Armenakis and Harris, 2009).

Some important antecedents of commitment are: information sharing about the change (Shum et al., 2008), the fit between the change and the organization’s vision (Neves, 2009) and participation in the change (Devos, Vanderheyden & Van den Broeck, 2001). Specifically employee participation and involvement in decision making about the change and in the actual change project are positively related to commitment. The feeling of stakeholders that they are informed in decision-making and significant information sharing enhances their level of committed to the change effort (Eby, Adams, Russell, & Gaby, 2000).

vision for change and are able, motivated and empowered to act on behalf of the change. This certain kind of commitment is manifested by the behavioral alignment of employees. They change their day-to-day activities according to the goals of the change and the learning and adaption of new desired behavior.

Sub question one:

How does the level of commitment to change influence the success of the introduction of Integral Health Management?

2.3 Change Process

The following subsections provide further explanation on the independent variable: the change process. The factors of the change process that will be investigated in this research are based on the Eight-Stage Process model of Kotter (1995). The five change process variables are: ‘Level of the Sense of Urgency, Power of the Guiding Coalition, Quality of Communication, Level of Empowerment and the Amount of Short-Term Wins. The following paragraphs describe these variables, their important antecedents and how they influence the level of commitment and thereby the success of the change.

2.3.1 Level of the Sense of Urgency. According to Metselaar & Cozijnsen (1997) a sense of urgency is ‘the extent an employee experiences the need for change through explanation of rational arguments and social pressure expressed by colleagues, management and directors’. A sense of urgency represents a shared need for change. The change initiators need to let others understand and share the need for change and the importance of acting immediately (Kotter, 1995). Only experiencing a serious business problem by the top management is not enough for successful change, there needs to be communication to employees about the nature and the cause of the change (Saunders, 1999) and most importantly what it means for employees (Sirkin et al., 2005). Moreover, the reason for change needs to be communicated repeatedly, by senior executives, and the message needs to be consistent across the entire management team (Sirkin et al., 2005).

Having a sense of urgency is one of the main drivers for successful organizational change. The mistake that is often made when change is initiated is a failure to create a high enough sense of urgency for change (Kotter, 1995). Because individuals are likely to neglect or reject changes when they feel that there is no need for change, creating a high sense of urgency among change stakeholders and recipients is important for any successful change initiative (Palmer, et al., 2009). The importance of a sense of urgency in change initiatives is also emphasized by Burnes (2009) who concludes that recipients need to be aware of the pressure for change by creating a feeling of dissatisfaction with the current situation.

change needs to be at the start of a change initiative if it were to result in commitment to change. According to Kotter (1995) it is actually the very first step that needs to be set for any successful change effort. A high sense of urgency amongst the recipients is important at the start of the change because it contributes to general commitment to the change, what in the continuation of the initiative will lead to success (Beer, Eisenstat & Spector, 1990; Herscovitch & Meyer, 2002).

This research accepts that a sense of urgency represents the awareness of employees for the need and cause for change, and the understanding of the pressure to change now. Expected is that a high sense of urgency creates the energy and commitment to change.

Sub question two:

How does the level of urgency influence the commitment to the introduction of Integral Health Management?

2.3.2 Power of the Guiding Coalition. Once the urgency for change is felt throughout the organization, the next step is the creation of a powerful guiding coalition (Kotter, 1995). The guiding coalition needs to be a group with enough power to lead the change effort. Although a powerful guiding coalition does not necessarily include all senior executives, in most successful change efforts it is rather powerful in terms of titles, expertise, reputation, relationships and information, and the group must include a senior manager. Schein (1993) also described the steering committee, which is an example of a guiding coalition, as a group that includes some members of the top management, but not necessarily all. Moreover the group can include members in all relevant positions in the organization that may be involved by the change, however groups without strong line leadership will not achieve the influence that is required (Schein, 1993). The quality of the project team is further discussed by Sirkin and his colleagues (2005). They state that the success of a change initiative depends on the quality of project teams and formulated some guidelines for successful project teams: ‘Since project teams handle a wide range of activities, resources, pressures and unforeseen obstacles, they must be cohesive and well led. Executives must clarify members’ roles, commitments and accountability and they must choose a team leader’. Moreover it is important that the team leader is capable and team members have sufficient time to spend on the change initiative. Kotter (1995) adds to this that the group should be encouraged to work together as a team.

‘it is about using power to win the hearts and minds of people to work together towards a common goal’ (Gill, 2001), creating commitment to the change. As Kotter (1995) emphasised, the guiding coalition models the behaviour expected of all employees.

In conclusion, in this research a powerful guiding coalition includes: team members with formal power in the organization, a guiding team leader and clearly defined roles and responsibilities. The guiding coalition is able to motivate and inspire others affected by the change through a vision and strategy for change. The effect of the power of a guiding coalition on the likelihood of the success of a change initiative is mainly induced by the ability of the coalition to steer the change process in the desired way, and its ability to lead the change initiative in a way that it connects stakeholders to work towards the common objective.

Sub question three:

How does the power of the guiding coalition influence the commitment to the introduction of Integral Health Management?

2.3.3 Quality of Communication. Communication is repeatedly described as one of the most important factors to achieve successful transformations. Communication is important for providing organizational members with information about the change and how it will affect them (Jones, 2007). Palmer, Dunford & Akin (2009) state that the way a change (process) is communicated and talked about is crucial for its success. This is further explained by Robertson, Roberts & Porras (1993), who describe the success of change depending on the ability of the organization to change the behaviour of individual employees, and the importance therewith of communication. ‘If organisational change is about how to change the individual tasks of individual employees, then communication about the change and information to these employees is vital. Communication with employees should be an important, and integrative part of the change efforts and strategies’ (Robertson et al, 1993). The role of communication in change projects is also described by Quirke (1996): ‘Communication is not the top down dissemination of management thinking, but the bottom-up means of connecting those who know the specifics of what needs to be improved to those who have authority to make changes happen’. This shows the importance of communicating the vision, what the change agents want to achieve, and the reasons for change.

Thus, high quality communication in change projects consists, for this research, out of sharing the vision and providing employees information on the expected consequences of the change and the change progress. This is expected to lead to commitment to change because recipients are aware and can understand the wider picture and their role.

Sub question four:

How does the quality of Communication influence the commitment to the introduction of Integral Health Management?

2.3.4 Level of Empowerment. Employee involvement is crucial to successful change, especially in situations that require attitudinal and cultural change (Burnes, 2009). Empowering others contains getting rid of obstacles to change, changing systems or structures that seriously undermine the vision and the encouragement of risk taking and non-traditional ideas, activities and actions (Kotter 1995). It is a change agents’ job to, after setting the vision, empower people to achieve that vision (Belasco 1991). Holman and Devane (1999) promoted the need for change agents to empower and encourage stakeholders and presented a variety of communication techniques (e.g. participative design workshop and open space technology) wherein the change agent acts as a facilitator of a participatory process that is designed to help move a change to success.

Research shows that empowerment of others is needed, because when people make their own change story, they are more committed (Aiken & Keller, 2009; Devos et al., 2001; Fedor et al., 2006). Change recipients will be more committed to the change if they are involved in the development and implementation of the change (Devos et al., 2001). This applies consequentially to middle management. Middle management often resists change because they have insufficient input in the design of the change project, but they do have major roles in the implementation (Sirkin et al., 2005). So once the urgency is high enough and a shared vision is developed, people need to have the chance to colour the framework themselves (Beer, Eisenstat & Spector, 1990), in order to ensure commitment and thereby enhance the success of the change effort.

Empowerment in this research is seen as the activation of employees (on all levels of the organization) to act on behalf of the change. It is the motivation of others to participate in the change process and to help to develop the organization. It is about ‘giving employees a voice’, and enabling them to contribute to the vision. The empowerment of others to act on the vision will enhance the change success since it leads to commitment.

Sub question five:

2.3.5 Amount of Short-Term Wins. Especially in long-term change initiatives it is important to keep people motivated and focussed on the change (Mento, Jones, & Dirnforfer, 2002). The commitment to the change and the proactive behaviour of empowered employees should be kept high during the whole change initiative in order to be able to ensure the success of the change. This can be realized by planning for visible performance improvements, creating those improvements and recognizing and rewarding employees that are involved in the improvement (Kotter 1995). These improvements are seen as short-term wins for the guiding coalition. This concept is closely related to the measurement of the progress of the change effort by using milestones and benchmarks (Mento et al., 2002). The importance of creating short-term wins and measuring milestones comes from the motivational value of feedback and success, short-term wins generate motivation for the change (Gill, 2003). Tangible benefits along the change journey will help the change team to stay energized and it prevents stakeholders from giving up. Without specific short-term wins, stakeholders may get to resist the change (Mento et al., 2002).

Thus, short-term wins are (small) goals that are set and measured during the whole change process. They will prevent the commitment to decrease, and thereby raise the chance of a successful change effort because short-term wins serve as motivational feedback for the people affected by the change.

Sub question six:

How has the amount of short-term wins influenced the commitment to the introduction of Integral Health Management?

2.4 Conceptual Model

The literature discussed in this chapter is graphically presented as a conceptual model in figure 2.

FIGURE 2 Conceptual Model

Commitment to Introduction

of IHM Level of the Sense

3. METHODOLOGY

In this chapter the methodology of this research is outlined. Section 3.1 describes the data collection methodology and section 3.2 provides explanation on the method of data analysis.

3.1 Data Collection

The intention of this research is to explore ideas and opinions on the introduction of Integral Health Management at Deltion College. As a consequence of the complex nature of this research multiple data collection methods are used. The process of data collection can be seen as an iterative process since the collection of the data and the analysis are alternated during the course of the research. In the following subsections the three ways of data collection are clarified.

3.1.1 Archives and documents. Diverse archives and organizational documents are collected to conduct descriptive analyses of the organization and Integral Health Management. Especially internal memos and reports, annual reports, meeting agendas and minutes are analyzed. These data provided information on what has happened: the change process.

3.1.2 Informal Dialogues. Over the duration of this research the researcher is involved in the daily organization of the HR department and the researcher participated in the project team on IHM. During the period that the researcher was present at the organization many unstructured dialogues took place. These dialogues provided background information on the function of the HRD department, the project team and other relevant HR topics in the organization. The dialogues also provided relevant perspectives on opinions and experiences on the topic of health management and the introduction of IHM. Moreover, during the progress of the research some findings and observations of the researcher were examined/affirmed by the dialogues. The dialogues are held with:

• HRD Advisors • Junior HRD Advisors • HRD Policy Advisors • Occupational Health Doctor

• Program Managers Professionalization (Learning & Development)

The selection of the interviewees is made in consultation with the HRD Manager, as principal of this research. Because the management question stems from the whish to get IHM more supported and disseminated by the management of the organization, the HRD manager decided to exclude employees and only consider the Sector Directors and Educational Managers as research population.

The respondents were chosen based on their expertise, function, role and involvement in the change project. Because the organization-wide implementation of IHM, it was important to have a proportional representation of the organization. Moreover since the change approach was aimed at the entire organization, this evaluative research resulted in a company-wide sight. Thus the selection of interview participants was divided across the tree main educational sections. The six interviewed educational managers were selected on the years of experience in their function. Because the IHM policy stems from 2009/2010 it was preferred that the interviewed managers are employed in their function before the start of IHM. All interviewees were free of choice to participate in this research and are informed about the topic and the nature of the research by e-mail before interviews were scheduled. The response on interview invitations was high; only one invitation was not reciprocated. Thus, the participants of the main interviews were:

• All three Sector Directors

• Two Educational Managers of each sector • All six members of the IHM project team

• The Manager of Human Resource Development department

• The HR Advisor for Health and Safety (and team leader of IHM working group) • The HR Advisor for Training and Development (also IHM working group member) Some background information on the selected interviewees is shown in table 1.

TABLE 1

Background information interview participants

Table 1 is a compilation of 4 tables. The two upper tables show the gender division and the years of service of the research participants compared to Deltion on average. The bottom left table displays the educational level of the research participants. The bottom right table shows the age of the participants in comparison with the organizational average. Source: Deltion College.

Deltion Sample Years of Service Average Deltion Sample Minimum Sample Maximum Gender Men 53% 66.7% 7.3 0.5 31 Women 47% 33.3% Level of Education

MBO HBO(+) Academic

Age (years) Average Deltion Sample Minimum Sample Maximum 0 13 3 45.7 34 58

The interviews with the Sector Directors and Educational Managers were structured by a set of open questions. All interviews allowed the interviewee and researcher to be flexible in the questions and sequence of topics, depending on the course of the conversation and on new questions that rose. Hence, the course of the interviews itself is left open. The interviews took between 30 and 70 minutes.

All interviews started by providing the participants some information on the background of the interview and the research they participated in. Facts like the duration of the interview, the topic, the goal, the approach of the interview, the reason for inviting the interviewee, and the expectations and role of the interviewee were discussed. Thereafter some general introductory questions about the function of the interviewee and his/her background in the organization were asked, which was useful to better understand the answers of the interviewee in the remainder of the interview.

need for change. The power of the guiding coalition is valued based on the current composition of the group and their formal functions within the organization. To evaluate the quality of the communication interviewees are asked on the existence of communication (examples) on the change and their opinion on this communication. The level of empowerment is examined by the experiences and opinions of employees on the empowerment and involvement during the change. In order to evaluate the amount of short-term wins the focus in the interviews was on the achieved activities and results so far, and on the current practices of Deltion on health and vitality. All detailed interview questions are included in appendix 3.

The relationships between the independent and dependent variables are discussed unstructured. By every topic the researcher asked for facts and the causes or consequences of these facts. Thus questions on the relationship between the variables followed on the information provided by the informant on the extent to which the independent variables were present. For example when an interviewee told that he did not have received information about the vision of the organisation on health management, the researcher asked what the influence was of this lack of communication on his commitment by IHM. Moreover, interviewees are asked on their opinion on the implementation of IHM in general, and about what they think that could have made it more successful. If they did not came up with anything, the researcher addressed the five independent variables and asked to which extent the interviewee felt that these factors could have influenced the success of IHM so far.

At the end of the interviews, all interviewees are asked whether they have missed any further questions, or if they want to add something that has not been discussed yet, and whether they have some recommendations for the further implementation of the IHM.

The interviews with the Sector Directors and Educational Managers are all tape-recorded, with approval of the interviewee. A small amount of additional notes of key terms were taken. The tapes are kept as a record, but no transcriptions are made. The other interviews/dialogues were not taped, but notes were made during the conversations. These notes were processed into detailed dialogue reports within two days after the interview took place.

Validity of the research methods is ensured by:

• The use of multiple data collection methods to examine the research objective from different perspectives.

• The use of semi-structured interviews ensured the researcher to pay attention to important topics at the moment of the interview.

• The guarantee of anonymity of the interviewees to decrease the change of bias. • The use of a tape recorder during a majority of the interviews.

3.2 Data Analysis

4. RESULTS

The preceding sections presented the conceptual model that forms the basis of this research and the methodology by which the case study is performed. This chapter presents the research results supported by the outcomes of the interviews, the informal dialogues and analysis of archives and documents. The chapter starts with an evaluation of the success of the change and the level of commitment. The subsequent sections present an evaluation of each change process variable and the answer on the question how these variables influenced the level of commitment.

4.1 Change Success

The success of the change is appraised in two perspectives. On the one hand, interviewees report to be dissatisfied with the progress made on the cultural aspect of Integral Health management. On the other hand, the facilitation of health and vitality of employees has had a major upturn since the formal introduction in 2011. Interviewees are positive on the outcomes from the effort of the guiding coalition on the BRAVOO-themes (sports, smoking, alcohol, food, personal development and relaxation). The goal of the BRAVOO program is to introduce guidelines and facilities for the enhancement of the vitality of employees. The six themes of BRAVOO each represent an area of interest on which actions should be taken. The guiding coalition has presented multiple actions on each theme; Last year, for example, they have offered a ‘Fit-week’, healthy-cooking workshop, a mindfulness workshop and a stop-smoking training. Employees welcomed these facilitative actions enthusiastically; the guiding coalition received positive reactions from employees. Also the introduction of the ‘Vitality-coach’ (lifestyle-coach) is successful according to the HRD manager and the coach. Especially the coach received a lot of positive reactions from employees: ‘I really got a lot of enthusiastic reactions of employees after I was announced in the annual social report.’

However, the cultural integration of IHM is not on the level it is desired according to a large majority of the interviewees. This is partly due to the intention of the guiding coalition. They focused on the facilitation of employees with the aim to get them aware of their vitality and to get them excited to enhance this. The limitation herewith is that specific actions targeted on the role and commitment of the management levels were missing. As a consequence, almost all interviewees reported to be dissatisfied with the cultural awareness of the organization on the importance of solid health management and each ones roles and responsibilities in that.

want a culture in which people are aware of the importance of health and employability. That awareness is not there yet. An open culture with open communication about health in a broad sense, is still far from the current situation.’ Both directors thus consider the success of the implementation of IHM unsuccessful since the aim to enhance cultural awareness for vitality is not reached.

Educational Managers. The majority of the interviewed educational managers also question the success of the cultural implementation of IHM, as one of them stated: ‘The cultural aspect of this policy should get a lot more attention’. Another educational managers commented: ‘health and vitality are not a strategic theme that is encountered as such throughout the organization.

Thus the appreciation of the success of the change is generally low by sector directors and educational managers. The awareness of the importance of noticed vitality of employees that is present is addressed to the personal interest of an educational manager instead to the change process, according to the interviewed participants.

Although, some of the educational managers actually do value health and vitality of their team members as an important topic, and act according to that. They consult with employees about their health and vitality and notice early signs of decreased employability, satisfactions, etc. As one of the managers stated: ‘in my team people do are aware of the importance of health and vitality. I find it very important and therefore it is a topic that is openly discussed in the team meetings’. This, however, seems to depend on the person of the educational manager and the nature of the team instead of the effort on IHM as one of the managers explained: ‘I think that is due to the nature of the team and the people within the team.’

4.2 Commitment to the Change

The second chapter of this report described commitment to change as a mind-set of employees in which they are aware of the change, share the vision for change and are able, motivated and empowered to act on behalf of the change. In the change initiative at Deltion, the most important stakeholders for getting vitality as a strategic theme that is embedded in the organizational culture are the educational directors and the sector directors.

conversation among employees. I think that the policy and its intention is known by only a very few people, the commitment thereby is probably very low.’

Educational Managers. The commitment of educational managers similarly fell short. Actually almost all of them reported to be unknown with the change. Some of the interviewed educational managers commented that health and vitality is not even a topic that is articulated by their sector director. Furthermore, three participants expressed the opinion that there actually should not even be a particular policy for health. They consider attention for health, vitality and employability of employees as something that is self-evident; ‘it is just one of the things you should take care of as an organization. It should be common, not a special policy.’ This point of view makes them far from committed to the implementation of the IHM program; nonetheless it does not imply that they are negative on the idea of giving attention to health and vitality.

Guiding Coalition. The guiding coalition encounters the lack of commitment from the management levels, as one of them stated: ‘The directors approved the policy proposal, but they do not carry out the message’. One of the other members added to this: ‘The approval of the policy was no guarantee for commitment’. The guiding coalition even appoints the commitment of the management levels as something indispensable. ‘We need more commitment from the top, only then IHM can develop further.’

4.2.2 The influence of the level of commitment on the success of the change. A positive relationship exists between the level of commitment to the change and the success of the change. The low level of commitment has had a major influence on the success of the change. The stakeholders should be the ones that carry out the change, and the ones that actually disseminate the new behaviour. They should make health and vitality subject of the dialogues between employees and their manager. But that has not been achieved yet. The low level of commitment of the management resulted in limited behavioural change from stakeholders. However, this low level of commitment is somewhat explained by the guiding coalition and the HRD director: ‘the intention of the guiding coalition so far, was to influence the culture amongst employees by bottom-up change initiatives’. Therefore the actions they deployed up until now were not directly focused to get the management layers of the organization committed by the change. Nonetheless, the low level of commitment of managers actually is experienced by the guiding coalition as a negative influence on the success of IHM so far, since they have an important role in the execution of health management.

4.3 Sense of Urgency

for the need and cause for change, and the understanding of the pressure to change now. It will lead to a high level of commitment to change since recipients understand and feel the need for change. Thereby it is important to share (communicate) the need for change across the recipients of the change at its start.

4.3.1 The level of urgency. The urgency and need for implementing IHM have been clearly described at the initiation of the change effort. The approved policy proposal for IHM presents multiple reasons for change that mainly stem from demographic- and economic developments. ‘The aging workforce is one of the bigger concerns for the organization; our workforce is getting older rapidly. We want people to be vital and employable until they retire, we require of them that they remain up to date with the needs of our students, and with new knowledge in their expertise/function’, said the HR manager.

Educational Managers. The interviews evaluated to which degree educational managers and sector directors are known with these motives for the implementation of IHM. All the educational managers reported to be not aware of the formal cause for the implementation of IHM, and they state that they are not (properly) informed on the reasons for change. However the managers do have their own presumptions. Five educational managers mention the reduction of absence through illness as expected reason. Two managers underline the prevention of illness, one manager mentions the ageing workforce and one manager also mentions employee satisfaction and good employment practices.

Sector Directors. The sector directors all acknowledge that the underlying reason for IHM is not clear to employees, as one of them explained: ‘We, as management, are aware of our responsibility to have vitality and health in our staff policy, that is self-evident for a good human resource policy, however the exact cause for IHM is not that obvious. This certainly does not help to empower employees to become more vital’

Guiding Coalition. Members of the guiding coalition noticed the lack of urgency by the management, one of them stated: ‘The awareness of the immediate cause is insufficient’. Another member of the guiding coalition said: ‘the policy does not seem to have enough urgency or importance for the management; this is probably the cause for their low commitment. We need to clarify the reason and urgency for IHM. This reflection of the guiding coalition is important for the continuation of the IHM implementation, since they herewith admit their understanding of the influence of the lack of urgency on the success of IHM.

understand why something is needed, than the rest will be very difficult. Explanation of the ‘why’ is the first step, after that you should offer support and assistance in the ‘how’, so people can move further’.

The results thus show that the important stakeholders in this change process do not feel a high level of urgency, because most of them do not know the reason for change or share the need for change. This made them less committed to the change. Therewith a positive relation is indicated between the low sense of urgency and the level of commitment to the change of educational managers.

4.4 Power of the Guiding Coalition

The second sub question regarded the relationship between the amount of power of the guiding coalition and the level of commitment. As stated in the second chapter, a powerful guiding coalition influences the success of a change through the ability to direct the change in the desired way and lead the process so that it connects stakeholders to work towards the common goal. The power of the guiding coalition in this case, is valued based on the current composition of the group and their formal function within the organisation.

4.4.1 The Amount of Power of the Guiding Coaltion. In this change initiative the guiding coalition is titled as a working group and consists out of: two HR policy-advisors, two sports teachers (of which one also is the Vitality coach), one advisor marketing & communications and the head of the internal Horeca Workplacement Company (HorecaLeerbedrijf). The current composition of the guiding coalition is based on the expertise of the members on the BRAVOO-themes, but the organizational functions that are represented in the working group hold no actual formal power as in a management function. The working group is aware of the shortage of formal power and the influence of this on the change project. They encounter problems in achieving results, ‘we often propose initiatives, but when nothing is done with it by the ones with power then the effort stops there’. Moreover, the group endeavours sometimes role ambiguity; they are not sure of what their actual goal is or what their influence can be. This makes them feel less influential, and less powerful to commit others to the change.

4.4.2 The influence of the amount of power of the guiding coalition on the commitment to change. The research results show that the working group has difficulties with steering the change and getting management committed partly due to the lack of formal power but also due to ambiguity on the role and task of the guiding coalition. Interviewees acknowledged that the involvement of organizational members with more formal power could achieve more commitment of employees. The constitution of the guiding coalition is an important topic according to some of the interviewees, as one of the HRD staff members stated in an informal dialogue: ‘a group with a broader representation of managers with formal power is required for the guiding coalition to be able to operate on the strategic level that is needed to gain broad commitment amongst change recipients and stakeholders’.

On the question who the interviewees expect or would recommend to be part of the guiding coalition for IHM, the majority of them answered with: ‘educational managers and the occupational health doctor’. These two stakeholders are acknowledged as the most important when it concerns health and vitality of employees. Moreover, educational managers have direct influence over their teams, which makes them powerful, and they can influence the sector of which they are part of by their participation in the management team of the sector.

Thus the results indicate the existence of a positive relation between the power of the guiding coalition and the level of commitment to change of stakeholders and recipients, concerning the implementation of IHM at Deltion College.

4.5 Communication

The third sub question of this research concerned the influence of the quality of communication on the level of commitment. As stated in chapter two, communication is important for change success, and communication of the vision has the highest importance in change initiatives. High quality communication in change projects consists, for this research, out of sharing the vision and providing employees information on the expected consequences of the change and the change progress. This will lead to commitment to change since it results in stakeholders’ awareness and understanding about the change and their respective roles.

The communication advisor, who is also a team member of the guiding coalition, articulates the nature of the change and therewith the importance of communication: ‘it is a culture change and a change that requires new behaviour of employees. These types of change are often susceptible for the type of communication. You will need the so-called ‘warm-lines’. Thereby we mean the face-to-face communication, the real talks, so that people will see and feel the change. They should not only read about it in an e-mail because that won’t change behaviour’. However, she indicated that up until now most of the communication about the implementation of IHM and all the activities that are offered is done by e-mail and intranet. Moreover one of the interviewed educational managers commented on this: ‘Communication is very important, only informing by way of the intranet is not sufficient’.

Almost all interviewed educational managers indicate that they are hardly informed about the change at all. They do notice information on the initiatives that are undertaken for health and vitality when they are informed by e-mail, but they are not informed about the new policy and the ambition of the organization.

4.5.2 The influence of the quality of communication on the commitment to change. The importance of communication of the vision is strongly emphasized by many of the interviews and informal dialogues. An educational manager indicated that the lack of communication about the policy and the vision negatively influences their level of commitment. They feel less involved by the change since the information provided about the change is not felt as important, whereas it only concerns some informative announcements. Participants in this research confirm the influence of communication and the influence of a shared vision on the success of the change. They feel less involved and committed because they do not receive adequate and proper information. Thus, a positive relation exists between the quality of communication and the level of commitment to the change.

4.6 Empowerment

The fourth sub question is concerned with the influence of the level of empowerment on the level of commitment.

Guiding Coalition. One of the working group members is aware of the force of empowerment. He stated: ‘we need more awareness of people for the importance of health, for the success of IHM. That awareness is something that we can achieve by getting people involved and let them think along or have a share in the change process. The involvement of educational managers is probably most important’. The guiding coalition acknowledges that there have not been targeted actions to empower educational managers. The outcomes of the interviews indicate the consequences of that.

Educational Managers. One of the educational managers explicitly mentioned the importance of the empowerment of employees for the success of the change, she stated: ‘my teams want to be more involved in all sorts of things like this. Too often they experience that new plans are developed by top management or staff departments and just implemented right away. People in the teams don’t feel heard. They want to be involved during the process, and have something to say about what is decided. Then they will feel more committed to what is changing and they will be more willing to adopt the changes’. Thus involving people during the process, by giving them a voice and listen to what they think, helps to get them more committed and willing to change. This is an important comment, because with regard to health management this has not been the case. All the interviewed educational managers have not experienced active involvement or empowerment during the introduction of IHM. They commented on this that they are not informed about their role, nor that they are consulted for input or feedback on the change process. This lowered their commitment to the implementation of IHM and on the topic of health and vitality in general.

Moreover, multiple educational managers indicate that the staff department, in this case the working group, decides what is developed and offered. As a result, educational managers denote that the deployed activities (the offered workshops and trainings) did not fit with the needs and wishes of the managers and employees. For example, employees were not able to attend workshops because of the time scheduling during the lessons. This lowered their commitment to the topic of health and vitality. A remarkable result because educational managers are seen by almost all the respondents as the most important actor in this change initiative: ‘I think that I, as educational manager, have a major role. I feel responsible to discuss these topics with the team, to empower the team to take action, and I have the responsibility to be an example for my team.’

have a higher stake in the development of plans and policies and have the ability to participate in an early stage of organizational developments’.

Thus, based on the research results, it can be concluded that a positive relationship exists between the level of empowerment and the level of commitment to the change.

4.7 Short-Term Wins

The last sub question addresses the influence of the amount of short-term wins on the level of commitment to the change. As presented in chapter two, short-term wins are (small) goals that are set and measured during the whole change process similar to milestones. Their objective is to prevent commitment from running low.

4.7.1 The amount of Short-Term Wins. The interviews with the working group and the analysis of archives and documents indicated that short-term wins for the change were not planned in advance; no actual short-term objectives were set at the start of the change. The objectives that are formulated in the original policy proposal that is approved by the board in 2010, comprises only more general objectives that are not planned in time.

Moreover, the analysis of documents and archives shows that no actual moments of measuring the progress of the change were planned, or executed. One of the interviewees commented on this: ‘there have not been intermediate reports on the status of the initiative to the board of directors’. One of the sector directors also missed feedback during the process: ‘After we approved the policy proposal it is started and sometimes I see some loose activities, but that’s all’.

4.7.2 The influence of short-term wins on the level of commitment. Only some of the initiated actions that are undertaken to achieve these goals were bounded in a timeframe, for example the ‘fitweek’ and the ‘Deltiondag’. These actions can be seen as milestones for the guiding coalition, because they were important moments in time during the change process. The importance of these visible actions on the commitment of employees is confirmed by a majority of the interviewees. As one of the sector directors stated: ‘Health was a relevant topic amongst people when something visible was organized. Carrying out the message is therefore very important I think’.

5. CONCLUSION & DISCUSSION

This final chapter presents the answers on the central research question and the sub questions by combining the findings of the theory and results chapters. The major findings are discussed and their theoretical and practical implications are presented. Furthermore, recommendations will be given on the general implementation of IHM and on how to improve the change process and enhance the success of Integral Health Management at Deltion. The chapter concludes with some limitations of this research and suggestions for further research.

5.1 Conclusions

The central question that is addressed in this research relates to the introduction of Integral Health Management in organizations; it is about the relationship between the type of change approach that is enacted on the one hand, and the employees’ commitment to the introduction of IHM and the success of the introduction of IHM on the other hand.

This study discovered that positive relationships exist between the enacted change process and the level of commitment and the success of the change. Therewith the research outcomes on the case study on the implementation of IHM at Deltion College confirmed the proposed relationships between the research variables. The implementation of IHM is not valued as successful yet as change recipients do not feel committed to the change. This is not an unexpected outcome for the organization since the management question that formed the motive of this research arose from the presumption of the Human Resource Development Director, that the change has not lead to the desired awareness of- and felt responsibility for health and vitality.

Assumed was that a high level of commitment of change stakeholders and recipients, enhances the success of the change since participation and involvement leads to learning and the adaption of new behaviour. The research outcomes confirmed this. In the case of Deltion, there was a lack of commitment of the stakeholders that negatively influenced the success of the change since there was no adoption of new behaviour or individual learning.

The low level of urgency negatively influenced the implementation of IHM at Deltion. Although the need for change has been specified by the initiation of the change, it is indistinctive for most of the change recipients and stakeholders. The interviewees report to be unknown with the actual need for change, however the majority can think of a number of motives. The low level of awareness of the need for change proved to be caused by insufficient communication of the motive and need for change. This is because the dissemination of the urgency for change has not been an indented and directed action of the guiding coalition.

managements commitment. Besides the lack of formal power, also ambiguity on the role and task of the guiding coalition caused a reduction of the strength and influence of the guiding coalition.

The quality of communication during the introduction of IHM at Deltion College also showed a positive relationship with the commitment to change of organizational members. In the case of the implementation of IHM there has been a lack of sharing the vision and informing the change recipients on the progress or the change plan. According to the interviewed organizational members this shortage of good communication led to less commitment.

The assumption that empowerment of change recipients leads to commitment, because involvement in the change process reduces resistance, is also confirmed. The empowerment and involvement of the Educational Managers and Sector Directors is low according to the research results. Interviewees reported that they not feel empowered to act on the vision and that they are minimally involved in the process so far. This led to less commitment with the vision and the goals on Integral Health Managers. Especially the Educational Managers remarked this as a missed opportunity, because they consider their own role as indispensable when it concerns health management.

With these results, this research contributes to the insight of the importance of a change process for successful change and confirms existing theory on change management. However, the key insight that is gained by this research relates to the nature of the change in relation to the change approach. The implementation of Integral Health Management implies a change in culture, but more importantly this research exposed the necessity of an integral (change) approach. When health management is approached as an integral strategic topic (as is supposed by IHM), it cannot be introduced or implemented in a project-like and isolated way. Integral means complete or in totality. This makes Integral Health Management not a separate topic; it is a mind-set, culture or a vision that is exposed in all sorts of ways, on all levels in the organization. The case study at Deltion shows the efforts of a guiding coalition to approach IHM as a topic on the operational level. The tactical and strategic levels were not (yet) included in the change. In this way, IHM is unlikely become integral in the organisation. The introduction of IHM in any organization will need an integral approach, which means that all levels of the organization are synergetically involved, driven by a vision, guided by an integral team with members from all levels of the organization.

5.2 Discussion