Change Initiative Paper


Perhaps one of the greatest triumphs in United States history, World War II was essentially ended upon the dropping of the atomic bomb on Hiroshima. The boom heard around the world was not the only important outcome but rather what came after which was the baby boom. Many weary husbands that were coming home to eager wives caused one of the biggest statistical jumps of birth rates following the war. Often referred to as the “baby boomers”, this generation becomes especially important to the medical field in the present day.

This is where hospice comes into play, allowing individuals the choice of obtaining this benefit upon reaching a 6 month or less terminal diagnosis. Hospice gives the individual a chance to die comfortably in a nursing facility, a general impatient hospital, or their own home.

As an individual who used to work for Vitas Innovative Hospice, I ran the Telecare department which was responsible for the after-hours phone lines available to the patients and families.

Patient Care Secretaries were assigned to handle calls and create tickets based on the customer needs whether it is a symptom or equipment failure. Nurses were similar, however, they were to receive the call from the secretary or call back the patient in order to triage the symptom properly. Vitas Telecare must adapt to be ready for the incoming flux of new patients from not only the baby boomers but from future generations to come.

The Need for Change

The change to be delivered is not a specific target but rather a broad change to efficiency to maximize profits while still maintaining Vitas’ core values “patients and families come first”.

In the past decade, hospice in general has been coming under fire for keeping patients too long in their services should their prognosis improve. According to the Union Tribune, it was announced on February 13 of 2013; San Diego Hospice had filed bankruptcy and closed due to the Medicare audits that investigated patient eligibility. This type of publicity not only brought a negative light upon San Diego hospice but all across San Diego including Vitas. While the change may not come too easily, steps must be taken toward reshaping the public view in
order to regain their trust to put their loved ones into Vitas services. Additionally, with the economy still not in a great state, lack of efficiency is costing the company. As the Patient Care Administrator of Telecare, I was responsible for maintaining a smooth flow of calls without tying up the customers on hold for too long. One of the biggest flaws that contributed to high call volume was the lack of both communication and following of scheduled breaks.

Too often, employees were all taking lunches or breaks around the same time creating a heavy back up of calls as the only remaining employees could not handle them all. Vitas recently implanted a break management system called Workforce Management that not only observes peak and down call flow, but also manages break times accordingly to maximize efficiency. The problem, however, is the lack of employee discipline to follow the suggested break times. Several changes must be enacted including following of Workforce Management, focus on customer service, and continued efforts towards preparing for the future.

The Change Model

One of the most influential men today, John Kotter from Harvard Business School developed the Kotter’s Eight-Step Change Model as the most effective way to implement a change within an organization. The eight steps in order is as follows: create urgency, form a powerful coalition, create a vision for change, communicate the vision, remove obstacles, create short-term wins, build on the change, and anchor the changes in corporate culture. Kotter believed following these steps in the correct order created long lasting and successful change in any business if done correctly. This change model was selected based on several factors including success rate, concrete order of directions, and its ability to build upon existing success.

The Role of the Leader in the Change Initiative

In order for this success to commence, there are several leaders that must be in place during this re-creation of the Telecare department. The most important idea to realize is that everyone plays a part and that the leaders are just there to lead by example. This must be reiterated time and time again to assure the employees that everyone is included regardless of position. Sometimes during change, individuals feel left out just purely out of their position in the matter or not being notified of everything going on. In order for employees to buy in initially, a sense of belonging must be established. The several leaders other than the Patient Care Administrator (PCA) would include supervisors under the PCA, a senior Patient Care Secretary (PCS) and a senior triage Registered Nurse (RN).

The supervisor would walk around throughout the shift to make sure breaks and lunches are being followed as well as address any concerns of any of the employees. The senior PCS and senior RN would be in charge of holding a pre-shift meeting prior to taking the phone calls making sure to reiterate important do’s and do not’s of the job. Anytime employees of the same discipline would have a question, they could address it to their senior. Finally, the role of PCA is to assist the supervisors or seniors in any way or if any individual needs additional help. Meetings lead by the PCA must be held monthly to address progress and award individuals for their hard work.

Process of Change

As mentioned above, adopting Kotter’s Eight Step Change Model requires a strict following of the steps in order to generate long term change success. The first order of business is to establish a sense of urgency among all the employees in Telecare. A meeting would be called by the PCA in order to introduce the concept of the change and the reasons behind it. The meeting will be mandatory but also offer food and beverages or even encourage a potluck to involve them. Several concerns for the company would start broad pointing out how hospitals are starting their own hospices and continue to threaten the current status quo of Vitas. A good example would be Scripps Hospice or Sharp Hospice. Additionally, address the economic downturn that has not improved too much over the last decade and that job security is a must due to the depleting social security funds. Lastly, ask individuals one by one why they work this job, what is important to them and what can they do to help it. Next is to create a guiding coalition to direct others in the right direction towards the change.

Change can be chaotic but when directed others will follow. As stated earlier, there is no hierarchy of bosses but rather a string of leaders to drive and lead by example. Employees must know that the supervisors and seniors are there to encourage them and address any problems they may come across during a phone call. For example, a PCS receives an angry caller and ends up becoming frustrated themselves so they put the caller on hold. Rather than allow the PCS to continue the call, the senior PCS could take the call and allow the PCS to take a short break to gather their thoughts. The beginning of the change is all about employee buy in. After the initial shock of starting the change, another meeting would be called to describe and communicate the vision, hoping that previous efforts have started to get employees to buy into the change. The main purpose of the change is to keep Vitas strong and competitive among other rising hospices by superior customer service and employees that well taken care of especially for their hard work.

The next step requires others to empower the broad based change, meaning that every individual must feel like they are always involved and an important aspect of the process. The constant reiteration of this by the seniors and supervisors should continue this effort. If a pre-shift is finished early, the seniors may ask individuals about their daily lives and allow them to connect with each other. Working alone is a preference for some but being able to come to work with friends just gives them another incentive. Kotter’s next step is planning for and creating short-term wins. If there is something that causes an individual to work hard, it’s something they want. The PCA should create an incentive system based on an individual’s consistency and dedication.

This all depends on the discipline since a PCS does not handle the medical work of a RN. An example of an incentive for a PCS would be a small raise for having a consistently high calls answered through several months. Additionally, an RN would receive a small raise based on customer satisfaction surveys or recommendation from a supervisor for observation of great work. The last two steps involve improving on previous successes and maintaining a bar by addressing the state of the call center every monthly meeting. Awards should be continued to recognize individual efforts but also continued awareness of each employee’s efforts.

Overcoming Barriers to Change and Sustaining Change

There will be always some resistance to change despite the hardest efforts but there are several ways that will encourage a shift. One reason a person works is for the money to pay and enjoy the lifestyle they have chosen. With the incentive already addressing this through incremental raises, employees should continue to look for ways to be consistent and work hard. Additionally, many people have families, personal days or things they would like to do on certain days. Vitas may address this through hiring of employees in order to be flexible with schedules. Lastly, in order to feel involved, the PCA should look to meet with individual employees to communicate the vision and address any concerns they may have. Sustaining change requires the efforts of everyone including the PCA. Continued reinforcement means fixing problems as they appear or prepping for future conflicts.


Despite the new technology to save more and more lives daily, so too does the technology to destroy them. E-cigarettes and processed foods are just to name a few. Vitas Hospice should be ready for the many years to come and the health problems that cause terminal diagnosis’ to arise. With this change in place, Vitas will be ready.


Sisson, P. (2014). SD Hospice to Close; Scripps Steps in. Union Tribune. Retrieved September 9, 2014, from, M. (2014). Successful Change Management – Kotter’s 8-Step Change Model. Retrieved September 9, 2014, from