The experience of change management in the Victorian public health system

This thesis is broadly concerned with the effects on human resources, in the Victorian health system specifically, arising from a fundamental shift in economic policy from a philosophy of universal coverage and free care, to one of economic rationalism and the free hand of the market. This change in policy, evidenced in reduction in the amount of public expenditure, rationalization of services, case-mix funding, increased managerialism in the senior ranks of the public service, and an emphasis on service-delivery and user payment, combined with a policy of amalgamation of hospitals, caused major disruptions within the health system, which were reported to have extremely adverse effects on the survivors of these changes within the hospital system. Contrary to expected performance improvements, survivors reported negative feelings and behaviours, with detrimental consequences for morale and productivity. The present research was constructed with the aim of exploring over time, and in a single case-study format, the effects on a group of survivors, of a forced amalgamation of two culturally-diverse hospitals. A second aim was to contribute knowledge in a sector of the economy under-researched to date. The predominant method utilized for data collection was that of narrative, an excellent method to use where a close examination of the complexities and patterns of employment experiences of small groups of workers is required. It is assumed that by allowing each individual to tell the story of their own unique experience, a rich data can be collected for analysis, which, once analyzed, can assist with a broader understanding of the issues involved. In this case, both the data and the supporting literature suggest that the management of change is complex and difficult, although the cultural conflict and emotional turmoil experienced by organizations undergoing amalgamations can be ameliorated. The thesis concludes that there is a need, for organizations managing change, to draw up an implementation plan; to offer appropriate support systems not only for those about to leave, but also, importantly, for those who are to stay; to communicate openly, honestly, and in a timely manner; for managers to offer genuine acknowledgement of their own and others’ pain and to assist in the grieving process; and for there to be an authentic search for both an enabling metaphor that can guide individuals’ behaviour and feelings as they strive to make sense of the change, and a new narrative to symbolize the newly-emerged organization.