Health Education Research, Vol. 17, No. 5, 680-682,
October 2002
© 2002 Oxford University Press
BOOK REVIEW |
Promoting Health through Organizational Change
Harvey A. Skinner Benjamin Cummings (Pearson Education Inc.), San Francisco, 2002 344 pp. ISBN 0-205-34159-4 (pb)
African Regional Health Education Centre College of Medicine, University of Ibadan Ibadan, Nigeria
Promoting Health is built on two major themes developed and reiterated in 19 chapters that are divided into three major parts. The first theme is that the changes needed to bring about health promotion should not only focus on the behavior of individual health care consumers, but also on the behavior of health care professionals and health care organizations. The second theme stresses the need to go beyond incremental change to the fundamental integration of public health and clinical services. Promoting Health is actually three books in one, each corresponding with the three major sections of the book. Part 1, entitled `Re-orienting Health Care Organizations', is an overview of the present `health status' of health systems in industrialized countries. Part 2 is a workbook and toolbox that helps the reader learn how to use the `Five Steps for Improving Organizations'. Finally, Part 3 is a state of the art summary of electronic technology in health care, entitled, `e-Health: The New Role of Information Technology'.
The heart and strength of the book, Part 2, is well designed as a practical individual self-study tool or formal training guide for workshops, and as explained in the Preface, the historical origins of the book were actually in the realm of training. Concepts, case studies and worksheets lead the learner through `The Five-Step Process', which consists of (1) building motivation for organizational improvement, (2) strengthening organizational capacities to change, (3) identifying strategic directions, (4) conducting critical functions analysis and (5) implementing improvements using `rapid cycle change'. The ultimate goal is not simply to identify and change a specific organizational problem, but to build within organizations the ability continually to `keep the organization focused on improvement and maintenance of gains'. Practical analysis and planning tools such as SWOT (Strengths, Weaknesses, Opportunities and Threats analysis), Stakeholder Analysis, Environmental Scans, Critical Functions Analysis and the PDSA Cycle (Plan, Do, Study and Act) are made available to the reader (or trainee) in an integrated, sequential and easy to use form.
Part 1 could be considered a textbook on organizational change for undergraduate and postgraduate education, which was one of the intentions of the author. One strength of this section lies in presenting and applying theories of individual behavior change to the various players in the health care system such as physicians and consumers, and includes useful overviews of Health Belief Model, Social Learning Theory, Theory of Reasoned Action and Transtheoretical Mode/Stages of Change. These models and theories are integrated into a `Likelihood or Action Analysis' assessment in Chapter 7.
Generally, the book lacks a coherent and consistent theory of organizational change, although a variety of theories are interspersed throughout the work. For example, the concept of first and second order change is used in Chapter 2 to demonstrate the challenges behind the book's second major theme. In addition, there is need for a basic definition of an organization such as provided by Mico and Ross (Mico and Ross, 1980
) who explained in their foundation textbook for health educators that an
...organization can be described as a social-legal structure for enabling input resources to be converted into output products for the purpose of gaining income or other compensation, either directly or indirectly, in return.
The currently popular change process paradigm, the Transtheoretical Model (Prochaska and DiClemente, 1983), is used frequently in the book, primarily to understand the behavior of individual players (consumers, physicians). Another change process model, Lewin's (Lewin, 1953) unfreezing–refreezing component of Field Theory, was presented in Chapter 14 to understand the broader process of organizational change. Of particular interest in the organizational change process is who first `contemplates' or perceives an organizational problem or need. This is addressed in part in Chapter 7, as well as in Chapter 9 in the context of `readiness for change'. The likelihood for successful change varies when the pressure for change comes from front-line, mid-level or managerial staff or from external courses like regulatory agencies, funders or consumer groups and such issues need to be addressed directly if organizational change agents are to be effective. The importance of assessing individual or group `power' within the organization should therefore, be analyzed (Wilson and Wagner, 1997) and tools such as the Stakeholder Analysis found in Part 2 would be useful.
A figure in Chapter 2 shows 12 forces at work to prompt organizational change, from cost issues to consumerism, but misses the opportunity to organize these into conceptual categories. Later, in Chapter 5, the PRECEE/PROCEDE model's three behavioral antecedent factors (Predisposing, Enabling and Reinforcing) are used to suggest appropriate change strategies and could be also used to organize the 12 change forces outlined earlier (Green and Kreuter, 1999). Also, the distinction between externally and internally driven change is implied in various sections of the book, but this concept is not fully developed.
Early exposition of an organizational `diagnostic' framework would help the reader. For example, Pigors and Myers (Pigors and Myers, 1981) present a paradigm that considers human, technical, policy, environmental and space–time dimensions of organizational functioning. Likewise, Wilson and Wagner (Wilson and Wagner, 1997) spell out the physical, technological, social, political and economic elements needed to understand `organizational climate' and change. The ACTSS Model proposed in Chapter 10 addresses the affective, cultural, technical, structural and strategic dimensions or organizational capacity to change and could be presented in Part 1 to give the reader a better understanding of the context of organizational change.
Like Part 1, Part 3 could also be seen as a supplementary anthology to the core of this book and presents actual organizational changes stimulated by electronic/information age social and technological changes. It provides a useful companion to this Journal's recent special edition on `Health Education and the Internet' (Bernhardt and Hubley, 2001). The four chapters describe programs and situations that utilized expert systems involving computer-based decision-making and problem-solving skills for patient education, provided an Internet health website for adolescents, addressed consumer health information accessing on the Internet, and enabled health professionals to engage in research and self-development.
Finally, a word is needed about organizational change in developing countries. While the author acknowledges that the training and teaching from which this book was developed were primarily of North American origin, he does indicate that the organizational change processes described therein are relevant internationally. Chapter 2 ends with a call for `adapting to the winds of change'. Keller et al. (Keller et al., 1996) spell out eight assumptions about the rough sailing through organizational change in store for NGOs working on the international development agenda, such as the need to balance flexibility and control, to involve all members of the organization and the recognition that organizations are open systems subject to influence from the larger environment. These assumptions would be equally relevant to readers of Promoting Health.
The book actually does address health status and health care disparities between the `haves' and `have nots' as a important issue to stimulate health organization changes in the context of North American experiences. While some of the case studies and examples would need to be adapted for training in Botswana or Thailand, the basic concepts are still valuable. Issues of motivation to change by health workers in systems where their salaries may be several months late and consumer access and regular use of alternative health systems, for example, would need greater emphasis, but the need to provide health care professionals with self- and system-analysis and planning tools is just as strong if not stronger where the whole health system (public, private and otherwise) is threatened with collapse from the demands of the HIV/AIDS epidemic.
References
Bernhardt, J. M. and Hubley, J. (2001) Health education and the Internet: the beginning of a revolution. Health Education Research, 16, 643–645.
Green, L. W. and Kreuter, M. W. (1999) Health Promotion Planning: An Educational and Ecological Approach, 3rd edn. Mayfield, Mountain View, CA.
Keller, D., Mclaren, K. with Bisson, R. (1996) Grabbing the Tiger by the Tail: NGOs Learning for Organizational Change. Canadian Council for International Cooperation.
Lewin, K. (1953) Studies in group decision. In Cartwright, D. and Zander, A. (eds), Group Dynamics. Row, Peterson, New York.
Mico, P. R. and Ross, H. S. (1980) Theory and Practice in Health Education. Mayfield, Mountain View, CA.
Pigors, P. and Myers, C. A. (1981) Personnel Administration: A Point of View and a Method, 9th edn. McGraw Hill, Singapore.
Prochaska, J. O. and DiClemente, C. C. (1983) Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395.[ISI][Medline]
Wilson, B. R. A. and Wagner, D. I. (1997) Developing organizational health at the worksite. American Journal of Health Studies, 13, 105–108.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||