Muutoksen ja arvioinnin paikka. Henkilöstö arvioi julkisen erikoissairaanhoidon organisaatiofuusiota eri positioista

Abstract

HENKILÖSTÖN PALAUTE MUUTOSPROSESSIEN YDINTÄ

Tuoreen väitöksen mukaan fuusioiden muutosjohtamisen taustalla on usein rajoittunut näkemys henkilöstön roolista muutostilanteessa. Perinteisesti kielteinen fuusiopalaute tulkitaan ilmaukseksi muutosvastarinnasta, kulttuurisista ristiriidoista tai johdon epäonnistumisesta. Merja Turpeisen väitöskirjatutkimus Muutoksen ja arvioinnin paikka. Henkilöstö arvioi julkisen erikoissairaanhoidon organisaatiofuusiota eri positioista. laajentaa käsitystä henkilöstön roolista fuusioissa. Kirjassa esitetään, kuinka organisaation jäsenten antamaa palautetta fuusiosta voidaan tarkastella aiempaa monipuolisemmin.

Julkisen sektorin organisaatioihin kohdistuu yhä enemmän paineita tehostaa toimintaa ja parantaa laatua. Organisaatioiden yhdistäminen on yksi keino tavoitella kustannussäästöjä ja lisätä asiantuntijaosaamista. Kahden organisaation yhdistäminen on haasteellista muun muassa henkilöstön muutosvastarinnan ja toimintatapojen erilaisuuden vuoksi. Henkilöstöllä on kuitenkin tärkeä rooli fuusion onnistumisessa, ja sen suhtautumisesta fuusioon on hyvä kerätä palautetta muutosprosessin ohjauksen tueksi.

Tuloksissa selvitetään, miltä fuusio näyttää, kun organisaation jäsenet arvioivat sitä työntekijän sekä aiemman että uuden työorganisaation jäsenen näkökulman lisäksi eri ammattiryhmien, eri toimialojen ja yksiköiden edustajana, työyhteisön jäsenenä sekä esimiehen tai alaisen kannalta. Fuusiota arvioidaan myös julkisen sektorin toimijan kuten julkisen sektorin työntekijän, veronmaksajan, tietyn kunnan asukkaan sekä potilaan näkökulmasta.

Eri positioista tehdyt erittelyt tuovat lisää tietoa siitä, miten monin eri tavoin julkisen sairaanhoidon henkilöstö asemoituu arvioimaan organisaatioiden yhdistämistä ja millaisia asioita pidetään tärkeänä muutoksessa. Tällaista tietoa tarvitaan erityisesti suurten muutosprosessien suunnittelussa ja ohjauksessa.

Muutospalautteen tutkimuksessa on sovellettu uudenlaista lähestymistapaa. Fuusioarvioita on tarkasteltu organisaation jäsenten toimintana niiden esittämistilanteessa. Kun fuusioarviot on esitetty esimerkiksi henkilöstökyselynä toteutetun fuusion arviointitutkimuksen yhteydessä, kertoo kriittisinkin palaute organisaation jäsenten osallistumisesta muutokseen ja vaikuttamispyrkimyksistä sekä toimimisesta johdon toivomalla tavalla ja uuden organisaation hyväksi. Tämä tulos haastaa perinteisemmät näkemykset tulkita kielteistä fuusiopalautetta ilmaukseksi esimerkiksi muutosvastarinnasta, kulttuurisista ristiriidoista tai johdon epäonnistumisesta.

Tämä havainto on tärkeä, koska se ohjaa keskittymään muutosjohtamisessa toimintaprosessien ja rakenteiden yhdistämiseen sekä perustehtävän tekoon liittyviin käytännön ongelmiin ja niiden konkreettiisiin ratkaisuihin.

Tutkimustulokset tuovat myös muutosten arviointiin uusia näkökulmia. Tutkimuksessa tehdyt arvioiden esittämistilannetta koskevat erittelyt tarjoavat mahdollisuuksia kehittää erityisesti lomakekyselyyn perustuvaa arviointia.

Merger is one possibility for an organization to improve performance and respond environmental changes. However, change processes are often difficult to implement and it is hard to achieve the original goals. The attitudes of employees have been considered as a significant factor to implement a merger successfully. In research literature it is suggested that particularly the actions of the management, resistance against change by employees, and the cultural conflicts between the merging organizations, cause practical problems in implementing the merger. Health care organizations are also regarded as challenging environments to implement the merger because of the professional power of the groups involved. Often these kinds of aspects are taken for granted starting points or presuppositions of the study, though they also have been criticized. According to the criticism the roles or standings of the members of organization are usually defined in advance which is likely to influence on how the research is performed and how the problems of change process are specified. The agency of the members of the organization may be ignored. Further, these kinds of presuppositions are not optimal in developing new practical solutions to implement the merger successfully.

The study examines the merger of public special health care organizations as evaluated by the personnel. The first aim is to reflect the starting points of the merger studies and the presuppositions of the organizational actors. The second aim of this study is to investigate the locality and situationality of knowledge about the members of the organization in merger process. The theoretical and methodological starting point of this study is positioning theory (Davies and Harré 1990; Harré ja van Langenhove 1991; 1999; Harré ja Moghaddam 2003).

In this theory our everyday life is understood to consist of different functional episodes in which people participate according to certain principles and rules (for example the wedding). The social categorizations of the actors are understood as acts during these episodes (for example the bride and the fiancé are positions taken by the couple and assigned to them by others). In this study these theoretical principles guide the analysis of both the research literature and the empirical data.

First, the research literature on mergers and organization change processes of public health care is reviewed. According to the literature review members of the organizations appear to be heterogeneous groups whose attitudes to mergers vary. However, their actions are often interpreted as actions representing certain organizational groups and their own agency and the variety of positions are often ignored. The impact of the research situation has also been passed as a factor that has an effect on the positioning of members of the organization. The research questions are how and from what positions do the members evaluate the merger and what sort of issues do they regard as significant to emphasize when evaluating the merger in a survey. The critical accounts of the merger given by the organization members re investigated as well.

The empirical data consist of the responses to an open question included in a questionnaire in which the respondents could express their own views about the merger. The research was carried out in the context of a research project evaluating an organizational merger of special health care organizations carried out in Southern Finland in 2000 and 2002 (N2000 = 3016 and N2002= 2729). In the analysis the answers were interpreted as acts occurring and positions taking within a research situation. The participants were regarded as actors in an organizational change who were capable of changing their positions with regard to the evaluated object while making the evaluation.

The results of this research show how the evaluators positioned themselves and other actors in their evaluations within three different functional episodes. They were 1) personnel survey, 2) scientific research and 3) formal evaluation. In the first episode as participants of personnel survey the members of the organization gave feedback on the topics that the management had asked them. They also described about disadvantages of the merger or the merger implementation and gave proposals for solutions. Second, in a research situation, as the objects of a survey, the members of the organization gave explanations dealing with their comments on the merger and the reliability of their comments. Third, in a formal evaluation situation the members of the organization positioned themselves to various actor positions. They evaluated the merger as members of the organization, as employees, as members of one of the merging organizations, as a member of a occupational group, as a representative of a operational unit or field, as a member of a work community, as a supervisor and a subordinate, as an actor of the public healthcare and as a patient. From these positions the merger is evaluated from different grounds and drawing upon different arguments with relation to the management, the researchers and the formal evaluators.

The evaluators emphasize the possibilities, rights, duties and responsibilities of the representative of the position in question as factors that affect their attitudes to the change process. As participants in a personnel inquiry they for example stress how the personnel have a possibility to give feedback about the merger process in an inquiry and how the management's duty is to utilize that feedback. As participants in a research they emphasize for example their own ambition to express reliable comments and the researchers' duty to pursue reliable results of the research. As participants in a formal evaluation they evaluate the object of the evaluation in a thorough way and from different points of view.

Similarly, evaluating the merger from different positions highlights the moral agency of the evaluators. For example as a member of the organization the participants comment how the merger has affected the membership of the organization and solidarity. The success and the challenges of the merger process are evaluated in relation to the willingness of the personnel to commit themselves to the new organization and in relation to the possibilities to achieve the expressed aims and ensure the success of the organization in the future. The positions are interlocked to each other and constitute many kinds of combinations.

An evaluator may evaluate merger for example from the standpoint of an occupational group. Even the representatives of the same occupational group, like nurses or doctors, may situate themselves differently as compared to other nurses or doctors, drawing upon many grounds like different operational units, geographical districts and so on. The evaluators also describe their positions as situational or as evaluation positions that they have taken in a research situation and that they can use to explain their comments to the researchers. Though their comments about the merger and the accounts they make to explain their comments the evaluators participate to the change process the way the management expected them to do and in the manner it is appropriate to act in a research situation.

The first conclusion is that the analysis of the positions brings out the diversity of the evaluators' attitudes to the merger. The same individuals of the organization also highlight different moral rationalities when they reflect the change process. The evaluations of the merger and the explanations regarding these comments are addressed to the management so that the management could direct the implementation of the change process and the development projects in a meaningful way. The evaluators also sensitively reflect their role as a participant of the study so that the researchers are able to evaluate the usefulness and reliability of the merger evaluations as results of a research. In a formal evaluation situation the evaluators try to evaluate the topic as thoroughly and in a versatile way as possible. They also stress the moral rationalities when they evaluate the merger from a certain position, for example as an employee and as a member of an occupational group they evaluate changes at work and in the organization with relation to their possibilities and obligations to do their work well.

In comparing the results with previous research of mergers it is observed 1) organizational actors and the personnel of merging organizations do not constitute coherent groups as evaluators of the merger and 2) the health care professions do not constitute coherent groups as evaluators of the merger. Instead, 3) the members of the organization take various positions as evaluators of the merger and also according to the situation, 4) the members of organization that evaluate the merger can be understood as active participants in the change process and committed to developing the new organization and 5) the realization and changes in moral rationalities that direct the activities of organizations and their members have influence the opinions on the merger.

In this study the evaluations of the members of the organization are also considered as acts in their situational and local place of representation: the evaluations are comments represented in an evaluation research on organization merger. From this perspective not even the most critical merger evaluations primarily express the failure of the management, the resistance of change among the employees or other organizational groups or the conflicts resulting from the cultural differences of the merging organizations. On the contrary, they can be understood as efforts to participate to the process of change the way the management expected, contributing to the development of the new organization. In conclusion the general psychological or cultural explanation models seem to be insufficient frames of reference when investigating and also managing the merger because they easily ignore various kinds of conditions, practices and principles that enable and constrict the working and the operations of organizations. They also easily ignore the moral agency of the members of organization. These results contribute to future research on mergers, management and evaluation in the following way: First in terms of research on mergers: 1) It is useful to study the attitudes of the members of organizations from comprehensive frames of reference that include the agency of the organizational actors, local moral rationalities that guide working and the activities of the organizations, as well as the functional situation in which the attitudes are being studied. 2) The postioning theory and the way in which it examines the factors relevant to the members of organization and different positions in a merger situation, can be useful, when planning and implementing a hospital merger, as well as other kind of organizations, especially when mergering public organizations.

Second in terms of management of mergers: 1) It is highly important to view the members of organization and their action from the standpoint they express themselves when considering challenges of the change process. This kind of approach will reveal the various standpoints towards the merger and may even facilitate the change process. 2) This understanding of the variety of standpoints towards the merger is a resource for change management and it helps to direct the implementation of the change process. It also helps to consider the grounds of the decisions related to the change process and the consequences of these decisions for various organizational actors. 3) The criticism towards change by the members of organization can be seen as a resource for change management instead of considering it as a negative factor.

Third, this study demonstrates possibilities to develop the evaluation of processes of organizational change and evaluation research in general. It shows how evaluators may take different positions in relation to the subject of evaluation and how the subject of evaluation may also be positioned in many different ways. Evaluation is understood as an activity taking place in a particular situation. The views and grounds for evaluations of the subject in question are attached to the localized reality of action and are guided by the interaction in ongoing situation.

Evaluating in the context of survey can be understood a multidimensional and active activity. The evaluators do not answer to the questions of an evaluation research in a simple or uniform way but tell their views, consider the grounds and the reliability of their comments and position themselves in relation to the subject of evaluation in various different ways. By increasing the knowledge about the formation of evaluations and taking into account this information in evaluation research it is possible to strengthen the reliability of the interpretation of evaluations based on survey-data.