Week 10: Change Theory

Lewin’s Change Management Model could be applied to the ACA 40 hours is full time employment definition policy. Normandin (2012) explains the three stages of this model. The first is the unfreeze stage, the second is the transition stage and, the third is the refreezing stage. As it applies to the policy, those employees affected, would have to disassociate the definition of full time employment as they have always understood it and realize that full-time employment had never been defined through the government but was always to be determined by the employer (www.dol.gov, n.d.). The transition stage would then involve every employer’s policy and procedures regarding full-time employment to be updated to state that full-time employment is defined as working 40 hours a week and employees beginning to work 40 hours, where perhaps they never had to, and the refreezing stage would be this new definition sticking and becoming the culture for all organizations. The problem with this is that a lot of employers’ already defined full-time employment as working 40 hours a week so this change management model would apply more to those professions and employers/organizations where the definition of full-time employment was not 40 hours per week. Normandin (2012) discusses other change management models but acknowledges that other models may be helpful as they all provide a guide to assist in making the changes needed but, ultimately, change is difficult to implement and manage.

Forti (2012) explains that a good theory of change should address some major concerns: who would benefit, what would be the benefit, over what period of time with the benefits be achieved, how these benefits would be achieved and, work circumstances will need to be addressed. Interestingly, some of these concerns have been raised in previous weeks throughout the course of this blog. These are all important concerns as they may be representative of the needs of society and especially those affected by this policy. Is it really necessary to define full-time employment and why? Not defining fulltime employment may not be a perfect way to function but it has worked so far. The possibility that employers could use the policy to avoid having to offer health insurance coverage benefits to employees is very concerning and more than that the fact that Medicaid might have to bear the burden of providing healthcare benefits to these employees should be considered. The publics’ opinion should be sought through polls and other means to better gain some insight into how this might affect everyone and not just some sectors of the economy and maybe the change would not be so difficult.

Forti, M. (2012). Six Theory of Change Pitfalls to Avoid. Retrieved from http://www.ssireview.org/blog/entry/six_theory_of_change_pitfalls_to_avoid

Normandin, B. (2012). Three Types of Change Management Models. Retrieved from http://quickbase.intuit.com/blog/2012/08/28/three-types-of-change-management-models/

United States Department of Labor. (n.d.). Work Hours: Full-Time Employment. Retrieved from http://www.dol.gov/dol/topic/workhours/full-time.htm

Week 9: Policy Governing Access to Data in an Electronic and Genomic Age.

This week’s blog topic comes on the heels of me listening to the United States Senate Committee on Health, Education, Labor and Pensions full committee hearing on America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care (www.help.senate.gov, 2015). The hearing proceedings had testimony from individual from organizations that use, design and develop electronic health records (EHR), with one of them giving her testimony not just as a health informatics educator but as a parent of a child who could have benefitted from better access to data.

An article by Schilling (2011) describes how the federal government budgeted and made available $27 billion in 2009, as part of an incentive program that would encourage hospitals and healthcare providers to begin to use EHR systems as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act. The article further acknowledges that it is not cheap to implement an EHR but this is a concern, the main concern is loss of revenue during the time spent implementing the EHR. The president of the American Academy of Family Physicians (AAFP) was at the senate hearing mention above as a witness and discussed the challenges of implementing an EHR in his practice and the fact that his patient volume has never been at the same level, lower volume, as prior to using the EHR.

The most striking piece of the discussion and testimony given by the witnesses was the fact that EHR systems are supposed to share patient data and information but this is unfortunately not the case. It was suggested that one cause might be due to competition amongst healthcare facilities for patients and thus an unwillingness to share data that may already have been gathered just that week by a competing facility. The truth is that the technology is there and has been built to facilitate the sharing of information but it is not being used as fully intended. There is the Healthcare Insurance Portability and Accountability Act (HIPAA) of 1996 which gives guidance on the sharing of protected patient information electronically and individually which also has facilitated the use of EHR systems.

The conclusion of the hearing was that EHR systems are being used inefficiently thus far and a request that the exchange of health information should be more accessible as the technology is already in place to do so and though there is policy that currently supports the practice, members of congress should continue to develop policy to support the exchange of healthcare information.


Schilling, B. (2011). The Federal Government Has Put Billions into Promoting Electronic Health Record Use: How Is It Going? Retrieved from http://www.commonwealthfund.org/publications/newsletters/quality-matters/2011/june-july-2011/in-focus

United States Senate Committee on Health, Education, Labor and Pensions. (2015). Full Committee Hearing – America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care. Retrieved from http://www.help.senate.gov/hearings/hearing/?id=61101b45-5056-a032-5218-102ca4deb5e2


This week’s blog discussion is on the private sector and its effect on policy advancement. The past few weeks have focused on the public sector and the fact that that sector is comprised of governmental organizations providing services to the general population. The private sector is however the part of the economy that is run by private individuals or groups such as businesses and so on. The private sector is influential not only in policy advancement but the innovative services offered and provided by the private sector have advanced the provision of healthcare services in a number of ways.

According to Smith, Brugha and Zwi (2001), the private sectors innovations in the delivery of healthcare are an important focus for governments because people use their services as they are often nearer and have longer hours of operation. These qualities make them more accessible though the government still has a say on standards and quality of care through healthcare policy (Kingdon, 2011).

This week there was a lobby day for the Advanced Practice Registered Nurses (APRN) in Arizona. The event was hosted by the Arizona Nurses Association (AzNA). This event and organization are an example of the private sector and its influence on public policy. The AzNA is the professional association in Arizona for registered nurses (RN) and is a member of the national organization, the American Nurses Association (ANA). AzNA works to advance the nursing profession to improve health care (aznurse.org, 2015). Though the ACA 40 hour full time employment definition bill was not on the agenda for discussion, the AzNa and its national body the ANA have been working to gather information to understand the effects that this bill would have on the nursing profession. Currently, the ANA opposes the bill and has been requesting input from nurses on how this bill would affect the profession negatively in order to forward the information to Congress (rnaction.org, 2014). This is an example of the private sectors role in the advancement of policy.

Other, private sector, nursing associations such as the Service Employees International Union’s  (SEIU) Nurse Alliance Northwest organization, according to their website http://www.seiu.org, have resumed their blog “Nurses Know the Truth,” Correct the Record on the 30-Hour Rule, to shed light on the facts associated with the passage of the 40- hour full-time employment policy one of which is that the bill could allow employers to cut hours for more people to avoid paying for their health insurance premiums (Barton, 2015). In an independent study, it was found that though employers would not face a penalty from the government for reducing work hours for employees, employers might still end up having to incur costs due to these employees with reduced hours having to use tax credits for health care coverage (Hope, 2013). The private sector is invaluable to any economy and has a lot to contribute to creating policies to assist with their delivery of services.


American Nurses Association (ANA). (2014). When Nurses Talk…Washington Listens. Retrieved from http://www.rnaction.org/site/MessageViewer?dlv_id=12121&em_id=15681.0

Barton, C. (2015). “Nurses Know the Truth,” Correct the Record on the 30-Hour Rule. Retrieved from http://www.seiu.org/2015/01/nurses-know-the-truth-correct-the-record-on-the-30.php

Hope, C. (2013). New Study Finds Failure to Expand Medicaid Could be Costly for Employers. Retrieved fromhttp://ccf.georgetown.edu/all/new-study-finds-failure-to-expand-medicaid-would-hurt-employers/

Kingdon, J. W. (2011). Agendas, alternatives, and public policy (updated 2nd ed.). Glenview, Il.: Pearson Education, Inc.

Smith, E., Brugha, R., & Zwi, A. (2001). Working with Private Sector Providers for Better Health Care: An Introductory Guide. Retrieved from http://www.who.int/management/partnerships/private/privatesectorguide.pdf