2) Discuss the dilemmas inherent in strategy development and change

management
The dilemma for change a strategic organizational change is to translate the uncertainty
of the strategic analysis and decisions into actionable plans to convey profit. The problem
is that there is no correct answer to the question "what should be our strategy?"
The strategists have looked to the future with the help of a number of strategy tools and
have a number of scenarios that seem to be well identified for the organization. The
resulting strategy it is chosen dependent upon a number of factors, under the control of
the organization, many do not. Since it is not possible to perform a test of the strategy
with one selected and the best of it.
In making the best of the current strategy, the change leader must also cover some
futures, so that any changes to keep the organization open as many options as possible for
the future and not the organization does not return to a position where he no longer works
in the reality that occurs.
What can change leaders to manage their dilemma?
There are two immediate actions to change leaders can do to help manage the uncertainty
of the strategy, while delivering real and beneficial changes within an organization
understand what the strategy was and be willing to change what you plan to change.
Understand the strategy
One strategy is the pattern or plan that the main goals of an organization, policy and
action sequences integrate into a coherent whole. A well-formulated strategy helps in
pooling and allocating resources of an organization in a single and feasible attitude based
on the relative inner competencies and shortcomings, feasible changes in the
surroundings, and restricted steps of intelligent opponents.

LIMITS ON Strategic choices

The strategic choices of a company are not unlimited; rather, they are dependent on the
capabilities of the company and its position in the market. "At the broadest level,
formulating competitive strategy involves the treatment of four major factors affecting
the limits of what a corporation can successfully achieve find out," Michael Porter wrote
in his classic book Competitive Strategy. Two of these limiting factors are internal, and
the other two external. The internal boundaries are generally strengths and weaknesses of
the company and the personal values of its leaders. "Strengths and weaknesses of the
company profile of the assets and skills in relation to competitors, including financial
resources, technological position, and the identification mark.
New approaches STRATEGY DEVELOPMENT
Traditional approaches to strategy development have been criticized for being too rigid,
inflexible and authoritative. Experts claim that this approach also were working to predict
the analysis and quantification and to quickly adapt to market changes.
To a large extent, the changes that have occurred in the company's strategy came as a
result of changes in the environment. As the global market has become increasingly
volatile and competitive, companies have had to adapt by reducing their time to respond
to changing customer needs. In addition, changes in business strategy came in part
because today's workers tend to want and have more control over their working lives
demands.
What goes into the change management strategy?
Change attributes - Changes can be formalized projects, strategic initiatives or even
small adjustments to the way the organization operates. Understanding the characteristics
of the change requires that you answer questions like:
What is the extent of the change?
How many people will be affected?

 Who is affected?
People are affected the same or are they experiencing the change differently?
What is changed - processes, systems, track rollers, etc?
What is the timetable for the change?
Organizational attributes - Next, to understand the work of the people and groups
affected by the change. The organizational characteristics are related to the history and
culture of the organization and a description of the background against which this
particular change is introduced.
What is the perceived require for this change among employees and managers?
How are past changes are managed?
Is there a shared vision for the organization?
How much change is going on at the moment?
Influenced group - The final step in the construction of the situational awareness is to
develop a map of the organization that will be affected by the change, and how they are
affected. A single change - say that the deployment of a web-based expense reporting
program - will affect different groups of very different. Employees who do not have to
report cost will not be affected at all. An employee who travels once per quarter will be
only slightly affected.

LEADERSHIP AND CHANGE MANAGEMENT IN HOSPITALS

The changing healthcare landscape
One of the most difficult sectors to renew the health care, in particular hospital industry. While
industry and most services industries, such as airlines, hotels, restaurants, and banks have
invented in order to provide better quality services to their customers, have the hospital processes
are not changed dramatically over the years as to the impact over all the satisfaction of the
patient. It is common and ironic to out-of-date management practices blended with state-of-theart medical equipment to see and advanced information technology. Quality of service is lagging
behind in many hospitals hardware and software quality.
Needed for long-term thinking
Unfortunately, the strategic long-term planning rarely done by hospitals. An excuse for lack of
thinking long term, short term, everyday firefighting nature of the industry. Hospitals are always
busy with a constant flurry of activity and recordings. It seems that you cannot stop the clock in
this 24x7 mills and ask strategic questions as:

Are we still going to do the right thing?

Is there a much better way or a different way of doing?
Are we still a step in the right direction?
Do we change gears and our course?

Perhaps the most important result of short-term thinking and fighting attitude of hospital
managers is all too familiar indifference to the plight of the patients. Hospital processes are often
characterized by bureaucratic delays and long painful wait for almost everything: wait for the
doctor to wait for a room, awaiting the results, in anticipation of the bill and the fees of the
elusive physician. No wonder that hospitals call their customers "patients" because they need a
lot of patience during their stay. At the top of the delays is the lack of transparency; patients are
not adequate or are not aware of all of the reasons for these delays. Many anti-policy clients,
such as multiple hand-offs, the point of sale or service is separated from the time of payment,
allowing multiple queuing by the same customer.

New paradigms, new leaders

Hospitals and their systems need to be adapted patient centered, patient-oriented to become, and
the patient-driven, rather than physician-driven. Special attention should be given to the "hotel
as" processes of the hospitals, which constitute the majority of the processes and the source of
most patients complaints: billing, housekeeping, records, admission (check-in), discharge
(check- out), safety, pharmacy, and food service. Hospitals are in actuality specialized hospitals.
The new hospital leaders need to be masters of change. They must be able to transform the whole
organization and turnaround of the setting and be able to turn on and excite about new
possibilities. They should serve as inspiration and models to emulate. With so many stakeholders
hospitals should treat the leaders must master communicators and negotiators who are always
looking for win-win solutions.
Two-headed hospital
There is one important aspect that leadership and change management is particularly challenging
in the hospital industry. Most hospitals are run by two top executives: hospital administrator,
responsible for the employees and business functions, and the doctor responsible for the medical
and clinical processes. Most companies and organizations have only one chief executive. There
are few other two-headed organizations. The closest analogies could be the publishing industry
co-managed by publishers and the editor-in-chiefs, and the movie business contributed by
producers and directors.
Doctors with three hats
On the other hand, is managing the biggest challenge of the medical directors, coordinate and
discipline doctors. Doctors, or rather consultants, wear three hats: employee, customer and
owner. They act as employees. Although receiving no salary from hospitals, they are employedlike to perform functions and processes from the perspective of the patient. They also act as
clients. Although they are unable to pay the hospital, doctors put patients, and actually decides in
most cases where hospitals their patients would be admitted. Most of them have links with many
other hospitals. Doctors have a significant impact on revenue generation.

Total Quality Management in Hospitals

Leadership and change management in hospitals is not an easy task - given the unique nature of
the environment and stakeholders. But the hospital of the future and its fate will be decided today
by the long-term strategy formulated by its leaders and the management. Remarkably, however,
is that all major hospitals in the country that eventually focused on customer service and
customer satisfaction as their long-term strategic objectives. Implement total quality
management and TQM, they have achieved very positive results. They also discovered in the
process that improving patient satisfaction, both image building and financially rewarding,
because it cuts length of stay (LOS) and unnecessary costs. We expect that more hospitals to
follow suit and emulate these pioneers of the new patient-first paradigm in healthcare.

Reference
http://ctb.ku.edu/en/table-of-contents/structure/strategic-planning/developstrategies/main
http://www.referenceforbusiness.com/small/Sm-Z/Strategy.html

http://www.change-management.com/tutorial-2007prep-strategy.htm

http://www.rtdonline.com/BMA/CSM/14.html