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Journal of Organizational Change ManagementEmerald Article: A healthcare case study of team learner style and change managementVelma Lee, Frank Ridzi, Amber W. Lo, Erman Coskun

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To cite this document: Velma Lee, Frank Ridzi, Amber W. Lo, Erman Coskun, (2011),"A healthcare case study of team learner style and change management", Journal of Organizational Change Management, Vol. 24 Iss: 6 pp. 830 - 852

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A healthcare case study of teamlearner style and change

managementVelma Lee and Frank Ridzi

Lemoyne College, Syracuse, New York, USA

Amber W. LoNational University, Sacramento, California, USA, and

Erman CoskunSakarya University, Esentepe, Turkey

Abstract

Purpose – The purpose of this paper is to explore the learner styles of a healthcare institutiontransition team and its respective members within a change management context. In particular wefocus on the role of learner style in the success of change efforts within a team setting.

Design/methodology/approach – This paper presents a case study that employs a questionnairesurvey, non-participant observation, and semi-structured interviews as part of a larger study ofhealthcare change management.

Findings – Findings suggest that a mix of learning styles is ideal for successful healthcare changemanagement. Specifically, this limited study suggests a learner ratio that favors convergers andassimilators over divergers and accommodators may be the most effective staffing strategy for changeleadership teams in a healthcare environment.

Originality/value – Managing change in healthcare has been researched from a process perspectivebut few studies examine the individual team members’ learner styles and the impact of these learningstyles over time. Implications for human resources and change implementation are discussed.

Keywords Change management, Team working, Learning styles, Change team, Health care,Implementation science

Paper type Case study

IntroductionThe Obama-Biden healthcare plan (2008) proposes to invest $10 billion a year for fiveyears to adopt a standards-based electronic health information system (HIS) thatincludes electronic health records (Walker, 2009). Hospitals and healthcare facilitiesnationwide are in the process of adopting or aligning their HIS with the standards set bythe administration. These adoption or alignment projects can be defined as changemanagement in the healthcare industry. Multilevel players (e.g. individuals, groups,subunits, organizations, inter-organizational networks, etc.) interact to impact theperformance of an organization (Hitt et al., 2007). It is important – albeit complex – tounderstand organizational development in an era of team-based organizations(West et al., 2003), communities of practice (Lave and Wenger, 1991), networks(Snow et al., 2000), strategic alliances (Hamel, 1991; Simonin, 1999), and virtualorganizations. Using Kolb’s (1984) learning style inventory, the purpose of this study isto explore the relationship of learner style and change management success. Definingthe team as the unit of analysis, data from non-participant observation, a survey,

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Journal of Organizational ChangeManagementVol. 24 No. 6, 2011pp. 830-852q Emerald Group Publishing Limited0953-4814DOI 10.1108/09534811111175788

and semi-structured interviews were collected. We then examined the ratio anddistribution of the learning profiles within and across teams and compared andcontrasted patterns of successful and less successful change teams.

Literature reviewHealthcare organization complexity and changeHealthcare organizations are inherently complex (Begun et al., 2003) because they dealwith the lives and deaths of patients through the interplay of physicians, researchers,technicians, nurses, specialized doctors, pharmacies, and other pertinent players.The complexity arises from:

. the number of constituents involved inside and outside of the healthcareorganization;

. the continuous discovery of new illnesses/diseases that could be encounteredwithout adequate existing knowledge for proper diagnosis or treatment; and

. the uniqueness of each patient’s case and special needs.

Workers in healthcare organizations are constantly confronted with change andpresented with new challenges requiring adaptation and innovation.

These complexities are then magnified in the case of drastic change such as theimplementation of new programs or practices such as those brought on by legislation,strategic partnerships, mergers and re-locations. The field of implementation sciencehas arisen as a response to such complexity (Petersilia, 1990; Taylor et al., 1999). It beginswith the premise that studying and learning lessons from the experiences ofimplementation is as crucial as designing and planning for change itself (Fixsen et al.,2005, pp. 16-24). Since learning from experience is such a key aspect of this approach toimplementation, we therefore assume that attention to learning styles will beinformative if not consequential. In this paper we explore the relationships betweenlearning style and implementation success by examining a team of medical andadministrative personnel responsible for the transition planning and implementation ofa new hospital. Change success was measured using an objective survey, self-reportedratings from a variety of constituents, and non-participant observation. We concludewith a discussion of implications for human resources planning at the individual, team,and organizational levels.

A critique of team learning modelsMost extant learning theories are stage theories that emphasize linear and iterativeprocesses. Cangelosi and Dill (1965), for example, suggest four phases of teamworkrelated learning: initial, searching, comprehending, and collaborating. In general,learning theories focus on the individual as the unit of analysis. Recent developmentsin learning theories increasingly consider environmental influences on learning. Oneexample is Situated Learning Theory offered by Lave and Wenger (1991) who positthat learning is unintentional and situated within authentic activity, context, andculture. Situated Learning considers the legitimate peripheral participation of membersat the boundary who play a major role in the knowledge creation process. Anotherlearning theory, problem-based learning (PBL), is an instructional method of hands-on,active learning centered on the investigation and resolution of messy, real-world

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problems that emphasizes open-ended problems, self-directed learners, teachers asfacilitators, and students as problem solvers (Finucane et al., 1988).

Social Learning theorist Bandura (1977) explains human behavior in terms of acontinuous reciprocal interaction between cognitive, behavioral, and environmentalinfluences. His Social Learning theory is descriptive and provides insights on trainingand mobilizing learning. However, a lack of quantifiable factors creates challenges forboth theorists and practitioners to measure and monitor learning – particularly teamlearning – in a systematic manner.

Kolb’s Experiential Learning theory (1984) offers a holistic perspective that combinesindividual experience, perception, cognition, and behavior to explain learning allowingfor team level analysis of member profiles and distribution (see Appendix 1.2 for asample distribution). Kolb’s Learning Styles have been widely adopted for predictingacademic achievement (Cano-Garcia and Hughes, 2000) and counseling careerdevelopment (Kolb, 1984) and yet no study has investigated the profile and ratio ofteam learning style distribution for improved organizational performance in a changecontext (see Appendix 1.3 for learner style sample question). According to Plsek andGreenhalgh (2001), complexity science considers Kolb’s Experiential Learning model atheory that allows examination of gradual attention development toward the issue oftime. Thus, Kolb’s learning styles theory was adopted in this study to examine learningpreferences because the framework is appropriate for explaining change over time,incorporates participant feedback for understanding their unique individual learningstyles, and provides useful information on the profile of members within teams. Theseaspects of the theory are important because understanding team member learning stylesguides effective information exchange among interacting parties. For example,a surgeon who wants to teach a nurse about the procedures required for a neworganizational change in program or practice will be more effective if the surgeonpresents the material in a way that was tuned to the nurse’s learning style. Effectivelearning by the nurse ensures a smoother operating procedure. Furthermore, it isimportant for the nurse to effectively communicate and update the surgeon on changesthat occur in her areas of work and so she too must be cognizant of the physician’slearning style. By understanding her own and her teammate’s learning styles, potentialconflict is reduced leading to better cooperation among parties during implementation.But do all learning styles work well together in a change experience? And are some moreadept at change processes? This study aims to begin to explore the relationship betweenlearning styles and change outcomes through a case study of a change managementteam and its staff in a healthcare context.

Research context and participantsTo qualify for inclusion in this study, the subject team had to meet the criteria of bothplanning for and going through a change or transition. In September 2006, a qualifiedteam was identified through the recommendation of the Provost of Research in asoutheast medical university. The organization is a medical center whose hospitalhouses approximately 850 beds with a daily capacity of about 200,000 patients. Thehospital was constructed in 1955 with federally supported funds. For six consecutiveyears, the National Research Corporation awarded this medical center the ConsumerChoice Award for overall quality and image among hospitals in the primary servicearea. In the 2000s, the children’s hospital, digestive disease, heart, and vascular centers

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were all ranked in the top 25 by US News and World Report’s (2010) surveys of the besthospitals in America. The medical center also received the Outstanding CommunityService Award from the Association of American Medical Colleges in its recent history.

Since the 1990s, leadership in the organization placed increased emphasis onstrategic planning for the new hospital. In response to changing market forces, theorganizational strategic plan set up three major initiatives: to reduce costs throughchange management efforts, to increase primary care capacity, and to explore possibleaffiliations with other hospitals in the region. The subject team for this study, anAction Coordinating Committee (ACC), was charged with the responsibility ofplanning the move of selected units in the existing hospital to the new, replacementhospital. Members of the ACC included directors and team leaders of various clinicalunits (e.g. heart and vascular, digestive disease, nursing) and supporting businessdepartments (e.g. hospital information technology, facility, human resources). ACCmembers met regularly for updates on project progress. Meeting frequency rangedfrom monthly to weekly as the targeted hospital opening date approached. Generalagenda items included personnel changes such as new hires and new coordinatorsassigned to leading key positions, reports celebrating good practice, milestonedevelopments to inform peer team coordinators of progress, logistical arrangementsconcerning appropriate movements of facilities and people, financial reports, andconstruction updates on the progress of financing and operational planning.

Members of the ACC team were invited to participate in our research with theknowledge that the team learner style survey would provide members with informationabout both personal and colleagues’ styles and that this information might result in bettercommunication and cooperation. All ACC team members and their respectivedepartmental staff (e.g. heart and vascular leaders and staff in the whole unit) wereinvited to complete the learner style survey. In the debriefing process (feedback on thestyles), the team leader was informed of his/her personal learner style and the overall teamprofile distribution (without specific individual information revealed to the team leader).Then, team leaders’ permissions were obtained to share their styles with respective staffmembers. Individual learner style information was shared with respondents on a privateand personal basis. After the debriefing, individuals were encouraged but not required toshare their learner styles with colleagues with whom they worked closely. All team leadersagreed to share their learner styles with members and most respondents who participatedin the exercise were eager to exchange learner style information with one other.An example team learner style distribution is shown in Appendix 1.

Profiles and data demographyIn this study, we surveyed the learning styles of an action coordinating team of23 senior managers (hospital administrators and directors) from 12 departments withina major medical university. Several departmental leaders volunteered to have theirmembers complete a survey yielding 77 responses. Information collected fromsemi-structured interviews, non-participant observation, and meeting minutes wasanalyzed to examine the patterns of communication and interaction among teammembers in the planning and execution of the hospital relocation.

Of the surveyed ACC team members and staff across a variety of departments,75 per cent were directly or indirectly involved in the transition project for less than one totwo years while 25 per cent of the respondents had three to six þ years of involvement


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in this project. The ACC team members and their sub-team members had worked for thehealthcare industry for an average of 16 years and this particular hospital for eight years atthe time of survey. Less than 1 per cent of staff members held their current positions for lessthan one year, 19 per cent had one to five years, 13 per cent had six to ten years, 10 per centhad 11-20 years, 12 per cent had 21-30 years, 7 per cent had 31-35 years, and 2 per cent had36-45 years. In short, the largest groups (19 per cent þ 13 per cent ¼ 31 per cent) ofrespondents worked for one to five and six to ten years, respectively.

Organizational cultureThis section discusses the background of the subjects under study, and their history,development and organizational culture.

Change management historyThe following is an excerpt from a 2007 hospital document obtained from an internalarchive regarding changes prior to the one focused on in this study:

The change management process revolved around an analysis of all functions and processesthroughout the organization while keeping a focus on the primary goal of providing qualityhealthcare at the lowest cost possible. Overall, change management resulted in the followingcost reduction and management changes: created a CEO position for the hospital; streamlinedthe management structure through the elimination of approximately 100 administrativepositions; created more direct lines of administrative reporting; eliminated approximately 800positions through termination and attrition; reassigned 315 positions through work re-design;cut operating costs by approximately $30 million; and adopted some performanceimprovement measures. Between FY 1994-2001, admissions to the Medical Center haveincreased by 38.1 per cent; the average length of stay (in days) has fallen by 25.0 per cent;outpatient hospital registrations have increased by 75.4 per cent and average full-timeequivalent staff persons have been reduced by 13.2 per cent (Hospital intranet site).

Since this restructuring there had been continuing emphasis on monitoring the numberof full-time equivalent (FTE) staff at the hospital. Management frequently calculatedthe number of FTEs per adjusted occupied bed as well as personnel costs as apercentage of total operating expenses. At the time this research began in 2007, themedical center was in the top quartile for this metric as compared with its peeracademic medical centers.

Most recent organizational cultureIn an attempt to understand the work culture of the organization prior to the launch ofthe change in 2006, colleagues indirectly involved with the new hospital project inadjacent departments (i.e. research, information technology, etc.) who would remain inthe existing hospital and not be relocated into the new hospital were interviewed forbackground information.

According to a researcher of the hospital, resistance to change is fairly strongbecause:

[. . .] change is not embedded in the system. There are “kings in different castles” who directand implement clinical pathways and guidelines.

There is a need for systematic indexing of guidelines for structuring processes of careto reduce the cost of care and length of patient stay with the hospital.”

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Ackerman-Anderson and Anderson (2001) suggest that any change that necessitatesa shift of an individual’s mindset to invent, implement, and sustain requires anenterprise-wide integrated change strategy that attends to all of the people involved andthe daily process dynamics between and amongst them. Since outcomes of change areusually uncertain and often have an indeterminable timeframe, change managers needto consider concerns about outcome responsibilities and accountabilities (McWilliamand Ward-Griffin, 2006). Hospital management decided to use an ongoing team meetingprocess to engage in critical reflection-on-action. This seemed especially appropriate forthose who had to create the change (Schon, 1983) because literature suggests ongoingmeetings may uncover the values, processes, and factors at least implicitly consideredrelevant to the intended direction (Page and Meerbeau, 2000; Patzer et al., 2000; Williamsand Walker, 2003). Such an approach helps to overcome resistance to change(McWilliam and Ward-Griffin, 2006).

Timeline and team developmentTo demonstrate change over time, we divided the overall project tenure into eight phases:strategic planning, obtaining approval, vendor selection, hospital design, hospitalconstruction, transition planning, transition execution, and moving into the new hospital:

(1) Strategic planning: 1998, the concept for a hospital replacement project wasintroduced.

(2) Obtaining approval: 2000, permissions and approvals were obtained from thecounty, historical preservation organizations, and other officials to construct thereplacement hospital.

(3) Vendor selection: 2001, architects and healthcare strategists were recruited tocomplete a comprehensive clinical facilities plan.

(4) Hospital design: 2003, the board of trustees approved the hospital design afterreviewing findings and recommendations.

(5) Hospital construction: 2005, ground breaking took place. The hospitalconstruction specifications by phase, capacity, and location were identified.

(6) Transition planning: 2006 (the year this research investigation began), the ACCteam was formed to encourage communication and coordination with alldepartments involved for an organization-wide change effort (i.e. hospitalrelocation upon construction).

(7) Transition execution: 2007, frequent meetings were held for updates onequipment and furniture purchase, facility arrangement, staffing, financing, etc.

(8) Moving into the new hospital: October 2007, an army style, one-day “big bang”approach (as opposed to a phased approach) was adopted to move all patients,equipment, and staff into the new replacement hospital.

Research approachThe field of implementation science has historically used case study to understandhow complex interpersonal dynamics take shape in concrete situations (Petersilia, 1990;Taylor et al., 1999). We are especially interested in the role of learner style in the success ofchange efforts within a team setting. Thus, a combination of qualitative and quantitativemethods was employed in this study to examine team behavior. As change in


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healthcare is an organic process that evolves over time with different unstructuredand serendipitous situations, Strauss and Corbin (1990) suggest that exploration of anunrefined phenomenon is best researched through the use of qualitative methods suchas interviews and case studies. Weiss (1994) particularly endorses the qualitativeinterview approach where the researcher can integrate multiple perspectives, describe theprocess, identify variables, and frame hypotheses for subsequent quantitative research.

Survey questionnaireTo understand whether there was a fit between individual learning styles within teamsand change management over time at different periods of the transition, data on:

. individual learning style; and

. perception of the transition team leadership were collected.

In March 2007, both electronic and paper versions of a survey were made available toteam leaders. In May 2007, missing data and incomplete surveys were identified and theresearchers went into the field and explained the proper procedure to the respondentswho needed to finish incomplete parts of the survey. A second round of invitations wassent in June 2007 to potential participants who had not completed the survey.By July 2007, 77 surveys were completed and returned.

Table I captures the sources, question categories and intended measurement for thesurvey.

The healthcare leadership assessmentThe healthcare leadership assessment (Bodinson, 2005) provides a snapshot overview ofemployee leadership perceptions (the transition team leaders) and effectiveness duringthe period of measurement. Example statements evaluated by respondents included “theorganization has a shared commitment to excellence and being a great healthcareorganization” and “the culture and work environment support physicians, clinical staff,support personnel, and management in their quest for excellence.” Respondents rank thestatements on a Likert scale of 1 (strongly disagree) to 5 (strongly agree).

Non-participant observationData on two levels of team meetings were collected including the transition leadershipteam (ACC) and respective unit departments.

Transition leadership team communicationThe lengths of biweekly transition leadership team meetings ranged from 60 to90 minutes and the purpose of the meetings were often multiple; they served to updatedifferent departments on the planning and development of the new hospital and alsoallowed managers to identify issues that warranted significant attention and support.

Source Questions/category Measurement

Kolb (1984) Learning style questionnaire(12 questions)

Individual learning style

Bodinson (2005) Healthcare leadership assessment(21 questions)

Understand employee perception of leadershipeffectiveness

Table I.Measurement of variables

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They were a forum for clarification on uncertainty and planning for contingencies.Questions posed by different managers were noted and discussions on the pertinentissues were recorded and analyzed. Key issues were also brought up and discussed in thetransition team meetings. Then, issues were placed into the hospital intranet system totrace the development of the issues, monitor the issues, and identify resources for furtherproblem solving. An example of the documentation format used for communication andinteraction is shown in Table II.

Agenda items varied depending on the developmental phases of the project.In general, updates on growth, people, finance, and service were always a part of themeeting’s agenda. About six months prior to the targeted hospital opening day,management added “celebrate” as a compulsory agenda item. In other words, a platformwas created to allow different sub-teams to report what had been finished and what hadbeen done right (best-practice sharing) as the checklist of to-do items was completed.

Unit departmental meetingResearch consent was obtained for the authors to participate as observers indepartmental meetings. The authors took notes on such areas as communicationpatterns, questions, updates, overarching issues, and the number of times someonecracked a joke or the group broke out in laughter. The authors observed 22 unitdepartmental meetings each of which lasted between 45 and 60 minutes.

Archived dataMinutes of the transition team meetings were collected from the intranet that tracks theproject progress. Using Weft QDA, data were analyzed to identify patterns of workdeliverables and team development.

Distinguishing effective vs ineffective change management unit teamsData from three sources were analyzed to differentiate effective from ineffective teams.The first source was the survey data, the second was archived data, the third was fieldnotes from observations and conversations with employees. The social learning cycle(SLC) model (Lee, 2005) was used to count the number of SLC deltas (Lee, 2010) presentin each team. The SLC delta is a team learning measurement concept that reflects theintensity of problem solving, abstraction, and diffusion of knowledge generated inteam interactions. According to Lee (2010), a team that experiences more SLC deltas isconsidered more effective in managing change/innovation than one that experiencesfewer SLC deltas. Appendix 2 shows the SLC model and an example of a delta count.Members of the team were asked to rank the hospital’s move project on a scale

Agenda/topic DiscussionConclusion/recommendations(when/what)

Follow up(who)

Patient safety netGrowth construction updateService – valet parkingService – medical record pick-up locationsPeople – implementation team reportsFinance – operational planning update

Table II.Communication format

during transition


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of 1 (inefficient and not successful) to 5 (effective and well executed). They were alsoasked for the rationale behind rankings.

Semi-structured interviewsInterviews were conducted both during and after the transition to deepen understandingof the change process. During the transition, some interviews were conducted in personwhile others were conducted over the phone.

Phone interviewsTo closely monitor team development, regular phone interviews were conducted withthe coordinators. This offered a more comprehensive understanding of the transitionprogress and team member development. Example interview questions include“According to your opinion/department, what are some of the latest issues identifiedregarding the new hospital?” and “Has there been any change in personnel in yourdepartment lately?”

Post-transition interviewsAfter completion of the relocation, semi-structured interviews were conducted withdepartment representatives and members of the transition team. Examples of theinterviews’ semi-structured questions include “according to your opinion, what couldhave been done differently?” and “how would you describe the current morale of thestaff in the new medical tower?” Between March and October 2007, 18 interviews wereconducted averaging 25 minutes each.

Results and discussionLeadership assessmentThe mean leadership score was 4.2 out of 5 on a scale of 1 (strongly disagree) to 5(strongly agree). This can be interpreted as management being well perceived byemployees. For instance, the following statements scored a mean of 4.5 or above:

. The organization has a shared commitment to excellence and being a greathealthcare organization.

. Accountability for achieving our goals and getting results is clear at each levelwithin the organization.

. Accomplishments are celebrated, recognized and/or rewarded.

. Our staff has easy access to the information and equipment they need to do theirjobs safely and efficiently.

Table III illustrates one departmental team’s interactions. It shows a leader (converginglearning style) who always meets with her sub-team members immediately after thetransition team’s biweekly or weekly meeting. Usually, she chooses the next 10 a.m. slotimmediately following the general transition team meeting to discuss updates with hersub-team members to identify questions and concerns. It provided an avenue for herstaff to ask questions, collect further queries and feedback from their frontline staff,and anticipate management updates and progress. This sub-team always started andended its meeting punctually. Many team members took notes and documented actionitems. The team leader was open in sharing her handouts from top management.

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Often, handouts with her own personal notes and remarks were also shared with herimmediate team members. The leader treated members as equally significant coworkersin managing the various healthcare units.

Learning styles and success of implementationWe found a notable correlation between the learning style makeup of change teams andthe overall success of the implementation. As seen in Figure 1, team members rated theimplementation as more successful when convergers and assimilators dominatedthe group’s numbers. In these cases, not only were group members on average morepositive about the implementation’s success, but the number of SLC deltas observed

SLC team learning codingexamples Healthcare transition team examples

Scanning Information access (IA) Communicate with traffic department for advice onparking lot size and facility needed for helicopteremergency landing to deliver patients

Selecting information (SI) Select information from the feasibility study report toshare with the community residents

ProblemSolving

Increased enquiry (IE) What if the permit is not issued in time, what are ourback-up plans?How about a “rain” plan? What would we do if it rainson the day of relocating patients?

Productive learning (PL) Learning about the park construction increases asmore information is collected for answeringcommunity queries

Change of performance (CP) We have to hire and orient the nurses for the Heart andVascular unit next month

Bring closure (BC) Now that inspection on XX is completed, we can installthe elevators

Abstraction Generate conceptualchange (GCC)

“I thought the equipment would be installed before thepatient would be moved in. It looked like we are goingto move everything in on one day.”

Guide for thinking (GT) The accounting department indicated to us that eachday of delay in opening the new hospital is going tocost us $X,000 interest. So, we need to stay on target asmuch as we can

Diffusion Codification of knowledge (CK) Based on government officer input and consultantfeedback, a new timeline for the relocation is projected

Protocol available fortransfer (PT)

The new hospital information is translated into postersand PowerPoint presentations for sharing with thecommunity residents

Knowledge diffused (KD) The revised relocation plan options are shared with themanagement team for comment and feedback

Feedback on diffusedknowledge (FDK)

External consultants and officials from relevantadjacent departments provided feedback on thefeasibility of the relocation plan optionsCommunity residents’ feedback on the cost and benefitof the plan in the long run

Diffusion beyond team (DBT) The revised plan and opening day of the new hospitalwas announced nationwide

Table III.Example of healthcare

transition team coded inthe SLC model


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were higher, suggesting, according to Lee’s (2010) framework, that they were moreeffective in managing change and innovation.

As seen in Figure 2, assessment of success was fairly consistent across learningstyles. If learning styles seemed to predict feelings of team success, we might havedoubted this measure. However, such consistency within teams and across learningstyles suggests that our measure of implementation success is indeed robust anda reliable indicator of success regardless of learning style.

Figure 1.Self-assessed changeeffectiveness andtotal SLC delta

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Figure 2.Change effectiveness bylearner style and teams

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Below we further probe why some of these groups seemed to be more successfulimplementers of change and how their changes in staffing composition over time mayhave influenced their progress.

Learning styles over timeThe following is a discussion of all the sub-teams’ changes in aggregated learner stylesover the various phases of the change. Since greater human resources were required forboth continuous planning and implementation of the change, it is important to notethat the teams expanded progressively as the new hospital opening grew closer, as seenin Figure 3.

The healthcare industry is filled with science professionals even though a variety ofroles are required for all the necessary positions in the typical hospital. According to Kolb(1984), individuals with converging learning styles are best suited to scientific professionsbecause their strengths include active experimentation and abstract conceptualization.In the strategic planning stage, the facility team was made up primarily of convergers.This is in alignment with Lee’s (2008) proposition that converging style learners areproficient at searching for information and scanning the environment.

Upon obtaining approval to build the new hospital, assimilators were added to theteam. Assimilators are planners (Kolb, 1984) so it was appropriate that the facility teamrecruited staff members that were adept at planning to join this stage in preparation forthe hospital design and construction. When vendors were being selected for the newhospital, the team experienced significant growth; divergers and assimilators wereadded to the team but no accommodators were present at that time. Divergers areexcellent environmental interpreters (Kolb, 1984) and create a team culture conduciveto launching initiatives (Lee, 2008). In this case, change in the form of expansion wasunderway and the addition of divergers to the team was a wise choice from a humanresources point of view. The team population then remained stable until the transitionexecution stage when more staff was again necessary.

According to Kolb (1984), accommodators are doers who are best for execution.In this case, however, the facility team played a strategic planning and control role,which explains why the added staff during the execution stage was an assimilator(planner). This facility team was evaluated and ranked as an effective team in bothleading and undergoing the change (m ¼ 4.3). Its convergers, assimilators, divergers,and accommodators ratio was 4:3:1:0. For a team that was predominately workingin a science environment charged with strategically planning a large change project,

Figure 3.Facility team

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the ratio was effective for its function: mostly converging workers, some assimilatingplanners, and a few divergers who could set the culture for change. If the team grewfurther, it would have been beneficial to track at what point accommodators, if any,were added to the team.

Nursing team 1Nursing team 1, as seen in Figure 4, was predominately filled with convergers andaccommodators. The team grew almost 300 per cent when the move into the newhospital approached since many additional staff members were anticipated. Unlike thefacility team who had a focus on planning, nurses are service deliverers synonymouswith Kolb’s (1984) characterization of doers. Thus, recruitment of additional nurses didnot begin until the transition planning stage. Some nurses were requested to play acoordinating and communication role between the senior planning transition team andthe nurse team during the transition planning stage; thus, additional staff was neededto fill the vacated positions. For the role of coordinating and execution through people,accommodators are best (Lee, 2008). Therefore, it was an effective move to choosenurses – who have an accommodating learning style – to play a coordinating role.

It is interesting to point out a replacement in team membership at that time. When anurse who bore the accommodating learner style was called on to assume new roles,her position needed a replacement. The new hire also had an accommodating learningstyle. By theory, convergers are best fit for the science professions, thus there is a highchance for the replacement/newly recruited staff member to be a converger. Instead,the accommodator who was called on to take new roles was replaced by a new hire ofsimilar learning styles. While this was not a deliberate human resources choice, onecan explain the phenomenon with nature’s ability to compensate. Perhaps the team’seffort to replace a member of similar strengths and skills turned out to have a similarlearner style.

After recruiting additional staff for the hospital design stage, the team experienced asecond surge of staff increase at the transition execution stage. Staff increased threefoldduring this period. In alignment with the expected need for a nursing team, the majorityof the staff recruited at this stage was convergers. Accommodators, divergers, andassimilators were among those newly hired but convergers and assimilators were thedominant groups. The distribution of the learning styles of this team was healthy andeffective for its function in a hospital: 4 (convergers): 2 (assimilators): 1 (divergers):2 (accommodators). Most of the nurses were converging doers who effectively deliveredhospital services. For example, nurses often work with healthcare equipment and adhere

Figure 4.Nursing team 1

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to strict schedules to maintain patient safety and monitor recovery progress. There wasa similar distribution of assimilating planners/educators and people-oriented,accommodating nurses. A small representation of divergers was present for patientswho might need the assistance of someone like a social worker.

Nursing team 2Nursing team 2, as seen in Figure 5, was not formed until approvals were obtained andvendors were selected. Nurses in this team were hired so the specialized unit would beavailable in the new hospital. When the construction phase of the new hospital began,even more people were needed. Initial hires were either accommodators or convergers.Many hired in the second round were divergers who eventually became the majority ofthe team. When the team was ready to move into the hospital, the team’s learning styleratio was 1 (convergers): 2 (assimilators): 4 (divergers): 3 (accommodators).

According to survey results, this team was not effective in its transition experience.Several reasons may have caused this ineffectiveness. First, the team was new andunfamiliar with the hospital’s culture. Second, convergers were the smallest group eventhough, by theory, they are best suited for scientific careers and the most likely groupto thrive in this working environment. If convergers are often top performers in ahealthcare profession, then it is unfortunate that the percentage of convergers on thisteam was only approximately 10 per cent. Using Kolb’s (1984) learner styles forevaluation, the number of convergers was inadequate. Third, divergers, who makegood artists and social workers, formed the majority of this team. The planning andcoordination between divergers (in this team) and convergers (the majority of theremaining organization) can cause conflict because these two styles are opposites inhow information is taken in and interpreted. Fourth, about half of the team wasassimilators and accommodators and their distribution ratio was similar (2:3).According to Kolb, these two styles are also opposites in how information is taken inand interpreted. Such a combination of team members may result in communicationand performance difficulties regardless of the changes that were taking place in theorganization.

Transition teamThe transition team, as shown in Figure 6, was the central leadership planning group forthe change project. It was composed of managers and representatives from varioushospital departments including physicians, nurses, human resources, ambulancepersonnel, surgeons, and information technology professionals. The team gradually

Figure 5.Nursing team 2

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developed and increased staffing after obtaining approvals to construct the hospital.The proportional increase over the trajectory of the whole change period was consistentand balanced. The transition team was the largest team during the planning stage whensenior management made a conscious effort to solicit opinions from as many departmentrepresentatives as possible. Subsequently, team membership dropped slightly because:

. there was no need for all members to remain on the team during the executionstage; and

. some smaller departments were represented by managers in larger adjacentteams.

These managers served to represent their staff and channel staff concerns.About 18 months before the hospital opening, the transition team met on a monthly

basis to discuss personnel changes, information technologies, and the finances needs inaddition to the construction progress. The team met bimonthly approximately one yearbefore the opening. Weekly meetings were held and additional new task forces wereformed to oversee and ensure a smooth relocation approximately two months prior tothe new hospital opening.

This transition team had a core group of members beginning at the strategicplanning stage. The ratio of team member learning styles was 6 (convergers):2 (assimilators):1 (divergers):2 (accommodators). The majority of the staff was scientists(convergers such as physicians, pharmacists, and nurses). At that time, a small portion of theplanning staff was assimilators (e.g. the CEO and the senior VP in human resources) andcoordinators (e.g. nurse managers and HR coordinators) who ensured development andoperation of the hospital. Lastly, a handful of supporting staff such as those in psychiatryand social work played advisory roles.

The transition team was considered effective because it experienced 50 per centmore SLC deltas (Lee, 2010) as compared to the other teams under study. In reviewingintranet archival records, data suggest that problems were quickly dealt with andresolved. In examining how long it takes to resolve the issues, some issues wereresolved in days, others in weeks, and still others in months. Nonetheless, they wereprogressively resolved to prepare for the new hospital.

Post-transition interview responses included:

[. . .] the transition was a success [Respondent: a specialize unit team leader].

On a scale of 1 to 10, I give it a 9 (10 being perfect) [Respondent: a patient].

Figure 6.Transition team

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If there were more facilities/supplies set up before moving in, it would have been better.Overall, it was a good move [Respondent: a nurse practitioner].

The move on that day was very good and smooth. The two weeks that followed was tough. Wehad nothing to work with [. . .] [Respondent: a nurse departmental head].

The 6 (convergers): 2 (assimilators): 1 (divergers): 2 (accommodators) ratio waseffective for this change management team. The majority of convergers (55 per cent)are doers and effective task executors according to Kolb’s (1984) activeexperimentation and abstract conceptualization dimensions. People who haveconverging learning styles prefer communication in a step-by-step, systematicmanner. In a change environment characterized by frequent interruption, uncertainty,and ambiguity, the presence of a majority group of convergers can be an advantagethat maximizes clarity and progress.

On the other hand, divergers are adept at viewing circumstances from multipleperspectives. They evaluate and absorb information using concrete experience andreflective observation. In a change context, they are excellent at creating the culturenecessary for the change to take place. However, too many divergers – consideredspontaneous, free spirits – can result in a ready-for-change situation without actualimplementation. Therefore, the minimal presence (9 per cent) of divergers in this teamwas adequate.

Accommodators are good at working with people such that the presence ofaccommodators is similar to the presence of coordinators/managers. The presence of afew managers keeps tasks under control but too many managers may result ininadequate doers needed at the operational level. Accommodators (18 per cent) andconvergers (18 per cent) could potentially work effectively together as small sub-teamsbecause both employ active experimentation as opposed to reflective observation. In achange context where many actions are required, this study suggests that the twoco-chairs leading the transition planning team were an effective“accommodator-converger” pair.

Assimilators – characterized by reflective observation and abstractconceptualization – tend to see the big picture and excel as long-term planners;their envisioning skills are valuable to a change management team (Kolb, 1984).However, too many assimilators (planners) in a change management context can createan inadequate number of doers for execution. In this team, 18 per cent of assimilatorsworked out effectively for giving direction to the team. Closer examination of datashowed that the CEO and senior human resources executive were assimilators and,consequently, played important strategic planning roles in the transition team.

LimitationsThis is a single case study that included examination of several sub-teams and how thesizes of the teams varied. Also, no comparison was made with other medicalinstitutions. A larger-scale study involving comparison of more than one hospital’stransition would be meaningful for further generalization. The possibility of observingmore departmental meetings could further enrich the data collection, especially forrelevant events that could not be captured in a standardized questionnaire.

Some might argue that individual learner styles change over time and that subjectsmay tune to a different learning style as the situation or environment required.


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While it is valid to say that people change over time, the focus of this exercise is on thepredisposition of the team members’ learner styles (i.e. the most often used orpredominate preference for the intake and processing of information) and their possiblecontribution in a change context. A longitudinal study of the team members’change/non-change in learner style may establish further insights into how learningstyles affect change effectiveness.

Conclusion and contributionThe purpose of this study was to explore the impact of team member learning styles(Kolb, 1984) on change management in a healthcare context. Extant literature hasexplored learner style and its impact on individual education (Weil, 1975) and careerdevelopment (Kolb, 1984). However, there is limited understanding of how learner styledistributions affect team members on task execution in a change management context,particularly in the healthcare industry. This study suggests strategic placement ofpersonnel throughout the change process to initiate, support, and reinforce the change.It surveyed the learning styles of an action coordinating team of 23 senior managers(hospital administrators and directors) from 12 departments within a major medicaluniversity. Several departmental leaders volunteered to have their members complete asurvey yielding 77 responses. Information collected from semi-structured interviews,non-participant observation, and meeting minutes was analyzed to examine thepatterns of communication and interaction among team members in the planning andexecution of the hospital relocation.

Results suggest that a learner ratio that favors convergers and assimilators overdivergers and accommodators may be the most effective staffing strategy for changeleadership teams in a health environment. Specially, the leadership team studied had aratio of 6:2:1:2 for convergers, assimilators, divergers, accommodators. Researchresults regarding the effectiveness of team diversity on team performance is mixed(Knight et al., 1999; Mohammed and Angell, 2003; Horwitz and Horwitz, 2007). Kramerand Standifer (2009) discuss the impact of temporal diversity of team process andeffectiveness. However, discussion on the degree and composition of the team diversityfrom a learner style perspective is still limited, especially in a change context. Thisfinding is significant for exploring effective team management in a constantlychanging and competitive healthcare environment.

Implications for managementAt the organizational level, top management can emphasize diversity such that avariety of talents with different learning styles and work strengths is available in thehuman resources pool. At the team or departmental level, managers need to pay closeattention to the development of the team. This way, the strength of each learner typecan be best placed to facilitate the change or team development. At the individual level,awareness of personal and coworkers’ learner styles can enhance communicationin terms of clear intake and interpretation of information. If a member seescommunication as a type of teaching and uses a style that is conducive to his/herteammate’s information intake, there will be more understanding and fewerbottlenecks in communication ultimately leading to fewer errors and improvedproductivity. In this study, survey respondents were encouraged to share theirpersonal learning style results with their respective team members. Such an exercise

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can encourage open communication and understanding among team members.Ultimately, members who chose to participate in the survey and were willing to sharetheir learner style results may have enhanced team member understanding and workproductivity.

Future research directionIn examining the quality of healthcare, Ferlie and Shortell (2001) suggest the need tostudy change that includes the individual, team, and the larger system level. Teamdevelopment is an area that warrants further attention. No previous research has usedKolb’s Learner Style theory to evaluate team development or change management.This research, therefore, leads learning style in a novel direction for two reasons. First,future research should investigate the application of Kolb’s learner style theory indifferent industries such as retail, banking, or entertainment. Second, the unit studiedwas a hospital as part of a larger medical university that had a typical healthcareorganizational culture – a relatively high aggressive-defensive culture dimension dueto legal liability – and good leadership. Private or community hospitals should be thesubject of further study to offer insights into best practices and dysfunctional cases.

The 6:2:1:2 ratio for convergers, assimilators, divergers, and accommodators wasappropriate for the transition planning leadership team in this study. However, the4:3:1:0 ratio (as illustrated by the facility team) was also effective within its function.While the facility team was only a functional team and the transition leadership teamwas composed of members from a variety of functions, subsequent research shouldcompare transition leadership teams across different hospitals. Future research shouldverify the optimum learner ratio for effective change. For example, would a 5:2:1:2 or6:2:1:3 be better than the 6:2:1:2 ratio learner style? If so, what are the conditions thatare helpful for determining the difference? As Plsek and Wilson (2001) advocate, it isadvantageous to study how variations in structure and process in the more successfulhospitals contribute to variations in outcome. Perhaps, the concept of staffing a teamwith different proportion of learning styles is the beginning of a better process formanaging change in the healthcare context.

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Baldrige National Quality Program (2005), “Healthcare criteria for performance excellence”,National Institute of Standards and Technology, available at: www.baldrige.nist.gov/HealthCare_Criteria.htm (accessed 17 May 2010).

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Weiner, B. (1972), “Attribution theory, achievement motivation, and the educational process”,Review of Educational Research, Vol. 42, pp. 203-15.

Appendix 1Sample learner style inventory grid

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Sample medical center sub-team – team member learner style inventory ratio distribution

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Sample LSI questionsRanking of learning preference (4 being most descriptive of you, 1 being least descriptive).

1. I learn best when. . . ( ) thinking ( ) feeling ( ) doing ( ) reflecting2. When I learn. . . ( ) I like to deal with my feelings

( ) I like to think about ideas( ) I like to be doing things( ) I like to watch and listen


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Appendix 2Operationalised social learning cycle (Lee, 2005)

Refined SLC Coding System

Category

1 Scanning

An act of learning which produces achange in performanceiii

Research and assess informationavailability

Increased enquiriesiv

Cause a change in performance

Presence of guides for thinkingix

Awareness of similaritiesxi

Codification of newly createdknowledgeProtocol made available for transfer ofknowledgeFeedback on the diffused knowledgeDiffusible beyond the team level toother units for adoptionLearning by external agentProtocol spread as organizational/industry standard*Attracted award, research grant, orindustry collaborationΦ

Patents and new market emergencenΦ

Competitor or legal regulationemergenceΦ

Training available for educationΦ

Generate conceptual changex orlearning

Bring closure, concluding that theproblem is solvedvii

Explore unkowns to find more order

A productive learning (knowledge thatleads to action or direction) preceded bya variety of simplier forms of learningvi

Thinking out of higher order rulescombining previously learned rulesv

Select information to applly to problemselect data pertain to question/problemdefined.ii

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Generalizing a product or concept,extending the range of usefulapplicationviii

Newly created knowledge isdisseminated spread and dispersedxii

Newly created knowledge isinternalized through repeated use andbecomes largely implicit*

Newly created knowledge becomesembedded in concrete practices andphysical artifacts*

Review data to decide what kind ofclassification can be made to providea more stable and useful frameworkfor which knowledge can be builtupon/relatedi

ProblemSolving

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Hypothesized stages of work group problem processing based on Social Learning Curve (Boisot, 1995)

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SLC2 (increased enquiry): Do we needan extra team of people to help withXXX if it rains on the moving day?

SLC3 (abstractconceptualization): In general,how much back-up resourcesdo we have for emergencyrelief?

SLC4 (knowledge diffusion):Transition team managementasked each departmental teamleader to do an analysis ofmanpower and equipmentneeded in case of emergency.The information is thenconsolidated and shared in theorganizational intranet.

An SLC delta (SLC 2-3-4) count in the observed transition team:

Corresponding authorVelma Lee can be contacted at: [email protected]

To purchase reprints of this article please e-mail: [email protected] visit our web site for further details: www.emeraldinsight.com/reprints

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