Running head: MRSA PREVENTION

Methicillin Resistant Staphylococcus Aureus Prevention.

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Abstract:
This paper is pertaining to organizational change and the dynamic processes involved when
analyzing the organizational systems to change. Our overall question was: How to prevent
Methicillin Resistant Staphylococcus Aureus (MRSA) infection for the disabled population? In
evaluating the Volunteers of America, the community agency that houses and serves this at-risk
population we had the privilege of discussing the organization with two Senior Directors of
different programs. These discussions aided us in gathering insight information about the
organization and the organizational knowledge base in regard to MRSA. We also researched
articles using OneSource with the terms: Volunteers of America, History of Volunteers of
America, Organizational Change Assessment, Lewins Theory of Change, MRSA prevention,
and current Center for Disease Control (CDC) protocols about MRSA. In this research we found
that assessing the organizational structure, and creation of the culture is necessary for
analyzing motivating factors for individuals to implement change, and in this analysis to increase
knowledge base about MRSA.

Introduction: Creation of the Organizational Culture

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The Volunteers of America (VOA) began in 1896 in New York as a religious and philanthropic
organization. The aim and objective of the organization was to reach the out-of-church and
neglected people, with the founder being known as the guardian of the unfortunate (Johnson,
1953). The Volunteers of America came from a need and continues to be a place to turn when
people are in need. We help over two million people per year (VOA, 2016).
Organizational culture is created through the mission of the organization. Charles Lusthaus
P.h.D an expert in organizational performance and assessment recommends that it is best to
first understand the mission of the organization, the history, how it was developed and how it
currently fits into the community (2002), for the Volunteers of America (VOA) the vision
statement: A world where all people live in safety, with social, emotional and physical wellbeing, spiritual fulfillment, justice and hope.(VOA, 2016). Since founding, the VOA has gone
through many leaders and still, the vision of the VOA continues. Since death of the original
founders, The Volunteers of America has shown that it is not only strong enough to survive but
to continue to grow (Wisbey, 1994). The VOA has a place within the community it serves and a
positive impact on society, and this is the established culture. The VOA has an ethically based
mission, with an inspiring vision, destined to have a positive impact on society and societal
change. As a moral based organization James OTool a theorist in organizational change
recognizes that change is an inherent trait (1999) and that the organization can rely on the
mission it serves.
Logic Model: Using Logic Models for Change
Logic models are useful for determining actions needed for to reach organizational goals and in
deciding where resources will be needed. Logic models are a useful tool in mapping out a
strategic plan. Yet, logic models are a linear way of thinking and even though they are helpful;
thinking in this manner eliminates the dynamic capacity of organization and ability to change
(Lusthaus, 2002). Lusthaus goes beyond the linear model in determining organizational change
and instead states that Change in organizational performance is depicted as a set of interactive

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or clustered changes that are perceived by organizational members in different ways and in
different time dimensions. (2002). In saying this, Logical Models have their place in the
organizational assessment, where resources should be distributed, what actions need to be
taken and in implementing where the outcome was not achieved and where change needs to
occur. In determining how to implement these changes Lewins Theory of change can be used.
Lewins Theory of Change: Organizational Change Through a Theory
To tie this to a theory of change, and look at organizational change, a behavioralstructural analytic theory is used to assess change. To assess change with Lewins Theory, the
current organizational structure needs to be evaluated. Based on this structure, the behavior of
the individual with reflect where there is a need for change. As Lewin explains, the structure
encompasses: structural aspects of the environment as: clarity and stability of the cultural
values and norms, stability of social structures, strength and sanctions arising from such social
structures such as peer groups, strength of the individual's emotions, ego-defensive needs and
well articulated cognitive abilities (Apter et al., 1972, p. 20-21).
Lewins Theory of Change states that after assessing the current structure there needs
to be a catalyst for unfreezing the current structure and an effort to implement the change. Karl
E Weick and Robert E Quinn, two professors from Michigan Business School, state that these
organizational changes and catalysts can be large, revolutionary, termed episodic change or
continuous, evolving, cumulative (1999). Motivational factors for change can be internally or
externally driven (Weick). With the Volunteers of America an external catalyst for change would
be the government mandated quality assurance. Our recommendation following our community
assessment for a fact sheet about MRSA has implications for change. This change would start
by unfreezing the current behavior and beliefs at the individual level knowledge base about
MRSA. In changing at the individual level, this could then impact the communitys cultural view
about MRSA as well as a systems structural change about MRSA treatment.

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Lewins Change Theory: Change as a New Trait
After thorough analysis of the current behavior we found that the lack of MRSA
knowledge was part of the current structure and the driving force of the current behavior of fear.
Currently the VOA does not have training about MRSA and the current behavior is to send a
client with any indication of potential MRSA infection to the emergency room. This activity not
only puts the client at a higher risk of contracting MRSA, it is also wasteful of community
resources. Our intended intervention addresses this.
The subsequent stages in implementing change is by implementing change at the
individual level through increasing knowledge base. We recommend implementing a MRSA fact
sheet at the next staff meeting. Presenting this information in this manner will allow for quick
diffusion of knowledge and is instrumental in individual behavior change.
The third and final stage is for the organization to refreeze with the new organizational
traits and behaviors. To evaluate if this is occurring we recommend that the organization
continually monitor MRSA infection and trips to the emergency room. Along with evaluating trips
to the emergency room, testing the caregivers on their knowledge base is recommended.
Refreezing with this suggested current behavior also aligns with the external structure of the
government. These external mandates would reinforce the organizational structure-behavioral
change.
Change at the Community Level: Addressing Resistance
An aspect of addressing resistance to change could be a facet of the community it
serves. This organization is constantly promoting organizational change by addressing the
current community. An example of this is The Western Washington regional cluster. This cluster
of the Volunteers of America established that there is a need within the Traumatic Brain Injury
population and has started a program to fulfill this need. These activities show that an
organization which is committed to its community can have a large impact the societal structure.

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The Volunteers of America as an organization is changing and growing constantly.. The
catalyst that presented itself for this newest change was a need within the community and the
Volunteers of America established a program to fulfill this need.
Resistance: Preventing Resistance to Change
At the Volunteers of America, individuals are not constant members of the community.
The organization must rely on the mission statement, the community it serves and the genuine
motivation of the individual delivering care (OToole, 1999). While speaking with the regional
directors from the VOA it became apparent that the individuals that provide care are not
permanent structures within the organization. Assessing each individuals ability to change and
barriers to change is not recommended due to limited resources, and the impermanence of the
temporary help, part-time employees and volunteers. For organizational effectiveness in regard
to the suggested change it is essential to motivate the long standing individuals within the
organization and integrate these individuals into the plan of change. For the transient individual
it is essential to integrate the individual quickly through creation of bonds to the community with
regard to the mission statement and by making membership of the organization a privilege
(Lusthausm). Having these bonds will also empower the individual within their position to
implement whatever change that was created.
The next area of potential resistance for change is at the individual level. Kotter and
Schlesinger, two professors from Harvard Business School, designed a model aimed to alleviate
resistance of individuals to change and provide motivational tactics. This model identifies four
reasons why individuals are resistance to change within an organization. The four reasons are
parochial self-interest, misunderstanding, low tolerance to change, and different assessments of
the situation (1979). The change that we recommend stems from the knowledge base of the
individual and providing adequate resources for information and being able to answer questions
about MRSA is the best way to address resistance, motivate, and implement change.
Change for the VOA: Force Field Analysis at the Community level

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In implementing an intended change that possibly has bigger implications to the
organization of Volunteers of America it must lie not on the transient individual worker for
change but on the community. The force field analysis model in determining driving and
restraining forces is best applied to the community for effective analysis. Motivational factors for
the community based assessment relies on a community common goal and a community based
solution. The recommended assessments to implement change is in addressing the cultures of
the sub-communities, the leaders of these sub-communities, and whether their missions align
with the current structure. This assessment would gather information on whether that subcommunity is fulfilling the organizational mission statement. If that sub-community has a
different vision, culture, or value system, than the overall community, then that would indicate a
need for change and would require a reforming and episodic change. The best way to create an
episodic change is by being a strong motivational leader, and in an ethic based organization
(OToole, 2009), use of the moral code could also be helpful.
Implementation of Intended Intervention: Suggestions for VOA
The intended change of increasing caregiver knowledge of MRSA that we are
suggesting fits within the current culture of the Volunteers of America and also aligns with the
mandates from the governing body. Implementation of this change will not be a paradigm shift
for the organization and adoption of training for MRSA is likely to depend on resource
availability. There is evidence that increasing knowledge in regard to MRSA can change the
prevalence of community acquired MRSA. In Klickitat county in Washington there was an
intervention for community wide education and distribution of fact sheets to change how MRSA
was handled. In a matter of four days this intervention was effective in changing MRSA
perception (DOH, 2007). In understanding that education has implications for action, and that
limited resources have implications for intervention, we believe that the MRSA fact sheet will be
the most effective intervention for the VOA.

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Diffusion of this fact sheet and education within the community would create many small
catalytic changes and result in a knowledge shift. This knowledge shift in regard to MRSA would
change the individual and community response to the situation. This change could possibly lead
to a systems change, where prevention, early identification, and assessment of the urgency of
the situation will reduce admissions at the emergency room and the predicted results from this
change would be that the overall community resources can be distributed differently.

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Appendix:
Force Field Analysis Model

Logic Model:

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References
Johnson, E.C. (1953). A Study of Agency Program and Casework Services of the Los Angeles
Post of the Volunteers of America. Los Angeles, CA: University of Washington.
Lusthaus, C. (2002). Organizational Assessment: A Framework for Improving Performance.
Ottawa, ON, CAN: IDRC Books. Retrieved from http://www.ebrary.com
Toole, J. (1995). How to Use Moral Values to Lead Change. Leading Change. Retrieved from
http://nathantnavarro.com/uploads/Leading_Change.pdf
Volunteers of America. (2016). About Us. Retrieved from http://www.voa.org/our-mission
Weick, K., Quinn, R. (1999). Organizational Change and Development. Annual Review of
Psychology. 50:361-386. DOI:10.1146/annurev.psych.50.1.361
Wisbey, H. (1994). The Volunteers of America: 1896-1948. Era of the Founders. Metairie, La:
Volunteers of America Inc.

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