American Journal of Business Management, Economics and Banking ISSN (E): 2832-8078 Volume 16, | Sep., 2023 P a g e | 24 www.americanjournal.org CHANGE MANAGEMENT AND EMPLOYEE PERFORMANCE OF HEALTH WORKERS IN RIVERS STATE Isokariari, Orusoso Waite Lawson Department of Management University of Port Harcourt Business School Eke, Haniel Okorafor (Ph.D) Department of Marketing University of Port Harcourt haniel.eke@uniport.edu.ng A B S T R A C T K E Y W O R D S Employee performance and adapting to change was the topic examined. Participants in this study are employed by one of the 346 primary healthcare (PHC) centres found in one of the 23 study LGAs. From the 23 LGAs in the state, 12 were chosen at random using multi-stage sampling; three from each senatorial district. Then, in each of the 12 LGAs, four Primary Health Facilities were chosen at random. Then, from among the chosen PHCs, health workers from various cadres were randomly selected using stratified selection. From each of the forty-eight (48) institutions, a random sample of 96 Community Health Extension Workers (CHEWs), 96 Community Health Officers (CHOs), 96 Nurses/Midwives, and 48 Doctors were taken. A total of 336 people were randomly selected for this analysis. This research was carried out using a descriptive cross-sectional methodology. In order to accomplish the goals of the study, five hypotheses were proposed and tested at the 0.05 level of confidence. Descriptive statistics (mean) were employed to examine the data, while the Spearman Rank Correlation Coefficient was used to evaluate the hypotheses. Health workers in Rivers State were found to benefit substantially from change management strategies like change communication and stakeholder engagement. Effective change communication techniques should be prioritised by the Health Care Management Board in order to foster a good and supportive work environment in which people may thrive despite change. Change Management, Employee Performance, Change Communication, Stakeholder Management, Work Quality, Employee Productivity Introduction Company goals cannot be achieved without employee contributions. Company employees are its most precious resource and can have positive and negative consequences. Modern organisations must advocate for employee performance improvements in response to unavoidable external developments. American Journal of Business Management, Economics and Banking Volume 16 Sep, 2023 P a g e | 25 www.americanjournal.org Change has been central to science and business. There is no single definition of change, but change management draws on several social science fields and traditions in its theory and practise (Burnes, 2014). Change is a combination of acts that propels an organisation. A "change management" process, tools, and practises are needed to implement a change and achieve the desired business impact. Organisational tools for change management can help people adapt and implement change. Change management is essential for adapting to modern life's fast pace. Change management involves systems, procedures, and people. Change management requires project team and end-user training, familiarisation with new procedures, efficient communication, and task redesign (Al- Shamlan & Al-Mudimigh, 2011). The healthcare industry evolves. Every goal, plan, and endeavour must involve change management. Change management can be applied to staff processes and to the people they serve by various healthcare organisations. Academics, industry experts, and policymakers agree that effective change management is essential to any organization's success, but there is surprisingly little research on the reciprocal relationship, especially in developing countries like Nigeria, where the business climate is fiercely competitive and constantly changing. Despite universal agreement on the importance of change management to enterprises worldwide, this study examines how change management affects health care worker performance in Nigeria due to the lack of current studies. As a result of these developments and widespread use of change management, employee performance should be on the upward. This is due to the fact that a shift in leadership can have a substantial impact on worker productivity, provided that the transition is handled well. This is due to the fact that, as Sidikova (2011) points out, in any proposal for change, there will always be both proponents and detractors. There has been conflicting evidence from previous empirical studies on whether or not change management improves productivity among workers. However, it has been noted that the healthcare industry in Port Harcourt, Rivers State, is suffering from low levels of staff performance. Their work quality and efficiency as a company are clear indicators of this. Is there any explanation for this strange occurrence? Based on Lewin's Change Management Model and the Uncertainty Management Theory (Barney, 1991), we hypothesise that effective change management will have a positive impact on the productivity of health care employees in Rivers State. Stakeholder involvement and change communication are two change management strategies that may help businesses succeed. Our focus is on healthcare employees in Port Harcourt, Rivers state, and we want to know how well change management affects their productivity on the job. Aim and Objectives Of Study The purpose of this research is to measure the degree to which health care personnel in Port Harcourt, Rivers State, believe that there is a connection between change management and performance. There were a few goals that this research hit on directly. (i) Assess the extent of connection between change communication and work quality of health care workers in Rivers State. (ii) Ascertain the connection between change communication and employee productivity of health care workers in Rivers State. (iii)Examine the connection between stakeholder engagement and work quality of health care workers in Rivers State. American Journal of Business Management, Economics and Banking Volume 16 Sep, 2023 P a g e | 26 www.americanjournal.org (iv) Examine the extent of connection between stakeholder engagement and employee productivity of health care workers in Rivers State. Literature Review Theoretical Background Two theories underpin this study which includes uncertainty management theory and Lewin's Change Management Model. Uncertainty management theory: Uncertainty management theory served as the theoretical framework for this investigation into the impact of organisational change on employee productivity, while the Lewin's Change Management Model served as the explanatory frameworks. Organisational upheaval and the stress that comes from erratic outcomes might put employees at risk and threaten their financial security (Terry et al., 2001). When a new piece of technology, product, or organisational structure is introduced, existing staff members may find themselves saddled with additional responsibilities. Whether or not this new position is a good fit for the worker is a major source of anxiety, stress, and openness on the workplace (Carnall, 2003). A sense of loss is fundamental to the passionate mood brought on by transition. In the preliminary phases, when nothing is considered about the change activity, people learn as little as possible about the promised benefits. In some cases, only the knowledge of intermittency can be relied upon. The theory of positive change orientation is laid out by Van den Bos (2001). Employees' reactions to change and the effects of that change are enhanced when there is less ambiguity, as shown by research by Rafferty and Gryphon (2006) and Lind and Van den Bos (2002). Change self-efficacy is derived from these predictors of the latent positive change orientation construct (Jimmieson, Terry, & Callan, 2004). High levels of change-related self-efficacy in the workplace indicate that workers have confidence in their own abilities to adapt to new circumstances and continue performing well throughout the transition process (Jimmieson et al., 2004). A specific connection between self-efficacy and threat appraisal is explained by Ozer and Bandura, who point out that threat is not a property of situations per se but rather a relational property regarding the fit between perceived coping abilities and potentially harmful aspects of the environment. Those who have faith in their own ability to fend off danger are less likely to entertain frightening thoughts in response to actual or perceived threats. Lewin’s Change Management Model Kurt Lewin's studies of collective action led to the development of a method for orchestrating widespread organisational transformation. Lewin considered group behaviour to be an important area of study. People's actions seemed to vary depending on the group he was observing them in, he realised. As a result, he was able to explain that members of a group may have diverse motivations for joining, but if they are working towards the same goal, they are more likely to work together to achieve it. To prevent the group's behaviour from reverting to its previous level, he insisted, it needed to be altered. Burnes (2009), in support of Lewin's theory, argued that "only by resolving social conflict, whether it be religious, racial, marital, or industrial," the human condition could be improved. Lewin's theories were founded on the idea that individuals might gain insight into and reform their perspectives on how to address social conflict via deliberate, instructional change. The three-stage process model for bringing about change is based on Lewin's research. Initiators of change inside an organisation often American Journal of Business Management, Economics and Banking Volume 16 Sep, 2023 P a g e | 27 www.americanjournal.org employ many tactics from the aforementioned three-stage model (Branch, 2002) to bring about the desired transformation. Unfreezing, starting the change (moving), and refreezing are the three stages outlined by Harper (2001). Organisational change might involve making adjustments to the people working there (their skills, characteristics, mindsets, and long-term behaviour) with an eye on achieving authoritative change; adjusting the organization's various hierarchical structures and frameworks (compensation plans, communication channels, and work schedules); or implementing new policies and procedures. Directly altering the ambiance or relational style of the organisation, including how often people interact, how conflict is managed, and how decisions are made. Lewin's theory focused on how elements like dependency and need play out between partners. This meant that the various sections and subsections of the organisation were able to rely on one another to carry out their duties. In addition, the relative importance of the various departments within the company determined the extent of the dependence. However, a substantial limitation of this model is that it presupposes organisations function best in predictable circumstances and can progress sequentially from one stable state to the next. This means that the model is unlikely to be useful in more chaotic business settings. Concept of Change Management According to Ecklies (2011), change management can plan and improve an organization's performance. Change initiatives, unlike business as usual, attempt to increase individual and team performance to stay competitive. According to Jones (2014), "Change Management" is the process through which an organisation optimises its internal processes to reach its goal. The author claims that organisations need change management to maintain competitive edge and increase productivity. Change management requires a company's adaptability, according to Osisioma (2014). Some people are constantly resistant to change. When the operation's goal and beneficiaries are unknown, people are less willing to change their successful methods. People's reluctance to change is partly due to future dread. Consistence comes from the need to feel secure. However, scepticism can significantly lower productivity. Numerous studies show that two-thirds of big reform projects fail. Thus, changing a company's culture, structures, or processes is dangerous and may backfire. Much thought has gone into the transition, which will be constantly monitored and controlled. Managing change. Executive Alignment, Communication, Stakeholder Engagement, Change Impact, Readiness, and Training are common change management steps. The research will focus on stakeholder participation and communication. Change management requires adjusting how you discuss and spread news of organisational changes. Change communication can help employees adapt to organisational changes. Due to the constant expansion and integration of new ideas in the workplace, professionals in all professions must be able to communicate effectively during transitions. Change communication is important, and we give tips for strengthening internal transition messaging. Stakeholder engagement relies heavily on establishing and maintaining connections with relevant parties. Keeping individuals motivated and committed throughout a change initiative's planned and implemented project or programme is also part of change management. You can learn a lot from their opinions on the success or failure of the change, both before and after it is implemented. Customers will be more invested and loyal if they are consulted early on in the process. American Journal of Business Management, Economics and Banking Volume 16 Sep, 2023 P a g e | 28 www.americanjournal.org Employee Performance Company success depends on employee productivity before, during, and after change management. Positive responses to changes affect how workers behave during the transition. Learning more about the topic makes workers fear change. They always choose safe careers. We must emphasise that employees are not noticing a change. The situation is unfamiliar and out of the comfort zone. Protection and bribery were guaranteed. This produces mental and emotional turmoil that affects output. As workers "scrabble" to cope with the change, workplace morale declines (Fedor, 2009). Workers' frequent job stress is the obstacle (Stringer, 2007). Change Communication and Employee Performance Effective communication during organisational transformation helps employees cope with uncertainty (Lewis & Sahay, 2018). This is because sensemaking includes collecting, analysing, and assessing data. Scholars advised firms to inform employees on the need for change, the process of change, and the consequences of change to overcome resistance, eliminate ambiguity, and help employees accept change (Elving, 2005). This communication should be regular, authentic, and optimistic, disseminating important data, eliciting answers, and fostering buy-in for behaviour change while emphasising its importance and timeframe (Lewis & Sahay, 2018). Scholars have underlined the importance of honest communication during the transition. Instead of a top-down information flow, organisations should involve people in change decision-making (Lewis & Russ, 2012). In conclusion, informational transparency emphasises firms' efforts to provide employees with accurate, substantial, and relevant information. High-quality information like this can improve internal communications and prevent misconceptions (Rawlins, 2008). It's different from telling workers everything (Yue et al., 2019), therefore informational transparency is needed. Businesses must inform employees of the shift's rationale, implementation, and effects on their daily lives. However, releasing information may overburden workers with superfluous or redundant information (Rawlins, 2008). This study examines how open communication in businesses affects employees' ability to adjust to rapid policy or strategy changes, building on earlier studies. Stakeholder Engagement and Employee Performance Stakeholder management, as outlined by Ad-esse Consulting (2008), entails the subsequent steps: The first step is to identify all stakeholders; the second is to classify them according to interest and influence; the third is to consider whether they are positive or negative; the fourth is to define the engagement or communication scope for each stakeholder; the fifth is to create a plan for managing each stakeholder, including measures of success; the seventh is to implement the plan; and the eighth is to evaluate the plan's effectiveness and make any necessary adjustments. Only by learning about and empathising with your stakeholders can you hope to manage them well. In order to manage stakeholders efficiently, they are sorted into groups based on a variety of criteria. Adesse consultancy (2008) adds that classifying stakeholders as a starting point for change management planning is a good practise. According to Mwikuyu (2009), one effective approach is to “please those with a high interest but low influence; interact with and inform those with a high interest and a high influence; keep those with a high influence but low interest up to date but with simple messages; and communicate clearly with those with a low interest and a low influence." (Donaldson & Preston, 1995). Management needs to understand the American Journal of Business Management, Economics and Banking Volume 16 Sep, 2023 P a g e | 29 www.americanjournal.org different ways in which the organization's actions and decisions affect its stakeholders (Ad-esse Consulting, 2008) in order to devise strategies that are mutually beneficial. Figure 1.1: Operational framework on the connection betwixt change management and employee performance of health workers in Rivers state Source: Adopted from Shaw (2018), Cecilie (2008), Bakar (2018) and Basit (2017) Hence we state our null hypothesis thus: Ho1: There is no substantial connection between change communication and work quality of health workers in Rivers State. Ho2: There is no substantial connection between change communication and employee productivity of health workers in Rivers State. Ho3: There is no substantial connection between stakeholder engagement and work quality of health workers in Rivers State. Ho4: There is no substantial connection between stakeholder engagement and employee productivity of health workers in Rivers State. Empirical Review Osei-Bonsu (2014) conducted research into three aspects of change management: employee participation, the effect of change management on job satisfaction, and employee outlook following an organization-wide shift. One hundred and forty people were selected at random and given a questionnaire they had created themselves, which included both open-ended and closed-ended questions. The data was analysed using descriptive statistics. According to the results, the employees' contribution to the process consisted mostly of providing relevant information. It was also found that employees' happiness on the workplace improved as a result of the shift. Positive sentiments were seen among workers following the implementation of the reform. Kamugisha's (2013) research on the outcomes of change management in organisations: a case study of National University of Rwanda (NUR) set out to answer the question, "What are the outcomes of change management at NUR?" According to the results of this research, there have been shifts in the administration of academic departments. Administrative personnel are now expected to have a bachelor's degree commensurate with the roles they hold, signalling a shift in both expectations and results. There were effects on human resources, such as layoffs, outsourcing, and hiring to fill new positions, as a result of these alterations. The increased internet bandwidth made possible by ORGANIZATIONAL STRUCTURE CHANGE MANAGEMENT EMPLOYEE PERFORMANCE STAKEHOLDER ENGAGEMENT CHANGE COMMUNICATION WORK QUALITY EMPLOYEE PRODUCTIVITY American Journal of Business Management, Economics and Banking Volume 16 Sep, 2023 P a g e | 30 www.americanjournal.org technological advancements has had a profound effect on the academic and administrative functions of the university. A study by Al-Jaradat, Nagresh, Al-Shegran, and Jadellah (2013) used a case study of Jordanian university libraries to investigate the effect of change management on staff productivity. Organisational shifts, technological advancements, and personal development were all discussed as potential sources of future change. In order to acquire the raw data, the researcher created a questionnaire, and after selecting a random sample of 220 people, they filled out the questionnaire. The research concluded that the University Library's current organisational structure is inflexible and, as a result, is not well suited to the commercial needs of the library. This has resulted in overlapping authorities and responsibilities. The correlation coefficients for organisational structure change, technological change, and individual performance were 0.589, 0.648, and 0.711, respectively, suggesting a favourable association between the three. According to the findings, a well-balanced effort to enhance employee performance, which in turn reflects the quality of productivity, necessitates a focus on organisational structure, human relations, and technology to guarantee the success of the change programme. Igwe et al. (2018) looked into the dedication of top management in industrial companies in South Eastern Nigeria to implementing change. Two hundred and five (205) manufacturing enterprises that are paid-up members of the Manufacturers Association of Nigeria (MAN) contributed to the data set. There were a total of 267 questionnaires sent out. The study used the Chi-square (X) statistic and the Pearson product moment correlation coefficient to determine that change management raises productivity and that there is a robust positive correlation between the dedication of upper and lower management and the success of change implementation in the sampled businesses. As a result, the authors argued that company heads and upper management should facilitate a more welcoming environment for change management. Methodology Study Area: Located in Nigeria's south-south geopolitical zone, Rivers State is one of the country's six states. An estimated 5.18 million people call the state home as of the 2006 census, with representation from roughly 20 different cultural backgrounds. Port Harcourt, the nation's capital, is home to a large and varied population of people from all walks of life. There are 346 Primary Health Facilities in the three (3) senatorial districts of Rivers state, as reported by the Rivers state Primary Health Care Management board (2022). There are 346 primary healthcare clinics (PHCs) located in each of the 23 LGAs, and each of these clinics is staffed by a physician. The research was conducted in 12 of the state's 23 LGAs at random. Then, in each of the 12 Local Government Areas (Omuma, Ogu bolo, Ikwerre, PortHarcourt, Opobo, Tai, Andoni, Oyigbo, Asari- toru, Abua/Odual, Degema, Akuku-toru, and Ahoada-west), four Primary Health Facilities were chosen at random. Study Design: A descriptive cross-sectional design was used in conducting this study. Sampling and Sampling Technique: Everyone who works in Primary Health Care in the state of Rivers. Medical professionals, nurses, midwives, CHEWs, and CHOs all fell under this category. American Journal of Business Management, Economics and Banking Volume 16 Sep, 2023 P a g e | 31 www.americanjournal.org In this research, we adopted a multi-stage sampling strategy. Starting with a frame of all possible Local Government Areas (LGAs), four were chosen at random from each of Rivers State's three senatorial districts (for a grand total of nine). The second phase involved selecting forty-eight (48) primary healthcare centres (PHCs) at random from a sampling frame of PHCs in each senatorial district, with an even distribution of the sample size among the selected PHCs (after a pre survey mapping revealed the existing staff strength per facility). Health workers were then picked from each of the PHCs using stratified sampling proportional to the size of the various cadres of health care professionals. Members of the CHEW, CHO, midwife, and medical doctor cadres made up these groups. Then, from the nominal rolls of the chosen facilities, two (2) CHEWS, two (2) CHOs, and four (4) midwives were recruited; and from a list of four (4) PHC facilities in each of the 12 LGAs, two (1) doctors were randomly picked by balloting. Forty-eight (48) facilities were randomly chosen, and from those, a total of ninety-six (96) CHEWs, 96 CHOs, 96 nurses/midwives, and 48 MDs were taken as a representative sample. A total of 336 people were randomly selected for this analysis. Study Instruments: This study used the quantitative method of data collection using semi structured questionnaires. Validity and Reliability Test Due to the quantitative nature of the study, a structured questionnaire was used to collect information from a sample of 336 healthcare workers. Below is the report of the validity and reliability test. Table 1: Properties of the Measurement Instruments. Constructs/indicators Factors loading(λ) λ2 AVE α CR Change Communication (CC) 0.79 0.88 0.92 CC1 CC2 CC3 0.912 0.882 0.878 0.832 0.778 0.771 Stakeholder Management(SM) 0.76 0.83 0.90 SM1 SM2 SM3 0.916 0.872 0.819 0.839 0.760 0.671 Work Quality(WQ) 0.81 0.89 0.93 WQ1 WQ2 WQ3 0.909 0.891 0.899 0.826 0.794 0.808 Employee Productivity (EP) 0.78 0.86 0.94 EP1 EP2 EP3 0.878 0.908 0.921 0.814 0.799 0.804 American Journal of Business Management, Economics and Banking Volume 16 Sep, 2023 P a g e | 32 www.americanjournal.org Table 1 displays the outcomes of the measuring model. All of the results reveal that the outside loadings are substantial and more than 0.7. Avkiran and Ringle (2018) state that an outside loading threshold of 0.7 should be used. Additionally, Cronbach Alpha and composite reliability have been used to establish reliability; these methods indicate that a value of 0.6 is the bare minimum for reliability, although values above 0.7 are preferable. When the cutoff is taken into account, it is observed that all latent constructs are credible, with Cronbach Alpha and composite reliability scores all exceeding 0.7. Moreover, AVE has been employed since it illustrates the interconnectedness of the latent variables, which is necessary for establishing the convergent validity of the latent constructs. According to Latan and Noonan (2017), the AVE threshold is set at 0.5, hence any value in Table 1 for a latent construct in this study more than 0.5 is considered legitimate. Results and Discussion Table 2: Socio-demographic data Variables Frequency (n=336) Percentages Age 20-30 years 46 14.0 31-40 years 123 36.0 41-50 years 115 34.0 51 years and above 52 16.0 Gender Male 124 37.0 Female 212 63.0 Religion Christian 336 100.0 Educational level Tertiary 317 94.0 Others 19 6.0 Work experience 0-5 years 74 12.0 6-10 years 126 39.0 11-15 years 99 36.0 16-25 years 37 13.0 Table 1 shows the socio-demographic data of respondents. The results showed that 46 (14%) were aged 20-30 years, 123(36%) 31-40 years, 115(34%) 41-50 years and 52(16%) 51 years and above. For gender, 124(37%) were males while 212(63%) were females. All of the respondents indicated Christian religion. 317(94%) had tertiary education and 19(6%) had other forms of education. For work experience, 74(12%) had 0-5 years of experience, 126(39%) had 6-10 years of experience, 99(36%) 11- 15 years of experience and 37(13%), 16-25 years of experience. American Journal of Business Management, Economics and Banking Volume 16 Sep, 2023 P a g e | 33 www.americanjournal.org Table 3: Occupational characteristics of the respondents Variable Frequency (n=336) Percent Cadre Senior Staff (>GL 7) Junior Staff (