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A Change Process:

Bereavement Workshop

Hospice of the Midwest

SWRK 380 Social Work Practice-III

Professor Melanie Berte-Hickey, LISW

Author: Courtney Jayne, BSW Student

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Table of Contents

Introduction………………………………………………………………………………..………3

The Need for Change……………………………………………………………………….……..4

Identifying the Change……………………………………………………………………….…...5

Analyzing the Change Opportunity……………………………………......................………….7

Goals and Outcomes…………………………………………………………………..…………..7

Designing and Structuring………………………………………………………………..……...10

Determining Resources…………………………………………………………………..………11

Implementing the Change Process..……………………………………………………..……….12

Monitoring the Change………………………………………...………………………..……….12

Evaluating the Change Process……………………………………………...……………..…….13

Reassessing and Stabilizing………………………………………………………………..........13

Conclusion……………………………………………………………………………………….14

References…………………………………………………………………………..…………...15

Appendices

Appendix A: Practicum Contract……………………...……………..…………………..16

Appendix B: Agency Mission Statement………...………………………..……………..18

Appendix C: Change Process Budget…………………………………………………....19

Appendix D: Grief and the Holidays Flyer………………………………………………20

Appendix E: Sanctioning Letter …….………..………………………………………….21

Appendix F: Grief and the Holidays Participant Survey...……………..………………..22

Appendix G: Gantt Chart………………………………………………………………...23

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Introduction

Suffering the loss of a loved one is a fact of life that, inevitably, everyone experiences.

Generally, people suffer the loss on their own or grieve with close family members. It may come

as no surprise that many, if not most Americans have a difficult time dealing with death (Rando,

1984).

Some of the reasons that Americans have a difficult time dealing with death include but

are not limited to urbanization, exclusion of the aged or dying, the movement towards the

nuclear family, secularization from religion, advances in medical technology, and mass deaths

(Rando, 1984).

American culture tends to deny the reality of death, even in the wording used surrounding

death. On the whole, American culture provides little support for grievers. One example is the

very brief time allowed off work to deal with a family death (bereavement leave is generally 1-3

days). For the most part, we are expected to hide our feelings and emotions (by considering them

private), to grieve alone and in silence, to keep up our schedule exactly as before, and to replace

our loss as soon as possible (Cable, 1998). We tend to see active grieving as a weakness and

encourage the bereaved to ‘be strong’ or make the bereaved feel like they are not handling the

death in a healthy manner.

This student completed a 450-hour internship and practicum change process at Hospice

of the Midwest from July 2017 to December 2017 in order to fulfil requirements for her

Bachelor’s of Social Work degree. Lynnea Andersen, Administrator of Hospice of the Midwest,

LISW, graciously agreed to be this students field work supervisor and provided Sister Fineran

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with all required paperwork and supporting information to complete the practicum contract

(Appendix A). Netting, Kettner, McMurty, & Thomas (2012, p. 304) define macro social work

as having four distinct parts: “1) understanding the important components to be affected by the

change- the problem, population, and arena; 2) preparing and overall plan designed to get the

change accepted; 3) preparing a detailed plan for intervention; and 4) implementing the

intervention and following up to assess its effectiveness”. This framework allows for students to

apply macro social work skills in a tangible way during their practicum experience.

Hospice of the Midwest is in Johnston, Iowa and services eleven counties in the

surrounding areas. The mission at Hospice of the Midwest is “Through quality and

compassionate care the hospice team provides a professional proactive approach to end of life

care. We at Hospice of the Midwest strive to advocate for patients, families and caregivers by

providing the best hospice experience” (Hospice of the Midwest, 2015) (Appendix B). The

services rendered include but are not limited to support to you and your loved ones during the

final phase of life, comfort cares, pain management, and goal fulfillment. Hospice of the

Midwest provides routine home care, inpatient care, continuous care, respite care, music therapy,

pet therapy, volunteer services, bereavement care, pharmacy services, equipment and supplies,

and outpatient medical care.

The Need for Change

The change agent met with Lynnea Andersen in the beginning stages of the practicum to

discuss expectations, the practicum process, and to go over any questions. The change agent

brought attention to the “change process” requirement for the practicum experience. The change

process assignment is a significant requirement for graduation from Briar Cliff University. The

change process is a structured, yet fluid framework for making change within a macro system.

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The change process involves the change agent in creating a new opportunity for change in the

agency or involving themselves in an agency change already in progress. This might consist of a

short or long term project, a program, a policy, or a combination therein.

While discussing the change process with Lynnea Andersen, she mentioned the need for

more bereavement services in the communities that Hospice of the Midwest services and her

desire to implement more bereavement services within the agency itself. With that being said,

this student and Lynnea Andersen agreed that bereavement workshops would be an excellent

change for the agency.

To address the need for more bereavement services, this student assumed the role of

“change agent” and resolved to be a leader in the change process. This student further defined

her change process statement as “to plan and execute a bereavement workshop in the agency

service area”

Phase I: Identifying the Change Opportunity

In beginning the change process, the change agent must first obtain sanctioning from her

supervisor. It is important because “without sanctioning, the change agent’s efforts will be met

with indifference or opposition. Even staff that may support the concept of the change process

may not get behind the idea unless there is approval from the appropriate persons” (Fineran,

2014, p. 39). The change agent then requested and received sanctioning (Appendix E) from her

supervisor Lynnea Andersen.

In speaking with Mrs. Andersen about the planning process, Taylor Geotzinger, LCSW

and Elizabeth Chalberg, BSW student were recommended to be a part of the change process

planning committee, along with Lynnea herself. Taylor Goetzinger is the current bereavement

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social worker for Hospice of the Midwest. Elizabeth Chalberg is a student who is currently

completing her practicum for her Masters degree in social work.

As a group, the planning committee was supportive of the change process throughout

and each member volunteered to be involved as much and in any way needed. This included

brainstorming ideas, providing suggestions for research, analyzing data, and providing feedback.

Each member played different but important roles in facilitating the change process. Each person

was able to provide the change agent with ideas on where to hold the workshop as well as dates

and times that would work best for the local population.

The change agent holds the responsibility of motivating the planning committee and

fellow employees to provide better bereavement services to the service community. The primary

beneficiaries include the general public due to the extra support available in the community. The

secondary beneficiary is Hospice of the Midwest and its employees due to the advertisement of

their services.

According to Fineran (2014, p. 45), the target system is the individuals and the

organizations that need to be changed in order to achieve the objectives of the change process.

The target system here is the bereavement coordinator for Hospice of the Midwest. The

bereavement coordinator will learn to implement these workshops into their work assignments.

The implementing system consists of Lynnea Andersen, as she has the authority to implement

this change into the job description of the bereavement coordinator for Hospice of the Midwest.

The complete action system is made up of the applicable public, Lynnea Andersen, the

planning committee, and the bereavement coordinator at Hospice of the Midwest. Each

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individual involved had a unique role that was essential to this student’s success in designing and

implementing the change.

Phase II: Analyzing the Change Opportunity

According to Fineran (2014, p. 49), the analyzing phase “examines why the change

opportunity exits and to define its aspects and implications. Analysis of the change opportunity

gives impetus to setting goals, objectives, and outcomes. Analysis provides the information

needed for the change process design and implementation”. This phase will identify the need for

a change and potential responses to it.

The change agent began to research bereavement services in the service area of Hospice

of the Midwest. The change agent contacted four different hospice agencies and inquired about

any grief education or workshops offered. All four agencies reported that they do not offer any

bereavement services to the general public. The change agent also called local libraries in all

eleven counties that Hospice of the Midwest services to enquire about any bereavement

workshops available. Each library reported nothing available. The change agent then went online

to locate any bereavement services in her service area and once again, she found nothing

available to the general public. It became clear that there is a definite need for bereavement

services in this service area.

Phase III: Setting Goals and Outcomes

Phase III sets and establishes goals and outcomes. As Fineran (2014, p. 59) states, “A

clear direction in which the change is to move is critical for the ultimate success of the change

process. In Phase III setting goals give direction to the planned change process and providing

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outcomes prepares for measuring progress.” Hospice of the Midwest’s mission statement is

“Through quality and compassionate care the hospice team provides a professional proactive

approach to end of life care. We at Hospice of the Midwest strive to advocate for patients,

families and caregivers by providing the best hospice experience” (Hospice of the Midwest,

2015). This change agent keeps the mission in mind in the goal setting process and when

evaluating the progression of the change process. Setting goals includes action steps and

objectives to assist in monitoring outcomes, ensuring the planning committee has a framework to

work with and build upon.

Goal One: To identify portions of the bereavement program that may need revision.

Objective One: To receive approval and support for change process.

Action Steps:

________Will obtain sanctioning from field supervisor to move forward with the

change process.

________Will put together change process planning committee.

Objective Two: Collect feedback from Hospice of the Midwest staff.

Action Steps:

________Will gather information during change process planning

committee.

Outcome: Hospice of the Midwest service area with benefit from revised bereavement program.

Goal Two: To make needed bereavement services more accessible to those in the Hospice of the

Midwest service area.

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Objective One: To call five local businesses to enquire about bereavement workshops in

the area and in hopes of finding one place to hold bereavement workshop.

Action Steps:

________Will summarize information gathered and consultation with change

process planning committee.

________Will discuss findings with field work supervisor to address and

questions and/or concerns.

Objective Two: To hold bereavement workshop by December 2017 and have at least five

people in attendance.

Action Steps:

________Will plan details for bereavement workshop with planning committee.

________Will advertise workshop via flyer and social media.

Outcome: Hospice of the Midwest will benefit by gaining potential patients from the

bereavement workshop via advertising and the service area with benefit from the knowledge

offered during the bereavement workshop.

Goal Three: To implement the bereavement workshop into the bereavement coordinators job

description.

Objective One: To determine with Hospice of the Midwest administration if

implementing workshop into job description is beneficial to the company.

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Action Steps:

________Will meet with Lynnea Andersen (Administrator) to determine

effectiveness and to discuss implementation.

Outcome: Implementation will improve services provided in the Hospice of the Midwest service

area.

This change agent used a Gantt chart (Appendix G) to track her goals and objectives. The

Gantt chart is much like a timeline or bar graph, providing visual deadlines of the development

of the Bereavement workshop (Grief and the Holidays). The Gantt chart ensures that all goals,

objectives and activities are met for the change process.

Phase IV: Designing and Structuring the Change Effort

A planning committee is a mandatory part of the design and structuring process. The

“design” aspect of this phase includes defining the purpose and structure of the change, creating

a delivery system, and specifying overall responsibility. The “structure” aspect includes defining

specific jobs, positions, responsibilities and outlining their relationship to each other (Fineran,

2014, p.66). This change agent contributed to the planning committee by planning the meetings,

creating agendas for the meetings, and bringing ideas to the committee to discuss. This change

agent’s role was to obtain sanctioning for the development and implementation of the change

process (Appendix E), gather information on grief workshops in Hospice of the Midwest’s

service area, establish a location to hold the bereavement workshop, write the presentation for

the workshop, and carry out the Grief and the Holidays Workshop. Mrs. Andersen’s role was to

provide sanctioning and bring ideas to the planning committee. Also, she had the role of formally

giving authority to approve, disapprove, and order the implementation of the proposed change as

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well as monitor the change after implementation. Taylor Geotzinger’s role was to help advertise

the workshop and brainstorm ideas with the planning committee. Mrs. Chaldberg’s role was to

assist with advertising of the workshop and bring ideas to the planning committee as well. Each

member of the planning committee was also available to answer any questions that arose for the

change agent. Each aspect of the change process was reviewed with the help of the planning

committee before implementation was finalized.

Phase V: Determining Resources

Determining available resources is an important part of the change process,

especially for those who approve and implement the change process. Determining resources is

essential due to the fact that many approvals or disapprovals are based on cost effectiveness to

the agency. Improvement in quality of life for patients is not enough of a rationale by itself to

dedicate valuable resources and personnel in support of the change effort. The change agent

should ideally have an idea of the cost of the change during the sanctioning process to help

decision-makers determine if it is worth the investment (Fineran, 2014, p.74).

Budgeting is one of the most important parts of determining resources. This change agent

requested access to the company budget but access was denied due to company policy. With the

assistance of Mrs. Andersen, this change agent was able to come up with an idea of Hospice of

the Midwest’s revenue and expenses in order to put together a budget for the change process

(Appendix C). Personnel expenses added up to approximately $500 due to the additional work

time used for paid staff. Rent expenses were $0 as the location of the bereavement workshop was

free public space. Printing, copying, supplies and travel expenses added up to $150. The overall

expense incurred by Hospice of the Midwest was $800. In factoring in the budget, this change

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agent and Lynnea Andersen decided that cost would not be a factor for the change process due to

the fact that money is set aside yearly for community outreach projects. In turn, this change agent

was given the go ahead by administration to continue the change process.

Phase VI: Implementing the Change Process

The implementation stage consists of how the change will take place and focuses on

actions that are taken by the change agent and the planning committee. The change process is

“implemented according to the plans that have already been determined in the Goals and

Outcomes, Design and Structure, and Determining Resources phases” (Fineran, 2014, p.75). The

planning committee contributed to the implementation stage by providing ideas, input, and

feedback. The change agent took action by obtaining sanctioning (Appendix E), gathering

information about local bereavement workshops, creating a Grief and the Holidays flyer

(Appendix D), advertising for the grief workshop, and holding the Grief and the Holidays

Workshop on Novemeber 15, 2017. Lynnea Andersen was responsible for reviewing and

approving the final program for the grief workshop (Grief and the Holidays). During the

implementation stage, there was no resistance from the planning committee of other staff at

Hospice of the Midwest. This change agent is awaiting final review and expects the bereavement

workshop be added as a requirement for the bereavement coordinator position at Hospice of the

Midwest by the beginning of 2018.

Phase VII: Monitoring the Change Process

As stated by Fineran “Monitoring involves developing a process-and a simple tangible

method-to keep the change effort on course and to keep track of implementation activities.” A

checklist or post-change survey are an excellent tools to monitor the change process.

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This change agent referred to her Gantt chart (Appendix G) to ensure she and the

planning committee are meeting all goals. The Gantt chart provides a visual timeline of events to

help with time management. Another monitoring tool utilized was the Grief and the Holidays

Participant Survey (Appendix F). Data was compiled from completed surveys to show a need for

change. These tools allowed for tracking of the development and implementation process and to

help determine if the change is having the effects intended. Monitoring the change is imperative

to the success of the change process.

Phase VII: Evaluating the Change Process

Evaluation of the change process must occur to access the value of the occurring change.

In addition, the purpose of evaluation is “to develop information that will lead to effective and

efficient interventions” (Fineran, 2014, p.79). The creation and utilization of the Grief and the

holidays Participant Survey (Appendix F) provided the change agent with an effective tool to

obtain feedback on the usefulness of the bereavement workshop. The Grief and the Holidays

Participant Survey will be offered to the attendees at the end of the Grief and the Holidays

Workshop. Completing the survey was completely optional. The post-change data will be

reviewed by administration to determine the success of the change process and help determine

the future implementation of the bereavement workshop.

Phase IX: Reassessing and Stabling the Change

According to Fineran, “The reassessment and stabilization phase is the last phase of the

change process and is a “time of transfer of responsibility (Fineran, 2014, p.85).” During the

change process, this change agent recognized the need for staff to reassess and continue the

change after her internship concluded. The bereavement coordinator was decided to be the

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individual responsible for continuing the bereavement workshop program in the future. The

Grief and the Holidays Participant Survey (Appendix F) will help to determine any changes that

will need to be made in future workshops.

Conclusion

Implementation of the grief workshop allows for continued and additional support to the

public while also acts as a means for Hospice of the Midwest to advertise their services and gain

potential clients. Improving the bereavement services assists in striving to provide quality care to

the service area, patients, and their families who choose Hospice of the Midwest. The change

process was an enormously valuable experience for this change agent and promoted professional

growth that this agent will draw upon in her future educational and professional career.

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References

Dollinger, M., Rosenbaum, E., & Cable, G. (1998) Everyone's guide to cancer therapy: How

cancer is diagnosed, treated, and managed day to day. Kansas City: Somerville

Fineran, S. (2014). Macro social work change process handbook. Sioux City, IA, Briar Cliff

University.

Hospice of the Midwest. (2015). Volunteer Coordinator Handbook. Johnston , IA

House.Netting, F., Kettner, P., McMurtry, S., & Thomas, M. (2012). Social work macro practice

(5th ed.). Upper Saddle River, NJ: Pearson Education.

Rando, T. A. (1984). Grief, dying and death: Clinical interventions for caregivers (pp.7-

8).Champaign, IL: Research Press.

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Appendix A

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Appendix B

“Through quality and compassionate care the hospice team provides a professional proactive

approach to end of life care. We at Hospice of the Midwest strive to advocate for patients,

families and caregivers by providing the best hospice experience” (Hospice of the Midwest,

2015).

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Appendix C

Revenue Hospice of the Midwest Bereavement WorkshopClient Fees $ 85,000 $ 0Contracts 0 0Grants 0 0Total $210,000 $ 0

Expenses Hospice of the Midwest Bereavement WorkshopPersonnel $285,000 $ 500Rent 24,000 0Supplies 20,500 150Telephone 1,000 0Copying & Printing 3,000 50Equipment 20,000 0Travel 15,000 100Total $368,500 $ 800

There are no project costs involving client fees, contracts, or grants. The amounts given

for expenses incurred by Hospice of the Midwest are approximates.

The personnel expenses incurred by Hospice of the Midwest are an approximate amount

of pay due to the employees that are helping with the actual planning of the workshop over the

next couple of months. The workshop will be held at a local library and the cost is zero. The

change agent is planning to hand out memory jars to the workshop participants. Also, paper/flier

supplies are considered in this cost as well. It should cost about $50 to print off all flyers and

approximately $100 for travel to put up flyers to advertise the workshop.

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Appendix D

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Appendix E

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Appendix F

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Appendix G