Introduction The environment under which health and social care organization are operating is rapidly changing due to technological advancement, change in legislation due to political activities, economical changes, social change among other. All these affect healthcare organizations which force them to regular review their strategies, process, system and goals. This Essay explains how change are introduced and implemented successfully in health and social care setting
. 1.1 Explain the key factors that drive change in health and social care services According to Alkaya and Heptaka (2003), change is a response to important threat and opportunities arising from external environments. Similar definition is given by Daft (1983), who defines changes as organization’s response to business event and economical factors as well as to processes of managerial perception, choice and actions. From the two definitions given above, it is evident that changes are driving by factors within and outside the organization. Analysis of literature show that these factors are usually classified as internal and external factors of changes
Internal factors of changes are all those factors whose origin can be traced to managerial choice, perception and action. According to Draft (1983), managers monitor the event happening within the organization to identify the needs to changes. This event may include inefficiency, ineffectiveness, customer satisfaction level, organization weakness or strength etc. According to Alkaya and Heptaka (2003), internal driver of changes is strongly linked to management philosophy, system of power, culture and structure.
According to Alkaya and Heptaka (2003), there are a lot of happenings that take place outside the organizations which have impacts on the organization operation. These factors may include changes in servicer user expectation and needs, technological changes, competitor action, quality standard, legislation and political activities. Based on current organization status and objectives, organization always respond to these factor in different ways which may including changing strategy, processes or even conducting organizational wide change. For instance, in our case scenario, failure to meet quality standard forced the care quality commission to demand for changes in RUH bath NHS trust hospital.
To identify both internal and external factor of changes, it is important that healthcare organization continually monitor their environment both within and outside. This can be achieved through SWOT analysis. SWOT analysis is a monitoring techniques in which organization identify it strength, weakness, scan for opportunity and threat that exist in external environment in order to respond appropriately (Draft 1983). The pressure put on RUH bath trust by CQC to changes could have been avoided, if the trust was continually monitoring it environment through SWOT analysis. This would have helped the Trust identify it weakness (i.e. inability to meet national standards) in advance and institute necessary step/ measure to correct the situation way before they being served with warning notice.
1.2 Assess the challenges that key factors of change bring to health and social care services Driving changes in an organization is not always a smooth ride. There are several challenges that must be deal with. One of the major challenges is limitation of resources. Changes cannot take place without considerable investment (Tushman and Anderson 1997). It is therefore important to plan and put in place enough budgets to cater for changes. However, this is nearly impossible when the need for change strike unexpected just like it happened to RUH bath. The Trust did not anticipate the need for changes meaning that no budgeting was in place for such activities which forced it to talk to partner for funding.
Another challenge of changes is gaining cooperation and support of the entire stakeholder affected. Not all stakeholder are motivated enough to cooperate and support the changes. Some stakeholders especially the Employees may want to maintain status Quo as it give them feeling of security and stability (McCalman 1992). Effecting Changes in RUH bath Trust Hospital given the pressure by CQC needed high level of cooperation and support from management and employees. However, gaining such support and cooperation is not always easy as employees may resist the changes especially if it threaten their job security, established relationship and the future remain unclear and ambiguous.
2.1devise a strategy and criteria for measuring recent changes in health and social care To implement changes in organization take time and money. The process is also not smooth and a lot of hidden factors exist which has the potential of making the changes difficult. It is therefore important to measures the changes in order to determine whether the change program was effective or not.
To measures the recent changes in RUTH bath trust, a measuring technique, and criteria and as well as statistic/data is needed. The measuring techniques involve identifying the approach to be used in measuring the changes. Given the situation and nature of changes at RUTH bath trust two approach are most suitable .I.e. quantitative and qualitative approach.
Quantitative approach involves using numeric to measure the extent of the changes (Olszewski 2015).In RUTH bath case, quantitative approach would be used to measure the effectiveness of the changes program in improving servicer user waiting time , waiting time at surgery unit and the response time taken to respond to customer needs and emergencies. According to CQC, there was long waiting time at medical units and waiting time in surgery unit before patient are transferred to ward was unacceptable and risky. The contribution of change program toward improving these conditions therefore need to be measured which can be done using numeric or statistical calculation. For instance the Number of hours/minute taken by servicer user in waiting line before and after changes can be analyzed statistically to identify any major change and it nature as a result of change program. Measuring changes using quantitative approach has several advantages. One, the method would help RUTH Bath hospital have capture the feeling and perception of wider stakeholder including employees, servicer user and other. Secondly, the approach is very cost effective saving the organization time and money (Olszewski 2015)
Qualitative approach also needs to be integrated to supplement the quantitative approach. According to Olszewski (2015), Qualitative approach involves measuring effectiveness of changes by gathering and analyzing events, facility or people’s opinion, view, behavior and action. In RUTH bath trust, qualitative approaches would be helpful in measuring different aspect of the changes including servicers’ user perception about the changes, staffs satisfaction with the changes and Management feeling about the changes etc
2.2 Measure the impact of recent changes on health and social care services against set criteria The impact of changes in RUTH bath trust hospital can be measured in a number of ways Including survey, interview and analysis of feedback.
There is a connection between changes and emotional, perception and opinion (Parkinson and Wadia (2010). The impact of changes can therefore be measured by analysis people feeling and perception. Survey is the best instrument in achieving this. In RUTH bath hospital, survey would help collect information relating to servicer user and staffs feeling and opinion on the changes implemented. Qualitative Analysis of their feedback would explain the impact the changes had on them
Analysis and calculation of statistic can also help understand the impacts changes had in Ruth Bath hospital. These can be done by collecting quantifiable information through questionnaire, or through analysis of computer record (Parkinson and Wadia 2010). For instances, in Ruth Bath hospital, computer or manual record may contain relevant patient information including appointment time, discharge time treatment administered etc. analysis of this information can help understand the situation before and after the change. The gap between the two time periods would help understand the impact of changes
2.3 Evaluate the overall impact of recent changes in health and social care The lifting of warning notice on RUTH bath trust by Care quality commission was a clear indication that the trust has managed change effectively. It also demonstrates that there was overall improvement and compliance with national standard applicable in the health and social sector. According to the
RUH bath NHS trust quality report, the trust changes program has resulted to a number of improvements which included, more patient focused leadership, improvement in facilities and equipments, improving in the overall safety of services, effective and safe handling of patient in surgery unit and improved arrangement for the provision of services(CQC 2014). All this improvement will contribute to delivery of quality services. For instance, the action of reversing the Day service unit to a 23 hour ward meant that more Bed capacity will be available to accommodate patient from surgery unit thus reducing the time and high level of Risk in the unit. Equally, the streamlining of data collection and management system in the trust mean that more and effective services will be offered to patients as point of references will be easily accessible.
However, this improvement did not meant that all the failing in the Trust was adequately dealt with there were number of issue that the staff need to deal with. According to the reports, the CQC observed that during busy time, patient need was not met. This was mainly due to insufficient of staffs put pressure on the exits one. This among other identified and future failings need to be look at and dealt with appropriately. Furthermore, to ensure that the improvements recorded are sustained, the trust should put in place a strong quality monitoring and management system in place.
2.4 Propose appropriate service responses to recent changes in health and social care services The warning Notice served to RUTH Bath trust hospital by CQC was a clear indication that the trust lacked effective system to monitor and manage the quality of services in the hospital. To ensure such thing do not happen again and also to ensure compliance with National standard applicable to the trust, RUTH bath Hospital needs to establish a unit to deal with Quality monitoring and management. As mentioned by Campbell (2008), having a unit with its own staffs, budget and objectives is very essential in achieving high quality in provision of services. The Unit should therefore establish and maintain and effective quality management system.
In additional to establishment on quality control Unit, the issues identified in RUTH bath trust can be improved and the improvement sustained in future by putting in place strong and strategic human resource management plans. According to CQC (2014), the Trust lack sufficient staffs to met servicer user needs especially during busy time. The Commission also identified Gap in staff skill and knowledge. These Failing can be dealt with by putting in place human resources management plans to identify manpower needed for effective service delivery, recruitment and selection of the rights individual to meet the needs of servicer user, training programs to ensure staffs skill and knowledge is up to date and relevant and also to put in place strong motivation program to encourage staffs to continue offering caring, effective and safe services. According to Campbell (2008), the success of any organization in achieving its Goal depends entirely on it staffs. Having the right number of staffs, with the right skills and with the drive to do their work is all what RUTH bath Needs to improve services delivery.
3.1Explain the key principles of change management Managing changes is not an easy task but it is also inevitable due to rapid changes in organizations environment. Fortunately, change management is already a well established field which is guided by evidence and tested principle. One of the key contributors to this is John Kotter with his model of Change management. In this model, Kotter do believe effective implementation of changes can be achieved if emotional and situation component are addressed (NLC 2012). To achieve this he proposes an eight step process to change management. The eight steps are categories into three phases.
Phase one- creating a climate for change Kotter believe that any change has two sides, the emotional/people side and the situation side. This phase is meant to deal with the emotional side. According to Kotter, employees and other stakeholder need to be prepared for the changes. These can be done by;
- Establishing a sense of urgency
- Forming strong coalition
- Creating a vision for future state (Kotter 1996)
In Ruth bath trust, this principle can be implemented in number of way. One, the management can prepare employee for change by letting them understand the current state of affair (I.e. existence of failing as identified by CQC), letting them understand why change will be needed and what will be changed. Additionally, they also need to create team to spear head the change.
Phase two- engaging and enabling the organization Kotter emphasized the need to involve employees in the process of planning, implementing and evaluating the program. According to his model, this can be achieved by
- Empowering other to take action toward accomplishment of change objectives
- Communicate the future state/selling the vision for change
- Planning and Creating short term win (Kotter 1996)
In RUTH bath hospital, this can be achieved by involving all the staff from top management down word in the decision making process. It is important that are stakeholder are widely consulted. According to NLC (2012) involving Employees in the process bring in new idea and thinking and it also create a sense of ownership. Worker should also be reward for every milestone achieved. This world encourage them to put in more effort toward the desired state of affairs
Phase three-implementing and sustaining the change Another important step in change implementation is the implementation part. According to Kotter, the change leader has a responsibility to ensure the implementation is going on as planned and the resulting changes are sustained (NLC 2012). To achieve this, the change leader agent needs to accelerate the change momentum by focusing on problem area, promote solution and individual behaviors for achievement of goals. He also needs to celebrate or any milestone achieved. To sustain the change, staffs need to be retrained, assistance provided and integrating the changes in to organization culture (Kotter 1996)
3.2Explain how changes in health and social care are planned The success of any change program depends on the planning process. If proper plans are put in place, implementations of the program not only become straight forward but also effective. To plan effectively for changes, the following plan needed to be developed
Stakeholder management plan Changes do not happen in Vacuum. A lot of individual will be affected by the process. It therefore makes sense if a proper stakeholder management plan is put in place (Al-abri, 2007). A stakeholder assessment needs to be conduct to identify different individual who will affect or will be affected by the changes. In case of RUTH bath Hospital there are several stakeholder of interest as far as changes is concerned. Care quality commission is one of such stakeholder. Given the facts that, CQC play an important role in ensuring compliance with national standards, the commission becomes a rich source of input needed to effect the changes effectively. It acts as point of references when in doubt of what is required to meet and improve the services. Another, important stakeholder is the employees. According to Campbell (2008), the success of any change program depend on it manpower as they are mostly relied for implementation. Involving the
Communication plan Communication plays a very important role in the process of implementation changes in the organization. According to Dowd et al (1998), the role of communication in the change process including dealing with employees resistance by making thing clear, selling the change vision to other stakeholder in order to again support, coordination of various changes activities, to delegate responsibilities and to motivate employees toward the desire state of affairs. However to achieve be effective in this role communication need to be relevant consistent, timely and purposeful. This can only be achieved by developing a proper communication plan. Communication plan need to address thing such as channel of communication, timing of communication and how the whole communication is done (Dowd, et al 1998).
Action Plan The most important part of any program is the action plan. Action plan state the objectives and the aims of the changes program, identifies various activities to be carried out, identify when those activities will be carried out, assign activities to different employees and estimate the financial cost of the change program (Al-abri, 2007). In Ruth Bath Trust hospital, the action plan should address several issue including setting the objectives to be achieved in each change process. For example, the plan should set objectives relating to improvement to be achieved in waiting time in surgery unit, medical units, data recording and management, staffs quality and quantity among other. Equally, the various activities to be done such as refurbishing wards, training staffs, collecting data, should be identified
3.3 Assess how to monitor recent changes in health and social care services Implementing changes is not without its own obstacles and challenges. It is therefore important to monitor the implementation process to ensure the change program is on the right course. According to Parkinson and Wadia (2010), monitoring changes involving a systematic and routine collection of information to identify what is working and what is not there are many ways in which changes can be monitored however, the suitability of these approaches depend on the nature/characteristic of the change. In case of changes at RUTH bath hospital, several approaches can be used. These approaches include;
Observation Some of the changes in Ruth bath trust hospital can be monitored through spot-check and observation. Observation involves studying and recording information on changes you
See, hear or experience (Parkinson and Wadia 2010). In RUTH bath Trust observation can be used in several area. For Instance, the changes in staffs’ behaviors can be easily done to monitor the impact of the changes on them. However for this approach to be effective, the observers need to be trained on what to observe how to do and record it. Observation checklists also need to be developed (Parkinson and Wadia 2010).
Survey The changes in RUTH bath trust can also be monitored through survey. In this approach, the change team design survey/questionnaires that elicit feedback from different stakeholder which give perception people have about the change program and the change factors that may contribute to success or failure of the program (Schwartz, 2013). Conducting survey at regular interval and comparing the feedback, can help the Trust identify areas of the change program that need more attention. By using this method, Ruth Bath Hospital cans benefits in several ways. One, this method enables collection of information from large number of stakeholder, which increases the visibility of the project. Two, regular systematic review of the changes enables issue to be identified and proper intervention introduced before they become a disaster (Schwartz 2013).
Issue log monitoring In this approach, issues which are not actionable or solvable immediately are recorded as they happen. Their frequency of occurrence and their severity is observed. This helps identify issues that might generate to a bigger problem that might hinder the changes from achieving their objective (Schwarts 2013). IN RUTH bath hospital; this approach can be used to monitor changes activities. Employees can be trained on how to identify and records issues as they happen. The team leader would then collect those recording from employees for analysis to identify issue that need attention. As a monitoring tools, this approach save the organization costs as information is easily collected and analyzed without wastage of any time.
Conclusion The information and discussion in this essay has shown that changes is inevitable in health and social care setting due to influence imposed on healthcare organization by the environment. Introducing change and managing them is not however a smooth ride. A lot of challenges and obstacle may be faced. Planning for the change is therefore an essential part of the process. Equally, measuring and monitoring the changes is very essential as it help in determining what is working and what is not working
. Health care organizations should therefore put in mechanism to ensure change are planned for, implemented, monitored and implemented properly for them to achieve their objectives
