Introduction
Just like any other organization care providers operate in very dynamic environments. This dynamic environment always forces them to changes the ways they have been operating. No single care organization can pride on having the right systems, policies, and procedures to survive in the dynamic environment. Care organizations, therefore, need to learn and be prepared to change to adapt to the ever-changing environment. This essay evaluates the process of facilitating changes in a care organization.
- Explain the key factors that drive change in health and social care services
Change is one of the crucial variables in health and social care practice. It refers to the process of moving from one state of affairs to another. There are a number of factors that cause changes in health and social care settings. This factor can be internal or external
Internal factors that drive changes may vary from one health and social care setting to another. However, some of the common internal drivers of changes include
New leadership- New leadership always bring in new idea and strategies. As a result, the health or social care setting with new leadership experiences some degree of changes in operation and practice (Harrision 2010).
The need to be more effective - Ineffectiveness and inefficiency in delivering Services is another internal factor that causes planned changes within a health and social care setting. When the practices of care organizations become ineffective or inefficient, they don't have any option rather than embark on the change process to improve the situation.
The external factors that drive change in health and social care settings can be categorized into Political, economical, social, technology and legal.
The political
The political forces within a country have direct impacts on how the organization operates. For instance, when elected in office, every government comes with its own ideas, strategies, and policies for the health care sector. The implementation of these strategies, ideas, and policies directly triggers a change in care organization.
Technology
Innovation in technology has been one of the factors driving change in health and social care setting just o keep up. In most cases, technology innovation offers wide ranges of benefits in regard to effectiveness and efficiency of services and such health and social care feel Pressured to adopt them. When adopted, a lot of change has to be done in order to incorporate the technology in routine practices. For Instance, Staffs need to be trained how to sue the technology, Premises may be redesigned to accommodate the technology etc.
Legal – The health and social care practice is regulated by the government. Therefore, a change in government regulation have direct impacts on how health and social care organizations Operates. For instance when new regulation in health and social care sector is introduce, Organizations has no option other that institute necessary change to comply with the regulation. In relation to RUH bath Trust, Legal factor were the major driving force for the recent change. The legal framework in UK allows CQC to regulate the practices of health and social care practice. Therefore, in process of fulfilling its Mandate, CQC noted that RUH bath trust was not meeting the required standard of service delivery and as it has to use it authority to force change in the trust for improvement of services.
- assess the challenges that key factors of change bring to health and social care services
There are several factors that might challenges the process of change in RUH bath. These factors include;
Employees’ resistance- employees may refuse to cooperate and supports the changes in RUH bath. There are so many factors that may cause them to resistance. According to NHS institute for innovation and improvement (2013), employees ‘resistance to change is in many cases trigger by fear of unknown and comforts with status quo, lack of understand the need for change¸ fear of losing job and corporate culture.
Lack of resilient- the process of transition might be tedious, challenging and demanding.For changes to be effectively implemented, the organization as well as it employees will need to be resilient. Lack of resilient always results to organization backsliding into older ways of working (Anonymous n.d). RUH bath and it employees therefore need to be resilient to avoiding the trust from sliding back to older way of doing thing. Resilient can improve by creating and rewarding/celebrating short term achievement (Kotter, 1997)
Resources – RUH bath hospital just like any other organization do have scarcity of resources. For instance the employees in the hospital are always stretched to the maximum in the normal operation (CQC 2014). Shortage of financial resources is also common in the Trust. On the other hand, the process of transition consumes a lot of organization resources. Scarcity of resources therefore becomes a major challenge in implementation of changes and RUH bath may need to inject extra resources to achieve it transition objectives. Resources can be acquired by engaging the local government for more funding, or negotiating loans with it financial service provider.
2.1 Devise a strategy and criteria for measuring recent changes in health and social care.
RUH bath needs to measure the change it is implementing to know their contribution to improvement of services. According to Greenan (2001), measuring changes is a process of collecting information to assess the contribution of the changes to achievement of organization goals. For measuring changes to be successful and meaningful, the approaches of collecting data and the variable to measure must first of all be identified(Walter 2015).
The change in RUH bath hospital involves change in system, policies and procedure. It is therefore logical that these systems, polices and procedure become the variables to be measured. Each system, policy and procedure should be evaluated to assess whether it is effective in achieving it aims. The assessment should be based on their contribution to patient outcome, satisfaction level and how well they help the trust achieve the basic CQC standards of care.
To assess the effectiveness of the systems, policies and procedures, different type information will be required. This includes staffs and servicers’ users’ perception and attitudes toward the recent systems, policies and procedures, and servicer user satisfaction level. This information would be collected using several approaches. Survey would be used to assess the staffs perception and attitudes towards the systems, policies and procedures. A combination of survey and Focus group approach would be used to collects feedbacks and opinion of servicer user and their family regarding the new system, policies and procedures in meeting and improving the care they receives.
2.2 Measure the impact of recent changes on health and social care services against set criteria
To measure the effectiveness of the recently introduced changes in RUH bath (.i.e. system, policy and procedures), survey and focus group would be used. Written Questionnaire survey would be used to collects staffs perception and attitude of the recent changes. The questionnaire would ask staffs multiple questions including their opinion on how the recent changes is helping improve care services, the appropriateness of the systems and their experience in using those systems, policies and procedures. According to picker institute (2009), written questionnaire provides the participant with a lot of convenience as they can answer the questionnaire at their free time. On the other hand written surveys can results to biased results if the questions are not well developed.
Face-to face interview and focus group method would be used to gather information from servicer and their families. In cases of face-to-face survey, patients in the wards and else would be reached. Predetermined questions would be asked to the patients and their answers recorded. Focus group involves face-to face interview with small group (picker institute 2009). It would be used to assess experience of servicer users’ families in the hospital given the new systems, policies and procedures. According to Rabinowitz (2015), focus group is a very effective way generating hard to get information from servicer users and their families.
Data collected using all of the above method would then be analyses to evaluate the servicer user satisfaction with services after the change are introduced. Analysis would also focus on identifying the effectiveness of the system policies and procedures in achieving their intended purpose.
2.3 Evaluate the overall impact of recent changes in health and social care
The recent changes in RUH bath hospital has recorded a mixed of outcome. There are a numbers of system, policies and procedures that have been very successful in achieving their intended objectives. Equally, there are a numbers of them that are ineffective.
The effective recent changes in RUH bath
According to CCQ (2014), RUH bath has demonstrated the ability to facilitate effective changes. A number of its recent changes have been very effective. For instances, the hospital had introduced a procedure for monitoring patients welfare needs known as comfort round record (CQC 2014). This procedure has resulted to improvement in the ways welfare of servicer users are assessed and met. This in turn led to service users ‘satisfaction. A procedure to be followed after surgery in the recovery units was also introduced. This system improved the ways patients were handle after surgery. Before the system was introduced, issues of patient spending unnecessary time in the recovery units due lack of bed capacity was very common. However, with the introduction of this new procedure, the personnel at the theatre are well informed about the situation at the wards to avoid unnecessary waiting time in recovery units. This procedure also included an enhanced communication system which gives alert when patients stay in recovery unit was extended. The improvement in communication system between theatre and ward has made it possible for proper coordination between the departments improves the patient safety after surgery.
Ineffective recent changes in RUH bath
Not all recent changes in RUH bath were effective. Several of them failed to achieve the intended the objective. For instance, the hydration bundle policy and the fluid charts were not being used appropriately. The policy was meant to ensure the patients’ hydration is well monitored. The fluid charts were to be used to record fluid intake and outtake of every patient. However, this was not being recorded as per the policy which means patient hydration needs were not being met as required by NICE guideline (“Patient experience in adult NHS services; improving the experience of care for people using adult NHS services”) (CQC 2014). The failure of this system can be blamed on employees’ lack of support and commitment. If nurses support and commitment was to be gain, filling in the fluid charts would become easier.
RUH bath has also established a system to assess and monitor the quality of services. However according to CQC (2014), this system was only operational and effective in some parts of the trust rather that the whole organizations. For instances, they system did not assess and monitor quality of care in adult wards.
2.4 Propose appropriate service responses to recent changes in health and social care services
There are a number of services response that RUH bath Trust can implement to address all the failing identified by CQC. Some of the appropriate service response includes;
Employment of new staffs- one way to services improvement in RUH bath trust is through employment of new Staffs. CQC noted that inadequacy of manpower in RUH bath was one of the factors contributing to poor services especially during busy time. Therefore, the Trust should embark on the process hiring additional staffs so as to ease the burden that was experienced by existing staffs.
Staff training – While conducting it inspection in RUH bath Trust, CQC noted that some staffs in the trust lacked necessary skilled and knowledge especially around the area of deprivation of rights for mentally ill patients and child care. It is therefore important to train the staffs in Trust so as to ensure they are well skilled and knowledgeable to improve the practice.
Change of equipments- CQC also found out that although the equipment used in the trust were well maintained, some of the equipment were too old or ineffective. It is therefore important the Trust embark on a process of replacing all the old and effective equipment with new one in order to improve it services.
Change of management structure - another important response that RUH bath trust should implement in order to improve the quality of services is change in management structure. While inspecting the Trust CQC noted that a disconnect between management and other staffs. This not only de-motivated staffs but it also hinder sharing of information between the two factions leading to poor decision making hence poor service delivery. It is therefore crucial for the trust to change it management structure to make it leaner so as to improve the flow of information between management and staffs.
3.1Explain the key principles of change management
Todenm (2005) define change management as the process planning, implementing and evaluating change in organization. Change management is defined by Paton and McCalman (2008) as the process of managing organization transition process from one state to another. The process of change management is made easier by several principles. Some of these principles are contained in the Lewin’s change management model.
According to Lewin’s change management model, the change process should start by creating a motivation for change. Motivation is created by freezing the existing behavior, attitudes and practices and preparing the ground for transition. Lewin emphasizes the needs for effective communication to ensure this happen (NHS North West Leadership Academy 2015c).
After preparing the ground for change the next stage should be to implement the change. Lewin argues that, in this stage, communication and empowering employees is vital. Both communication and empowerment of employees help to embrace new ways of doing thing and new values, attitude and behaviours (NHS North West Leadership Academy 2015c).
According to Lewin model, the final process in change management is refreezing. This involves creating stability in the organization to sustain the new way of doing thing, new values, attitude and behaviour adopted by the employees. To create stability, reinforcement is needed, result should be monitored and measured and reward given where achievements have been achievement and employees need to be generally motivated (NHS North West Leadership Academy 2015c).
Lewin model of change management provide manager with several principle which they should follow when implementing change in RUH bath currently and in future. The model emphasis the need for preparing and motivating employees for change, communicating and empowering employees, providing reinforcement and integrating the new changes into organization culture. To ensure RUH bath realises the goals of the recently introduced changes in the trust, it needs to be open and ensure smooth flow of information between key stakeholder including employee and management. This would help employee understand the expectation they must meet. Employees also need to be empowered to work on the new systems, policies and procedures. They, therefore, need to be trained. Additionally, to avoid the trust from backsliding in it old way of doing a thing, reinforcement will be needed. Furthermore, the recent changes need to be integrated into the organization culture.
3.2Explain how changes in health and social care are planned
Proper planning of changes in RUH bath is crucial as it determine the chances of success in implementing changes. To plan effectively, RUH bath hospitals need to involve several stakeholders.
Care quality commission is one of the organizations of greater importance in the planning stage. CQC is the agencies responsible for licensing and monitoring quality of health care services to ensure basic standards in delivery of services are achieved. RUH bath hospital should consults a lot from CQC to ensure the planned changes will conform to the requirement and standards by CQC. Consulting CQC would help RUH bath Set Goals achieve and priorities
The local government is another stakeholder that RUH bath should engage in the process of planning. The local government are key player in the health and social care sector as their providing funding to the NHS trust in their locality of jurisdiction. Change can only be effectively implemented if proper financial budgeting is done (NHS North West Leadership Academy (2015e).Engaging the local government would help in financial planning section as the local government would decide how the amount of funding to release to the trust.
One of the requirements of CQC standard is that services provided by healthcare providers should be responsive to need of servicers user (CQC 2014). This requires RUH bath to understand the health and social care need of the servicer user so that services can be designed to meet them. The Local government together with the local commissioning group can help RUH bath in understanding the health and social care needs of the community it services. The local commission group also would help in designing and commission services in RUH bath needed to meet the need of the servicer user.
3.3 Assess how to monitor recent changes in health and social care services
RUH bath needs to monitor the recent changes to ensure they are being implemented effectively. Monitoring is simply checking and measuring changes to ensure they are achieving the intended goals. Monitoring help identifies challenges faced in the way of facilitating for their removal. This increases the chances of success in the transition process. Monitoring approaches that can be used to monitor recent changes in RUH bath include analysis feedbacks from servicer users and spot check.
The feedback shared by servicer users is one of the best ways of tracking implementation of changes. Servicer user feedbacks basically refer to the reaction and opinion of the patients and their families that are affected by the changes in RUH bath. According to Rabinowitz (2015) feedback refer to reflection of perception other has on organization action. By using feedback, an organization is able to design services that are responsive to customer needs. The feedbacks help to know what servicer users value or may need to be changed or adjusted. By using feedback as monitoring tools, RUH bath would come more servicer user-centred since the feedback would help it adjust it system according to servicer user perception and needs. Obtain servicer users’ feedback in RUH bath hospital can be done through survey, interview and focus group.
- Survey is one of the most used methods of collecting feedback. The survey can take a different form which includes written, face-to-face or phone. Written surveys usually in the form a questionnaire where several questions are asked to the service users. In the Face-to-face survey, the interview asks the servicer user multiple questions and records the answers. The phone survey is a very impersonal survey conducted through the phone. The interview asks service users multiple questions and record the answers for analysis (Rabinowitz 2015).
- Feedback can also be collected through interviews. An interview is a face-to-face conversation between two parties for the purpose of achieving certain objectives (Picker institute 2009). Unlike face-to-face survey, in meeting the servicer users are asked very open-ended questions. Meeting open the possibility of collecting more and honest feedbacks that any other methods since servicer user are given the opportunity to express themselves freely.
- Finally, feedback can be collected using focus group. Focus group is a small group interview usually consisting of 5-10 members with certain purpose to achieve. In focus group, the questions are predetermined and the role of interview is to facilitate discussion that would help reveal as much information as possible (picker institute 2015).
Conclusion
Effective management of changes is much needed in health and social care setting. To lead a health and social care organization through the transition process, the manager should be able to monitor factor driver changes, plan for changes and be able to lead the implementation of the change. In addition, managers need to have the ability to measures and monitor changes.