1. Introduction
The purpose of this report is to analyse the change at the Urology department of a NHS hospital in England, make recommendations that can help resolve the crisis and explain why the recommendations are most likely to work for the urology department. This document has explored dimensions of change in order to achieve effective implementation of new policies and increase overall organizational productivity.
2. Identifying Key Issues
2.1 Mistrust among Managers and Doctors
Analysing the case has brought to the conclusion that one of the most pressing issues is the existing mistrust among the managers and health care service providers like doctors, nurse, physicians etc. it was becoming a bottle neck in implementing change practices across the organization. Difference of opinion or divergent ideas were causing problem and giving rise to the conflict between managers and clinicians. Health care practitioners in hospital perceive that managers are motivated via financial benefits and are not really concerned with the patients care. In addition to this fact, doctors and nurses also believe that managers lack specialized knowledge hence are not competent for implementing new policies. On the other hand managers point of view is that cost cutting and measures leading to increased efficiency actually lead to better outcome in terms of patient health care. This issue is decreasing collaboration hence needs immediate attention.
2.2 Incompetent Problem Identification and Data Collection Procedures
Problem identification has been really slow and staff members have not been able to identify issues in a timely manner hence rendering steps towards solution botched. The role of problem identification and data collection team is critical since their input directly impact on the strategic decision-making.
3. Justification for Prioritization of Issues
3.1 Force-Field Analysis
| Force Field analysis for Urology Department Change Management Rating: +Ive. +5 = high driving force -Ive. -5 = high resisting force | |||
| Driving forces | Rating | Resisting forces | Rating |
| Financial impact of claims | +4 | Conflict among Managers and Doctors | -5 |
| NHS issued an improvement notice | +5 | Slow Ambiguous data collection and representation and problem identification. | -4 |
| Potential for improved efficiency | +4 | ||
| Senior management support | +4 | Extra bed issue | -2 |
| Requirement to comply with legislation | +5 | Lack of junior staff | -3 |
3.2 Justification for “Mistrust among Managers and Doctors”
Mayer et al. (1995) identifies trust as a basic building block of the organizational effectiveness and its ability to manoeuvre change. According to Marris (2014) bring about a change can be a painful process where established norms and culture dear to some might have to be transformed in to a new identity.
Here it is important to know when mistrust exists within teams conflicts and resistance will be on maximum. Hence, it is imperative to address mistrust issues and bring both stakeholders of the change process on collaborative terms to achieve better results. Many change theories advocate that initial process is to remove the distress and bring about the acceptance for change (Bridges, 2009). It is well understood that mistrust or conflict in goals would render the process as failure hence, bringing the entire stakeholders under the umbrella of a single mission with complete understanding would help the cause to implement the change smoothly and effectively.
3.3 Justification for “Poor Problem Identification and Data Collection”
According to Cummings and Worley (2014) solving organisational problems mostly require bringing about a change within the existing and established structure or practices. Starting random can be very costly for the organization and moreover ineffective. Hence it is very critical to identify the right problem and priorities it accordingly to skilfully deal with issues and implement the change. Currently Urology department has a very poor system for problem identification and teams assign with data collection are incompetent. Management of Urology department have assigned teams to perform survey in order to enhance the efficient of operating theatres however the result of that survey which was held six months ago is still not available which had contributed in issues for the hospital. This is accompanied with poor quality of that data which has been collected by departmental members.
3.4 Initial Recommendation to Solution
Urology Department considering the above two key issues identified needs to adopt a systematic approach towards the change management. To comply with external pressures Urology department has to put its house in order. The recommendations are that management has to create an atmosphere by creating acceptance for change.
- Create Positive collaborative organizational culture
- Reduce cost to increase productivity and patients care
- Create effective team for work sharing
- Focus on real time data collection for targeted and in time proactive actions
- Reduce reliance on outsourcing rely on internal teams.
4. Mapping Urology Department Issues with Theoretical Perspective
The patterns of change that occur at work places are multi-dimensional. This pattern ranges from Hayes (2010) Tipping Point, the Gradualist Paradigm of Brown and Eisenhardt (1997) and the Punctuated Equilibrium Paradigm of Gersick (1991) and Gould (1978). Among the above listed patterns, this report falls under the Hayes ‘Tipping Point’ pattern. This is obvious when we understand that, as Hayes stated an organisation that undergoes change dramatically, where change becomes sudden and occurs all at once, it can be termed as the ‘Tipping Point’ pattern. This is exactly the situation with the Urology department.
4.1 Lewin’s Theory of Change
In the light of initial recommendations and the key issues requiring attention it has been classified that Lewin’s change management model is very effective in addressing the concerns surrounding urology department.
4.1.1 Unfreezing
Unfreezing stage of Lewin’s model for change management informs the management of Urology department that their current system and practices are resistive to change (Šuc et al., 2009). Managers and doctors are divergent of recognizing each other but desiring the same thing. The mission of both stakeholders might be perceived different but is actually the same to improve the current system and create a win-win scenario for patients and the management(Hayes, 2014).
At this stage it is required Urology department’s change manager needs to approach the doctors and inform them that collaboration is a way through which the department can tackle in effective processes and build in house practices for increase productivity and patients care. The change manager need to inform the doctors and bring them in to trust that managers are not motivated via financial gains rather their concerns are also to increase patient care. Here change manager can present and interactive presentation where explaining how efficient system will allow doctors to address more patients in an effective manner hence increasing the over all patients care.
4.1.2 Change
Once the organizational elements are willing to accept new practices the management initiates change plan. At this stage stakeholder mapping is done and stakeholders are managed using power interest matrix. To ensure collaboration and boost positive sentiments for change so that each member can act as an advocate for change (Jones and Education, 2010).
Secondly the R&D team should be informed of their slow and negligent processes and also made clear that management is willing to train in order to improve their efficiency (Soft approach) and if they still fail to comply with the new effective measures its would be increasingly difficult for department to continue employing their services (Hard approach).
4.1.3 Refreeze
Here the Urology department will adopt a more quality and productivity outlook organizational culture that will help the organization to induce continuous improvement process and reduce negative outcomes.
4.2 Implementing the Recommendations
Having analysed the pattern of this case, the theory that underpins my recommendation is Lewin’s 3-Stage Model of Change but implementation will be based on the economic strategies.
This section will explain how Urology department can effectively implement the change while achieve the recommendation made. Apart from the above measure being recommended, the following two strategies were seen as the best combination to help implement the measures. The two causative factors of this case study are to some point rooted in economic issues. As a result this report recommends the use of:
4.2.1 Economic Strategy
The managers perspective is to make Urology department self sufficient and reliant on the in house resources rather then outsourcing and incurring increased cost. Doctors on the other hand desire patients well being even if it means expending more resources. Through Lewin’s model of change it has been possible to create an environment that is very effective in addressing concerns for both (Carnall, 2007). Now the managers would work to reduce expenses on operational matters by removing waste and would offer similar services to the patients in more improved and cost effective manner. The managers would tend to build in house capacity rather then outsourcing in order to enhance quality/value delivered to patient and while maintaining cost (Drucker, 2009).
- Trimming off the budget of non-essential staff.
- Establishing in-house staff capacity. This will increase number of medical staff without resorting to private hospitals with its attended costs.
- Focusing on research and development to find more effective way to reduce cost and increase patients care
- Effective problem identification processes to keep management informed of the real time data in order to help them in making effective decision-making.
5. Theories and Change Implementation
5.1 Organizational Development Strategy
As Lewin’s model for change and economic aspect of the urology department are made clear it is the time to implement that change following the process defined above in the strategies. This section will explore the creation of an atmosphere where change can manifest its self and can take its roots to allow organization to develop along side it.
5.1.1 Creating an atmosphere of commitment and trust
In order to make the change process implemented in an immaculate way then it is important to follow the OD strategies (Weiner, 2009). Creating an atmosphere of commitment and trust pertains to the creation acceptance for change. Bringing stakeholder to discuss their difference and communicate the purpose of change as in the greater interest of the organization. The commitment is very essential for any sort of activity to suffice and trust gives the process a valuable meaning. In Urology department commitment and trust both were significantly lacking as manager didn’t trusted doctors vice versa and R&D staff was not committed to their work and didn’t understood the impact that comes due to their their performance. In Urology department this all need to be change with the systematic approach of Lewin’s change theory and OD strategies. Commitment and Trust will act as a basic building block for the organization to take a leap towards effective working.
5.1.2 Encouraging staff to work as a team
Every individual might be very skilled in one area but in another he she might not excel it is very essential to understand each members core competencies and then encourage them to work in a team. Teams are more proactive in problem solving and require less management or supervision (Brown and Harvey, 2011).
Urology department encouraging teamwork will be able to create work-sharing techniques and would be able to reduce cost and also would be able to tackle the shortage of the employees. As trust and commitment takes root within the organization people will collaborate and will seek initiative in making things better as creativity will give birth to innovation and overall organizational productivity will improve and will enable organization to act as a Launchpad for future endeavours.
5.1.3 Schedule weekly or monthly appraisal medical staff meeting
In order to ensure the change refreezes effectively it is essential to perform monthly appraisal of medical staff. The appraisal of the staff will be carried out using 360-appraisal system; every response will be recorded to ensure enough data is available to make clear judgements (Avey et al., 2008). The appraisal system via monthly staff meeting will ensure no work is delayed beyond the tolerance level. The meeting will ensure the communication of the work completed and objectives achieved hence any deviation will be effectively recorded and proactively dealt with to record minimal waste.
6. Conclusion
In conclusion, this report has examined and analysed the crisis within the urology department. In the process it identified the UK government new regulations and the EWTD directive that cut the working hours to 48 hours thereby triggering shortage of medical staff. Thou, change were initiated due to external factors but it was analysed that many internal resisters were real epicentre for all the issues hindering Urology department to achieve its desired goals. The report based its process on Lewin’s 3-stage model for change and made effective recommendations to increase commitment and trust. This lead to effective team creation that was able to share work to meet the targets. The report has also been able to recognize how controlling economic wastes can help in increased health care services. The report reduces resistance and implements the change in a systemized process.
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