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1. Critically evaluate leadership theories and assess their utility in the management of change

2. Explore and critically appraise the strategies and methods used for the planning and management of change

3. Develop an effective plan to effectively manage a specified change

Change Management at Mid-Staffordshire NHS Trust

The report is prepared to discuss the various aspects of leadership and change management at the health and social care organization named Mid-Staffordshire NHS Trust in United Kingdom. The health and social care organization has managed two hospitals in Staffordshire, England and even has provided the best quality care services to the people all over UK for a long time. The organization manages two hospitals including the Stafford Hospital and Cannock Chase hospital with 3560 beds and 115 beds respectively. There are more than 320000 people who are provided with services by the hospital and this has improved their health and well-being (Shekelle et al. 2013).

Mid-Staffordshire NHS Trust has undergone significant changes and improvements in the last few years, because there have been reports regarding the excess death statistics in the final prepared Healthcare commission report. Due to this, the company’s reputation deteriorated and the Foundation Trust’s status was de-authorized as well. Based on various researches conducted and enquiries, it was found that the trust would get dissolved and most of the staffs would be transferred to the North Staffordshire Trust to ensure that the emergency services could remain open and the consultant dependent services should move to the University hospital (Midstaffs.nhs.uk 2018). Other changes that were made with the help of proper leadership included recruiting the permanent replacements for making sure that the elective surgeries could be stopped during that time and more focus should be placed to focus on the utilization of resources on emergency care. The cost of changes incurred over £300m, and the remaining amount of money was used to renovate the A&E department at the NHS trust to prevent issues like overcrowding, long queue and lack of space for filling the patients (Mendenhall et al. 2014).

The stakeholders are the individuals who are concerned with the management and functioning of the organization at various levels such as investors or shareholders, employees, customers, customers and suppliers of the organization. Knowledge could be used as power to produce the best quality services and at the same time, facilitate the management of intellectual capital for gaining a competitive edge over its competitors. The stakeholders hold different kinds of power and responsibilities at various levels of the organization to ensure that the team members, individuals working at the NHS trust and various departments could possess enough knowledge and information to advance the interest of the organization with ease and effectiveness (Goetsch and Davis 2014). The stakeholders are also responsible for controlling the resources as power and furthermore enable proper availability, accessibility and utilization of resources to ensure that the issues regarding resource scarcity can be overcome. The managers are other stakeholders who play integral part in managing the workforce and make decisions and due to this, they hold the most responsibilities and power to resolve the cultural differences and even maintain successful business functioning. Some stakeholders do hold the power of forming effective networks as power and manage accessibility to information, furthermore assist in proper resources’ utilization and making decisions accurately for the business benefits at Mid-Staffordshire NHS Trust. Thus, it could be clearly understood that the stakeholders in business hold enough power and authority to manage changes within the organization and bring out positive outcomes in terms of enhanced service delivery, better customer satisfaction, higher revenue generation and competitive advantage in business too (Van der Voet 2014).

Stakeholders and Power Sources

There are three different kinds of stakeholders considered within the health and social care organization including the internal stakeholders, interface stakeholders and external stakeholders. The internal stakeholders are the individuals who work within the organization and few of them are administrators, staffs, nurses, doctors, safety service personnel, housekeeping staffs, etc. The interface stakeholders of the health care are the individual who work both internally and externally for the organization and they are the Board of Directors, medical staffs, etc. whereas the external stakeholders provide inputs to the organization to bring out the desired positive outputs (Bolman and Deal 2017). The external stakeholders of the organization are patients, third party payers, suppliers, material vendors and other individuals who have specific interests in the business functioning related to economic growth and development, proper management of resources, etc.  The power is hold by various stakeholders of the NHS Trust such as the patients who have the power to make decisions while receiving the care services, trainees such as pharmacists and foundation doctors associated with the combining of services and training sessions and trusts that enable clinical risk management and safety of individuals by reducing the adverse effects of drugs. The Deaneries or School or Pharmacy are associated with the training and development programs provided to the individuals while the wider NHS has distributed the good clinical practices through the BTBC pilots (Cameron and Green 2015).

One of the most effective theories could be the four Rs theory that should assess the roles and responsibilities, rights, rewards and stakeholders’ relationships with the other groups at  Mid-Staffordshire NHS Trust. The power source for the internal stakeholders at the organization were organizational hierarchy or structure that provided the managers of the NHS Trust to gain authority and power to influence the formulation of policies and ensure successful business functioning. The management of strategic resources helped the leaders to gain power to formulate strategies and implement those while the knowledge, skills and expertise of the staffs had been considered as the power sources of the top management level (Beck and Cowan 2014). The power sources for the external stakeholders were dependence on the resources such as obtaining funds and loans from banks and deriving power to manage changes. Being a highly authoritarian organization, it became easy for obtaining links, which had created more scopes and opportunities to enhance the effectiveness of the strategic management process. By maintaining power, it became easier for the organization to meet the safety and legal health service requirements and even helped in maintaining the quality standards to become one of the high performing hospitals in UK, according to the Care Quality Commission report (Nandan 2017).

Drivers for Change at Mid-Staffordshire

There are various drivers for change at the Mid-Staffordshire NHS trust and changes have been done to improve the business functioning and overcome the issues that are faced by the health and social care organization. The eight steps of the model are to create an urgency, forming an effective coalition, creating a vision for change, communicating the vision and mission of the organization, creating short term wins, developing the changes and finally implementing the changes within the corporate culture of Mid-Staffordshire NHS Trust, United Kingdom (Renz and Herman 2016).

Step 1: Creating urgency

The hospital was facing some major issues related to the excess numbers of deaths and large queues made by the clients due to lack of beds and space within the hospital. Due to this, it was important to formulate change management strategies, which helped in improving the functioning of the organization as well as allowed the hospital to maintain re health, safety and quality standards according to the Care Quality Commission. Investigations were made and there was immediate need to change to improve the quality of care services provided to the service users of Mid-Staffordshire NHS Trust, UK. As soon as the urgency was created, the potential threats were identified and the opportunities had been evaluated to provide reasonable explanations about the current scenario (Lachman, Runnacles and Dudley 2015).

Step 2: Forming an effective coalition

The stakeholders of the organization were informed and communicated about the necessity of change, which was further facilitated with the support of good leaders and skilled staffs. The leaders were identified with the most effective skills to make decisions and there was more focus on developing teams to identify the areas of weaknesses and at the same time, communicate the roles and responsibilities that should be managed by the various stakeholders.

Step 3: Creating a vision and mission to enable change

To create a vision, the values were determined along with a perfect strategy for executing the vision, furthermore ensured that the change coalition to practice the effects of change that would be experienced afterwards (Finkelman 2015).

Step 4: Communicating the vision

The vision was communicated by the leaders of the organization to the concerned people of the organization to address the people’s concerns and preferences along with the management of operations such as training sessions and performance appraisal techniques.

Step 5: Overcoming obstacles

The issues were mainly related to the long waiting queues, lack of enough beds, improper quality of services and lame culture within the workplace. Communication was managed properly at Mid-Staffordshire NHS Trust to maintain a positive culture where people managed to work as a team and consider the views and opinions of the other team members before coming to a conclusion. The managers also listened to each of the team members and discussed about the approaches and leadership rationale. It not only helped in managing the channels of communication properly to gain feedbacks and information, but also allowed to encourage change management at the hospital. The infrastructure was improved with the management of a good hierarchy, which further created more space for allowing more clients to visit the hospital and obtain the relevant health care services (Carter et al. 2013). More investments were made to improve the organizational functioning and provide relevant training and development programs to the individuals for improving their skills, knowledge and expertise level. This was how the obstacles were overcome at the hospital to maintain the quality standards and ensured safety and wellbeing of the individuals who availed the services of the organization (Midstaffs.nhs.uk 2018).  

Eight Steps Model for Change Management

Step 6: Creating short term wins

Nothing other than success motivates and encourages the business functioning the most. With the achievement of short-term success, it became easy for the organization to understand the feasibility of the entire project and even the project costs were reduced to a certain extent. The advantages and disadvantages of the targets to be achieved were analyzed thoroughly and the changes were built (Kuipers et al. 2014).

Step 7: Building on the changes

At Mid-Staffordshire NHS Trust, change was brought with the development of a patient centered culture with proper consideration of compliance with the fundamental standards for ensuring transparency and openness. It was necessary for the NGS to examine the financial and clinical standards to form a   positive culture and at the same time, overcome the issues related to communication.

Step 8: Implementing the changes within the corporate culture

The changes were implemented by creating a patent centered culture, where the needs and preferences of the patients were prioritized on the most. Communication was established between the staffs and the clients to know about their needs and provide services accordingly to fulfill the standards of meeting the health and safety of the individuals admitted to the hospital (Williams 2013).

Another important driver for change is the leadership at the organization, which ensured implementation of successful changes and making the staffs accustomed with those to achieve business success and long term profitability. The leadership approaches were managed properly to ensure that the people could work as an unit and enable team work to facilitate the improvement of customers’ services and best quality services provided to the service users. With the support by NHS Leadership Academy, leadership model was developed for the NHS trust to develop programs and intervention techniques for enabling changes in the culture through the involvement of multiple delivery partners. There was better professionalism in leadership along with NHS funded services, which further maintained a consistent approach in maintaining good leadership skills at various levels of the organization (Buller 2015). The leadership model or framework was created to improve the patient safety and well being along with better care services’ delivery to meet the standards and requirements of the Care Quality Commission. The behavioral standards and technical competence and skills were further combined together to provide the leaders with necessary information and knowledge about the management of proper values, ethics and an appropriate culture within the health and social care organization in UK. The leaders were much aware about monitoring the license conditions to strengthen the corporate accountability within the health and social care as well (Hammer 2015).

A proper leadership approach could not only contribute to the achievement of goals and objectives, but would also transform all the workers at the hospital in pursuit of a better and collective purpose. There was lack of communication and coordination among the staffs, due to which, the leaders made sure to engage the staffs and managers altogether while practicing transformational leadership (Midstaffs.nhs.uk 2018). This promoted the establishment of trust and loyalty and even focused on the concerns of the employees, furthermore implemented changes to improve the level of safety and wellbeing of patients at the hospital. The leaders conducted frequent negotiations with the staffs to respond to the changes occurred due to the external forces and made sure to secure their commitment to the organization (Grohar-Murray, DiCroce and Langan 2016). Knowledge was shared and the tasks were allotted to the employees based on their level of skills, knowledge and expertise, which assisted in bringing out a transforming effect through the development of work hour policies and proper time scheduling at Mid-Staffordshire NHS trust, UK. To balance the business efficiency and performance of staffs, the leaders also provided them with good working conditions and established a good culture, where the workers could feel secure and encouraged to perform better. The training and development programs were arranged by the leaders to enhance their knowledge level and allowed them to perform to their potential too (Van der Voet, Groeneveld and Kuipers 2014).

There were multiple barriers associated with the implementation of changes at the concerned health and social care organization. The barriers were mainly caused due to the lack of proper standards maintained at the hospital in terms of quality and effective service delivery along with long waiting queues.  The service delivery was delayed and even the quality of care services deteriorated with time, which further created difficulty in maintaining the standards of the Care Quality Commission and many patients died too.  Questions started arising regarding the lack of efficient services provided by the hospital and so there was immediate need to implement changes at Mid-Staffordshire NHS Trust. But changes were not as easy to implement as it seemed to be and there were multiple barriers, which hindered the successful application of changes (Bolden 2016). Other barriers associated with the changes implemented could be the prevention of healthcare assistants to provide care services to the patients without being registered. The budget was another factor that acted as barrier prior to the management of changes at the organization. Statutory obligation imposed for managing the duties related to care services’ delivery could also be a major barrier to change at Mid-Staffordshire NHS Trust (Midstaffs.nhs.uk 2018). Due to the deaths of many patients, the hospital had to pay more than £1.1m as a compensation amount, which resulted in huge loss as well and lack of sufficient financial resources. Before managing the changes and improvements within the organization, the medical staffs and doctors failed to blow the whistle on the patients receiving poor care services. The managers did not properly supervise the junior doctors due to which the targets were not achieved within he assigned time too (Hornstein 2015).

Other barriers to change at the hospital were lack of employee engagement, an inappropriate culture, lack of proper communication and organizational complexities faced due to inaccurate knowledge and information sharing. The engagement of employees lacking in the organization can be considered as one of the major barriers to change management. The employees felt afraid to adjust to the changes and due to the organization’s poor functioning, the engagement of employees further deteriorated. They even failed to embrace the new culture and enough resources were not available to drive them towards the management of changes at Mid-Staffordshire NHS Trust, UK (Osiyevskyy and Dewald 2015). There was lack of effective communication strategy and due to this, the leaders and managers also were incapable to adjust to the new development. A bad culture shift planning was another barrier to change, which made the team fail to make decisions properly based on the intuitions and feelings. There was no proper planning administrative structure and the staffs were not allotted with the right roles and responsibilities to provide the best care services to service users. The organization developed complex processes, which created complexity during the planning and implementation of changes at the hospital. To overcome this barrier, it was important for the hospital to manage employing meticulously considering the skills, knowledge and expertise of the staffs and bring out enhanced quality and efficiency in the change management approach too (Cummings, Bridgman and Brown 2016). Therefore, these were the major barriers to change faced at Mid-Staffordshire NHS Trust in United Kingdom, due to which its reputation deteriorated and the care services’ efficiency declined resulting in lesser profit. It had been important to implement changes and ensure improving the business functioning and creating positive mindset among the service users too (Lozano 2013).

Conclusion

The report was prepared to analyze the concepts of leadership and change management at a health and social care organization in United Kingdom. The report included the concepts of providing an organizational overview, which showed that Mid-Staffordshire NHS Trust managed significant changes and improvements due to the emergence of multiple issues including higher numbers of deaths of individuals, long waiting queue of patients and lack of appropriate culture and leadership, which hindered the communication and coordination among the employees. The stakeholder analysis was done to determine the level of power and interests of the various stakeholders while sources of power were both internal and external. Kotter’s 8 step model was used to identify the drivers for change and how changes were made possible at the organization. The leadership approaches were considered as relevant and effective for bringing out changes and improvements within the organization, furthermore overcome the barriers to change experienced at Mid-Staffordshire NHS Trust.

References

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Van der Voet, J., 2014. The effectiveness and specificity of change management in a public organization: Transformational leadership and a bureaucratic organizational structure. European Management Journal, 32(3), pp.373-382.

Van der Voet, J., Groeneveld, S. and Kuipers, B.S., 2014. Talking the talk or walking the walk? The leadership of planned and emergent change in a public organization. Journal of Change Management, 14(2), pp.171-191.

Williams, D.A., 2013. Strategic diversity leadership: Activating change and transformation in higher education. Stylus Publishing, LLC..

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