Leadership and Change Management within the Healthcare System: A Case Study of Macro Level Change - Assignment Example

?Leadership and Change Management within the Healthcare System: A Case Study of Macro Level Change Badge Number: College Name: Course Name: Lecturer name: Word Count: Table of Contents Introduction 4 Problem Analysis 6 Problems and Issues faced 6 SWOT Analysis 7 Strengths 7 Weaknesses 7 Funding available for the reform of the health system 7 Trained professionals already exist 7 High prices for medicine 7 Patients perceive staff as being rude and uninterested 7 Long wait times to see a professional 7 Medical doctors have low qualifications 7 Opportunities 7 Threats 7 Health Care Reform 7 Countrywide transition to a market orientated economy from a centrally administered economy 7 Shift to a family medicine approach 7 Low confidence in the government and the MoH as a consequence of failed promises 7 Resistance of internal medical specialists to the proposed reform 7 Little knowledge about the planned reform 7 Core Problem and Direct Effects 8 The Role of Leadership 8 Relation to Saudi Arabia 10 Change and Change Approach 12 Level of Change 12 The case study of change in Biladistan is macro level change. This is because it is a widespread reform that is the consequence of policy and law changes at the level of the MoH and government and the effects of the change are country wide. Changes occur at all different levels within the country, as hospitals and health care establishments must now consider the new position of GPs, internal medicine specialists must consider whether they retain their current working position or become GPs, and patients must decide whether they want to visit GPs or other medical professionals. Structures and processes are also being significantly altered as a consequence of the reform. The environment is turbulent, as the country faces an economic crisis and a shift in management of economy at the same time that the reform is being implemented. The change approach that is being used is bold stroke change, which consists of transformational, large scale change within a turbulent environment. 12 Change Management 12 Change and Risk Management 14 Prevention of Problems 14 Managing the Primary Health Care Reform 15 Conclusion 16 List of References 17 Introduction Change management is the collection of tools, techniques and processes that are used to help people manage and understand the processes associated with change in order to achieve the outcome that is desired. It aims to look at realising the change efficiently at a number of levels, specifically the level of the individual, team and organisation. The main focus of change management is people and how they are affected at the level of the individual, of the group or organisation and in the wider picture. There are two main forms of change in systems, either micro level change which occurs primarily at the level of an organisation or at the macro level which can be at the level of an entire country, a province or a state. These types of systems offer different advantages and disadvantages. Macro level change is able to orchestrate widespread consistent changes that cannot be obtained through piecemeal changes occurring through one organisation at a time. In addition to sweeping changes macro changes are often accompanied by law and policy changes making their implementation easier. Micro level change is generally the result of decisions made by management of an organisation and is often much more flexible. Because of this it is better able to take advantage of the benefits of leadership, as leaders have more ability to interact with individuals on a one-on-one level, and are also able to let groups and individuals have a role in decision making, which cannot be done to the same extent with macro level change. One particular area where change management becomes important is in health care. The health care system forms an integral part of our society, providing a service that is necessary for people across every reach of life and occupation. It can be broadly defined as the prevention, treatment and diagnosis of disease, illness and injury which put human life and well being at risk as well as any other forms of mental or physical impairment. There are a wide range of people, institutions and roles involved in the system, including medical practitioners, pharmacists, hospitals, nursing staff and care providers. Within developed society, the government often plays a strong role in health care, developing policies and guidelines that allow for the care of members whether they are privileged and have ready access to finance, or whether they have little to no access to finance. Because of the importance of health care, it is crucial that any changes within the industry are implemented effectively. This report will look at looks at a case study of attempted macro level change occurring within the country of Bilidistan that has been in progress for 15 years. A problem analysis will be done of the situation, using various techniques including SWOT analysis and the problem will be analysed as to whether a comparative issue could arise in Saudi Arabia. Following this, the approach to change and risk management strategies will be analysed. Problem Analysis Problems and Issues faced Biladistan is a middle income country that has been undergoing an economic crisis for a number of years. The health care system is primarily public, and is designed to provide free health services, however this is not happening. Instead, the health care system is ineffective, which were critiqued due to the high prices of drugs and low qualifications of many of the doctors in addition to long waiting times and distain towards patients from many of the staff. The primary type of medical staff in the health system are internal medical specialists. Satisfaction with the health care system is low, and the perceived solution was the complete reform of the primary health care (PHC) for the country increasing the focus towards family medicine. The main part of this reform was the introduction of the General Practitioner (GP) profession, which is a part of family medicine that is used in many countries and in this case would replace the previously used internal medicine profession. To help this process, the Ministry of Health (MoH) offers courses that allow internal medicine specialists to retrain as GPs. However, no more than ten percent of those who have trained as GPs are actually practicing in the public sector. The reform has now been underway for 15 years, and is showing little signs of progress. There have been a number of reasons given from within the country about the lack of progress. Part of the problem is a lack of management, as there is no model for how restructuring is to progress, or how the internal medicine specialists are to be replaced with the new GPs. In addition, many of those who graduate from the programs that train them as GPs are unwilling to practice. This unwillingness stems from poor salary as well as a stigma attached to working in the PHC sector. Those who previously had internal medicine practices are unsure of how their qualification, reputation and salaries as an internal medicine specialist will be affected and know little about the reform. As a consequence, it can be assumed that most of the internal medicine specialists that are retrained remain in their roles within internal medicine due to the increased stability it provides, and because they see no benefit or need for the change. SWOT Analysis Strengths Weaknesses Funding available for the reform of the health system Trained professionals already exist High prices for medicine Patients perceive staff as being rude and uninterested Long wait times to see a professional Medical doctors have low qualifications Opportunities Threats Health Care Reform Countrywide transition to a market orientated economy from a centrally administered economy Shift to a family medicine approach Low confidence in the government and the MoH as a consequence of failed promises Resistance of internal medical specialists to the proposed reform Little knowledge about the planned reform Core Problem and Direct Effects There are a wide range of problems with the health care system in Biladistan and with the planned reform. Despite promises of a better health care system, there has been little change in the effectiveness of health care during the 15 years that the reform has been in place. The effects of this problem are widespread on the population. They continue to face frustrations at the current health care system, and it can be assumed that one of the consequences of high prices of the drugs is that many will be unable to afford them or unwilling to pay the price. This can result in an increase in the number who are ill in the country, and a further increase in dissatisfaction in the system as a consequence. The core problem that the country is facing in its failing reform is lack of leadership. There is no clear drive or direction to the reform, those in charge of managing it do not appear to know what a suitable process is, and as a consequence those involved in the health care sector and the general public lack confidence in the reform and their government, have little knowledge about the aims of the reform, and are likely to feel that it is not worth the required effort. Thus the country’s health system remains in limbo, stuck between two different systems of health care and effective at neither of them. The Role of Leadership Leadership is a key trait that is present in some people that allows them to draw out the best in people, helping to get people working towards a common goal as well as being a motivational presence. The ability to lead differs between individuals, with many different styles of leadership being present including democratic, authoritarian and laissez-faire (Van Vugt et al., 2004). It is debated whether leadership is a result of innate ability, trained ability or of a combination of the two. Notwithstanding, not all people are good leaders but those that are can make a substantial different to a situation, often completely altering the outcome. It is often proposed that failures in change are representative of poor management, with inefficient organisation, direction or planning, however the failure can also be the result of lack of leadership, which can cause many of the same overall effects. While management is clearly an important part of initiating any change within an organisation or country, it is the leader who provides inspiration, vision and helps to develop and grow individuals and groups towards interest and passion in the goal. As a consequence the aim of the organisation becomes shared with the individuals within, and they begin to emulate an interest for the change also (Gill, 2003). Leadership in the Biladistan case study is lacking in several areas: There has not been effective communication of the vision of the reform with citizens and employees There has been no plan for how the changes are to be integrated There has been no timeline for changes There is little to no direct communication between the MoH and the health care industry, and professionals from the health care industry have been given no role in decision making. It can be assumed that as a consequence there is little trust or respect for the MoH or their decisions. The consequences and risks for the change in health care do not appear to be fully analysed. While the case study gives a clear indication as to why the proposed changes are being initiated, there is little evidence of how they are expected to be effective. The MoH is not acting to motivate the implementation of the reform. There are little to no perceived advantages for internal medicine specialists to switch from their role to that of a GP, so most choose to stay with what they are familiar with. There is little motivation for transition to the new system, and both citizens and members of the health care industry appear to be disillusioned, and believe the change will not cause a significant benefit. Strong leading and inspiration as well as incentives for the new system are needed. Relation to Saudi Arabia Saudi Arabia is a country in the Middle East that operates under a monarchy. The predominant religion is Islam, and there are widely differing rights and responsibilities between the genders (Central Intelligence Agency, 2011). Data indicates that health care is widely available across the country, with more than a 2000 survey finding 99% of the population had access to health care services. Within the last ten years there have been reforms in the regulations concerning drug distribution, and there are a number of reforms planned. Planned reforms include the expansion of the use of information technology (IT) in health care, and increased budget allocation, ensuring that the costs for both drugs and technology are reasonable, and increasing the performance of PHC by increasing the number of people involved and the administrating portion. The problem that occurred in Biladistan is possible for Saudi Arabia, but it is less likely. Biladistan suffered from a lack of management and of leadership. Saudi Arabia already has a clear system of PHC management, with an already effective and affordable health care system. There isn’t the concern of disillusioned public and Saudi Arabia already has a respected leader. The leadership of the monarch can be used to inform the public of the planned reforms, as well as encouraging them that this is in the nation’s best interest. Change and Change Approach Level of Change The case study of change in Biladistan is macro level change. This is because it is a widespread reform that is the consequence of policy and law changes at the level of the MoH and government and the effects of the change are country wide. Changes occur at all different levels within the country, as hospitals and health care establishments must now consider the new position of GPs, internal medicine specialists must consider whether they retain their current working position or become GPs, and patients must decide whether they want to visit GPs or other medical professionals. Structures and processes are also being significantly altered as a consequence of the reform. The environment is turbulent, as the country faces an economic crisis and a shift in management of economy at the same time that the reform is being implemented. The change approach that is being used is bold stroke change, which consists of transformational, large scale change within a turbulent environment. Change Management The health care system in Biladistan was facing problems of high prices and low quality of care, resulting in increased dissatisfaction of the public in the system and a reduced effectiveness of the system in general. In order to address these problems, a reform was initiated that worked on the replacement of internal medicine specialists with GPs. There are a number of potential goals to this reform: Increase in the role of Family Medicine in the health care system Increased relationships between staff and patients Increase in training and knowledge of medical practitioners Decrease in the cost of medicine Strategies to implement planned changes: Create a timeline of planned changes and make this available to citizens and health care professionals Publicise the planned changes and what the expected outcomes will be Establish a monitoring system to determine the quality and effectiveness of the changes Undertake focus groups and conferences with internal medicine specialists about the planned changes and involve them in the decision making process Increase the available training for health care professionals and workers Improve knowledge of available health care services Create incentives for movement to the new system such as increased wages for GPs, increased available training, wide support and allowances Conduct training courses and workshops for health care professionals and providers Change and Risk Management Prevention of Problems Risk Likelihood Consequence Solution Distrust in reform High Medium Keep people informed about the aims of the reform and how it will help the current situation Create a timeline of planned changes, what can be expected and when Be accountable to the public Reluctance of internal medicine specialists to enter the new field High High Provide intensive training Involve medical professionals in the decision making process Reassure about the stability of the GP role, the affect that this will have on current practices and the effect on income Provide incentives to enter the new role such as increased income and ample support Reluctance of Citizens to use GPs Low Medium Provide ample information about the benefits of using a GP Provide financial incentives such as decreased cost of medication when prescribed by a GP Managing the Primary Health Care Reform The first steps in managing a reform effectively is information, those planning the reform need access to as much information about the problem as is possible and providing information about plans to the public. As the health care industry is the focus of the reform my first step would be to communicate with them, finding out what problems they have with the current situation and what solutions they see. The next step would be to plan out a timeline of what needs to be done, how it should be implemented and how long each part of the process will take. These plans will be shared with the public and the health care industry. To look at implementing GPs I would use the training programs that the MoH used in the case study, but I would make sure that these have all the required information, and would follow up with the internal medicine specialists about how they viewed the training, and about the next steps for them. One important step is to make the change appealing through providing incentives and through explaining the advantages and the need for the change. In general, change is resisted as a part of human nature. Unless there is some benefit to change, or the individual finds that they are faced with no other choice, the tendency is to remain at the present situation (Hall-Jones, 2011). One mechanism to circumvent this I would put into place would be a pay increase for moving to the GP field as opposed to internal medicine. This is likely to be effective as there are widespread concerns that the pay for health care is too low and does not scale well. In addition I would put into place a date that internal medicine specialists would not be front line in the health care industry. I would keep information about the progress of the reform transparent, and make sure people remain informed about the advantages, the need for the reform and the main objectives. Conclusion Health care is an important aspect in any country, as the associated roles and services help to ensure that citizens remain healthy, free from sickness and disease and have access to all the facilities that they need. The industry is one that needs to change as time progresses and new information, medication and skill are released. In the case study of Biladistan a reform of the health system was needed as the current system was inadequate. The planned reform involved the replacement of internal medicine specialists with general practitioners as part of a turn towards more family medicine. However, 15 years after the start of the reform there is still little sign of progress. Although many internal medicine specialists have trained as GPs, few have converted to practicing. This situation represents a lack of both leadership and management. Citizens have little information about the planned changes, and do not believe they are likely to ever take place. An approach that focuses on leadership and communication is needed in this situation. A leader can often restore confidence of people, and work with them rather than ordering them, and this often results in better responses (Searle and Skinner, 2011). Communication with the public and the health care industry, particularly the internal medicine specialists is important in this situation, as this transparency allows for increased confidence with the reform and with the MoH body behind it. List of References Central Intelligence Agency. 2011. The World Factbook: Saudi Arabia [Online]. Available: https://www.cia.gov/library/publications/the-world-factbook/geos/sa.html [Accessed September 1 2011]. Gill, R. 2003. Change Management-or Change Leadership? Journal of change management, 3, 307-318. Hall-Jones, J. L. 2011. An Exploration of the Relationship between Supervision and Leadership among Middle Managers in Student Affairs Administration. Ohio University. Searle, R. & Skinner, D. 2011. Trust and Human Resource Management, Edward Elgar Pub, 1-20. Van Vugt, M., Jepson, S. F., Hart, C. M. & De Cremer, D. 2004. Autocratic Leadership in Social Dilemmas: A Threat to Group Stability. Journal of Experimental Social Psychology, 40, 1-13. Read More