East Neasden General Hospital's Organizational Problems - Case Study Example

HRM – The case of NHS in East Neasden I. East Neasden General Hospital - Organisational structure and culture East Neasden General Hospital is a health institution of high importance for the specific region. The services provided are divided into the core health services (offered to the city’s population) and the support services which are provided to neighbouring authorities. The traditional structure and culture of the organisation has been set under reform using the guidelines and the suggestions made by Griffiths in his report prepared after an inquiry of NHS related with the organizational structure of all its particular health units around Britain. Specifically, for East Neasden, the ‘branch’ of NHS that was set under evaluation was the General Hospital which has showed points of weakness and lack of effectiveness in facing the challenges set daily in the area’s health sector. Moreover, the hospital’s department mainly set under examination was the Dietary one. The main problems related with the delivery of healthcare services under the existed organizational structure (before the reform attempted) were the lack of efficiency in handling the resources available but also the lack of sufficient and effective communication between the various managerial levels. This had as a main result the significant delays when delivering the healthcare services and the failure in handling the budgets available for the institution’s restoration and development. The whole department is running by 13 people who are working either on a full time or a part time basis. The main characteristic of the organizational structure is the existence of a specific routine in the department’s daily operations. More specifically, all the decisions referring to the department’s needs in terms of clinical supplies are handling by the administrators while the more important cases are evaluated by the doctor and are set under examination and approval by the hospital planning board meeting twice a year. The above method of handling of the supplies’ needs could be characterized as a rather flexible and effective strategy, however, it could be possible criticized as of its applicability in cases that supplies of ‘high importance and value’ will be required to be available in a short time period (a rather difficult target to be achieved under current departmental structure). On the other hand, the communication between the staff could be characterized as very satisfactory, a phenomenon which can be possibly explained by the distance that separates the specific department from the rest of the hospital (a fact that lead to the development of a friendly climate among the staff). However, the existence of such a practice could lead to the creation of severe problems when referring to the application of the rules and the principles set by the management team of the organisation. More specifically, according to the practice held currently by the staff of the specific department, the hours and the duties of the staff do not follow a specific order but, instead, they are formulated in accordance with the needs and the demands appeared on a daily basis. The above practice has a result the ‘exchange’ of duties among the staff, like the provision of consultation from nurses in cases where a dietitian is unavailable. Any problem occurred during the week regarding the communication, the staff’s duties and the practices of delivering healthcare services is discussed on the Friday’s weekly meeting. II. Managerial practices and motivation The organizational structure and culture as formulated in the specific department, is characterized by flexibility (in working hours and in duties) and adaptability (in accordance with the needs of the particular cases). On the other hand, the existence of a friendly climate has enhanced the communication as well as the clients’ satisfaction. Under these terms, the evaluation of existing motivation standards should be based on the above facts and norms. In the field of literature, the reference on motivation has been very limited, and according to Ashforth (1995) overly rational. Theories of emotion based on expectancy theory (Vroom, 1964) and behavior modification in organizations (Luthans & Kreitner, 1975) heavily rely on rational, logical and verbal processes and exclude emotion almost entirely. Moreover, Ashforth (1995, 97) presented the background for this liaison among motivation, emotion and leadership: ‘Leaders may persuade with logic, but they motivate through emotion. Leaders must come to grips with the challenges of emotion, a key driver of productivity, quality and other factors that lead to business success. The words "motivation," "emotion" and "motion" all derive from the same Latin root meaning "to move." When you want to motivate people to take action, engage their emotions’. In the same context, Pool (1997) looked at the relationship between leadership, job satisfaction and motivation. Under these terms, it could be considered that although job satisfaction was described by Ashforth as a superficial or "quasi"-emotional component, it is at least one ingredient of emotion. Job satisfaction is an attitude that individuals maintain about their job (Fulton et al., 1998). In Dietary department, current practices have led to the formulation of a particular managerial style which is characterized by the absence of strict rules regarding the delivery of healthcare services on a daily basis. In this context, motivation can be considered to be in high levels among staff in the specific department. The above assumption can be based on the findings of the literature but also on the staff’s behaviour regarding the responsibilities and the duties distributed among the employees daily. Moreover, it seems that staff participates voluntary in the provision of healthcare services or other type of duties (like administrative ones) whenever necessary without the intervention of managerial decisions or guidance. III. Recommendations for change Under the above terms, the restructuring of the managerial practices held by the Hospital and the specific Department have to be examined as of its applicability and its effectiveness in terms of real benefits both for the employees and for the clients. At a first level, the priorities of targets and goals in the organizational context, are proposed to be changed. More specifically, the hospital will be (under the suggested restructuring) more budget – orientated (see interview of District General Manager with first candidate) than patient – orientated, a strategy that would be proved profitable in financial terms but would differentiate from the basic principle that characterizes the health industry, which is the protection of the patient’s health providing the most appropriate medical services in the most short period of time. On the other hand, the existence of intense competition among the rivals in the healthcare industry could justify such a strategy (financially planned) but only guaranteeing that the patients’ health would be protected at the best possible level (see also the statements of new general manager during the meeting held at the conference hall at East Neasden). Another issue that would be held under discussion is the existence of ‘political wheeling and dealing’ (see above mentioned statements) when deciding on resource allocation between the various groups. All the budget – related decisions are expected to be taken at a corporate level and all particular departments have to follow them. The use of media in order for more budgets to be allocated regarding specific needs is absolutely prohibited (especially when related with the narration of ‘shock horror stories’ in order to achieve the above target). The roles of the staff will be re-considered and re-allocated in accordance with the competencies of the employees and will be evaluated periodically as of their performance and their adaptability in the corporate environment. In order for the above practices to be successfully implemented, individual managers will be identified for each unit. These managers will have the power to proceed to any initiative that would consider as necessary for the provision of a successful leadership and the enhancement of motivation among staff. Although the above recommendations can be characterized as integrate regarding their scope and their targets, they have been proved to lack of applicability regarding the specific department. More specifically, the application of the corporate strategy that has been set as a priority by the district general manager has been limited by the practical problems appeared on a daily basis regarding the organisation’s operation and administration. In this way, the restructuring of the reception area and the renewal of the stationery used on a daily basis have been included in the department’s priorities after the relevant manager’s decision. Another issue is the fact that the efforts to alternate the department’s ‘family’ climate to a more ‘corporate’ one setting the application of the corporate strategic decisions as a principle priority, has resulted to the limitation (and in some cases the elimination) of enthusiasm and motivation among staff. The ‘corporate’ model of organizational structure has been proved to be inappropriate for the specific department which had based its daily operations on the communication with the patients and not the strict application of the corporate decisions. This does not mean that the specific department has lost its efficiency and its prospects for the future, however the proposed measures should be alternated in order to be more close to the existed organizational structure and culture and any change required could be implemented gradually giving the employees the chance to participate actively in any decision making (at the most feasible level). IV. Conclusion The presentation and the attempted application of the reforms suggested by the Griffiths report have proved that every organization has its particular characteristics and its specific rates of development and performance. In this context, any suggested restructuring of the existed strategies and practices should be based on the ethics and the principles of the specific organization (Fulton et al., 1998). In the case of East Neasden General Hospital the introduction of a more ‘corporate’ – based culture has been resulted to significant failures regarding the performance of the staff, a fact that can be explained mainly by the limitation of the motivation among the employees. In the specific case, it seems that the District area manager did not consider one of the fundamental principles of change management (Cooper et al, 2005) which is the participation of the employees. References Ashforth B. E. (1995). Emotion in the workplace: A reappraisal. Human Relations 48(2): 97 Ashkanasy, N. M., Subramaniam, N. (2001). The Effect of Organisational Culture Perceptions on the Relationship between Budgetary Participation and Managerial Job-Related Outcomes. Australian Journal of Management, 26(1): 35-40 Benson, K., Oliver, B. (2004). Management Motivation for Using Financial Derivatives in Australia. Australian Journal of Management, 29(2): 225-240 Birley, S., Dunn, M., Norburn, D., Payne, A. (1990). A Four Nation Study of the Relationship between Marketing Effectiveness, Corporate Culture Corporate Values, and Market Orientation. Journal of International Business Studies, 21(3): 451-459 Cooper, B., Densten, I., Gray, J., Sarros, J. C. (2005). The Organizational Culture Profile Revisited and Revised: An Australian Perspective. Australian Journal of Management, 30(1): 159-180 Isaac, R. G., Pitt, D. C., Zerbe, W. J. (2001). Leadership and Motivation: The Effective Application of Expectancy Theory. Journal of Managerial Issues, 13(2): 212-223 Fulton, R., Maddock, R. (1998). Motivation, Emotions, and Leadership: The Silent Side of Management. Quorum Books. Westport, CT Lajara, M., Garcia Lillo, B., Sempere, V. S. (2002). The Role of Human Resource Management in the Cooperative Strategy Process. Human Resource Planning, 25(2): 34-46 Luthans F., & Kreitner R. ( 1975). Organizational behavior modification. Glenview, IL: Scott, Foresman Martin, B., Riemens, W., Wajcman, J. (2000). Managerial and Professional Careers in an Era of Organisational Restructuring. Journal of Sociology, 36(3): 329-335 Vroom V. H. ( 1964). Work and motivation. New York: Wiley Read More