Health Service Management - Assignment Example

Managing Health Service Name ---------------------------------- ---------------------------------- ---------------------------------- Introduction Rapid technological and medical advancements make it necessary for healthcare organisations to institute changes to keep pace or they could be left behind. There is a need to effectively manage this change as heath care organisations have become increasingly complex. They are subject to a variety of conflicting interests both political and professional which need to be effectively managed in the interest of the organisation and the ultimate beneficiary who is the patient. The demand and cost of health care has risen sharply and new methods need to be devised to contain them. There is also a need for cultural change within the organisation so that healthcare services follow sound business practices while conforming to medical ethics and societal demands. At the same time the workforce within the health care organisation must be a part of the process of change so that there is a high level of job satisfaction. 1. Describe your understanding of the term ‘organisational culture’. List the observable aspects of a culture and identify how you have either experienced them or witnessed them in organisations you have been a part of in recent years. Organisational culture is basically measured within the parameter of a mixture of any two or all three studies that consist of organisational psychology, social psychology, and social anthropology. In simple terms it means that people who make up a particular organisation have similar characteristics like beliefs, traditions, routines and certain behavioural patterns that make sense. This means that organisations believe in training that will equip its personnel with certain set skills that are important for the functioning of the organisation and the values that reflect the best work culture. “An organisation’s culture is reflected by what is valued, the dominant leadership styles, the language and symbols, the procedures and routines, and the definitions of success that make an organization unique” (Cameron & Quinn, 2006, p17). In health care this can be seen through how the personnel best manage the need of patients and how the families are handled. It also reflects how well the hospitals have a strategy in place for handling patient safety. Often however it can be observed that “in hospitals doctors, nurses and administrators are often fighting with each other rather than collaborating to improve patient care” (Schein 2010, p8). Also sometimes each sub-group within the larger organisation is independent and hence they are not involved in the action of the other groups in the organisation. If the case of paramedics is taken, it has been observed that paramedics, or allied staff as they are now known, often suffer from exhaustion. Debriefing about the cases also takes it toll and they often feel that other health care professionals do not really support them. The care that they bestow to the families of unsuccessful cases takes up a lot of their time and it is one aspect of the service that is not recognised by the larger organisation. There job is stressful as they are the first to reach and administer emergency treatment and are not sure if the patient will survive. When the unfortunate happens they also feel the stress that is generated through the family but training comes into play and they need to be professional. Organisational culture, thus, is traditions, beliefs, routines and certain behavioural patterns that people in an organization and the organization itself follow to give the organisation a distinct identity of its own. 2. Culture is difficult to change and requires effort. Based on your readings on the topic, what conditions would need to exist if culture was amenable to change? “Medical and nursing subcultures are cohesive, robust and resistant to change” (Scott et al, 2003 p 25). It is a ready made hierarchy as doctors talk to doctors and nurses to nurses. Also with the change in medical restructuring there has emerged a need for separate identities like dieticians, physiotherapists etc. There is definitely a need for the separate identities like paramedics to be acknowledged within these identities. Their work needs to be appreciated and their tension and stress needs to be addressed by the organisation including doctors. Organisations need to understand that their primary need is patient care and that should be the focus when formatting change. Paul Parkin (2009) on the other hand advises changes that are more action oriented and which are focused on problem solving rather than collection of data. He feels that organisations have to gear up to change as the parameters of medicine now include technological changes, aging population requires a different approach and so does teenage pregnancy and drug abuse. New diseases like handling HIV/ AIDS patient’s needs to change. The National Health and Medical Research Council, government of Australia acknowledges the need for changing its medical services according to the cultural change of its population and therefore have fostered change where “consumers have a right to health initiatives that respond to their social, cultural, linguistic, gender and spiritual/religious diversity and promote their health and well being in this context.” It can be concluded that when culture is talked about vis-à-vis organisations, it also implies culture not in the borader sense, but in the narrower one where people push themselves to several individual units basd on the type of work they do in an organisation. 3. Explain, in your own words, what organisational politics is and describe briefly its role in organisations. “Organisational politics is an exercise of power and influence that primarily occurs outside of formal organisational processes and procedures. This behaviour is based upon influence tactics designed to further self and/or organisational interest and is aimed at reconciling potential competing interests” (Hawkins & Miller 2006, p331). Here interests could be individual ones that conflict with the organization or the interests of other individuals or subgroups. The subgroups in the healthcare besides the professional groups that comprise of doctors, nurses, could also be “groups that refer patients, hospital boards and administrators, county and state medical societies, and other national organizations are essentially political organizations as well. These state and national groups may represent general medical interests or specialty interests” (Knote, 2001). Lawrence David Brown says that the health services are basically divided between two heads one is the administration head comprising of managers, accountants, legal advisers and marketing staff and the other is the medical head and other doctors. Conflicts of interests occur when making profits clashes with patient care and saving lives and resources are not available. Organisational politics, thus, is a means for either the organisation or its people to strengthen and pursue the fulfillment of their personal aims, ambitions or goals. 4. What differentiates power from empowerment in organisations? “The purpose of power is to prevent groups from participating in decision-making processes and also to obtain the passive agreement of these groups to this situation” (Sadan 2004, p39) whereas empowerment means giving the employees opportunities to be part of the decision making according to their level in the organisation and unless like the Japanese a tremendous value is placed on the “integration of people with organisational objectives, equipment and processes” (Apostolou, 2000 p3) an organisation can no longer succeed. According to Kimberly Alyn empowering will foster many changes including the building of a better team, improving morale, a more efficient organisation, a feeling of trust, higher productivity and these are all necessary for a healthcare organisation. Many healthcare providers are disillusioned by the reality that they don’t have enough time to do a better job of caring for patients but by empowering employees healthcare leaders can ensure “better patient care, greater job satisfaction and lower healthcare costs” (Jones) . It can be concluded that power is an advantage vested in someone to make decisions almost unchallenged whereas empowerment is a bit of freedom gives to an individual or a group allowing either of them to participate in a decision-making process. 5. Write a short explanatory essay (about 1000 words 30 marks) on organisational change. In your essay you are to define the concept, identify the types of change, address how processes of decision-making, communication, conflict and how to manage it, influence how change is implemented. Identify barriers to effective change (e.g. resistance) and describe how these might be managed effectively. In recent years emphasis has been placed on the need to change healthcare in both organisational culture and structural reform. However it is a difficult task as health care changes really result after experiencing the change as the change needs to be feasible. They further go on to say that organisational culture can affect performance and is very much a part of the health system reform though there is no clear evidence for it but is assumed to be so (Parmelli et al 2011) Change can be planned or unplanned. Unplanned changes occur unconsciously and are sometimes unspoken but could be related to the organisation and its future. When change is well thought out and action oriented it is planned as it will take the organisation towards a particular goal. Well thought out changes in an organisation are possible only through efficient process of decision-making. Efficient decision-making is culmination of a series of steps, where each step requires a specific input in terms of information. Information well-executed through different stages of the process, as well as a process for periodic feedback yields desired results for which the decision-making process was initiated. Information, as a tool of communication, is vital to the decision-making process and is made up of several facts, beliefs and data sets. Again data in isolation might not serve that purpose as would data analysed before being put to use as an aid for decision-making. The Australian Allied Health System is a fine example of how structural changes were an evolutionary change. “As early as 1992 there were calls by a cohort of hospital-based Directors of Allied Health for a new national health management organisation. It took 12 years for that aspiration to be fully achieved” (Boyce, 2006 p 94) Change in healthcare is measured differently and planning can be derailed if it is not effectively communicated to each person in the organisation as it involves a continuous system change. Iles & Sutherland (2001) describe change as developmental when focus is placed on developing a skill or process. Transitional change occurs when the present situation is altered according to Lewin’s theory of unfreeze, move and refreeze. From the present situation it will move to a new one and once a new balance is established it will refreeze. For this to occur, change needs to become a part of the personality and relationships in the organisation. Finally change can be transformational change is radical and will alter all present processes, structures but can turn into change that learns, adapts and improves. The healthcare organisation is riddled with subcultures which are seen as necessary to the working of the organisation but this hierarchy is now being seen as a barrier that will come in the way of total quality management. “As medical science progresses multidisciplinary teamwork is required to perform complicated health care services with total quality management”(Takada, p4) Another barrier that comes to the forefront is the role of the paramedic. At the site of the emergency the paramedic is the person in power and when the management questions their treatment of the patient or their actions at the scene of medical emergency. Coming from a so called “non-medic” this results in more bitterness than their relationship with doctors or nurses. Nurses are generally seen by paramedics as the ones occupying the lowest rung (Tangerherlini 2000). The relationship between nurses and doctors is also replete with hierarchy. A nurse needs to have a lot of courage to intervene in the work of a doctor even if she sees that a patient’s life is being endangered by the doctor’s action like prescribing drugs the patient could be allergic to and which the doctor could have overlooked. Conflict situation can also occur between the nurses and head nurses as hierarchy in the establishment is strong and out of fear of losing their jobs most nurses keep quiet or change their jobs. The idea that culture can impact the effectiveness of the employees as well as the organisation is now generally accepted and if this much can be understood with people in healthcare organisation and people who actually are affected by the subculture and how it governs behaviour in an organisation then should not such change be brought about that is effective in the final outcome of serving the patients? Change can occur only when the requirement is conceived as to what type of change is needed. According to Scott et al ( 2002) culture is seen as an ‘attribute’ which the organisation has and they also define it as something that encompasses what the organisation ‘is’. How the organisation is viewed will formulate the change needed. They go on to describe three kinds of change that health care organisations can adopt. The first being structural dimensions and the second is emergent or process dimension. To bring in change is not easy as it may not have the desired effect. This change is a wave that must be watched to see if it can be ridden, deflected, created or simply waited out and then followed if its direction is the one anticipated. The third change is of a contextual nature and results from an external factor. Changes within the organisation have to be made once the external environment changes so that it can be saved form becoming obsolete. Initiating and managing change in groups, teams or organisations causes fundamental disruptions to systems, structures and plans and more significantly causes pain and discomfort to people particularly the organisation’s staff but also initiators and managers of change themselves (Parkin 2009 p78). Therefore change needs to be thought out and planned according to the mission, culture and the value system that rule the organisation. People will be involved from the first step right from design to completion and lastly evaluation. Barriers to change that if not handled properly could see the organisation going through a crisis. Therefore it is important to keep in mind the following that any any culture change programme should be readily accepted by the majority of employees as a disaffected work force can have a disastrous fall out, and the change should be within a realistic time frame as the benefits will accrue at different times to different areas of the organisation’s culture. The organisation can have external influences as well which have to be kept in mind as external stake holders may adversely influence changes within the organisation. On top of it, it must be born in mind that good leadership is the key to bringing about a successful change in the organisation. Leaders who can communicate effectively are generally more successful as they carry the work force with them. In the same manner, cultural diversity has to be honoured and the effect of change on different sub groups such as doctors, nurses and others must be factored into the strategy so that it is seamlessly accepted by all and there are no dysfunctional consequences. Dysfunctional consequences have to be handled with equal expertise as at times change generates certain adverse behavioural patterns. Individuals may, for example, resort to creative accounting or fraud or misrepresenting in order to meet revised targets. Safeguards need to be in place. Given this backdrop, it could be concluded that a need has been felt recently to revamp healthcare in both strcture and organization, even though the task might seem as difficult. Changes made have to be feasible since only such changes are acceptable that do not compromise organisational performance. Conclusion Culture change is linked to performance in health care organisations and several methods can be adopted to bring change. However managers must have a profound understanding of the impact this could have and so strategic planning should involve the participation of all stake holders and employees. Leaders who while fostering change must steer the organization in the right direction. They should at all time be consistent and communicate their intentions so that there is no place left for uncertainty. This communication will also reduce undue conflicts or alliances that could be detrimental to the organization. Where conflicts occur the leadership should make reconciliatory efforts so that the conflicts of varying interest groups do not harm the patients who are of prime importance. Democratic behaviour works better in today’s environment rather than dictatorial. If the organization is considerate about the interests of each individual and subgroup then there is no conflict of interest in the organization and this leads to better job satisfaction and better performance With a change in medical technologies and medication and surgical interventions, it has now become necessary to work as a team with the same vision and mission rather than be at cross purposes. Interdependence in medical services is a foregone conclusion and should be seen as a strength that defines the organizational culture. References Alyn, K. (n.d). The Power of Empowerment in Leadership. retrieved from http://www.kimberlyalyn.com/Articles/The%20Power%20of%20Empowerment.pdf Apostolou, A. (2000). Employee Involvement Report. Produced for the EC funded project INNOREGIO: dissemination of innovation and knowledge management techniques. January 2000 retrieved from http://www.urenio.org/tools/en/employee_involvement.pdf Australian Government: National Health and Medical Research Council, (2005). Cultural competency in health: A guide for policy, partnerships and participation. 9 December 2005 retrieved from http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/hp19.pdf Boyce, R.A. (2006). Using organisation as a strategic resource to build identity and influence” Robert Jones R and Jenkins F (Eds) Managing and leading in the Allied Health Professions, Radcliff-Oxford, UK. Cameron, K.S. & Quinn, R.E. (2006). Diagnosing and changing organisational culture: based on the competing values framework” John Wiley and Sons, UK. Hawkins RK & Miller R (2006) Organizational politics: Building positive political strategies in turbulent times in E.V Gadot & A Drory (Eds) Handbook of orgainsational politics (p 328-352). Cheltenham, UK: Edward Elgar Publishing Limited Iles, V. and Sutherland, K. (2001). Organisational Change: a review for health care managers, professionals and researchers. Manging Change in NHS; published by the National Coordinating Centre for the Service Delivery and Organisation (NCCSDO) research programme, managed by the London School of Hygiene & Tropical Medicine, retrieved from http://www.sdo.nihr.ac.uk/files/adhoc/change-management-review.pdf Jones, S. (n.d). Healthcare: The Role of Leadership and Empowerment in SQM/TQM Quality Texas Foundation, retrieved from http://www.texas-quality.org/SiteImages/125/Body%20of%20Knowledge%20(BOK)/Healthcare%20The%20Role%20of%20Leadership%20and%20Empowerment%20in%20SQM-TQM.pdf Knote, J.A. (2001). Medical organisational politics. American Journal of Roentgenology retrieved from http://www.ajronline.org/content/177/5/1001.full Lawrence, D.B. (1983). “Politics and health care organisation: HMOs as federal policy” Brookings Institution Press, Washington. Parkin, P. (2009). Managing Change in Healthcare: Using Action Research. 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Heroes and Lies: Storytelling tactics among paramedics Research Article Folklore 111 (2000): 43-66 retrieved from http://tango.bol.ucla.edu/publications/A40.pdf Read More