Managing the United Kingdom Health Service - Assignment Example

Managing the United Kingdom Health Service Prepared by: Module: Q How do you understand the problem of management in the United Kingdom National Health Service What organisational factors have contributed to these problems Defining Management The current decade has been marked by a growing public and governmental concern about the United Kingdom National Health Service. Starting from 1998, the Labour government initiated a series of broad and diverse initiatives meant to modify both the financial and organisational aspects of the NHS functioning. The reforms were launched largely due to the recognition that the NHS had been seriously underfunded for the previous decades (Wanless, 2002), but numerous difficulties which emerged during the process of reformation led to increasing understanding that the organisational, specifically managerial aspect of the NHS operation is as important as the problems of funding. As any organisation with relatively long history and thousands of employees, the NHS has certain norms and rules that traditionally determine the nature of managerial practices. However, these rules and norms do not seem to be effective these days when the problem of management in NHS has turned into one of the major issues associated with this organisation. The case study and other scholarly studies provide sufficient information to identify the factors that may contribute to such situation. Absence of the Evaluation Framework There are several types of standards applied within the organisational practices to evaluate effectiveness of management. However, the NHS is a specific organisation with outputs which are exceptionally difficult to measure objectively: for example, a middle level manager in a construction company has absolutely clear performance goals which must be achieved by certain deadline with the available resources. Failure to achieve the goals despite favourable situation and no force majeure circumstances demonstrates that the manager might lack skills and/or qualification to effectively perform his basic functions. These functions have been formulated over the second half of the 20th century and include planning, organising, leading, controlling and assessing (often these functions are abbreviated to POLCA) (Morgan, 1986). Evidently, this set of basic functions is valid for the NHS, but it is also clear that the specifics of healthcare does not allow for the possibility to evaluate the manager's failure or success in the same way as it is done in other industries such as construction, automotive, financial, etc. The explanation is simple: there are too many factors affecting health outside the health care industry to evaluate performance of the industry in easily measurable terms such as deaths per 100 beds and other statistical data. The impressive amount of intangibles involved in the process of healthcare management requires specific approach in evaluation of associated factors, including effectiveness of management. Therefore, one of the major problems related to management in the NHS might be absence of the correct evaluation criteria. As Willcocks (1997) puts it, "...the research literature fails to provide empirically-based standards against which to judge and compare managerial behaviour. A central problem is that the researchers have neglected the manager's role demands or expectations and concentrated on role performance or behaviour" (Willcocks, 1997: 181). Development of the adequate criteria that can be applied to assessment of managerial performance in the environment characterised by lack of statistically measurable parameters and oriented rather toward improvement of the process than achievement of any final goals may be a helpful solution in this regard. Absence of such criteria can probably be referred to as the most essential primary problem which acts as the major reason for other problems associated with management in the NHS environment. Managing Professionals Managing educated professionals such as doctors, architects, lawyers or IT professionals whom often possess highly specific knowledge their managers do not have is a very difficult task. The style of management plays a very important role in whether the managers will be able to fulfil it or not. There are four basic management styles described in the management literature: Directive Democrat: managers make decisions in participation with their subordinates, but at the subordinates are closely monitored and controlled. Directive Autocrat: mangers make decisions on their own and keep a close watch on the work and activities of their subordinates. Permissive Democrat: mangers ensure that the subordinates also participate in the decision making process and give latitude to the subordinates in performing their duties. Permissive Autocrat: mangers make decisions on their own without much involvement of the subordinates, but provide their subordinates with relative freedom in performing their work (Muczyk, 2004). Each of these styles has certain advantages and drawbacks, and there is no way to objectively compare their effectiveness: in some organisations directive democrats may be more successful than permissive democrats, in other organisations directive or permissive autocrats may exhibit high effectiveness, and visa versa. Effectiveness of the management style directly depends on the type of organisation and nature of work performed. The style of permissive democrats seems to be the best solution for the NHS largely because managing highly skilled professionals and keeping them motivated implies their active involvement in the process of making decisions related to their very specific work. The involvement provides them with the sense of belongingness to work and they demonstrate more commitment in performing their duties. However, the style of permissive democrats has one essential limitation: active involvement of the subordinates in the process of decision making, coupled with lack of strict control often produces a deceptive impression that the manager adopts a laissez-faire attitude and simply does not perform his direct functions, namely controlling (Muczyk, 2004). An expert in management practices would understand that this impression is wrong because highly structured processes or highly experienced and responsible employees do not require excessive supervision and control, unless in emergency case or especially complex problems. Strict control and monitoring is the right choice with less responsible employees and poorly structured processes. However, in laymen's opinion this simple logic often remains unnoticed in favour of another classic logic: more control results in better performance. Therefore, the seeming lack of control and 'laissez-faire attitude' negatively affect public perception of NHS managers. For the sake of objectiveness, it is necessary to admit that the style of permissive democrat requires the ability to balance on the verge between managing and actual laissez-faire attitude (Muczyk, 2004). The problem is that despite high level of education and very specific skills doctors and nursing personnel are human beings that may sometimes confuse active involvement in the process of decision making and lack of control with the opportunity to act on their own. In order to avoid such situation the manager must find some non-autocratic methods to motivate his subordinates perform effectively despite lack of traditional control. Evidently, this task can be fulfilled only by skilled managers with sufficient knowledge base about the peculiarities of their profession. Unfortunately, this problem is rather topical with NHS managers. Thus, Preston and Loan-Clark (2000) observe that many of them have moved into management from a clinical background or have been forced to take on the manager's profession an element of their primary occupation. In many cases the risk that such managers lack adequate knowledge to effectively manage NHS personnel is very high. Pressure from the Government The existing literature, both scholarly and non-scholarly, emphasises the increased pressure from the government to improve the quality of management in the NHS. This pressure embodies in very strict control over the performance of NHS managers (Case study). The logic of such approach is fully understandable: the NHS is a public organisation and the government should ensure accountability over the increasing amounts of funding allocated to healthcare annually. Consequently, the government sets certain goals and action plans and requires the NHS to strictly follow them. However, such approach turns NHS managers into mere implementers deprived of active decision making power whom simply implement the rules and targets formulated by the government. Pressure from the Subordinates Pressure from the subordinates represents another difficulty experienced by NHS managers. As the case study reports NHS personnel often feel that managers do not share the information underlying the reforms and changes in the organisation with them (Case study). Evidently, this problem is directly related to the problem of managing professionals and the need to involve them in the process of decision making. However, since the government does little to provide comprehensive information on the story behind the new rules and targets viewing NHS managers as only implementers, they simply do not have the information that has to be shared with the subordinates. In other words, "...they [NHS managers] have less autonomy and less involvement in key decision making than their staff assume" (Case study, p. 3). An absolutely similar opinion is expressed by Preston and Loan-Clark (2000) who claim that NHS managers "...feel that they themselves do not have all the information they would like, despite the fact that their staff fully believed that they were withholding information from them" (p.105). Concealing the information from NHS managers the government seems to neglect the difficulties associated with managing educated professionals: managers working with this group of personnel should not be treated as mere implementers of the goals and targets set without their participation; they should be treated as a part of decision making process. Consequently, managers at NHS feel that whatever work they do, it goes unrecognised by their own staff, public, and the government. There is no motivation or encouragement for their performance. Managers at NHS are overworked and struck in the middle between public, their own staff, as well as the government. The Department of Health makes their jobs more difficult by issuing a stream of initiatives and targets leaving managers struggling with paper and distracting all from important tasks, and NHS managers lose sight of their own role and responsibilities in the process of making NHS a more effective organisation. Thus, lack of adequate criteria to objectively evaluate performance of NHS managers, the need to manage educated professionals, poor recognition of the managers' role in the NHS structure by the government which results in small decision making power and lack of motivation seem to be the major contributors to the difficult situation with management in HNS. Q-2: Do you think that it is possible to successfully control an organisation without managers Support you answer with examples from organisations with which you are familiar. The existing literature in the field of management provides sufficient information to understand the role managers play in organisational performance. Therefore, the question whether it is possible to control organisation does not seem to reflect the whole complexity of managerial work: controlling is only one function of managers. Alternatively, the question may be formulated as whether an organisation can operate successfully without managers Analysis of the most popular model of management - POLCA - will help to find the answer to this question. 1. Planning Planning is a broad term that relates to the way, managers anticipate the future of their unit or department. Planning also includes how managers devise ways to achieve their unit's goals and objectives. There are four types of planning - strategic, tactical, contingency, and action: Strategic planning - relates to defining the mission, goals and objectives of a unit or organisation in general (depending upon the level of manager), and creating an overall approach to achieving these goals and objectives; Tactical planning - not as broad as the strategic planning; it deals with methods and measures undertaken within the overall plan shaped during strategic planning; Contingency planning - deals with creating alternatives to possible outcomes as the strategies and tactics are executed. It is being ready for both opportunities and setbacks. Action planning deals with the sequence of acts and events needed to achieve objectives, when things should be ready, where they are needed, etc. It involves what actions will be performed to achieve objectives in a timely fashion. It is a timed sequence of action (Bartol & Martin, 2003). However, all these types of planning can be carried out either by the manager alone or by the unit - it depends entirely upon the manager and his style of work. 2. Organising Organising is another key function of the manager. This includes: defining the nature of each job in the unit, department, or organisation, defining the way subordinates will perform their work (either alone or in teams), determine the level of authority and responsibility for each of the subordinates, and arrange appropriate communication within the unit or organisations, and find a way to integrate various sub-goals and activities carried out by the subordinates. Another aspect of organising is making sure that the production process of the organisation is properly designed, built and operated. It is the manager's responsibility to respond to structural changes, choose vertical or flat organisation, a mechanistic or organic one. For example, mechanistic organisations tend to function well in static and simple environments since their procedures are highly formalized, their jobs more specific, and their decision making more centralized; organic organisations tend to function more effectively in changing and more complex environments, decision-making is more peripheral in organic organisations, jobs are more flexible, and constituent needs are more complex (Bartol & Martin, 2003). 3. Leading An effective manager should also be an effective leader for the subordinates. Only in this case the manager will understand how to adequately motivate people, to inspire them, to maintain their morale, settle conflicts, understand individual differences between subordinates, and perceive their varying needs for recognition, achievement, approval and personal growth (Bartol & Martin, 2003). 4. Controlling Maintaining effective procedures of production, setting standards and norms of acceptable behaviour and productivity is another important function of managers. A manager is responsible for supervising subordinates in a manner that is relevant to their skills and the overall goals of the organisation; for meeting the group's objectives marinating acceptable quality and quantity level; for monitoring activities of the group and comparing the actual state of affairs with the planned outcomes. A manager must have the authority to take corrective action if standards are not met or if the actions of group members do not express the mission and values of the group. He or she must have the power to reward members for their work, whether these are material or psychological rewards. If punishment is needed it must be given in a timely fashion with an eye toward creating positive behaviour (Bartol & Martin, 2003). 5. Assessing Although the term 'assessing' is familiar to many its meaning in management is rather different. While a traditional way of assessing something or somebody is based exceptionally upon certain results (whether material outcomes or non-material impressions), managerial assessment must take into consideration not only the outcomes of the organisation but the effectiveness and efficiency of its procedures and processes. Therefore, assessment and evaluation of organisational performance implies several highly controversial points. How shall the group or organisation be evaluated as a total system Shall it be measured according to its ability to satisfy its elements materially and psychologically What criteria should be applied to assessing such things as productivity, efficiency, adaptability, development, and long-term survival in entirely different organisations (Bartol & Martin, 2003). These and many other questions associated with the issue of assessment reflect the complexity of this process and demonstrate that assessment of organisational needs, external demands, and survival challenges also plays one of the key role in the managerial practice. The POLCA model shows that managers represent a critical intermediate link between the personnel and the top authorities which determine the policy of organisation. In the absence of managers, it might become very difficult to ensure effective performance of each department and each employee across the organisation. One may state that all professionals working in an organisation are managers to some extent as they are responsible to manage their own tasks and roles. This leads to an assumption that the basic functions of manager identified above may be distributed among all members of an organisation. In this case effectiveness of organisational performance will depend on the ability of each employee to successfully cope with the elements of management process he is responsible for. However, this case seems to ever take place only in theory because it requires an unbelievable complex system of balances, specific relationships and self-motivation abilities of each employee. Unfortunately, each employee is a human being and precisely the human factor is likely to be the main obstacle in making a successful organisation without managers. In the absence of managers the whole organisation is likely to become orphan with no one to supervise the activities of each department and employee. Even while it is right to agree that professionals are managers in one sense that they are well aware of their role, but at the same time, importance of manager in an organisation can hardly be ignored. In order to illustrate this statement, I would like to provide the example of an organisation called MD synergy. MD Synergy is a leading provider of Practice Revenue Optimization (PRO) solutions, which help medical practices, improve efficiency, increase operational control and maximize revenue potential. It works to support the admin and back end operations of the hospitals and physicians. It was formed in 2005, and for one year, the company was working with one CEO, client services officer, and finance director. The company had a human resource team for two people for scanning perspective employees and lines them for interview with the management. Within six months of its inception company suffered huge loss and a 70 percent attrition rate. On a careful analysis of the situation, the management discovered following things: Management was not able to juggle properly between the quality of recruitment and staff care. As a result, many incapable employees were hired that deteriorated the quality of services provided to the clients. As a result, many unsatisfied clients move to other service providers. Again, try to bring business for the organisation; the management was unable to pay attention to grievances of employees. This led to huge dissatisfaction among employees, who went out to other organisations. At the same time, management was not able to control or supervise the flow of work which led to chaos, delay and loss of quality and services. If there were managers to take care of the planning, organising and staffing needs of their specific department, it would have ensured a smooth work flow, quality of recruitment and subsequent quality and timely delivery of services and work to the client. These are the core needs for any organisation to grow. The management soon realised the importance of managers in the company and suitably recruited managers for each department. Now, after two years, MD synergy is a leading provider of medical revenue optimization services for the USA and company is soon planning expansion in Europe. The above example of MD Synergy clearly demonstrates that the role of managers in an organisation must not be underestimated despite the theoretical possibility of such scenario. Probably such possibility is a natural outcome of the abovementioned confusion between effective management process following the style of permissive democrat and the laymen perception of such style as laissez-faire attitude: when a non-expert sees that the manager allegedly does nothing to actually manage he starts to believe that the role of manager is minor and the organisation can easily do without them. In reality, success of any organisation depends on the availability of proactive and effective managers. At the same time, to ensure that managers work efficiently for the betterment of the organisation, it is essential to provide them with adequate decision making power and information, especially in such organisations as the NHS where managers must deal with educated professionals. References Bartol, K. & Martin, D. 2003. Management: 3rd Ed., McGraw-Hill Inc. Morgan, G. 1986. Images of Organization, Sage, London. Muczyk, J. P. 2004. 'A Systems Approach to Organizational Effectiveness: The Alignment of Critical Organizational Dimensions with Selected Business/Competitive Strategies' [Electronic version], Journal of Comparative International Management, Vol. 7, No. 1 [available online http://www.lib.unb.ca/Texts/JCIM/bin/get.cgidirectory=vol7_1/&filename=muczyk.htm] Preston, D. & Loan-Clarke, J. 2000. 'The NHS manager: A view from the bridge', Journal of Management in Medicine, Vol. 14, No. 2: 100-108. Wanless, D. 2002. Securing Our Future Health: Taking a Long-Term View: Final Report [Electronic version], HM Treasury. Retrieved July 25, 2007 from http://www.hm-treasury.gov.uk/consultations_and_legislation/wanless/consult_wanless_final.cfm Willcocks, S. 1997. 'Managerial effectiveness in the NHS A possible framework for considering the effectiveness of the clinical director', Journal of Management in Medicine, Vol. 11, No. 3, 181-189. Read More