Leadership, Management, and Informatics - Case Study Example

Leadership, management and informatics 0 Introduction: All organizations whether it belongs to the private or public sector or to a non-for-profit organization exist in a dynamic environment. The external and internal factors seen in this environment requires changes within the organization so that it remains effective and achieves the purpose for which it was formed. This is especially true in the case of government provided health services. This paper is a report on the change process in the ENT department of a hospital (centre of excellence) in Liverpool managed by the National Health Service. It is proposed that the successful process seen in the centre be taken as a model for similar changes in departments and hospitals run by the NHS in the country. In the process the paper will review a wide range of theory and literature on change management. An appropriate process will be selected by taking relevant information from the literature and will be implemented in the ENT department. 2.0 The UK National Health Service: The sixty year old health system is recognized as one of the three pillars of the UK social policy, the second one being National Insurance and the third pillar comprising of “various forms of minimum provisions” (Merkel 2008, 54). The importance of this service can be seen from observing its core principles namely, meeting the health needs of every citizen based on clinical needs rather than the ability to pay. But these principles, though noble, were not seen as adequate by the organization and a new set of guiding principles were evolved in 2000 (NHS Core Principles 2009). Those changes are reviewed briefly, after which the rationale for the change as per this report will be given. A comprehensive range of services apart from treatment will be provided to the citizens and will include areas liked health information and disease prevention. The care will be extended to look after important needs of care givers and family members of patients. A continuous quality improvement program will be a part of the operational process of the organization. It will also increase its responsibility towards NHS staff members. The change management process provided in this process is primarily a part of the core guiding principles of the organization mentioned above. 3.0 Rationale for change: Change is often resorted to when the stakeholders are dissatisfied with the current state of affairs (Deek, McHugh & Eljabiri 2005, 213). The ENT centre in Liverpool consists of physicians, anaesthetists, surgeons, trainee assistant practitioners, and nursing/ward/theatre administrative staff. One of the important services provided at the Liverpool centre is operation of tonsils in young children. At present, the patient is treated as an inpatient for a period of three days after the operation. It is felt that this is unnecessary, and they need be treated as such for only a day after which they can be discharged and left to recuperate from their homes. The ENT centre provides care and treatment for more serious ailments which need acute care and hospital stay. The extended stay of tonsillitis patients is taking up valuable bed space in the hospital which can be freed up to for treatment of more serious ailments. A change management process involves management of change, handling resistance to change, leadership, organizational culture, and other elements for effective implementation. The next sections will provide the theoretical implications and the practical management that took place in the organization with the help of change agents and planned change management. According to Sisaye, a major change “involves a complete transformation of the organization’s mission, strategies, and leadership” (Sisaye 2001, 68) In this instance, a major change is required in one of the departments, namely the ENT department. It is prudent to put into practice accepted methods to analyze the environment before formulating a change policy. Hence a SWOT and PEST analysis of the organization is done here. 3.1 SWOT analysis: Management of change requires strategic planning as mentioned above. According to Marquis and Huston, “one of the most commonly used in healthcare organizations is SWOT analysis” (Marquis & Huston 2008, 143). This widely accepted method was developed way back in the 1960s at the Stanford University by Albert Humphrey (Narayanasamy 259) In a SWOT analysis, strengths and weakness pertain to the internal environment while opportunities and threats pertain to the external one (Grant 2002, 15).   3.1.1 SWOT analysis of the ENT centre: The ENT Centre of excellence is a part of the NHS and all the factors involved in the analysis are relevant in this case also. Specific factors in the analysis pertaining to the center are also provided. According to the British Medical Association, they include the following (BMS 2005, 8). Strengths: A strong commitment to care for public health, as per guidelines issued by the Government through competent senior staff specifically trained in this area. Ability to provide core public health programs like immunization and screening, risk management, and performance of statutory responsibilities. Flexibility, corporate responsibility, and ability to respond quickly to public health issues. Good image and credibility in the eyes of the public and partners Highly motivated staff with good leadership Specifically equipped to handle a wide range of ENT problems Excellent technology for surgery and treatment Weaknesses: Bureaucracy in the NHS may cause delays in decision making within the ENT centre. Investment in technology not at par with private clinics and hospitals Change might not be welcomed by everyone at the centre. Opportunities: Favourable government policies planned to better health services Increase bed utilization to deserving patients by reducing hospital stay of those subject to tonsil surgery. Higher levels of decentralization being planned Threats: Inadequate funding so that the centre is unable to invest in the latest technology. Efficient functioning is not solely dependent on the centre, but on the efficiency of the NHS and the attitude of different governments and political parties. Increased risk of relapse/infection at home Difficult to educate parents with poor educational background 3.2 PEST analysis: Another widely practiced method of understanding the external environment is to conduct a PEST analysis (Rushton, Croucher & 2006, 105). It stands for political, economic, social, and technical analysis. The PEST analysis of the ENT centre is given below. Political factors: A strong stable and democratic governing system and judiciary. Commitment towards community governance Plural state concept – Partnering with other government sectors, private organizations and NGOs Economic factors: Problems of funding the many NHS centres to be on par with private health providers in terms of quality of service As a service organization, the centre is not in a position to charge actual expenses incurred. Hence, it is dependent on government assistance, and share of donations made to the NHS. It cannot even operate on a ‘no profit/loss’ basis. Social factors: Increased responsibility for parents regarding post-operative care at home Increased staff responsibility in educating parents regarding post-operative care at home Restructuring of post-operative treatment, admission, and discharge procedures Technical factors: Unable to attract the best medical and technical talent due to financial constraints. Being unable to avail the best technology due to financial constraint 3.3 Types of change: Changes within organizations can be incremental or radical. Denison referring to other authors state that “incremental change is convergent, meant to improve the fit between the organization and its environment, while radical change is divergent, meant to fundamentally change the firm’s processes, systems, structures, strategies and capabilities” (Denison 2001, 270). Interestingly, the proposed changes in the ENT centre can be both radical and incremental depending on the way it is looked at. For example, for the NHS as a whole, it is incremental since it is a part of its process of adjusting to the needs of the external environment. But for the centre itself, it is partly radical since it involves some major changes in the areas mentioned in the quote above. The latter view will be taken here since the change is done in the centre itself and not for the NHS as a whole. 3.4 Models and theories of organizational change: Definitions of organizational change does not do justice to the complexities involved in the whole process. for example, Dawson (which is similar to many other definitions) states that change is “new ways of organizing and working” (Dawson 2003, 16). While this statement is correct, it does not provide the complexity involved in managing change. One of the biggest challenges that can come across is resistance to change. According to Palmer, “from a pragmatic perspective, you should understand that all changes brings resistance. This knowledge lets you anticipate and mitigate it” (Palmer 2003, 41). Kroon, referring to Gelatt, states that there are primarily four types (reasons) of resistance. (Kroon 1995, 515). They are future phobia (uncertainty/fear about the future), paradigm paralysis (unable to think out of the box), infomania (information overload), and reverse paranoia (not willing to take responsibility). Another challenge is the metaphor of the organizational iceberg. Only tangible factors (rules, spoken words, deeds etc) are visible above while the bulk of the iceberg remains below water. They are the intangibles and include beliefs, value systems, and culture (Hatch & Schultz 2008, 131). The biggest challenge for managers is modifying the intangibles for effective change. This is precisely the reason why so many models and approaches for implementing change have evolved over the years. Cameroon and Green provide the following approaches to managing organizational change. They include Lewin’s 3 step model, planned change of Bullock and Batten, eight steps of Kotter, the Nadler and Tushman congruence model, model of William Bridges, systemic model of Peter Senge, and the complex responsive process of Stacey and Shaw (Cameroon & Green 2004, 96). Some of the relevant ones to this particular instance is briefly reviewed here. Lewin’s three step model is quite simple and involves an unfreezing, changing, and refreezing of attitudes and behaviours of people in an organization (Marks 2003, 58). Kotter’s model is more detailed and involves the following steps. The first one is to create a sense of urgency, then formulate a compelling vision. A team for the process should be created after which the vision and urgency has to be communicated to each member of the organization. Any obstacles that come up have to be removed. People have to be empowered to bring about respective changes. This should be followed by short term targets and wins. Finally, the whole change process has to be anchored in place. The momentum of change should not slack during the whole period (Kotter 1999, 7). The Bullock and Batten model involves four stages namely, exploration, planning, action, and integration (Randall 2004, 154). The concept of William Bridges may not be relevant here in the sense that he differentiates between planned change and transition. Transition is more complex and involves a total letting go of the past (Cameroon & Green 2004, 108). It is clear in this instance that the ENT center is only going in for a planned change. It is also more attuned towards managing psychological coping with change. Change at the center does not involve too much psychological stress. Peter Senge, who coined the term ‘learning organizations’, stresses on systemic thinking within organizations on as a built in process rather than for organizational change alone. In Senge’s own words, a learning organization is one where “people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole together” (Peter Senge’s necessary revolution 2008). According to him, this capacity of organizations is critical in times of change. There are also many similarities between the five disciplines and Kotter’s model. Shaw and Stacey stresses on human interaction through communication as an essential element within organizations. According to the authors organizations are complex entities and hence they coined the term complex responsive process for ‘communicative interaction’ (Shaw & Stacey 2006, 128). 3.4.1 The Coping Cycle: Developed by Coiln Carnall, the coping cycle primarily deals with employee attitudes during the change process. (Elearn Limited (Great Britain), Pergamon Flexible Learning 2005, 75). First is denial when the argument is that there is nothing wrong in the current system and hence there is no need for change. Then comes defence by bringing out reasons for no change. Once seen as inevitable or the need for change is understood, the previous attitude is discarded and become cooperative. The next natural reaction is adaptation in order for the change process to take place. Then the change becomes rooted in the mindset and is referred to as internalization. 4.0 Leadership and change: Many aspects of management of change have been reviewed here. But according to a publication by the ‘Network of Asia Pacific Schools and Institutes of Public Administration and Governance’, both leadership and management is essential for effective change management. According to the article, “when management is strong but leadership is lacking, short-term positive results are likely to occur, but significant organizational change will not take place” (Straussman n.d. , 45). In the opposite scenario, there will be encouraging results initially, but lack of effective management will ultimately lead to failure. Hence a brief review of leadership models will be relevant here. There are different views and theories to leadership. With regard to approach, it can be charismatic, transactional or transformational (Klegg, Kornberger & Pitsis 2005, 245). With regard to style, it can be autocratic, democratic, or laissez-faire (Straub 1999, 34). 5.0 Informatics: Informatics, as the name suggests deals with effective management and dissemination of information for optimal use of resources and maximization the effectiveness of the business or activity of an organization. In other words, informatics help organizations to provide employees, clients, customers, and other stakeholders with timely information in areas that are pertinent to each of these groups. It is a necessity that effective informatics in today’s world necessitates large scale use of information technology for processing large volume of information. The data that is available to an organization has to be processed in order to convert it to knowledge and information. In a healthcare setting, it is means using IT in practically all fields of medicine and includes treatment, care, and prevention. According to Cohn and Hough, “the primary gaol, if not the ultimate goal, of most health care practitioners is the delivery of quality patient care that expedites healing, lessens pain, and promotes the general health and well-being of their patients” (2008, 94). Major organizational change can involve improvements in the medical informatics area also. In an NHS centre setting like the one in Liverpool, informatics can be used for better data processing. This can speed up the routine practices like record keeping and billing to a great extent. It can also aid in providing timely information to patients through emails. Providing information and knowledge through the internet is seen as a practical way to educate people while cutting down administrative costs. Some estimates states that public service health organizations can save costs up to hundred times when compared to manual systems (O’Carroll & Yasnoff 2003, 43). The authors also caution that one of the main problems associated with changes in informatics practices in an organization is resistance to change. Employees, for various reasons may resist change because they fear that it is difficult to handle new technology. A qualitative and quantitative change in informatics may require the same change management practices required in general organizational change. A person in charge of implementation (change agent) should take the following factors into consideration, namely the attitude of the employees towards the management and the quality and effectiveness of past IT implementation (O’Carroll & Yasnoff 2003, 186). 6.0 Change management process at the ENT Centre: As mentioned earlier, the management model used at the centre was a mix or adaptation from all the relevant theories and literature mentioned above. This is because there is no one single plan that can be solely used in such instances. As Anderson puts it succinctly, “there is no formula that guarantees successful organizational transformation. There is no absolute right or wrong way to lead change” (Anderson 2001, 199). The foundation for the change process was the Kotter model. A team was formulated for managing the change process with one member from each category of employees. The change agent was the chief physician. It should be mentioned here that the change did not involve any huge adjustments and as a result went on quite smoothly. There were resistance from some of the physicians, nursing, and administrative staff. It was mainly due to increased responsibility due to the fact that more children will be served by the centre in the future. The physicians were worried about increased risk of infection at home. This can be construed as future phobia. Two of the administrative staff did not feel the need for change (paradigm paralysis). But the team leader managed to convince them by presenting them with the vision of serving more needy children. The lack of resistance from surgeons may be due to the fact that not much change in operational procedure was involved. Moreover, post-operative care was primarily the responsibility of physicians and nurses. The resistance became apparent when the team leader talked to each member of the staff individually. There was no resistance from any area with regard to infomania or reverse paranoia. Once the bottom part of the organizational iceberg became clear, the change process went on quite smoothly. With regard to the coping cycle, most of the elements were seen during the change process. There was denial (especially the administrative staff) followed by defence. The argument was that they will have additional burden without any increase in compensation. But again, the compelling vision and inevitability of change led to discarding of the resistance. The team then managed to instil a sense of urgency so that more children could be served as soon as possible. As for the rest of the staff, there were only adaptation and internalization. The fact that the change team had seen to it that all members of the centre were involved in the change was in tune with Senge’s systemic thinking paradigm. The high level of communication also showed that the team and especially the team leader the concept of communicative interaction (as per Kotter model and Shaw Stacey model) were followed. The only obstacles (resistance to change) were removed once the vision was effectively communicated. With regard to leadership, it was a democratic approach which worked very well in this instance. The whole objective of change was short term in nature and hence Kotter’s view of short term targets for achieving major change is not relevant here. One senior staff member from each category was empowered to bring about necessary changes. For example, the head nurse was put in charge of bringing about the necessary changes in the nursing section. The team used to get together once every week to review the progress and to discuss any change of plan. The whole process took about three months for anchoring it in place. Now the centre effectively sends children home the same day or within twenty four hours. Only in rare instances do they need to be provided more days at the hospital. This could, for example, happen if the child has poor general health. Improvements in information and informatics within the NHS were not done at this stage because it also involves other decision making bodies and areas. Additional investments in the area will require sanction of the NHS of UK and will also depend on government policies. 7.0 Conclusion: A review of planned change at the ENT centre at the NHS run hospital in Liverpool was done here. It should be said that the change was not major and hence resistance to change was not a big problem. None of the members of the change team was really theoretically qualified regarding change management principles. But many of the prescribed change management principles were unconsciously present in the process. The same process can now be extended to other NHS centres having ENT treatment facilities. One thing that is clear from the study is that departmental heads and senior staff be provided training on scientific change management. This can make the organization more dynamic, flexible, and effective. References Anderson, D 2001, Beyond change management, John Wiley and Sons.   British Medical Association 2005, An opportunity for better public health, BMA, Viewed 05 August 2009 , Cameron, E. & Green, M 2004, Making sense of change management, Kogan Page Publishers.   Clegg, S, Kornberger, M. & Pitsis, T. 2005, Managing and organizations, SAGE. 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