Human Resources Management in Health Care Industry - Assignment Example

Human Resources Management in Health Care Industry a) (i) In 2002 three hospitals were merged to form the King Edgar Hospitals NHS Trust in a bid to reduce duplication but this did not go down well given that just after a year, the conditions continued to deteriorate further particularly with regards to inefficient processing of patients which resulted in long waiting lists. As part of the turnaround strategy, there was need to improve the performance of the admission-to-discharge chain and Tracey Burns was tasked to take the lead in the proceedings. This meant that some changes were to be put in place and change is normally met with resistance as a result of different factors. Against this background, this essay seeks to critically analyse the sources of resistance Burns and her team encountered as well as to evaluate how they tried to overcome the challenges they met. Change can be described as a transition from the current situation or the status quo to the desired future state (Amos et al 2008). Implementing change in an organisation is not often an easy task to do as it would be met with different reactions. Various constraints are likely to be encountered and in this case, one notable obstacle is resistance to change. This is a natural phenomenon caused by many sources but if it is ignored, it may hinder the change process which may result in loss of time, money and resources. In this particular case, the main source of resistance encountered by Burns and her team is that her proposal to give the nurses the responsibility to lead discharge processes (NLD) was interpreted differently where others suggested it to mean that authority of other influential people such as physicians would be stripped. One physician remarked that, “under no circumstance can a nurse discharge my patient.” This was a major setback as the physicians could form a very powerful group that can resist anything they opposed. Thus, it can be noted that a challenge to someone’s authority is seen as a source of resistance in this particular case. The physicians wanted the status quo to remain unchanged such that the power and authority would remain intact. The physicians also felt that this would increase the workload where by discharge planning could mean plucking someone who might deteriorate. The other source of discontent is that the physicians believed that they knew the right time to discharge the patient depending on their assessment whereby they cited that planning to discharge a patient was not ideal given that the condition could deteriorate any time. Whilst this is a contestable argument, the major source of resistance with regards to this stance taken by the physicians is that they were afraid of more workload added to their tasks. This meant more paperwork to be done for them since it meant that they will closely monitor progress of the patient and submit timely reports that would be used as the basis of discharging the patients. Noble as the idea maybe, the physician were afraid that this initiative would constrain their working conditions which is the source of their resistance to change plan being spearheaded by Burns and her team. The other source of resistance is that the nurses were reluctant to take extra workload given that it meant more training for them. This initiative was new to them hence there was need for them to get training so as to be acquainted with the dictates of the initiative. People often react negatively to certain programs they feel can add more burden in their day to day dispensation of duties and this may be a result of lack of knowledge of the benefits of the initiative as was the case when the program was being introduced. This also meant reduced time for them to practice their traditional nursing roles such as counselling and talking to the patients. There was a general feeling that tasks related to discharge issues were not directly related to their medical profession as this was more of an administrative task which could be performed by the cleric specially trained for that. This would also raise more liability problems should anything go wrong. They reasoned that their duty was mainly concerned with dealing with health related issues which meant that doubling as discharge agents was tantamount to duplication of duties whereby they would be crossing functional lines. Another source of resistance encountered by Burns and her team is that a variety of change initiatives were running parallel and some were complimentary to the discharge effort. The initiative was running head on with the social services which would look as if they were trying to raise a blame game whereby the social services would be seen as not properly doing their duties. The likely impact of this scenario is that it would sour the already strained relationship between the hospitals and social services. In most cases, people would not gladly accept a change initiative which ironically lay the blame on them. In this case, though indirectly, the social services department is seen as not executing its duties the reason why there will be long waiting lists. The social services department is seen as lagging behind in terms of offering the needed services to the patients who would require their services upon discharge from the hospital. (ii) Burns and her team tried to overcome these mainly through training and development as well as improving the communication system. Training and development programmes were put in place for the nurses so as to attempt to give them knowledge about the benefits of the initiative. Training is very important in ensuring the sustainability of organisational change. One advantage of offering training and development skills to the employees is that it promotes learning within the organisation where they would have hands on experience with its operations (Amos et al 2008). It can be noted that a good lesson that can be drawn from the case study shows that the system to be employed ought to be accommodative to a diverse range of views and ideas in order for it to be sustainable given that the initiative is not readily acceptable. There was marked improvement after training and development initiatives were rolled out. Learning also formed part of the initiative to try to overcome the barriers that were encountered. It can be noted that learning is no longer restricted to individual experience but has become teamwork which requires new ways of thinking which became the guiding philosophy in Burns’ training programmes for nurses about the change initiative that was put in place. Change is a process and it usually requires the involvement of various stakeholders particularly the workers which can lead to formation of working teams. Thus, according to Robbins et al (2001), teamwork is where individuals participating collectively, work together towards the attainment of certain goals as well as objectives within a given organisation. Thus, the essence of this stance taken by Burns and her team was to promote real learning among the nurses so that they could see the benefits of the change initiative with regards to issues related to the discharge of patients at the hospital which was under performing. This also helped in sharing of ideas where it can be seen that even some of the physicians who were opposed to the initiative later on openly showed their willingness to learn from other embers. In this regard, there ought to be open channels of communication in the organisation where there is free flow of information and the employees should take a role in contributing towards decision making as a way of creating a sense of belongingness. Thus, another alternative that was put in place to try to avert the challenges faced by Burns and her team was the need to improve communication between people involved in the whole process that deal with issues related to admission or discharging of patients. It was suggested that for any patient that would require the input of social services upon discharge, the hospital had to send official notification on admission to allow the social services to prepare for the needed help needed by that particular patient. Another official notification was required 24 hours before the patient’s discharge. Communication was also meant to be improved across the departments so that all the employees would share a common understanding about the change initiative that was being spearheaded by Burns and her team. This stance taken emanates from the strong belief that under normal circumstances, no organisation can successfully survive without communication which involves dissemination or exchange of information between the employees, management and other stakeholders (Werner 2003). In this regard, there ought to be open channels of communication in the organisation where there is free flow of information and the employees should take a role in contributing towards decision making as a way of creating a sense of belongingness. It can be noted that communication between the medical admissions and the social services was not good which resulted in uncoordinated events whereby there was a tendency to blame each other over the poor performance of the admissions department mainly. There are likely chances that people would understand each other better and clearly if the communication process between them is improved and this will certainly go a long way in alleviating the chances of misunderstanding of each other in a bid to solve problems affecting the operations of the organisation. (b) (i) I am a recently graduated doctor and I am working in quite a big hospital which offers all services related to health care. We work in teams which are made up of a consultant, specialist, resident and intern. We also have nurses and staff nurses in each department and every department has its own chairman. Thus, using the Harrison questionnaire culture, it is my strong conviction that the type of culture in my department is role culture. This kind of culture works by logic and rationality and its pillars represent functions and specialisms (Jarvis 2005). In this case, departmental functions are empowered with their role and ours is specifically concerned with medical related issues. Coordination is at the top and people are usually appointed to role on the basis of their ability to perform the roles within specific departments. In each department, there are certain rules and mechanisms in place that are meant for resolving any disputes that may arise and the lines of authority are clearly delineated. To a certain extent, this kind of culture is effective in meeting the department’s own goals. It is common knowledge in our department that all the members know what is expected of them and they also know how to perform their functions as required by the departmental regulations. It can be noted that in my department, this kind of culture can be said to be good and supportive towards the good work. Emphasis is on the functional roles where goal achievement is seen as a virtue. My department is stable to say the least and we all strive to pull our strings towards the attainment of the goals set. More importantly, we prioritise standardisation and consistency of the services we offer as our target goal. Thus, to a certain extent, I can say that this culture is effective in meeting the department’s goals and objectives. However, the major obstacle is that this kind of culture is not flexible particularly in a changing environment. The problem at our hospital is that it is managed by the American medical universities which are comprised of other people from outside. It is my belief that we learned a lot from them at level of administration, doctors, nurses and the rest of staff. However, the biggest challenge is that they brought the exact ideas and ways which are applied back in the states but the sad reality is that this kind of culture is a bit different from the one obtaining in the society in which we operate. Against this background, I believe this is the biggest problem related to the culture used in my hospital. Indeed, we have started to work on it by making guidelines for such universities hired to manage the hospital so that they can modify their ideas in such a way that will suit our society and keep the quality of the service we offer at a similar level with theirs in the states. Usually, it is a bit challenging to impose a culture on people particularly in an organisation given that culture itself is not static and it can also be noted that the organisations operate in a dynamic environment. Imposing a culture especially from outside can be problematic in that it will be resistant to change. This is not a good development given that the organisation will lag behind in terms of keeping pace with the changes taking place in the environment in which it will be operating. Thus, according to Seel (2008), for a practitioner who works from a complex or living systems perspective, describing culture is vital because he is part of the change process itself. The classical approach to culture takes diagnosis as a key stage in rational change process. The business person needs to conceptualise change as the gap between the current reality and the desired situation for the betterment of the organisation. Therefore, this classical approach views change as a natural and desirable state of the organisation and culture is seen as an expression or property of a particular state. (Lewin 1999 as cited in Seel 2008). It can be noted that there is a correlation between culture and change but the problem with the questionnaire is that it views culture as something that is easily pinned down. There is need to discover new ways of how the organisations function in view of change and culture. Thus, it can be noted that, “work in a role-culture is frustrating to someone who wants discretion and opportunity for innovation in his or her work. Those who are ambitious may focus on procedures and existing methods and work the committee structure,” (Jarvis 2005). Role culture acts like something that is entrenched in the way the organisations operate and it may be difficult to change it on an individual basis. Bringing new ideas may be a bit challenging given that there is an already clearly defined way of doing things within the organisation. In terms of personal growth and development within the organisation, this approach to culture is somehow prohibitive. The structures in place make it difficult for individuals to manoeuvre in terms of innovation and creativity. (ii) The major lesson drawn from the given case study and experience from my own department is that culture can impact on the change process in many ways. Culture itself should not be imposed or seen as something that is static as this may jeopardise the change initiative that can be proposed in an organisation. It has also been noted that member participation plays a pivotal role as far as success of a change initiative is concerned. There are likely chances of facing stiff resistance from the other members if they are not given the opportunity to be part of the change process and it can be noted that continuous training and development are vital tools that can be used in order to ensure that the change agent does not face stiff resistance from other co-workers. From the learning drawn from the two cases, it can be noted that in practice there is need to consider organisational culture in view of change as emergent and not solely planned. Thus, a better appreciation of the nature of organisational culture can be found by considering it as an emergent result of the conversations and negotiations between the members of the organisation (Seel 2000). The emergent approach on the other hand is primarily concerned with dealing with emerging situations within an organisation. Changes related to human resources issues can emerge within the framework of the operations of the organisation and appropriate action should be taken to cater for these changes (Werner 2007). In practice, there is need to view culture as something that is not static hence the emergent approach to culture can be effective as far as attainment of goals set forth in the change initiative are concerned. In working experience, it is also advisable to implement the culture excellence approach which gives precedence to the shared values within an organisation as a way of promoting better performance in the face of implementing a change initiative. To enhance an organisation’s cohesion, it is imperative to create a culture that promotes innovative ways of identifying a problem and finding a solution (Locke and Kirkpatrick, 1995). Brand (1998), posits to the effect that innovative and supportive culture will encourage better performance and cohesion with regard to implementation of changes in an organisation. Implementing change can be effective where organisational culture can integrate with individual’s values, perceptions and capabilities in the workplace. Implementing a new order in an organisation is concerned with change of the current operational system and in most cases, change is met with resistance by many employees as a result of many factors. There is need to identify the agendas of the stakeholders and for the initiative to be successful. In practice, it can be noted that sustaining organisational change requires learning where there is need to constantly re-orientate the workers through provision of basic training and development which would be closely monitored upon implementation. Members of the organisation ought to engage in collective learning that creates norms, shared assumptions and beliefs that become organisational culture. Learning organisation can be defined as an organisation which facilitates the learning of all its members and continuously transforms itself (Peddler, Boydell & Burgoyne, 1988). Against this background, the culture of the organisation can be continually moulded on the changes taking place. Involvement of the members of the organisation in programs that are related to change is a virtue given that they will be part of the process and it will help reduce the chances of misunderstanding. References Amos T.L. et al (2008). Human Resources Management. 3rd Edition. JUTA Brand, A., 1998, Knowledge management and innovation at 3M, Journal of knowledge management, Vol. 2 No.1 Health Services Research (2003) Impacting health Practice and Policy through state-of-the-art research and thinking. [online] Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360923/ [Accessed 12 November 2010]   Jarvis C (09/06/2005). Harrison: Typologies of organisational culture.[online] Available at: http://www.bola.biz/culture/harrison.html [Accessed 12 November 2010] Locke, E. A. and Kirkpatrick, S. A., (1995). Promoting creativity in organizations. London. Thousand Oaks: Sage Publications. Robins S.P., Odendaal A.& Roodt G. (2001), Organisational Behaviour, Pearson Education Seel R. (12/01/2008). Describing culture: from diagnosis to enquiry. [online] Available at: http://www.new-paradigm.co.uk/describing_culture.htm [Accessed 12 November 2010] Werner A. Et al (2007). Organisational behaviour: A contemporary SA perspective.2nd Edition. Van Schaik Publishers. 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