Managing change in the Urology Department of a National Health Service hospital in England

Managing change in the Urology Department of a National Health Service hospital in England

Introduction

            The case study is about managing change in the Urology Department of National Health Service in England. The Urology department is under pressure to undergo changes to improve service delivery as well as comply with the provisions of the law (Case Study n.d). The purpose of this report is to analyze change taking place, and producing recommendations and an action plan to be put in place. It will examine the key issues requiring attention before carrying out a detailed analysis to inform theories surrounding the same. Theories will be used to determine how the issues can be solved to ensure successful change. This will then be followed a conclusion which will summarize the key points in the report.

Analysis of Issues

Key Issues

            As mentioned in the introduction, Urology Department of National Health Service in England has been forced to undergo change as a consequence of external pressures. For one, it is being compelled to change to meet new government regulations regarding service delivery. Equally, the financial crisis had adverse effects on the department’s ability to handle its financial obligations. At first, the strategies employed by the management to deal with the issues were deemed ineffective. For instance, the administration had opted to sub-contract some of the services rendered by the department to private hospitals. Eventually, it realized that the solution was not effective, hence the need to consider other options. Currently, the department is considering adding more staff and resources to improve its capacity. Agreeing on the way forward seems to be a challenge as different stakeholders hold opposing ideas (Case Study n.d). Disagreements on issues are also evident. It is essential that the issues are solved for the department to achieve its change goals and objectives.

One issue that is impacting change at the department is tensions between managers and clinicians. The case shows that some nurses and doctors perceive managers as being motivated by concerns not directly related to patient care. In their view, managers lack knowledge about patient needs. On the other hand, managers are of the opinion that clinicians fail to appreciate the fact that efficiency and cost-cutting goals can be achieved without compromising quality and safety of patient care. Information overload is another problem. The senior executive team seems to send many emails to staff on a daily basis. This has resulted in some staff members ignoring messages with the consequence that essential information is not always circulated effectively. These issues must be solved if the department is to implement change as expected. Finding a solution is also imperative considering the effect such matters have on the quality of services rendered to patients. Ultimately, another problem that needs solving is the poor quality of data collected by clinicians at the department on a regular basis. This is a serious problem as it affects the organization’s ability to forecast future income. Medical procedures are also often wrongly coded which increases the risk of medical errors (Case Study n.d).

Detailed Analysis

            Tensions between managers and clinicians have a significant impact on the change process. Apparently, provided clinicians and managers are supporting different ideas regarding the proposed change, achieving its goals becomes a problem. To effectively implement change, it is important for change agents to enlist the aid and support of stakeholders to be impacted by the same. According the Kotter’s change model, it is essential for change agents to work with other stakeholders, especially those affected, to effectively manage change. Failure to ensure the same can increase resistance and the risk of change failure. Clinicians will be affected by the proposed change. As such, it is only reasonable that they are in support of the initiatives to ensure smooth implementation. Failure by the management at the department to ensure the same will only lead to increased resistance. In essence, the risk that people will not support new initiatives is increased. The department is keen to change to adapt to external trends and pressures with an aim of improving service delivery (Case Study n.d). It defeats the logic behind the change if it is not supported by relevant parties affected by it, in this case, clinicians. In general, the management and clinicians must find a way to deal with their differences and come up with a resolution that is acceptable to both parties.

According to Hayes (2014), it is common for individuals in an organization undergoing change to differ on the way forward. Differences arise as a result of diversity in the way they think or perceive the world. People with different skills and knowledge also often differ during the change. This is because they understand things from different perspectives. In the Urology Department, managers and clinicians have different training, hence possess varying skills. Managers understand the art of cost management and improving efficiency. On the contrary, clinicians know how to ensure patient safety. This diversity is the cause of the tensions. Every party is trying to justify their ideas and concerns based on their skills and knowledge. As such, the tensions are not in any way unusual. Lack of trust between members of a team committed to change can also cause tensions. It is hard for individual members to allow others to make decisions in the absence of trust (Paton & McCalman 2008). The department is also suffering a similar challenge. The management is confident that is suggested solutions will work. However, clinicians do not share the same sentiments as a consequence of poor trust. Principally, clinicians do not trust that that the management has what it takes to steer the department in the right direction, hence the tensions.

Tensions can also arise during change as a result of poor communication among members of an organization (Have, Have, Huijsmans, & Eng 2015). This is common especially when the top leaders fail to inform low-level employees of what they are doing and the reasons behind their decisions. Typically, this leads to misinformation. In the same regard, some members may not understand why a change is needed and how they stand to benefit as well as their firm (Hughes 2010). The management at the Urology Department has failed to inform clinicians on many issues. For instance, it did not communicate the decision to subcontract some services to private hospitals. It came to this conclusion and implemented the decision without consulting even the consultant surgeons. Eventually, the move did not work. They have continued to exclude clinicians in important decisions, hence the tensions. Communication aids in dealing with tensions as well as conflicts that arise during the change. For example, it helps change agents to explain to other stakeholders the need for change and how this can be achieved. Addressing concerns assist in easing tensions as people get the opportunity to raise their questions and receive feedback. They also support change with the knowledge that they are a part of the process (Kushniruk & Borycki 2008).

Information overload is a significant concern. Staffs receive many emails on different issues which increase the risk of relevant information being ignored. This is also a problem that impacts the change process. Clearly, communication is important during a change process. With staff dealing with many emails, it is hard for the executive team to share valuable information relating to the change process. This is a common problem when one form of communication is utilized to communicate all information (Örtenblad, Löfström, & Sheaff 2015). The department relies on emails to send different messages when there are other forms of communication. The use of various forms of communication can enable executives in the organization to avoid the issue of their people having to deal with many emails. In the process, the chance that a message will be delivered will be increased. Information overload also occurs when communicators fail to filter what they share. In organizations, some information is less valuable than the other. Focusing on the most relevant knowledge is an uncompromising imperative. Unimportant information can easily be communicated through other means other than official ones. Evidently, the Urology Department is yet to master this art as everything is communicated through emails.

The poor quality of data collected by clinicians at the Department is also a great concern. Change agents require access to information and data to act as the basis for their decisions and actions. They must justify their proposed change using knowledge acquired from different sources (Taylor & Woodhams 2012). Unreliable data impacts negatively on the change process. Specifically, it can lead to the change agents making the uninformed decisions, hence their inability to handle the issues at hand as expected. The case shows the department faces the same problem. The fact that members collect poor quality data means that the management cannot rely on the same to determine actions essential to the success of the hospital in the future. The issue has contributed to losses of income at the department and, as such must be dealt with to mitigate future risks. This must also be done to improve the quality of services rendered to patients. Lack of motivation and poor training also contribute to the collection of poor quality data. Unmotivated individuals may not see the need to collect the right information required by their companies to maintain their positions. Equally, people are less likely to perform well in data collection when they lack the skills and knowledge associated with the practice.

Recommendations

Different approaches can be used to deal with the issue to enable successful change management at the Urology Department. For one, managers at the department must embrace the art of communicating with other stakeholders when implementing change. They must appreciate the fact that the change will impact everyone, hence the need for active involvement. The strategy will go a long way in reducing the tensions (Shore 2014). Clinicians must be informed of the need for the department to improve efficiency and ensure proper cost management practices. As it is, these stakeholders do not understand why this is important. The management must also allow clinicians to make their case regarding the quality and safety of patient care. This will give the managers an opportunity to explain how the proposed plan will not affect the quality of services. In general, the two groups are in conflict just because they are not communicating. They have ended up misjudging one another and resisting suggestions that serve the interests of the department. Communication will also improve the level of trust between parties in conflicts.

The top leaders at the hospital should also consider involving other stakeholders in the decision-making process. Consistent with Suchman, Sluyter and Williamson (2011), involving others in decisions during change help in reducing resistance and conflicts. It also improves the level of trust between members. Managers at the Urology Department have in the past made change decisions without consulting or involving even consultant surgeons. In the end, their change initiatives have ended in failure. This is one of the reasons as to why clinicians believe they do not have what it takes to ensure the quality of care provided to patients. Collaborating during decision making will help in eliminating similar challenges in the future (Hayes 2014). It will also lead to everyone owning the decisions, hence their willingness to support the same. Involvement ensures that issues and concerns are addressed before the final decision is made. Clinicians will willingly support initiatives if they are involved in their creation or development. They will also trust the management if it trusts them enough to include them in determining the future course of action. This will also increase the quality of decisions made by the management. Fundamentally, the management will have to consider the many issues and concerns raised by different stakeholders before determining the way forward.

The department should also consider the use of various forms of communication to send different messages. For instance, it can rely on emails, meetings, and memos to share broad issues. Important messages can be shared through meetings. Alternatively, senior executives at the Department need to flag some of the emails or marking the important or urgent to ensure staff members read them. The use of memos can also help in sharing certain information especially important ones. The memos should be communicated on company notice boards (Shore 2014). In essence, senior executives should avoid emailing when it is easier to communicate with people through a call or in person. They must also ensure they consider who needs to receive certain information as opposed to sending emails to everyone. Seeking feedback is also essential (Örtenblad, Löfström, & Sheaff 2015). Staff should be required to reply to certain emails to ensure they have received the message. The same strategy can be used to collect views and ideas on the proposed change as well as share the reasons as to why the change is required. Collaboration tools also offer a solution to the problem. Instant messaging tools can be used for day to day internal communications as opposed to handling everything through emails. In essence, the primary goal should be to reduce the number of emails received by staff members on a daily basis. Different forms of communication should be used to communicate with various stakeholders during the change process.

Motivating staff members to collect and store the right data is also paramount. Apparently, information from statistical performances is required during the change process (McSherry & Warr 2010). The organization has been suffering as a consequence of the financial crisis. Its income is not sufficient enough to finance its activities. The storage of unreliable data has also contributed to the problem. Dealing with the challenge will ensure the management and clinicians have access to reliable information that can be used in determining the way forward. The management must make sure it explains the need for proper data collection. Clinicians also need to be trained on how to collect and store information as expected. Improving these skills will not only affect the quality of data but also services rendered to patients. The wrong recording has led to incorrect coding in regarding medical procedures. This increases the risk that wrong practices are used to treat patients. The organization cannot afford this luxury as the issue can attract legal ramifications.

Conclusion

The Urology Department of National Health Service in England has been dealing with a number of challenges associated with change. It has embarked on the road to change as a result of external pressures. However, the process is being hindered by issues such as tensions between managers and clinicians, information overload, and poor quality of data collected by members on regular basis. It is essential for the management to involve others in the change process and the in particular decision-making process to increase support and reduce resistance. Different forms of communication should be utilized to avoid information overload. Ultimately, individuals must understand the importance of collecting reliable data to support decisions. Training and development are also of the essence.

Bibliography

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