Change Management for Quality Improvement. A Case Study of the Mid Staffordshire Hospital Scandal

Content

Introduction

The Kotter’s Analytical Framework

Establish a Sense of Urgency

Create a Guiding Coalition

Develop a Clear Shared Vision

Communicate the Vision

Empower People to Act on the Vision

Create Short Term Wins

Consolidate and Build on the Gains

Institutionalise the Change

Leadership Approaches for Change Management

Justification and Conclusions

References List

Introduction

Guaranteeing that the National Health Service Organisations and the affiliated human resources deliver high quality and equitable care is one of the major priorities in the contemporary health services (Bottle et al., 2011). Yet, the metrics necessary to evaluate the quality and assurance of the healthcare is a matter subject to continuous debate. In the recent past, the concerns associated with the quality of care has attracted wide-ranging interests, particularly by the Mid Staffordshire Hospital scandal. An inquiry report into the Mid Staffordshire NHS Foundation Trust, the Francis Report, released on February 2013 paints a grim picture of the events that transpired during fermentation of the scandal (Francis, 2013). Unfortunately, these events led to the loss of lives, due to issues which could have been managed or addressed better.

Briefly, the Stafford and Cannock Chase hospitals decided to pursue the Foundation Trust in 2005, which was subsequently granted in 2008. However, abnormally high death rates raised eyebrows from various quarters, triggering the formulation of the taskforce to look into the matter (Dixon-Woods et al., 2013). It is largely believed that the scandal was triggered by the quest of the managers to cut down the operational costs and accomplish the minimum labour requirements in attempts to achieve the foundation status and qualify for the NHS trust funds. This indicates that the scandal was as a result of catastrophic organisational challenges that were triggered by poor change management.

Nonetheless, the Mid Staffordshire Hospital has since undergone significant changes as the concerned authorities strive to restore the efficiency and effectiveness of this facility (Salge and Schäfer, 2015). The events that transpired after the scandal was unearthed presents appropriate platform to understand effective change management for quality improvement. The case is also suitable for evaluating how the process of change management since the Mid Stafford Hospital reforms started in 2013 (Francis, 2013). Apparently, the Mid Staffordshire NHS Foundation Trust was placed under the management of the University of North Midlands NHS Trust. At the centre of the scandal, the Stafford Hospital has also renamed to the County Hospital, Stafford, in attempts to create short term wins for the public along with the management. Notably, the County Hospital, Stafford has extensively taken into consideration radical and drastic changes reconstruct the damage sustained in the wake of the Mid Staffordshire NHS Foundation Trust scandal.

The Kotter’s Analytical Framework

According to John P Kotter changes in organisational are inevitable and must be evaluated using an eight-step analytical framework, in attempts to ensure that the transition is managed appropriately and successfully. Analysing the changes that the County Hospital, Stafford has undertaken will provide explicit insights on how the facility in collaboration with NHS and other organs in the UK healthcare system attempted to manage changes attributed to post-scandal management and interventions (Mohammed et al., 2013).

Abbildung in dieser Leseprobe nicht enthalten

Figure 1 Source (Kotter and Cohen, 2014).

Establish a Sense of Urgency

It is paramount for organisations to be ready and responsive to changes that happen within the organisational environment. According to Kotter, it is imperative to identify potential threats along with the consequences that might emerge in the future when the status quos remains. Evaluating potential opportunities which can be used to establish effective interventions is also paramount (Francis, 2013). This should be followed by the commencement of honest dialogues with the stakeholders. Following the dissolution of the Mid Staffordshire NHS Trust organisation, the management was transferred to the University Hospitals of North Midlands (UHNM) NHS Trust. The UHNM NHS Trust creates a sense of urgency through persistent desires to provide safer services in a conducive environment, in which people get effective treatment along with healthcare services. This is

Create a Guiding Coalition

Kotter observes that change cannot be enforced by a single person alone, but rather a group of people from key positions in different levels of organisation must support the transformation process. The coalition members are required to have leadership, influence, credibility and the necessary expertise in the required change (Traynor, 2014). The UHNM NHS Trust has since partnered with multiple agencies to implement and sustain the change. Some of the notable partnerships are Keele University Faculty of Health along with the Staffordshire University. Most of the medical staffs serving at the County Hospital, Stafford are obtained from the two institutions. This relationship is paramount as it allows the UHNM NHS Trust to consistently ensure that its staffs are trained and guided with respect to the expectations of the local community and also based on the change implementation process (UHNM 2017b). The current hospital staff at the County Hospital, Stafford has also been integrated in the change process in attempts to enhance the outcome in the long run. This coalition is essential in promoting and sustaining change.

Develop a Clear Shared Vision

Managing change requires effective visions and objectives that are explicit and observable to all. The quest to initiate change in the Mid Staffordshire NHS Foundation Trust was based on observable and clear vision, to establish the factors behind increased death rates and poor services in the midst of the inter-organisational and public outcries (Bottle et al., 2011). As previously mentioned, the County Hospital, Stafford is bound to the UHNM NHS Trust management. Thus, this foundation is the primary organisation that is responsible for the development of the facility’s vision. In this regards, the UHNM NHS Trust vision states that the primary vision is to become one of the best university teaching hospitals by 2025 in the United Kingdome and subsequently develop a world-class status by the year 2030 (UHNM 2017a). This vision as a guiding principle for constant enhancement of patient care and nurture innovations within the organisation. The UHNM NHS Trust also aspires to provide a safe and attracting working environment for the staff. These visions are essential in influencing the change process within the facility.

Communicate the Vision

Having established the vision, it is paramount to communicate effectively as it provides the guiding principle for initiating change. The UHNM NHS Trust has over five thousand followers on Tweeter and other social network platforms, which allows it to articulate its vision to the public. It has also become vocal in popularising its activities through the main website and affiliate World Wide Web platforms, in which the organisation’s vision is explicitly outlined and explained to the public. Besides, the Latest News platform on the UHNM NHS Trust’s website constantly communicated with vision (UHNM 2017b). This is essential as it lays a firm foundation to stimulate and manage change within the County Hospital, Stafford.

Empower People to Act on the Vision

Kotter requires the lead change agents to communicate sensible vision to the organisation by removing structural barriers in attempts to make the change proposal compatible with the vision. As a consequence, it is fundamental to provide the required training and align the system with the vision, as well as address resistance from the concerned parties. The staff at the County Hospital has undergone massive and sustained training to enhance the care delivered to the patient. The feedback collection system has also improved as the UHNM NHS Trust engages the public to evaluate and address various issues arising from the treatment. An improved feedback collection mechanism is essential in change management as it empowers all the stakeholders to air their grievances, which reduced possible resistance. It empowers the staff, patients and the general public to keep the management in check to ensure that the vision is delivered according to the expectations (UHNM 2017a).

Create Short Term Wins

The County Hospital has developed a framework, which allows it to acquire monthly quality and safety reports. This allows the public and the staff to assess short term wins due to the change implemented in the organisation. The County Hospital opened two new wards in 2017, a Renal Unit and an Elective Orthopaedic Unit. The resulting expansion allows the staff to have a spacious and developed working environment while the Stafford community can access these services closer home. The new wards allow the patients, their relatives and the staffs permits sufficient rooms for confidential conversations, which are essential in enhancing the quality of the treatment process (UHNM 2017b). An audit by the Trauma Audit and Research Network indicates that for one thousand major trauma clients treated at the UHNM NHS Trust, including the County Hospital, thirteen people survived who would not have survived traumatic incidents. This is one of the major short-term gain observed at the hospital since the transformation process started. Moreover, the County Hospital has quadrupled the number of rooms to increase the capacity and also developed new services such as plastic surgery, eye surgery and orthopaedic surgery. These short term gains are essential in supporting the change process in the facility.

Consolidate and Build on the Gains

More changes are paramount in consolidating the gains obtained during the change initiation process. Constant training of the staff and monthly performance evaluation at the team, division, area, committee and Trust Board levels are some of the strategic approaches that have been taken to consolidate changes at the facility. In particular, performance indicators play a central role in assessing the change management and also evaluating whether the primary objectives and cumulative goals align with the County Hospital’s vision (UHNM 2017a).

Institutionalise the Change

Lastly, it is inevitable to institutionalise the change, based on the findings and recommendations developed from the change management process. Constant performance evaluation and management as observed in the consolidation of change allows the UHNM NHS Trust to institutionalise the change process as the data acquired informs the priority of the organisation. It allows the management to enhance the value for money through the assessment of demand and capacity metrics, which allow the Trust and the County Hospital to identify shirt in demand pressures, which also informs the distribution and allocation of healthcare resources. The County Hospital has institutionalised numerous changes such as the expansion of the outpatient facilities, particularly for the emergency access clinics, starting and refurbishing operating theatres and maternity units (UHNM 2017b). This is paramount as it incorporates the changes into the organisation through the institutionalisation of the transformation.

Leadership Approaches for Change Management

Transformational leaders are driven by the need to recognise and understand essential demands for change, which allows the modification of the existing environment to achieve ideal situations for supporting a successful transition (Van der Voet, 2014). This leads to the creation favourable population attitudes and control indications to monitor and address emerging issues and challenges throughout the transitioning process. Practical communication skills are paramount in transformational leadership due to the potential of inspiring confidence in people through administrative infrastructures (Ghasabeh et al., 2015). Notably, transformational leadership is applicable in different levels and fields of organisations and governance in the quest for the maximum possible efficiency. Current studies show that transformational leadership is made up four major components, including idealised influence, intellectual stimulation, individualised consideration, and inspirational motivation (Hayes, 2014). Nevertheless, communication stands out as a key customary requirement in significant leadership theories. This underscores the significance of including dialogue as an essential constituent in the assessment of transformational political leadership (Svendsen and Joensson, 2016). Besides, interaction process predominantly features as one of the most critical platforms for transformational leaders in politics.

[...]