Introduction
Many organisations have embraced the pivotal role played by capacity building in improving the overall quality of the functioning of the setup. This has led to massive investments in capacity building programs aimed at enhancing the organizational performance and maximizing productivity of the workers. Capacity building generally refers to the ability of an organisation to deliver and fulfil its goals and objectives in an effective and systematic manner (Kaplan, 1999, p.18). The concept has gained popularity with managers and practitioners who are pushing for its wider application in the management of the non-profit organisations especially the health care institutions such as the National Health Service (NHS). Organisation capacity usually refers to the increased ability or potential to utilize the resources and expertise at its disposal to deliver the set goals while increasing value for the shareholders. More importantly, the ease of integration between capacity building and other core aspects of the institutions has rendered it useful and applicable to small and large organisations (Institute of Medicine, 2001, p. 45). The NHS hospitals are lagging behind due to their inadequacy in providing strategic leadership that is vital in enhancing their functioning. This essay will look into the building of organizational capacity in the management of National Health Service hospitals with particular interest in their strategic goals while outlining the steps, approach and performance indicators in improving the performance.
Organizational capacity
According to Horton et al (2003, p. 29), there has been great and massive investments in terms of resources and time aimed towards enhancing the organizational performance and development. The major aim of enhancing organizational capacity is to boost the performance of the organisation as set out in its strategic goals while ensuring it is in tandem with the amount of resources at its disposal. A sizeable proportion of this investment has entirely focused on improving the organizational capacity of the key functional departments in the National Health Service. Organizational management has received great focus owing to its role in directing the overall functioning and performance of the human resources and services especially in the National Health Service (NHS). Ting has noted that organizational capacity is imperative in ensuring the effective implementation of health policy (2009, p. 1). This brought into fore the need for legislators and bureaucrats in the United Kingdom to consider more emphasis on the role of organisation capacity in the eventual implementation of policy and legislations. Ting asserted that the achievement of the desired outcomes lied with the commitment shown by the management in terms of training and equipping of personnel, and investing in technology and research by the affected agencies and organisations. In this case, the acute trusts, mandated to run the NHS hospitals, have shown commitment in capacity building of personnel.
Organizational capacity forms one of the key elements of organisation assessment framework aimed at improving the efficiency and effectiveness of the organisation. It mainly encompasses the human and financial resources, the level of knowledge and the processes employed in delivering the set targets by the organisation. It focuses entirely on the strategic leadership due to its importance in ensuring that there is synergy and efficiency between the various factors of production such as technology, staff and infrastructure. Program development and networking in the NHS hospitals are crucial pillars of organizational capacity that need greater focus to ensure there is effective linkages with the outside world. The consistent application of the resources and management elements in the NHS has proved fruitful in the meantime (Horton et al, 2003, p.12).
Organizational management
Management is a concept that is overly concerned with the understanding and generation of the right conditions that will enhance the achievement of the appropriate objectives. The NHS hospitals are run by acute trusts that work under the supervision of the Department of Health in the UK (NHS, 2010, para. 10). The managerial responsibilities include the planning and controlling of the overall running of the organisation and its resources (Horton et al, 2003, p.14). The management has become an important aspect of boosting organizational performance in the NHS and other healthcare organisations. United Kingdom and Australia experienced a wide range of pressures emanating internally and externally owing to the realignment and adaptation to change by the health care organisations. The implementation of far reaching reforms affecting these organizations was responsible for the instability in the organizational environment. Moreover, the dynamic nature of the social and economic aspects in Australia and UK has led to increased pressure for real change especially in the running of the health care system. The increased globalisation necessitated the realignment of the management thus making it competitive in tandem with the set standards by international bodies (Harris & Associates, 2006, p. 60-63).
Strategic goal and objectives
Strategic planning is imperative in organizations since it provides them with opportunities to improve their performance. Strategic planning refers to the process utilized by the organisation in defining the strategy and coming up with decisions on the most appropriate way of allocating capital and human resources in order to achieve this strategy. The analysis technique employed during the strategic planning is determined based on the needs, desired outcomes and the prevailing conditions (Corrigan & McNeil, 2009, p. 206). Careful planning is required since the document sets the direction an organisation will strive to achieve within three or five years. Thus, it is crucial to invest a lot of money, time and resources during its development.
The strategic objectives and goals normally outline the aspiration and the direction an organization will embark on to achieve their desired vision and mission. The objectives and goals are in line with the overall mission of the organisation and are bound to change after a specified period (Leggat et al, 2000, p. 12). The goals cover a number of areas and are vulnerable to changes in trends in the social and political environment. The objectives and goals are affected by the national and local government healthcare reforms and the structural changes in the setup. In this regard, various hospitals will develop and revise their plans in less than three years in order to keep with the structural changes.
The management structure is charged with overseeing the development and eventual implementation of the strategic plans. The objectives and goal s mainly focus on the core functioning of the healthcare institutions. Quality patient care and ensuring increased productivity of the employees are the major areas emphasised in the strategic plans of NHS. The managers would therefore consider working towards the achievement of the national development agenda that may include the expansion of health facility to increase the total admissions in the hospital. Improving the quality of in-patient is imperative in ensuring the institution gets recognition for its services.
Strategic objectives touching on the of the NHS hospital management involve the paradigm shift from overreliance on hospital administrators to clinicians. This forms part of the far-reaching reforms aimed at checking the number of healthcare workers who must be proportionate to the population served by the hospitals (Corrigan & McNeil, 2009, p. 206). Career development to commensurate the changing responsibilities of the clinicians also appear as a major goal that the NHS strive to achieve (Institute of medicine, 2001, p. 45). The demand for high quality and individualized care to patients has also resulted in the need for specialized nursing care. In line with this development, the NHS management has to set aside resources for internal and external training on best nursing and clinical practices thus ensuring efficiency, patient satisfaction and eventual increase in productivity. The increase of productivity to its maximum potential brings into fore the strategic objective of provision of quality care while ensuring the hospital reaps maximum benefits from the venture (Institute of medicine, 2001, p. 45). The organisations must also ensure that the human resources receive treatment as stipulated in the national workforce planning implemented across the UK (NHS, 2010, para, 15). The national healthcare workforce plan helps the management to devise local regulations governing the deployment, movement of labour, balance of human resources between various departments and the in-service training of the staff (Harris & Associates, 2006, p.34).
The regular review and bolstering of working relations at the strategic level especially with the relevant stakeholders in UK healthcare is important to enhance effectiveness and efficiency in the running of the institutions. The continued focus by NHS on ensuring the institutions achieve accreditation with the regulatory bodies is a goal each member of the acute trust should strive to achieve (Mulller & Winter, 2006, p.14). Furthermore, the organisation should devise ways of ensuring that quality improvement and sustained development of infrastructure. The hospital management must also ensure that their services are tandem with the laid down policy in the locality and the service offered act as complement to the existing hospitals rather than rivalling them. The goals and objectives of the organisation must respect the rights of the employees (Kaplan, 1999, p. 16).
Organizational performance
Organizational performance has gained popularity with the non-profit making institutions such as NHS. It generally refers to the overall ability of organisations to achieve the desired mission and meet its strategic goals. The measurement of the performance of the NHS hospitals is based on some key indicators. The indicators include effectiveness, financial sustainability, efficiency in its production and the relevance to the needs and priorities of stakeholders. For a hospital to achieve excellent performance, it must achieve its desired objectives, offer services at the lowest cost, reflect the needs of stakeholders and ensure it remain financially viable at all times. However, uncertainty in job responsibilities and the lack of performance feedback are the major causes of negative performance in healthcare organisations. Inadequacy in the physical infrastructure and the lack of motivation in the human resources also contribute to the decline in the performance. Ineffectiveness in the processes and limited skills has always resulted to failure especially when the management is overly affected. In order to achieve improvement, concerted efforts that involve all employees from the management to the lowest cadre in the NHS hospitals, is a first step (Horton et al, 2003, p.16).
Lifecycle performance improvement is the method mostly applied in addressing the negative performance in many organisations. The method, which is applicable to NHS hospitals, follows an eleven-step process that delves to identify the structural weaknesses while offering concrete solutions. The process starts with the identification and subsequent review of the organizational goals and objectives with specific interest on the quantities and quality. The method then focuses on the desired results, in terms of products required by the stakeholders, through conducting a baseline. Ensuring that documentation and the reports on the performance are well kept to enhance regular future retrievals is also imperative (Horton et al, 2003, p.16). The documented results are compared with the desired results in order to ascertain the gap in the performance of the hospitals. This allows the prioritisation of the improvements depending on the overall impact, resources available and the ease of implementation. Underlying and the overly root causes of the decline in performance are identified and addressed to avoid wastage of resource during the improvement period. This herald the generation of a performance improvement plans depending on the identified weaknesses.
The plan ensures that unattainable measures and standards are achieved through development of solutions informed by the analysis of the root causes. Implementation of the concrete solutions start by developing a guiding tool called an action plan. The action plan outlines the required steps while indicating the target date, available resources and the person in charge for any single action. The success of the action plan is complemented by regular exchange feedbacks with a view of enhancing the identification of root causes. Lastly, continuous monitoring and evaluation of the entire process is imperative since it helps gauge the speed of progress and the achievements made by the plan. It also helps maintain accountability and in the making of future recommendations and decisions (Harris & associates, 2006, p.49-98).
Approach best suited to improving performance in the NHS hospitals
The utilization of approaches to improve organizational performances has gained momentum in the last few decades due to the changing social and economic environment that has resulted in increased competition. The managerial shortcomings has imparted on the performance through failure to offer strategic leadership and direction on the functioning of the hospitals. Benchmarking is the most applicable approach to organizational performance particularly in the UK healthcare institutions (Dugas, Eckholt & Bunzemeier, 2008, p.69).
Benchmarking is the continuous process that allows the comparison, projection of the performance and the implementation of the plans. It encompasses the tendency to compare various aspects of the organisation with the best in the market. It also entails the discovery and projection of the best trends in healthcare practice while ensuring that the expectations of those looking upon you are met and sometimes surpassed. Benchmarking is helping shape the management of the health care organisations through encouraging the uptake of approaches that has proved successful in other healthcare facilities. Benchmarking is instrumental in the learning process since it allows the grasping of a wide array of success experience stories while providing a chance of gauging the organisation performance in relation to the best in that line of practice. More importantly, it gives the acute trusts the chance to identify the strengths behind the success while also shedding light on the weaknesses threatening to bring down the organisation. In this regard, the management gains access to prior information thus leading to effective prioritization of the improvement activities (Harris & associates, 2006, p.49-98). The other strength in this approach is its propensity to provide the managers with a corrective plan. Since the benchmarks offer crucial reference points, it enhances the managers to strive to achieve or surpass the set targets. Furthermore, it becomes easier to assess the performance of the organization after certain intervals or duration of time when the set standards acting as the reference points (Dugas, Eckholt & Bunzemeier, 2008, p.69).
In this instance, the problems encountered by the NHS hospitals leadership can be resolved by setting targets achievable after a certain period. The comparison of the performance measurements of several competing providers keeps the management in the lookout for root causes instead of the problems themselves. It is therefore worth noting that the performance measurements has led to enhanced cost saving on the part of the users since decisions on utilization of products gets influenced by the information (Fraser Health, 2010, p.2).
More importantly, its application is imperative to the managerial problem since it enhances the critical analysis of the situation with the aim of reinventing the whole system. It helps the manager or the team leader to see things from a different perspective hence informing them on taking the most proactive step that ensures the organisation remains ahead of the competition.
Type of performance indicators or measures selected
Majority of the highly regarded healthcare organisations in USA and UK has continually utilized benchmarking as the preferred tool for learning and improving their systems. Moreover, the organisations invest considerable resources in order to carry repeatedly and successfully the best practice benchmarking projects. The utilization of benchmarking tool requires the development of performance indicators imperative in monitoring and evaluation of the project’s efficacy. The indicators help the organisation to achieve its goals and outcomes since they act as the measuring tools for the projects outputs. Careful planning and wide consultations during the development of the performance indicators has helped many NHS hospitals to implement the benchmarking process with considerable success. In this regard, the organisation sets up concrete and all round performance indicators essential in the evaluation of the transformation of the managerial function (Dugas, Eckholt & Bunzemeier, 2008, p.69)..
To start with, the workforce has become an integral part of the NHS thereby leading to the development of healthcare workforce plan that enhances their welfare. The successful training and retraining of the staff in better service delivery measures would form one of the major milestones for the acute trusts. The achievement of this indicator would act in tandem with the NHS’s goal of improving the overall quality of the patients by offering specialized and individualized care. More importantly, the capacity building of the workforce has always formed part of the performance improvement targets for the NHS. Following the advancements in information and communication technology, the acute trusts have earmarked the training of all staff on its utilization with an intention of enhancing the accessibility and application for evidence based practice. The eventual utilization of the available technological advancements coupled with successful completion of the information and communication would form one of the performance indicators.
The acute trusts devised cost saving mechanisms aimed at lowering the expenditure of the hospitals thus ensuring quality service to the maximum possible clients. In this regard, the development of budget plans and ordering restrictions aimed at reducing excessive wastage of non-reusable medical and surgical products. The organisation developed a concrete inventory that involved the entry of the consumption of all materials on a daily basis. The inventory was instrumental in promoting accountability on the departmental heads thus bringing considerable savings to the organisation. The sustained utilization of the inventory by all the departments would act as the key indicators of cost saving (Brignall & Modell, 2000, p. 289). More importantly, this would enhance savings that would find their way into infrastructural development in the hospitals. Improvements on the existing medical devices and other machines would enhance the overall efficiency of the NHS hospitals thereby ensuring quality and accuracy in patient care.
Currently, the NHS and the hospitals have undergone major transformations in their administration structure particularly when it comes to the composition. Normally, the top brass in the organisation usually comprised of administrators with vast experiences and widely read particularly on management issues. However, the paradigm shift where key administration managers are pooled from the technical and professional background has gained momentum. As part of the performance indicator, the top brass management, including the various departments, were supposed to have a composition that favours the health care professionals (Brignall & Modell, 2000, p. 293). Considering the professionals have also undergone training on management and other aspects of administration, their inclusion would avail a new pool of ideas on the improvement needed to ensure the NHS hospitals deliver quality services to their clients. More importantly, this indicator acted in tandem with the organisation goal of promoting efficiency while lowering expenditure on non-core areas. The combined effort of the new structured administration has the capacity to make management decisions aimed at helping improve the overall quality care in the organization (Champagne & McAfee, 1989, 208).
Strategies for motivating stakeholders in ongoing performance improvement
Performance improvement has become pivotal in the creation of an edge between competing organisations. It is therefore understandable when organisations invest colossal amounts of money towards the achievement of the intended improvement. More importantly, the understanding that there are forces that influence the achievement of performance improvement has led the acute trusts to devise strategies to enhance the timely achievement of their goals. Motivation has always played a major role in influencing the outcome of performance improvement. Performance refers to the function of ability combined with aspects of motivation. Whilst ability is dependent on factors such as experience and educational background, motivation is a flexible aspect modifiable to fit the situation. It is for this reason that several strategies have come into fore in bridging this gap particularly in the running of NHS hospitals (Champagne & McAfee, 1989, 208).
Positive reinforcement of the stakeholders is imperative in ensuring the success of the performance improvement plan. This involves giving out incentives to the most effective stakeholders thereby boosting their morale by showing them that their contribution did not go unnoticed. High expectations in the stakeholders, particularly in the health workforce, receive the needed attention by engaging them regularly in the whole process. Positive reinforcement not only instils short-term goals but also build a better and positive association that ensures success in future projects. The continuous engagement of the workers also ensures that potential problems during the process get the necessary attention (Champagne & McAfee, 1989, 210).
Effective discipline and punishment also plays a major role in motivating the employees since they understand the benefits of mutual respect in each other and their conduct must conform to set guidelines. Considering the sensitivity of the work of the healthcare workforce, it is imperative to incorporate strict disciplinary measures that take into account the professional conduct governing the workforce. Fairness especially when dealing with the various stakeholders is crucial in minimising resentment that would otherwise shift attention from the core objectives of the plan. Fairness enhances the creation of professional bond among the various stakeholders thereby boosting the output of the group. More importantly, fairness helps stakeholders to bring out the full potential of their expertise while allowing amicable problem solving without undue influence (Brignall & Modell, 2000, p. 293).
Setting specific goals and mechanisms that ensure that the hospital stakeholders needs receive due attention is paramount in making them focused and provides impetus for hard work. The goals must reflect the mission and enhance the achievement of the organisation vision in the end. The consideration of integrating the stakeholders’ preferences is a prerequisite for success while implementing a performance improvement plan. It is therefore imperative to conduct wide consultations before embarking on the long journey of implementing the plan. Moreover, the continuous monitoring to ascertain the progress in the achievement of the stakeholders expectations must accompany that of the whole project (Fraser Health, 2010, p. 3; Sunil, 2004, p. 5).
Conclusion
Performance improvement in the management level of health care organisations has gained popularity because of the potential it has on the whole functioning of the organisation. The decisions taken by the acute trusts usually have far-reaching ramifications in the lower levels of the organization. The development of strategic objectives that advocate the improvement of quality care to patients is a major step toward the achievement of its core values (Sunil, 2004, p. 5). The measures implemented by the management must reflect the goals and the objectives that make the NHS hospitals distinct from the others in the world. Benchmarking has provided one of the best tools that organisations have applied to achieve improved organizational performance. The approach offers flexibility and allows the users to customize it in a bid to achieve the desired outcomes. Performance indicators help the organisation to measure the progress in the achievement of the outcomes. Motivation strategies have ensured that the performance improvement process runs smoothly. The correct application of the best approach is imperative in the effectiveness of a performance improvement plan.
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