Team planning and managing human resources is a challenge for healthcare managers because this filed is affected by uncertainty. This case study details a process of implementing a new team management system based on the analyses of absence data for the personnel from the previous years. This paper aims to introduce a case study and analyse the strategies used by the management of the hospital to recognise a problem, create a plan and implement the change initiative.
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Case Study Background
This case study is a recollection of events from a local hospital, which provides inpatient and outpatient services. For the purpose of this case study and to avoid disclosing the details about the hospital, the facility will be referred to as HW hospital throughout this paper. HW serves a population of approximately 10,000 and has units dedicated to small surgical procedures and general practice care. There were six general practice (GP) doctors working full time. HW was involved in the NHS’ ‘Productive General Practice’ program that allows the hospital’s management to assess the number of GPs and determine the adequate staffing levels to maintain it throughout the year.
At HW the management team was concerned with the issue of staff turnover, which placed a burden on the teams because in many cases, some employees had to work for longer hours or do more to account for the shortages. However, HW is not the only healthcare establishment in the United Kingdom that has problems with understaffing. According to the BBC News (2019, para. 1), the NHS recognises that there are not enough healthcare professionals and will soon begin to ‘recruit health workers from other countries to meet growing staff shortages’. This suggests that the problem affects not only the healthcare facility that is the focus of this study but also other hospitals across the United Kingdom and the approach adopted by this hospital can help others.
Typically, this hospital has a list of positions that must be filled with medical professionals, including general practitioners, nurses, surgeons and other specialists. Naturally, some employees choose to change their place of work and leave, which is when the management has to recruit a new candidate for a position, but these changes are usually not difficult to manage because they do not happen suddenly. A greater issue is that some employees may need to skip several days of work due to sickness, and often the management has a difficulty finding a replacement. As was mentioned, this is a part of a greater problem within the United Kingdom’s healthcare system — there is not a sufficient number of medical school graduates to fill all the vacant positions of medical professionals in the country.
It is difficult to imagine a hospital without doctors or nurses available to work with patients. However, shortage of staff is common and causes delays or long waiting hours for the patients, which decreases the quality of provided services, patient satisfaction and in some cases may endanger the health of the patients. Hadad, Annamaraju, and Toney-Butler (2020) state that the shortage of nurses leads to higher chances of errors and increased rates of morbidity and mortality. Hence, maintaining a suitable patient-nurse ratio and ensuring that there is a sufficient number of medical professionals in a hospital is vital.
In this hospital, one of the managers offered to partner with a company that provides analytical services and use personnel data from the previous years, such as holidays, sick leaves, vacations and other information about the availability of the personnel to predict the peaks of demand and create a model that would help address staff shortage. The idea was to use the data that the HW’s management already had — the information about the periods when the hospital had to invite temporary workers and use the services of staffing banks, which is less convenient, can be stressful for the medical professionals and their management and is more costly.
As was determined through the analysis, sick leaves were the main problem that affected different units, because they were reported typically on the same day when a person could not arrive for work. A similar problem is mentioned by the NHC (no date, para. 5) since sickness reporting is typically ad hoc, which means that management of personnel is ineffective. The prediction model created as a result of this change aimed at addressing this challenge. The model used data from previous years to alarm teams that there may be a staff shortage on a specific day, allowing the leaders of units to find a potential substitute in advance.
The problem that was addressed with this change was the team planning with an aim to reduce the pressure on HW’s staff as a result of not having enough medical professionals to perform the daily tasks in this hospital. Gopee and Galloway (2017) state that an effective manager must work collaboratively with the staff and create a work environment where employee’s physiological and social needs are met. Moreover, the manager’s task is to ensure that the daily care needs of patients are addressed. With the issue of staff absence, the quality of care is reduced, and the pressure on the workers’ increases.
The problem that the management of this hospital addressed is not uncommon for the United Kingdom or other states. Accordion to Kumar et al. (2019, p. 1), ‘most nations face a range of medical workforce challenges with questions over not only how to overcome public demand for healthcare and maintain a sufficient number of general practitioners but also how to fill shortages in particular hospital specialities and ensure an even distribution of doctors across the population’. Hence, the ability to predict the demand for specific healthcare professionals at specific locations is essential for the proper functioning of the system and to ensure that the needs of the population are addressed. Kumar et al. (2019) refer to the shortage of medical professionals problem as one of the most pressing issues of the 21 century. This undersupply is a threat to the entire healthcare system and although the strategy used by HW’s management does not address a wider contextual problem, which is the need to provide training opportunities and encourage more people to work in healthcare. However, it helps address the short-term shortage and reduce the burden of other hospital workers.
The case study addresses one aspect of this shortage, which is the local shortage of medical professional at a single location due to workforce planning practices that make it impossible to account for sick leaves or peaks in demand for certain services. However, artificial intelligence (AI) and other technologies allow collecting data and developing prediction models that can help the managers of hospitals approach the issue more effectively. Moreover, Hosny and Aerts (2019) state that AI systems available now can provide decision-making support for general practitioners, for example, by providing suggestions or monitoring patient’s condition. This study and the shortage of medical professionals suggest that hospitals should be prepared to implement innovative systems that will help manage patient cases.
The general approach to managing shortage is hiring locums, or personnel that will perform the job temporarily instead of a different medical professional. However, such practice is typically more expensive, and it is more cost-effective for the hospitals to assign GPs to cover for the absent colleagues. The NHS chief even addressed the issue of higher pay that locums typically receive, by stating that there is an ‘intrinsic unfairness’ of locum doctors earning substantially higher rates of pay than their staff colleagues’ (Iacobucci, 2017, p. 502). The issue of pay may create an incentive for personnel to revert to working as locums instead of holding a full-time position at a clinic. Moreover, Murray (2017) notes that the NHS aims to reduce the spending dedicated to hiring locums. Hence, although locums help address the problem of personnel absence in the short-term, the widespread use of this practice creates problems for specific hospitals and for the NHS in general.
Thus, a wider contextual problem that is addressed through this case study is the global shortage of healthcare professionals in both developing and developed countries that may result in a collapse of the healthcare system if not addressed in time. The application of data analytics and algorithms can help hospitals understand the demand and supply of their workforce better and prepare for short-term changes better. The management of HW chose to approach the implementation of the new system by beginning with an analysis of available information and evaluation of options that this hospital had.
The management of this hospital was aware that during some periods, different departments lacked the personnel to attend to patient’s needs, mainly due to sick leaves and increased demand for medical services. At HW, the process of managing change began with one of the managers recognising there is an issue with rotas and staff cover. Gopee and Galloway (2017) note that some changes may happen naturally and therefore meet little resistance or issues. However, it is important to consider the timing of a specific initiative and its appropriateness. HW was experiencing some shortages, and one manager believed that this was due to the fact that the practice needed more than six GPs, while others disagreed. To address the problem effectively, the team contacted the NHS and enrolled in the ‘Productive General Practice’ program, where the first step was the analysis of staff availability. The timing of this initiative was appropriate since the management was able to carry out the analysis during a low demand period and enroll in a program from the NHS for additional support.
Initially, HW’s management anticipated that they would need to hire another GP. As Gopee and Galloway (2017, p. 139), ‘changes in care interventions are often triggered by new evidence and are usually related to assuring or enhancing the quality of care provision and delivery’. The analysis of staff availability has shown that there were many absence leaves, and the majority of rotas and coverage problems were connected to this. Moreover, upon further investigation, the management found out that the current staff availability problem contributed to the increasing patient dissatisfaction and team members’ burnout that was a result of not having enough employees. Next, the management analysed the costs of hiring locums and found that HW can significantly reduce its expenditures if the management finds a way of addressing shortage with the hospital’s resources.
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The decision-making process was facilitated through the analysis of available information. One of the managers, the leader of the initiative, spoke to several employees to gain a first-hand comprehension of how shortage impacted the staff and what options they perceived as the most suitable in this case. As suggested by Gopee and Galloway (2017), the management process consists of the following steps: planning, organising, directing and supervising a change. In this case, the process was guided by the same model, the team gathered information, discussed options, developed a plan and tested a new team management system. Over the three months since the system’s initial implementation, the leader of this initiative supervised the use of the new system and developed plans for undressing issues, such as staff shortage that was not predicted by the algorithm.
At first, the management announced that they plan on implementing a more effective personnel management system for absence and sickness management. Notably, the announcement was met with caution because the personnel feared that they would have difficulty using their sick leaves or that they would be burdened with additional work, and this challenge will be discussed in detail in the following section of this paper. With this case, the management relied on data when making each decision. Problem-solving, as defined by Gopee and Galloway (2017), is a decision that needs to be made to avert a potential issue. In this case, the main central problem-solving decision was the initiation of a process for creating a new system for managing absences and staff rotas, which could have resulted in an increasing level of patient dissatisfaction and staff burnout, leading to turnover and potential errors. Another vital problem-solving decision was made by the leader of the change when the personnel began voicing concerns regarding the new system. The manager decided to enhance communication with the personnel and explain the detail of the change initiative.
As with most organisational changes, this initiative was marked by several challenges. With this change, the staff was afraid that the changes to the policies would mean a more difficult process for having a sick leave or planning a vacation, which led to the initial dissatisfaction with the initiative. Miscommunication is a dangerous error in healthcare, for example, Foronda, MacWilliams and McArthur (2016, p. 36) report that improper communication with patients leads to poor health outcomes and ‘egos, lack of confidence, lack of organisation and structural hierarchies’ are the main problem that contributes to miscommunication, while Omura et al. (2017) distinguish the contribution that effective communication makes towards healthcare management.
Tools used to tackle these challenges include communication management, which played a vital role in determining the success of the initiative and people management strategies. Here, the people management strategy that the executives of the hospital used played a vital role in because the management prioritised the wellbeing of the staff and aimed to improve their working schedules. Since a good manager strives to create an appropriate work environment for the personnel, this initiative, in general, is a result of HW’s management care for their personnel. This change required substantial additions to the hospital’s holiday and sick leave management policies, as well as holiday protocols.
As a result, the main issues with this initiative were the communication with the staff and the availability of quality data to create a prediction model. At first, the management did not address this problem directly, which they could do by, for example, holding a meeting with the employees and telling them about the issue, which is the improper people management, and the proposed solution: data analysis and a model that will predict employee absences. Inevitably, this failure caused confusion and fear among the personnel, until some physicians complained to the management about their concerns. As Hilton (2017) notes, clarifying the purpose of the change is one of the vital steps for success. This was when the latter recognised the need to clearly state the central premise of the change initiative, and they did so by sending an email to all employees and encouraging them to write a response with questions and suggestions. Moreover, all units had separate meetings where the change was discussed in detail, with specific references, for example, the ICU consistently lacked nurses, and most employees were overworked because they had to work for longer and care for more patients to cover for the inconsistency. As a result, the physicians and nurses agreed that there was a problem and that the analyses of data from previous years could be a solution for making staff schedules to cover for absences.
In addition, Lewin’s model of change can be used to describe the process of implementing the new people management policy at HW. At first, the management recognised that there is a problem with ineffective management of personnel’s work hours — there is a shortage of qualified professionals on some days, and the cost of locums is high. This is the ‘unfreeze stage’ during which the decision-maker behind to recognise that there is a significant problem that affects the performance of the hospital (Morris, 2018). The next stage of the change implementation process is titled “change”, and during this stage, the management introduces the plan and changes to the personnel and implements a new system. With this hospital, the “change” process was initially met with resistance from the staff. At first, the management team did not communicate what specific changes they planned on implementing to address the shortages, although they encouraged the staff members to share their ideas and opinions. However, the executives quickly recognised the problem mainly because they were open to communication and did not fear to talk to the doctors and nurses in person.
I will use Gibbs’s reflective cycle to examine the change implementation discussed in this case study. The cycle implies six stages of reflection, beginning with a description of the experience. With HW, I was not directly involved in the process of managing the change initiative, so I can only describe it from the perspective of a staff member. Similarly to my colleagues, at first, when the management announced that they plan on changing the way they manage holidays and sick leaves, I was concerned because I had a bad experience with overworking or having to cover for my colleagues. So, in terms of feelings, as the second stage of Gibbs’ model, I would say that I experienced mostly negative feelings at first. However, about a week from the initial announcement, the management held a meeting explaining what they were trying to do and that the new system should reduce extra work hours. At this point, I felt relieved and excited about the new system.
The next step of the Gibbs model is evaluation, and in this case, I would evaluate the change management process as ‘good.’ The reason why it was not ‘excellent’ is because of this initial confusion and miscommunication that the management did not address at first. From a perspective of analysis, this initiative was successful at the end, despite some initial problems, because the management was attentive and was open to feedback from the employees. My supervisor, for example, asked everyone in the department to approach her if we had ideas or concerns about this initiative. In conclusion, from this case study, I learned that an essential element of managing change is communication. Hence, as an action plan for the future, I would focus on ensuring that I am able to explain the objectives and vision for an initiative beforehand. Overall, this paper provides an assessment of a case study detailing how HW hospital implemented a new team management system with the use of data analytics and planning to address the short-term shortage of staff.
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