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King Edgar NHS Hospital Trust’s Performance Change Case Study


Introduction

This paper provides an examination of the concept of organizational change with a specific focus on the case of improving hospital performance at King Edgar NHS Hospital Trust. The case involves Tracey Burns, who is the director of the Trust and head of a project aimed at improving the efficiency of the flow of patients within the hospital. The case presents the empowerment of nurses to proactively help in the discharge of patients. Additionally, the case study highlights the financial challenge that the Trust was facing, the problem of adhering to government’s requirements regarding the waiting targets, as well as the problem of adverse media scrutiny.

As such, this report seeks to critically analyze the sources of power and the power tactics employed by any one of the main protagonists in the case study. In this analysis, a lot emphasis will be on the French & Ravens model of power. In addition, the analysis covers the concept of organizational politics, and how such aspect affected the implementation of the nurse led discharge at King Edgar NHS Hospital Trust. The stem of the analysis is the approaches they used to manage the resistance encountered as far as the implementation of the nurse led discharge was concerned.

Background on Power and Political Behavior

All organizations suffer from the impacts of power as well as associated political behavior. For this reason, it is important for organizations’ management to be aware of the sources of power as well as the evitable political behaviors to encounter in any organization. Power can be divided into five forms including expert power, referent power, legitimate power, coercive power, as well as reward power (Blois & Hopkinson, 2013). All these forms of power are used in organizations for different purposes such as social or even personal gains.

Sources of Power

As noted above, power is a very vital aspect in an organization and it can be used to ensure that the required activities in the organization run as expected. For this reason, leaders in a company can use their power to instill organizational change whenever needed. In spite of this, Erwin and Garman (2010) noted that the adoption of any change within an organization faces significant resistance from employees based on various reasons.

In support of this, Oreg (2006) observed that the business environment is ever changing business, which explains the inevitability of resistance of employees to change as well as any associated political behavior. According to Jansson (2013), organizational change is a ubiquitous process and hence, the resistance of employees to such changes can play a significant role to the organization’s failure to achieve the goals and objectives of any proposed change, and well as the organizational goals. For this reason, leaders of change are required to use their power whenever necessary to counter any form of resistance to change that does not align with the organization’s set goals and objectives.

In the case of King Edgar NHS Hospital Trust, there are several sources of power that Burns and her team. In addition, various power tactics are employed by Burns to ensure that the project to improve the efficiency of the flow of patients within the hospital is adopted. The major sources of power and power tactics are highlighted below:

Reward Power

This form of power refers to the control that a given individual in an organization has over rewards such as promotions, bonuses, praises, as well as salary increase (Blois & Hopkinson, 2013). Based on the case study, the nurses and the matrons resisted the adoption of the propose change on the basis that some of them felt that the new patients’ discharge initiative was an addition to their workload. In addition, there were concerns that the cost of adopting the new discharge system according to the proposed change was high in comparison to the benefits associated with adopting the needed changes as far as the flow of patients was concerned.

However, Burns used her reward power to assure the matrons that by complying with the proposed changes regarding the discharge of patients within the hospital, they would be relieved the burden of bed management duties. This proposal was wholly accepted by the nursing staff.

Legitimate Power

This form of power is a resemblance of authority and, hence, it has a lot of bearing on an individual’s position in an organization, as well as mutual agreement between parties. Such power is given to various individuals by the organization. In most of the cases, the legitimate power is used where leaders are uncertain about their capacity to convince their followers through the use of other ways.

However, it is important for organization’s leaders to be aware of expected impacts of an organizational change before deciding which power to use. This is attributable to the fact that the majority of organization’s changes necessitate various individuals within the affected organization to alter their physical routine for the purpose of accommodating the change (Lundy & Morin, 2013). In most of the cases, the change in the behaviors of workers form the basis for any proposed change (Alasadi & Askary, 2014).

As evident in the case of the Trust, the nurses and the matrons were required to assist in the discharge of patients. Furst and Cable (2008) pointed out that organizational change does not occur automatically, and its success is determined by the cooperation between the affected people and those implementing it. Considering the case of the nurses and the matrons resisting the proposed change on the basis of the fear of the associated implications to their work was justified. This is attributable to the fact that at first, Burns and her team did not take the initiative to provide the necessary information about the proposed change, its reasons, and implications. However, using the legitimate power tactics, Burns convinced the nurses to support the initiative.

In addition, Burns through her legitimate power understood that the resistance to adopt the proposed change among the majority of nurses was influenced by their feelings that the initiative would increase their workload.

As such, Burns requested Green to carry out a study for the purpose of enlightening the nurses about the need for such a change in the organization. When provided with the right information including how such initiative would lessen the bed management duties, the nurses were willing to offer their support to the adoption and implementation of the change. The inference from this scenario is that effective communication with change agents can be very instrumental in the success of any organizational change (Nelson‐Brantley & Ford, 2016; Roberts, 2014). On the contrary, the lack of such communication increases the resistance to change among the affected individuals.

Expert Power

The knowledge and skills that an individual have define their expert power. As such, it is important for followers to see their leaders’ expertise, as well as have trust on its validity as far as the use of such expertise in solving organizational problems is concerned. To deal with the resistance of the nurses and the matrons, there was a need for the team to provide these individuals with the necessary information about the proposed change.

This aligns with the views of Thomas and Hardy (2011) that people resist change on basis of the lack of the necessary information. As such, Burns and her team used their expertise to provide the nurses with the information about the discharge situation at the hospital.

According to Green’s findings, based on a study carried to investigate the state of bed occupancy in the hospital, 17% of the hospitalized patients were in a stable condition and hence, there was no need to keep them anymore in acute beds. In addition, the team provided important information to the nurses about the waiting situation at the A&E department that was worsening with each new day. In addition, Burns and her team carried out a project that was aimed at ensuring that all the nurses and matrons were actively involved in the execution of the proposed change within the hospital. This was done through a workshop whereby all the matrons were invited to seek for their support regarding the discharge project.

Coercive Power

This form of power describes the ability of an individual to administer consequences that might not be unpleasant to a certain group of people within an organization. In most of the cases, such power has implications of punishments and threats (Singh, 2010). There were a lot of challenges witnessed by the team trying to seek the support of the physicians. In spite of this, Burns and her team ensured that all the necessary information was available for the physicians to understand why a new discharge system was needed. Such communication was effective as it led to the conviction of some of the doctors.

However, when one of the doctors remained adamant to adopt the change, Edward involved a senior physician to help in the implementation of the change. Such an approach was effective as the senior physician obliged to help in the adoption of the discharge initiative by communicating to the junior staff about the importance of the initiative. In the end, coercion was used for the change to be implemented since all the nurses were in full support of the new discharge project.

Organizational Politics

Organizational politics are inevitable in organizations and they tend to have adverse impacts on the smooth operations of any given organization. Singh (2010) noted that organizational behavior entails influential acts that are carried out for the purpose of protecting or enhancing groups’ or an individual’s interests. There were several cases at King Edgar NHS Hospital Trust during which organizational politics affected the implementation of the nurse led discharge.

For example, the resistance encountered by Burns and her team majorly from the matrons, nurses and the physicians, who are the key stakeholders in the operations of the hospital, was based on organizational politics where influence tactics were in play. This led to all the nurses and physicians failing to support the discharge project. In another instance, organizational politics was evident in the case of the use of coercion to implement the discharge project after all the nurses had showed their support.

Conclusion

As evident from the case study of King Edgar NHS Hospital Trust, the implementation of any change in an organization requires active participation of all the organization’s stakeholders, as well as the consideration of the impacts of certain changes on people.

In addition, the case study shows that the power and politics are vital elements in an organization. This is attributable to the fact that various forms of power can be used for the purpose of achieving organization’s set goals and objectives. As evident in the case of the discharge initiative at King Edgar NHS Hospital Trust, Burns and her team used various forms of power such as the coercive, expert, legitimate, as well as the reward power to ensure that all the stakeholders supported the implementation of the project. In spite of this, the analysis of the case study shows that it is important for the managers and project team in any organization to communicate and provide all the required information about a proposed change for a chance to evaluate the individuals’ reaction and perception regarding the change.

This is attributable to the fact that the extent of use of various forms of power determines their significance to an organization. Therefore, such an approach is important in that it gives the project team an opportunity to seek the support of all stakeholders for any change from the start, as well as gives the leaders the chance to evaluate which form of power would have the expected results.

References

Alasadi, R., & Askary, S. (2014). Employee involvement and the barriers to organizational change. International Journal of Information, Business, and Management, 6(1), 29.

Blois, K., & Hopkinson, G. C. (2013). The use and abuse of French and Raven in the channels literature. Journal of Marketing Management, 29(9-10), 1143-1162.

Erwin, D. G., & Garman, A. N. (2010). Resistance to organizational change: Linking research and practice. Leadership & Organization Development Journal, 31(1), 39-56.

Furst, S. A., & Cable, D. M. (2008). Employee resistance to organizational change: Managerial influence tactics and leader-member exchange. Journal of Applied Psychology, 93(2), 453.

Jansson, N. (2013). Organizational change as a practice: A critical analysis. Journal of Organizational Change Management, 26(6), 1003-1019.

Lundy, V., & Morin, P. P. (2013). Project leadership influences resistance to change: The case of the Canadian public service. Project Management Journal, 44(4), 45-64.

Nelson‐Brantley, H. V., & Ford, D. J. (2016). Leading change: A concept analysis. Journal of Advanced Nursing, 2(1), 2-31.

Oreg, S. (2006). Personality, context, and resistance to organizational change. European journal of work and organizational psychology, 15(1), 73-101.

Roberts, G. E. (2014). The SLHRM change management process and the barriers to effective change. In Servant Leader Human Resource Management (3)2, 53-69.

Singh, K. (2010). Organizational behavior: Text and cases. Upper Saddle River, N.J: Pearson Education Inc.

Thomas, R., & Hardy, C. (2011). Reframing resistance to organizational change. Scandinavian Journal of Management, 27(3), 322-331.

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