Introduction
In the context of a medium-sized NHS trust hospital in the UK, detection and solution to problems are as easy as discovering weaknesses and strenghts. Transformation of an organisation by implementation of changes in the system can be a challenging task (French & Bell, 1999).
Eventhough management and employees are aware of the positive impact of change, transforming an inefficient business operation, to one that is a model of efficiency, may invoke resistance to proposed solutions. In NHS Trust hospital, the recommended changes were anticipated to be minimal.
But in the attempted implementation of the new work programme hospital officials were not prepared for the hostile reaction of employees.
Drafting the transformation was easy. A pilot program was designed to affect a small percentage of the 2800 staff. The proposed change was focused like a laser beam to 250 people. An overview of the plan created the illussion of efficiency to managers, however, the reverse was true. People were frustrated and upset as to why management tried to fix something that was not broken.
Initial conclusions by hospital officials appeared to be substiantiated by facts. Aside from the insignificant number of people involved in the programme the change required a simplification of the process.
All workers, regardless of roles and responsibilities received training thereby equipping everyone to do similar job. Management viewd it as a simplified change, subordinates viewed as complicating their jobs. Only a few people who viewed the new proposal as a positive development to the working environment.
Arguably the porters benifitted because of the anticipated increase in revenue from the proposed change. Alternatively it can also be argued that the porters were not contented with the new deal because the task they were required to perform were demotivating. This includes cleaning the premises and rooms, a job they consider to be appropriate only for female workers.
Transformaton’s consequence is unpredictable in nature. Thus, management was faced with the challenge of convincing employees of the positive effect of change (Morgan, 1998).
In this case, change was viewed as a process that can cause “unanticipated delays, costs, and instabilities” (Chew, Cheng, & Petrovic-Lazarevic, 2006, p.59). Employees resisted the transforming process because they have to undergo a phase where they are made to feel inadequate and ill-prepared for the challenges thrown their way (Gallos, 2006).
Transformation of any organisation necessitates major adjustments in the workflow and their expectations (Bradford & Burke, 2005). The managers working for the NHS Trust hospital must be equipped for change so that they can help develop a relevant organisation that provides cost-efficient healthcare services to the community (Jackson & Carter, 2000).
This can be achieved by changing their business process. In a highly competitive environment, clients are aware that there are other of alternatives (Johnston, 2005). It is imperative that managers continue to develop ways to increase the efficiency of their organisation. Managers must be open to new strategies that enable waste reduction and increase their capacity to serve people (Huczynski & Buchanan, 2004).
Managers’ commitment to continually improve management systems must be coupled with the realisation that there will be resistance to change (Cummings & Worley, 2009). In the case of the NHS Trust hospital, managers were incapable of convincing employees that the proposed change can advance the service of the hospital. More importantly managers were unable to develop appropriate solutions to the dilemmas faced.
Organisational transformation is only possible if the following conditions are met:
- it must focus on or result in the change of some aspect of the organisational system;
- there must be learning or the transfer of knowledge or skill to the client system;
- there must evidence improvement in or an intention to improve the effectiveness of the client system (Cummings & Worley, 2009, p.1).
Organisational transformation is also synonymous to organisational development and it is defined as: “a systemwide application and transfer of behavioral science knowledge to the planned development, improvement of the strategies, structures, and processes that lead to organisation effectiveness” (Cummings & Worley, 2009, p.2).
Organizational Transformation involves changes in the organizations structure where different areas of administration are affected by the change, for example, management may increase or decrease the number of managers or supervisors (Bradford & Burke, 2005). It may target organization culture which affects everyday activities.
Maximum utilization of human potential can be achieved through education on flexibility and teamwork as a way of implementing new strategies, hence promoting healthier working relations(Cummings & Worley, 2009). In the case study, transformation was achieved from working individually to team dynamics.
Team dynamics promoted organisational development by incorporating the spirit of working together or “esprit de crops”. It is also madde possible through the process of encouraging better problem solving skills through team participation.
Organization theories focus on individual processes and shape organizations productivity trend because individuals play key developmental roles in organizations(Griffin & Stacey, 2005). Any organization unaware of its organizational goals and objectives tends to have adverse issues.
Frederick Taylor’s theories of organizational transformation set firm foundation for the managers of NHS Trust hospital to gather data about workers in order to implement developmental changes in the hospital. Division of labor amongst workers promotes responsibility and lessens the work load.
Taylor’s emphasis on laying down the procedures of carrying out specific jobs was not heeded. Taylor believed that organizations should remove or reduce the work force in order to monitor the quality of services provided.
Prior to the change there was a central pool for the whole hospital and the employee had a specific task, which created a factory setting of the same set of mundane tasks. However, it created dissatisfaction and boredom (Gallos, 2006). Another important factor was the hospital staff as they were in a central pool that lacked strong management structure.
There were no instructions given at the ward level, which created a lack of accountability (Huczynski & Buchanan, 2006). The Hotel Services were lacking a specific purpose, because of the centralization which created an in and out group with other highly skilled staff (Jackson & Carter, 2000).
Analysis
Hospital officials proposed a new work programmein keeping with management principle related to Lean Management Systems. It is a strategic tool that enables managers to increase profitability without sacrificing quality (Cartwright & Cooper, 2009). It can be argued that this strategy improves the quality of service thereby increasing customer satisfaction.
The objective was that workers increase productivity by not wasting a single hour. Management viewed the consoladation of the workforce into one single yet flexible unit could eliminate significant constraints in their business process (Bell, 2006).
Change was necessitated by the desire to achieve total quality management which forces managers to focus beyond the provision of service but on the efficiency and effectiveness of the whole system (Elsevier, 2010).
Thus, it can be argued that the goal is not only to reduce cost and increase customer satisfaction but to develop a system that aims to please all stakeholders including the employees (Elsevier, 2010). It is in adherence to the idea that the change process must directly affect the bottom line.
Managers at the hospital are aware that it is of primary importance not only to consider productivity but service quality (Johnston, 2005). The purpose of changing the process is to create a workforce that is more flexible. Managers of the hospital understood the importance of transforming a mechanistic structureinto something that can react to a particular problem at a moment’s notice.
The idea is supported by the argument: “that mechanistic structures – which rely on standardization, centralization, and hierarchy – support efficiency, whereas organic structures – with their high levels of decentralization and autonomy – support flexibility” (Elsevier, 2010, p.80).
The proposal to radically alter job requirements and qualification standards for workers has adversely affected everyone especially those belonging to the lower levels of the workforce. But a careful review of the proposed solution does not automatically guarantee a quick and efficient remedy to the problem.
It can be argued that it complicated the job and added more workload to employees. In the original system porters were only required to learn a particular skill. But in the new sytem they are supposed to learn the work of those who are under the hotel service department of the hospital.
It was supposed to simplify the process but in reality it was more complex because porters were not only required to undergo training, domestic staff were also required to learn another skill. In the case of porters, management proposed to increase their wages to encourage them to work harder and accept added responsibilities.
The problem with this solution was highlighted by the domestic staff who also receive increase in compensation but upon closer examination it was relatively lower compared to the porters. In other words they were expected to work harder but the pay increase was not significant.
Another problem that management failed to recognise was the lack of sensitivity to the needs and aspirations of workers. This can be interpreted as a weakness in human resource management (Griffin & Stacey, 2005).
The hospital should hire a qualified human resource manager in order to determine the perspective of the workers and develop a strategy based not only on the need of the organisation but also on the skills and motivation of the workers (Griffin & Stacey, 2005).
The case investigates strategies for continuous improvement mode thereby maintaining positive developments in the service provision by staff. It also highlights the importance of motivation in order to keep employees positively focused by creating an atmosphere of employee appreciation.
Organizations which have no systems to provide employees feedbacks face difficulties in implementing their work programmes. The reason is that nobody knows if they are doing right or wrong (Taris & Schreurs, 2009).
Since the hospital offers midwifery services, the majority of its employees are females. This is based on the fact that females easily identifies with issues relating to newborn babies. This keeps the organization better positioned for the work it does for the community.
The few number of males in the organization were allocated duties that they were familiar with in order to enhance quality work. This means that jobs are allocated according to individual abilities, in order for management to attain the expected efficiency and work quality. This is because people work within their areas of specialization (Morgan, 1998).
A sustainable solution to the problem must be created only after consulting all stakeholders, from government officials, to the clients and employees. It is only after carefully considering all the factors and all the perspectives of the people involved that a more realistic work programme can be created.
In the case of NHS Trust Hospital, the desired transformational change was achieved after the management retrenchedsome employees and deliberately reduced the size of the work force. The purpose was to purposefullygenerate change. This strategy of firing employees affected those who had a habit of absconding duties, and this transformed the organization completely.
This means that implementing some of the recommendations from theories formulated by Frederick Taylor reflected almost immediately making the organization achieve its transformational goal abruptly. In the ward the area of significant change was the hotel services, which include the food, cleaning and portering services. Prior to the change there was a central pool for the whole hospital and the employee had a specific task.
Another important factor was the hospital staff as they were in a central pool was lacking in a strong management structure as there was no direction at the ward level, which creates a lack of accountability. The final problem is the realisation that the Hotel Services department lacked a clear understanding of their specific purpose.
This was the result of centralization which created one group composed of highly-skilled staff mixed with others that were not properly trained. The hospital’s proposal to change the work programme raises issues that includes human resource management.
Focus on staffing in the NHS Trust hospital is imperative. Issues concerning quality improvement and ensuring value for money should be discussed. Transformation requires that employees appreciate the fact that patients use their hard-earned money to avail of health care services.
Employees are requested to work in accordance to the expectations of the hospital in order to retain patients in a healthy manner and build the goodwill of hospital. The element of trust must be fostered so as to retain and maintain client loyalty.
The issue of staff turnover is addressed in order to identify the causes. Scientific-rational approach argues that human beings are economic beings hence they should be treated in a manner befitting their status and nature (Griffin & Stacey, 2005).
In 1978 Max Weber’s theory provides some important insights into management. He stresses the importance of hierarchy and accountability within the organizational structure for employees (Gane, 2002).
Weber’s theory emphasises more than a lineal interaction between the management and employees (Gane, 2002). Weber’s theory argues that “management is made up of wertrational – value orientated rationality and zweckrational – goal orientated rationality” (Gane, 2002, p.194). Therefore there needs to be additional aspects to work programme proposed by the NHS hospital.
It is important to eliminate the dictatorial stance employed by present managers. There must be techniques to support the promotion of positive values, goals and motivation. The change aimed to devolve all portering and domestic staff to ward level. They would be multiskilled and consequently able to undertake a full range of domestic and portering roles, including cleaning, transporting patients, moving equipment and serving food.
The key notion that Weber developed in order to balance out the inherent inequalities is that of the rationalizing of the organizational structure where those who benefit the company and follow rules and procedure enjoy incentives; whereas those who breach rules are punished.
Hence if the values of the company’s structure and the goals of the employee can be rationalized and de-mystified, then, a satisfied and motivated workforce can be instituted to achieve the best organizational structure.
In order to do this there needs to be a structure which ensures that at the higher the level of management, there is a higher standard of care and duty. It must be seen in the transparent structure of management for specified wards and a variety of tasks for the staff within the organizational structure.
Weber realised that the individual is the key because rationalisation can help him understand his work environment. Therefore rational management of individuals is important, to limit the emotions and interests of the management in respect to the rights and goal of company in general and the individual in particular (French & Bell, 1999).
This process must be approved in order to to create a system of fairness, transparency and accountability for the employees.
A small management team comprising the Director of Site Services, her deputy and the managers of domestic and portering staff fine-tuned, customised, and planned the implementation of this initiative. The new approach understood the lack of transparency and accountability.
However, it also opens the hospital to liability, especially in the highly publicised problems with cleanliness, food quality and disease control within the NHS. This problem was put to light because of the highly efficient regulatory system in society (Griffin & Stacey, 2005).
The NHS was subjected to more scrutiny. There was concern that employees were cutting corners due to the lack of control and accountability. There was a high price to pay for this indiscretions. They have to realise that the hospital operates using tax payers’ money (Gallos, 2006).
The new approach understands the problem with non-compliance of duties of management,from the line manager of hospital services to the hospital directors, rooted in the lack of strong management structure (Cummings & Worley, 2009).
The result of the process is the lack of organisation and the absence of effective control by an accountable and efficient manager. As a result the legal liabilities of the company increased (Bradford & Burke, 2005). This is because without a responsible and reliable individual managing the situation, employees predictably cut corners. In other words the lack of organisational development placed the hospital in great peril.
There were problems regarding unreliable delivery of healthcare services. Other issues concern the possibility of privacy violations and the inability of the hospital to protect personal information of the patients. This would put the NHS hospital and the NHS as a whole, in a difficult position if safety guidelines were not kept. This may result in a scandal if laws are breached.
In the event of breach of protocol, the hospital is liable, because as a public service the NHS owes a duty to provide high quality care to tax payingmembers of the community. The new approach underscores the problem of accountability and transparency in the management structure.
A single employee’s actions can open up the company, managers and the individual to civil and criminal liability. Therefore, an appropriate management structure needs to be adopted to ensure accountability and efficiency in the organization. Furthermore, thse changes must create job satisfaction.
In any organizations, absenteeism arises because people have different issues which results in non-attendance to their jobs. Managers are expected to appreciate and address these diverse factors including family issues, which results in absenteeism. Addressing issues can reduce conflicts in the worklplace.
On the other hand, honesty and following the right channel of communications when it is time to explain a valid excuse for being absent in work is essential for an effective management of the organisation. Communication gives employers a chance to reschedule duties ensuring no gap left unfilled (Cummings & Worley, 2009).
Recommendations
In the world of business and management it is important to understand how to increase the efficiency of an organization (Gallagher & Tombs, 1997, p.286). An efficient workforce for instance means a highly-profitable business venture (Gallagher & Tombs, 1997, p.286). It can also mean an effective organisation able to accomplish its goals (Watson, 1995, p.248).
A company composed of productive workers can manufacture products and provide service at lower costs as compared to an organisation with disgruntled workers (Gallagher & Tombs, 1997, p.286). It is therefore the goal of every business leader or entrepreneur to maintain this high-level of productivity (Taris & Schreurs, 2009). It is therefore crucial to consider the fact that a satisfied worker is an efficient worker.
The officials of the hospital must acknowledge that they failed to deal with significant aspects of business operation. They failed to consider the human element in the creation of an innovative strategy. The proposed alternative business process can easily result in a burnout because of three major reasons:
- job demands;
- job control;
- social support (Tarris & Schreurs, 2009, p.125).
It was discovered by many managers that if there is high demand, low control and low social support then there is a higher tendency for employees to be dissatisfied with their work (Barrick & Ryan, 2003). In this particular case workers were forced to do something that they feel they have not mastered. Others also felt that they were asked to do something that they are uncomfortable with.
The managers quickly interpreted it as insubordination but viewed from another perspective there are valid reasons why many workers did not vote for the implementation of the new work programme. Consider for instance the issue regarding job satisfaction. The members of the domestic staff were already working on the same assignment for many years.
They have mastered the type of work that was assigned to them. But more importantly they developed a certain kind of pride to their contribution to the company (Cartwright & Cooper, 2009). With the new work programme they can no longer say that they are the best cleaners in the organisation because everyone are now expected to clean.
Emotional exhaustion (Taris & Schreurs, 2009) set in because the workers could not express what they truly felt regarding the new strategy. The inability to address emotional exhaustion can lead to higher employee turnover (Dube, 2003). The employees will also experience burnout if they feel that they did not receive appropriate emotional support from the organisation (George, 1992).
It is therefore important to provide open communication channels so that the hospital adminisrator would be able to determine the thoughts and other inputs that the employees would like to communicate to the management team.
It is also important to establish a correct corporate culture (Watson, 1995) within the said hospital. The managership base must be strong. A strong leader is needed not just only efficient managers. There is a big difference of having a great leader and a great manager (Cavaleri, 2005). A good leader will be able to bring the organisation to a higher level of improvement.
At the same time a good leader can ssee what has to be adjusted and can persuade the people to follow his vision of a new business operation or strategic approach. A good manager on the other hand can effectively and faithfully execute the strategies laid down by the managership. Thus, it is important to strike a perfect balance between effective management and effective managership (Cartwright & Cooper, 2009).
The use of a knowledge and information management system can help eliminate human errors in collecting, sorting and accessing data (Cavaleri, 2005). For instance, instead of using paper and ink, the device can record information regarding the work completed by a particular employee. The obvious consequence would be heigthened efficiency (Cartwright & Cooper, 2009).
Furthermore, the information collected through Information Technology is more superior to the manual system used since the beginning of human history. In this particular process there is little chance of loss of data especially if the hospital will hire professionals who will handle their management information system department.
In a switch of a button the managers of the NHS Trust hospital can immediately access pertinenet information regarding their human resources. The most important feature of the data management process that must be addressed is the one concerning collection of information, storage and security of the same.
Thus, it is imperative to invest in the the kind of data management software that can store, process, and provide easy access to information. This in turn can greatly affect the decision-making process of the management team of the said hospital.
The hospital administrator must also invest in technology that can help them provide feedback to their workers (George, 1992). The employees must be able to know the end result of the evaluation process made by the hospital administrators and other members of the management team. In this way there is an effective feedback mechanism that serves as a corrective measure for unwanted behavior.
Without this system then employees will continue to believe that their performance was acceptable to their superiors. As a result there is no way for them to change their ways in order to contribute to the improvement of the healthcare service that the hopsital provides to the community (Raisch & Birkinshaw, 2008).
The use of information technlogy to measure the progress of each individual with regards to training and other learning process can help in the need to achieve a certain competitive advantage. Information technology can help them track their goals and as a result they will be able to monitor their productivity.
In this way the management team handling the human resource aspect of the hospital will be able to determine the exact cost per employee and calculate if the resource allocation for a particular employee can be translated to productive behaviour.
Conclusion
The management of the hospital were ill-advised regarding the correct way of developing strategies that can lead to positive organisational transformation. They developed a solution without properly consulting the stakeholders affected by the innovative strategy. They failed to recognise that even if they had created a new way of doing things the employee union can easily derail their plans.
If they spent time to persuade the managers of the employee union and other influential people linked to the organisation then they would have a greater chance for success. At the same time they did not use all resources available for them and as a result they developed a solution to a problem that was not acceptable to the workers.
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