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Organisation Development Initiative: West Bravenhurst NHS Trust Case Study

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Updated: Jun 25th, 2022

OD Initiative

The case study of West Bravenhurst NHS Trust explores an intervention that involved the organizations’ nurses and their performance. It can be argued that this project represents an Organisation Development (OD) initiative. First, it is necessary to understand what OD is, including its primary expressions and processes. Scholars offer many definitions of the term ‘OD’; however, they all focus on a number of its characteristics. According to Sharp (2018a), OD is a practice of adapting where OD specialists focus on improving the internal processes of an organization in order to support its advancement and growth. Roper (2018) provides another definition, stating that the concept of OD is complex and describing it as an investigation into the parts of an organization and their interconnectedness in order to create specific conditions for organic growth. One can see that the main aim of OD is to help a business entity outside of the individual ideas of human resources or technological innovation. The approach of OD is systematic- addressing the connection between various organizational departments and their impacts on each other.

The focus of OD interventions depends on the type of organization they target. For instance, manufacturing plants that want to implement more automated processes need to understand which organizational resources that require and how these materials or service have to be distributed (Sharp 2018a). Here, the maximization of value that can be extracted from each source is put under investigation. Apart from that, OD also contributes to the development of a firm’s purpose, goals, and strategy (Sharp 2018a). This part of the process is linked to organization design that reviews the needs and wishes of a company and creates a model in which all objectives can be achieved in the most efficient way (Sharp 2018b). If a company fails to incorporate its goals or purpose into its innovation, it may lose focus and encounter other problems.

In cases where OD is utilized in organizations operating with people rather than machines, this approach applies human resource knowledge that relates to behavioral sciences. Aside from pay, benefits, and duties, people require non-financial incentives, motivation, and teamwork to feel accomplished and satisfied (Casey et al., 2015). Here, OD works to improve a business’s processes on the basis of people’s behavioral patterns and group dynamics. Finally, it is important to note another characteristic of OD – continuous improvement (Sharp 2018a). The aim of an OD initiative is not to introduce changes that produce a temporary solution to a company’s issues. In contrast, OD hopes to implement systematic change that will encourage further initiatives and allow organizations to enjoy gradual growth with new projects.

Using the presented definition of OD, one can apply it to see whether the intervention at West Bravenhurst NHS Trust can be considered an OD initiative. First of all, the main aim of the trust’s program was to enact change. It is stated that nurses met to work together and identify problems in the current processes with the intention of introducing change. It is clear that the organization wanted to improve the performance of its nursing staff and deliver better care to patients. This description of the program’s purpose aligns with the primary objective of OD initiatives (Sharp 2018a). As mentioned above, OD’s central goal is the improvement of the current organizational practices.

The next feature that shows similarities between the OD approach and the trust’s actions is the structure of the latter’s activities. The NHS Trust established a definite system of actions for the nurses and managers. The first step was to collaborate with other professionals to collect information and identify which problems exist in the organization. After that, the same professionals were taught how to use multiple analytical tools that aid one in developing improvement practices. Finally, new initiatives were not only introduced to the trust but also evaluated based on their effectiveness and nurses’ opinions. A transparent course of action is what OD programs utilize when implementing change in organizations (Burton, Obel & Desanctis 2011). To conclude, the course of the trust’s actions is the same as that for other possible OD initiatives.

However, one may argue that, while the NHS Trust was focused on change, if its actions were not systemic, it could not be considered an OD project. In this case, it is necessary to consider how the organization approached its need for change. The case shows that the nurses were recruited to discuss such issues as patient satisfaction, clinical ineffectiveness, and stakeholder’s input. Nonetheless, apart from addressing these concerns, the intervention also acknowledged the hierarchy that existed prior and restricted nurses’ voice in all organization conversations. Nurses provided feedback and were directly involved in changing the company’s structures and policies, revealing their professional competencies as well as using the newly acquired knowledge. As a result, the employees felt empowered and confident in their roles as healthcare providers and leaders. Such a strategic inclusion of nurses and their change in self-perception is systemic – it overcomes the divide between professional and personal outcomes and acts to improve both patient and nurses’ satisfaction.

The NHS Trust’s intervention is not only systemic but continuous as well. One of the principles that OD is based on is its commitment to ongoing improvement. OD specialists try to introduce practices that allow organizations to evolve according to the changing needs of their stakeholders as well as their environment. As the trust introduced such tools as stakeholder analysis to the nurses, it encouraged them to re-examine their relationship with the most important contributors constantly. Stakeholder analysis can be viewed as foundational to continuous change since it is dynamic and flexible in nature (Hörisch, Freeman & Schaltegger 2014). If nurses adhere to the practices that they learned during the program, they will think about new ways of delivering the best care. Moreover, the nurses’ increased commitment to the organization and their profession can also have an effect on sustained growth.

Organization Culture

The OD initiative implemented by West Bravenhurst NHS Trust likely had an impact on the organization’s culture. Organizational culture is a combination of values, beliefs, and communicational methods that form a company’s environment (Körner et al., 2015). Culture’s characteristics depend on several factors, including the type of industry or business in which an organization operates, customs of workers and employers, internal rules (both written and unwritten), and many others (Pacanowsky et al., 2017). For instance, in healthcare, organizational culture can be influenced by the hierarchy between different professionals, the clinic’s aims, and the leaders’ attitude towards subordinates. These aspects may form a setting that is formal or informal, hostile or friendly, collaborative or competitive. Organizational culture is crucial for every organization because it explains how workers will act in different situations and what potential does a company has for growth.

To see how an intervention can be effective, one can distinguish three levels of organizational culture. The first one is artifacts – it is a set of norms that are visible to all individuals (Giancola 2011). For example, uniforms are present in many industries, including healthcare, and their existence is often not questioned. The second level is espoused values, combining conclusions, philosophies, and objectives that the company introduces to its employees (Giancola 2011). These may relate to specific business strategies, standards, operations, and formal communication. The third type of culture is basic assumptions that constitute the essence of the organization’s environment (Giancola 2011). These values and opinions are not as transparent as those presented by the business since they form with time, being influenced by employees’ personal and professional beliefs. Such assumptions are difficult to change because they are inherent to employees’ attitudes. The three levels define culture, and their disbalance leads to internal problems.

One of the approaches to OD projects that have a positive impact on organizational culture is the 7S model. Introduced by McKinsey, the 7S framework considers seven factors that contribute to a company’s harmonious performance. These elements are separated into hard ones (strategy, structure, and systems) and soft ones (shared values, skills, style, and staff) (Ravanfar 2015). The first group of these aspects is called ‘hard’ because they are easy to describe and influence, while ‘soft’ elements are obscure and intangible, having a bigger influence on culture. McKinsey’s model demonstrates that all seven factors are interconnected, and a change in one of them can affect others. Shared values lie at the center of this framework since their establishment and improvement are crucial for an organization to improve both its culture and performance (Ravanfar 2015). As previously explained, employees’ opinions and behaviors can significantly change how the environment evolves. The 7S model demonstrates how an intervention targeting one or several of such aspects can completely change the whole company.

In the present case study, the previous experiences of nurses show numerous issues with the trust’s organizational culture. The staff commented on a rigid hierarchy in which nurses did not have any voice when discussing the organization’s processes. Managers did not acknowledge nurses’ problems, and their training was not emphasized as necessary for their careers. As a result, it becomes apparent that the person worked in a setting that did not encourage them to improve or even participate. It is possible that this lack of attention contributed to the employees’ basic assumptions that the trust did not care about workers’ well-being and success (Mohrman 2007). As an outcome, many nurses expressed a desire to leave both their job and their profession. The staff also did not exhibit any leadership characteristics, which affected their interpersonal communication and collaboration with other professionals. The dissonance between artifacts, which likely were presented as strict rules for nurses to follow, and the personnel’s dissatisfaction with their job halted innovation and improvement.

The OD intervention improved the organization’s culture in multiple ways. Applying the 7S model, one can identify that almost all elements of the trust underwent a change. The strategy to maintain a competitive advantage was shifted to include employees in the decision-making process. It is known that the core activities in the program were nurses’ collaboration and training. As an outcome, the new approach influenced nurses’ skills in leadership and communication as well as created systems for specialists to cooperate on a daily basis. It should be noted that the change was met with no resistance, revealing workers’ desire to challenge the existing hierarchy. While the description of the improved structure is not detailed, it is apparent that nurses started to feel more represented in the trust, and their channels of communication became direct and accessible.

Hence, the main element in the framework – shared values – was influenced as well. Nurses commented that the program reminded them of the aims and purpose of their profession. It raised job satisfaction levels, reduced conflicts, and improved the overall morale of the staff. In response to the implemented change, nurses showed interest in participating in the organization’s activities, greatly enhancing its performance and patients’ experiences. The OD intervention contributed to the creation of a new culture in the trust. It is now based on nurses’ knowledge, experience, and commitment to healthcare provision. Notably, employees also addressed various hospital policies and structures during the initiative. It is known that they used collaborative effort to reduce barriers to change. Their expectations for the job changed, thus influencing the organizational culture and improving the balance between artifacts, the company’s values, and workers’ assumptions.

Implications and Recommendations

The discussed OD intervention shows the importance of organizational design and development for companies. In this case, the program’s adherence to OD principles led to a substantial change in all aspects of the trust’s performance. The strengths of the initiative included its focus on structure, collaboration, skill attainment, and personal growth. The OD of this company had many weaknesses before the intervention. Its communication with and among nurses did not have clear channels, limiting workers’ contribution to the organization. The past design of the trust was vertical, and it lacked horizontal overlays for better communication (Anand & Daft 2007). As a result of the program, all staff members now know that their opinion has some weight. Furthermore, the previous structure did not favor collaboration from nurses adequately, leading to them feeling discouraged and unorganized. Their readiness to work together reveals that the previous practices did not encourage OD and did not perceive systemic problems within the trust.

The lack of personal improvement and positive cultural values is also identified in the company before the OD program. The environment was tense and negative, putting additional stress on nurses without supporting them with additional bonuses or influential leadership (Brady & Rohde 2015). It becomes clear that nurses were not asked to provide feedback through surveys or consultations. The organization did not embrace a learning approach before the intervention, which staggered their ability to innovate (Burnes 2004). In contrast, the new initiative paid attention to these aspects, greatly improving OD in the company.

The implications of this initiative for OD as a strategy are that human resource (HR) professionals can considerably benefit from educating themselves in the field of development and design. It also reveals the lack of companies’ interest in continuous improvement, which is only taken into account when the staff is experiencing serious mental hardships related to their profession. Thus, the effectiveness of OD remains unrecognized by some employers and managers (CIPD Podcast 2018). The current skills of HR specialists are limited to separate aspects of people’s jobs. Additional knowledge of OD uses such abilities as a base, providing specialists with an insight into the connection of all elements of a business. HRs should examine the change management strategies that incorporate both resources and systemic ties between employees, managers, clients, and the organization’s resources.

The intervention in West Bravenhurst NHS Trust followed several organization design principles that can be used in future OD projects. The company rejected the older structure when nurses revised their barriers to change, thus avoiding unnecessary comparisons to the old model (Neilson, Estupiñán & Sethi 2015). The trust focused on areas that were under their control, paying attention to stakeholder analysis and nurses’ commitment to the organization and their profession. Moreover, they utilized their strength, employees wanting to receive additional knowledge instead of searching for other ways to maximize performance. As a result of the trust’s decision to change the organization’s culture organically, the values of the organization came in balance with those of its major stakeholders.

While the OD intervention had a substantial positive effect on the organization, some recommendations can be provided for future changes. First of all, it is vital for the trust to continue following OD-based models. As noted above, OD’s main feature is that it encourages continuous improvement. The trust’s relationship with nurses and clients will not stay positive if it fails to incorporate new strategies or follow the changing needs of stakeholders. To achieve constant change, the business can educate its current HR specialists on how to adopt OD practices. It can also continue working with nurses, approving their desire to grow professionally through new programs, benefits, and promotions. It is possible to include nurses in a committee with HR professionals that would think about new OD interventions. Interprofessional collaboration increases the outreach of its members as well as their understanding of organizational systems (Brady & Rohde 2015). These steps will support the trust’s current strategy of innovation.

Another possible addition to the plan is an introduction of the balanced scorecard (BSC). The use of this management system was not mentioned in the case study. According to Zizlavsky (2014), the BSC is a tool for strategic planning that allows organizations to demonstrate their objectives in a single framework with daily actions, key performance indicators (KPIs), and priorities. The trust will benefit from documenting its values, goals, and strategies in a BSC since this document provides managers with a perspective for the future and shows how internal processes should be organized.


The program introduced in West Bravenhurst NHS Trust can be considered an effort in organization development. The idea of OD is challenging since it requires HR specialists to consider all factors that may influence a business, applying system-wide solutions and encouraging continuous change. According to the main OD principles, the intervention was focused on constant and systematic improvement that benefited all elements of the organization. In this case, the trust acknowledged its imbalanced relationship with nurses, providing the latter with tools and knowledge to assume responsibility. As a result, the OD initiative led to a significant shift in the organizational culture and helped nurses to regain confidence.

Reference List

Anand, N & Daft, RL 2007, ‘What is the right organization design?’, Organizational Dynamics, vol. 36, no. 4, pp. 329-344.

Burnes, B 2004, Managing change: a strategic approach to organisational dynamics, 4th edn, Financial Times Prentice Hall, Harlow.

Burton, RM, Obel, B & Desanctis, G 2011, Organization design: a step-by-step approach, 2nd edn, Cambridge University Press, Cambridge.

Casey, M, Fealy, G, Kennedy, C, Hegarty, J, Prizeman, G, McNamara, M, O’Reilly, P, Brady, AM & Rohde, D 2015, ‘Nurses’, midwives’ and key stakeholders’ experiences and perceptions of a scope of nursing and midwifery practice framework’, Journal of Advanced Nursing, vol. 71, no. 6, pp. 1227-1237.

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Mohrman, SA 2007, ‘Designing organizations for growth: the human resource contribution’, Human Resource Planning, vol. 30, no. 4, pp. 34-45.

Neilson, GL, Estupiñán, J & Sethi, B 2015,, Strategy+Business, Summer, no. 79, Web.

Pacanowsky, M, Arsht, SS, Mackey, A, Baxter, BK, Banks, L, Henage, RT, Ingle, P, Manship, J, Martin, A, McGovern, JM & Scott, A 2017, ‘Employee voice: foundation to the scaffolding of CHG Healthcare’s culture journey’, Organizational Dynamics, vol. 48, no. 1, pp. 16-27.

Ravanfar, MM 2015, ‘Analyzing organizational structure based on 7S model of McKinsey’, Global Journal of Management and Business Research, vol. 15, no. 10, pp. 7-12.

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Zizlavsky, O 2014, ‘The balanced scorecard: innovative performance measurement and management control system’, Journal of Technology Management & Innovation, vol. 9, no. 3, pp. 210-222.

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