Human beings are resistant to change. In fact, most individuals always want to maintain their status quo. However, in a rapidly changing environment, change is inevitable. Change management is a thoughtful implementation of strategies and tactics with the aim of transitioning individuals, teams, and organization by redirecting the use of resources, business processes, and various modes of operations. This report is on the change management at the NHS, UK. It focuses on the challenges faced in the replacement of the Primary Care Trusts (PCT) with general practitioners (GP) organizations called Clinical Commissioning Groups (CCGs).
The replacement of PCT by CCGs will affect the decision-making process and how finances are spent by the NHS. The PCT control on expenditure accounts for 80% of the finance spent by NHS and mainly focused on the cash spent by dentists, hospitals, medical tests, and in medicines. However, the changes in the management of NHS will result in a transfer of 60% of the cash to CCGs. According to the NHS, the general practitioners are in a better position to determine how finances are spent since they have a clearer understanding of the patient’s needs. In decision making, the CCGs will replace the PCTs in deciding the hospitals care that they should pay for the GP. Due to the reconfiguration of the NHS operations, there will be difficulty among various stakeholders on how to adapt to their new roles.
Force Field Analysis
A force field analysis on the factors that affect the change in NHS was done by listing, discussing, and evaluating various issues that emerged after the reconfiguration of its operations (Connelly). In this regard, the force field analysis was drawn by considering the driving and restraining forces that affect NHS. Below is the Force Field Analysis for NHS, UK.
Table 1: Force Field Analysis for NHS, UK
|Driving Forces (Pros)||Rate||Changes||Restraining Forces (Cons)||Rate|
|· The CCGs are led by GPs who are more responsive to the needs of patients.
· GPs are able to have a better estimate of the budget needed in these facilities because they have a direct contact with the hospital.
· Having GPs at the senior decision-making levels in NHS has eliminated unnecessary bureaucracy.
· The new system has a regulator called Monitors who will ensure that competition in the private sector does not affect the quality of service offered to patients.
|· The PCT was replaced by CCG’s in decision making and determination of finances are spent by NHS.
· There was the introduction of Monitors to ensure there was healthy competition in the health sector.
|· GPs lack managerial skills needed for their work in CCG since they are trained on healthcare and not organization management.
· Proper estimation of the health budgets requires analytical and financial skills that most GPs lack.
· There is the possibility of a conflict of interest since CCG is composed of GPs and yet it is charged with the duty of deciding the hospital care they should pay for CCGs.
· The involvement of GPs in decisions of CCGs may compromise on the doctor-patient relationship due to financial costs involved in running CCGs.
|TOTAL RESULTS||30||TOTAL RESULTS||27|
Methodology for Force Field Analysis
This section gives a detailed view of how the force field analysis was conducted with an aim of developing the most appropriate strategy for NHS, UK. In terms of scoring, weights of between 1 and 10 were used for each factor. 1 indicated the factor with the lowest impact while a score of 10 showed the factor with the highest impact. Accordingly, the greater the weight, the more impact it had on NHS. Total results were the sum of the weights of each factor. The “driving forces” had better results, at 30, while restraining forces had 27.
Explanations for the Chosen Weights
“The CCGs are led by GPs who are more responsive to the needs of patients” had a weight of 8. This high score was because medical personnel are better positioned to determine how the needs of patients can be addressed than managers. In addition, their direct communication with patients puts them in an advantaged position of understanding the social and public health factors that may be the cause of their ailments. The direct relationship between GPs and patients also enables them to respond much quicker to the needs of patients than PCT.
“GPs are able to have a better estimate of the budget needed in these facilities because they have a direct contact with the hospital” had a score of 6. Although the closeness of GPs with the health facility gives them the advantage of knowing the infrastructure, equipment, and medication that are needed in hospitals, these individuals do not have adequate knowledge on procurement laws. Since the decision of determining the appropriateness of various healthcare infrastructure, equipment, and medicine is best determined by a health professional, this factor was considered to be a driving force. In addition, the quick communication of these issues is essential in determining when the NHS addresses them. Based on the pros and cons of having GPs report these issues, a weight of 6 is the most appropriate.
“Having GPs at the senior decision-making levels in NHS has eliminated unnecessary bureaucracy” had a score of 7. The replacement of PCT by CCGs meant that decisions of NHS will be made much quicker since GPs will easily and quickly table out their opinion in the CCGs meetings. As a result, there will be quick decision-making by the NHS. The only undoing is the fact that CCGs lack individuals from various professionals such as engineers, financial analysts, and researchers who can give advice on technical aspects faced by NHS. Therefore, there is a possibility that the CCGs may make inappropriate decisions due to the lack of appropriate managerial and technical skills. With this regard, a score of 7 is appropriate since it was the right balance between speed and accuracy of decisions made by CCGs.
“The new system has a regulator called Monitors who will ensure that competition in the private sector does not affect the quality of service offered to patients” had a score of 9. The introduction of Monitors into the new system is a great improvement in the operations of NHS. In particular, these individuals will ensure that there is no compromise on the quality of healthcare offered by both public and private institutions. However, just like other organizations, it has externalities which are cost and interferences on operations. The Monitors will lead to an increase in the NHS financial expenses. In addition, they will interfere with the smooth operations of GPs, public health facilities, and private health care centers as they carry out their monitoring work. Due to the aforementioned, this factor has a weight of 9.
“GPs lack managerial skills needed for their work in CCGs since they are trained on healthcare and not organization management” had a weight of 5. The lack of proper managerial skills was one of the main undoing for the involvement of GPs in CCG. Although the GPs do not have training in management, basic managerial skills are taught in the health care course. In addition, most GPs have undertaken private courses on management for their own private business. Since the management of a healthcare institution like NHS should have individuals who have technical and analytical skill, the excessive concentration of GPs in the CCG, which controls a major proportion of NHS budget is a limiting factor. In consideration of the above factors, a weight of 5 caters for these issues.
“Proper estimation of the health budgets requires analytical and financial skills that most GPs lack” had a weight of 6. The CCG is entirely made up of GPs who lack analytical and financial skills needed in the preparation of the health budget. Since one of the roles of the CCG is the preparation of the budget and determination of finances to be used in various health care projects, the lack of these skills is a serious shortfall. Nonetheless, the CCG can outsource these skills from various departments of NHS. However, this will result in inefficiencies on the side of NHS. With this regard, a weight of 6 is appropriate.
“There is the possibility of a conflict of interest since CCG is composed of GPs and yet is charged with the duty of deciding the hospital care they should pay for CCGs” had a score 8. Given that GPs are directly involved in the provision of health care, they may have self-interest when passing resolutions on matters that directly affect their activities. Despite this risk, only the GPs are in a position to have an in-depth understanding of the patient’s needs. Due to these issues, a weight of 8 is the most appropriate.
“The involvement of GPs in decisions of CCGs may compromise on the doctor-patient relationship due to financial costs” had a score of 8. The conflict of interest created by the GPs when making decisions on healthcare at the CCG has a risk of influencing the doctor-patient relationship. In particular, the issue of finance such as compensation paid by NHS on some health issues can influence the willingness of healthcare workers to treat certain ailments. With this regard, this issue has a score of 8.
Management Approach for Implementing the Change
According to Lewin, the change process involves three main steps; unfreeze, change, and freezing. These stages simply indicated the common process that organizations must go through before they fully implement a change (Luthans 127-132). Unfreeze simply refers to the stage when individuals understand the need for change and acquire the urge and drive to implement appropriate policies. The change step refers to the implementation of the desired systems and processes. Finally, freezing refers to the enforcement of the desired changes (Harwell 7-9). To achieve the desired change, the Kotter’s eight step model will be used to establish the strategy that should be used by NHS. Importantly, this strategy ensures that the change process is smooth and orderly.
In the first stage, the NHS should increase the urgency for change by informing all stakeholders on the need for a new healthcare system. To achieve this objective, the NHS should highlight on the inadequacies of the former system. In particular, it should mention the passive role of the GPs in making decisions on health yet they are primary stakeholders in the healthcare sector. In addition, it shoul discuss about of the long and bureaucratic process at the NHS that has resulted in poor quality health services. Finally, it should mention about the lack of a monitoring department that ensures the health care system is competitive and open so that there is no compromise on the quality of health care offered in hospitals.
Build the Guiding Team
Having developed the urgency for change, the NHS should build a team of skillful individuals who will implement the desired changes. In particular, there should be the development of a team of skillful and experienced GPs who will spearheaded the development of CCGs. At the same time, individuals who worked in the PCTs should be transferred to their respective departments in the CCGs after the reorganization of the NHS. The guiding team should also be trained on team management to enable them guide their members in an appropriate manner.
Get the Vision Right
The teams spearheading the change should be given a clear insight of the vision of the re-organized NHS. In a particular, they should be informed that the NHS aims at providing quality but affordable health care to all individuals in the UK. Further, the NHS should state that it aims at ensuring that it wants the decision-making process to be quick, transparent, and accurate. When emphasizing on the needs for accessible and affordable health care, the NHS should state the importance of GPs participation in the CCGs, especially whe making decisions that relate to health care.
Communicate for Buy-in
After ensuring all the major stakeholders have a vision of the goals and objectives of NHS, its next strategy should be communication for buy-in. In this strategy, the NHS should communicate its changes to the public in order to make them aware of the steps and strategies that it is implementing. In addition, the communication of the changes that NHS is making enables the public to welcome this new structure and to familiarize themselves with the new structure. The NHS should use the public media and its website to indicate the changes that it is implementing. This strategy will play a critical role in ensuring the public is aware of the changes in the health care system. In addition, it will enable the public to have trust in the new system.
The NHS should also empower all stakeholders so that they can freely incorporate their inputs in the new system. In particular, the NHS should recognize the roles played by individuals in the implementation of its strategy. As such, it should give various individuals the responsibility of overseeing specific changes in their team. Interestingly, these roles will empowered the team leaders to input their creativity and energy in the development of a working system.
Create Short-Term Wins
The NHS should create both short term and long term goals for the project. To ensure that the NHS is successfully re-organized, the organization should use a phased system in the implementation of its goals. For example, it should first train the leaders who will in turn oversee the implementation of the changes in their own teams. This systematic approach will ensure that the NHS achieves its long-term goal of eventually restructuring the national health care system.
Don’t Let UP and Make the Change Stick Steps
To ensure there is permanence in the new system, the NHS should recruit, train its employees, and consistently revise and improve its system. Through training and practice, the GPs will become familiar with the working of the CCGs. The NHS will also promote this new system via the radio and social website so that the public is familiar with how the new system works.
The action plan will enable the organization to achieve its vision and objectives. The NHS, UK action plan will ensure there is a smooth transition in the way it carries out its activities. Specifically, it will ensure there is an orderly transition of the activities carried out by PCT to the CCGs. The CCGs will also be trained on how to make decisions that affect hospitals, health care workers, and health care infrastructure. The main activities that will be involved in the action plan are the training of GPs in order to facilitate a coordinated restructuring of the NHS. There will also be the recruitment of employees, the financing of the new system, and the establishment of the monitoring department.
Training of GPs
The main activity will be the training of GPs on their role of setting up the CCGs that will replace the PCT. Notably, the main change in this new system is the replacement of the PCT by the CCG. This process will enable the restructuring of the NHS. The chief operating officer at the NHS and his department will be the one involved in the training process. Since these individuals are aware of all activities of the NHS, they will be able to equip the GPs with the skills that they require for their new roles in the CCG. The training process will be done for 1 month in the organization’s headquarters. The NHS will communicate to the GPs on this training through public media, social media, and personal e-mails to GPs.
Recruitment and Transfer of Employees
The NHS will also recruit new employees for the vacant positions that will be created by the restructure of the NHS system. For example, there will be need of an office that will coordinate all the activities of CCGs. There will also be a need for individuals with various technical skills that GPs do not have for the effective management of CCGs. Employees who used to work in the defunct PCT will be transferred to their respective positions in the CCGs. This process will be done by the NHS human resource department. It will be conducted for one month immediately the re-organization process starts.
The financing of the re-organized NHS will be crucial for its survival and existence. The financing will be done NHS department of finance. The CCGs that will be established to replace PCTs will get direct funds transfer from the NHS finance department. Once they have been fully established, the transfer of funds to the PCTs will end. This process will take 4 months before it is fully operational. The reason for the long implementation process is to ensure that the CCGs are fully operational before they start getting access to all the funds under their control.
The new Monitoring team will be essential for ensuring that quality health care is offered by the public and private sector. The human resource department will establish these team. It will recruit competent officers who will monitor the health care activities in the country. The establishment of this new department will take 4 months and will entail recruitment, training, and equipping of these individuals with essential tools for their work. The department of finance will also allocate funds for this department. The recruitment process will be communicated through the radio and local dailies.
To sum up, the change management process of the NHS aims at ensuring there is a smooth transfer of roles on decision making and finance management from the PCT to the CCGs. This transfer will ensure that the health care system is managed by individuals who have a clear insight and knowledge of the issues in the country’s public health system. In addition, the introduction of Monitors will ensure there is the provision of quality health care by all stakeholders. In this regard, the new NHS health care system will result in quality and affordable health care in the country.
Connelly, M. The Kurt Lewin Change Management Model. 2016. Available from: http://www.change-management-coach.com/kurt_lewin.html
Harwell, S. ‘Impediments to Change: An Application of Force-Field Analysis to Leader Master Teacher Training in an Elementary Level Science Systemic Reform Initiative.’ Journal of Elementary Science Education, Vol. 12, No. 2 (Fall, 2000), pp.7-19.
Luthans, F. ‘Successful vs. Effective Real Managers.’ The Academy of Management Executive (1987-1989)¸Vol. 2, No. 2, pp. 127-132.