Posted: February 15th, 2022
Leadership and Change Management
Name of Student
Course Name and Code
Investigation of the Case Scenario. 5
Causes and Triggers for Change. 6
Types of changes encountered. 9
Analysis of the change situation. 12
A case of square Pegs and Round Holes
The Government’s reforms of the NHS are part of a more comprehensive reform plan that aims to create a more open, autonomous, and responsive system. Alongside the shift in commissioning structure, structural reform measures include service regulation and governance, financial capability and transparency, and public accountability. The coalition government has given responsibility for public health and social care to these groups following warnings that there is a growing financial crisis in the NHS (Anderson, 2016). This means they will decide who provides what services, how they are provided, and who pays for them. The role of CCGs is to ensure that NHS services are made available to patients. Due to patients’ wishes, CCGs will not see their role as commissioning hospital care but will play a key role in commissioning primary care. This model is called the Integrated Care Model and it consists of clusters formed by GPs, PCTs, and other providers of NHS healthcare (Zulch, 2014).
CCGs will be run by local doctors, nurses, and other health professionals who will decide how money should be spent on health care in your area. Sometimes a CCG may commission services directly, but most STPs aim to do this through care programs or sets of care delivery organizations (Atkinson, 2015). As part of this change, there is a responsibility on all health and social care staff to ensure they understand the new arrangements arising from the transition. An unintended consequence of the National Health Service (NHS) changes will reduce funding. Primary care trusts [PCTs], accountable for funding health services for a population of approximately 250,000, will subsequently be replaced by clinical commissioning groups [CCG], which are expanded to include all the PCTs in their area, plus some others. This means that CCGs can be responsible for a population of up to 1 million (Atkinson, 2015).
The changes are being rolled out and involve GP-led groups of clinicians taking responsibility for population health, commissioning health services, and prioritizing access to care. For example, they will decide which members of their local population get access to new drugs, opportunities for preventive health screening, or help with contraception and family planning (Anderson, 2016). The Department of Health is responsible for ensuring policy implementation, developing new policy, and improving the quality and availability of NHS services. A coalition of interested parties across the region and a formal democratic process eventually chose to form clinical commissioning groups in place of primary care trusts. These groups are charged with taking control of the health services in their area and making decisions about how best to provide quality care for local populations (Atkinson, 2015). This means more control from local doctors and patients on the front line, which we hope will help improve quality over the long term. CCGs need to respond to local needs, put patients first, and have a sound financial footing on which to build services. So, while recognizing that this will not always be easy, we want providers (including G.P. practices) and CCGs to work together more closely in the future.
This report aims to investigate an organizational change-based situation which will further provide an opportunity for it to analyze quite several causes that are linked to the entire organizational change situation within the case study together with the incorporation of both organization and social consequences that are known to have emerged based on what is entailed within the case study (Elliott & Stead, 2008). The entire National Health Service is known to be having many changes over the past few years based on its strategic level of focus and design, based on the changes in various government terms of office (Zulch, 2014).
With the aim of making their role more clinical, the Government intends for all primary care trusts to be replaced by clinical commissioning groups (CCGs). These are groups of doctors and other health professionals who will have responsibility for planning, buying, and providing services in your local area (Zerfass & Huck, 2017). There are still some issues around CCG structures, including their services. Still, the main aim is to increase the influence of doctors on health spending by getting rid of unnecessary bureaucracy. On the other hand, the case scenario that involves both square pegs and round holes are known to be linked to a variety of major issues known to have emerged from various perspectives. The entire health department apparently viewed the organizational structure linked to PCT as lacking (Worren, Ruddle, & & Moore, 1999). This was based on its large administrative presence and its failure to deliver value-based on addressing the localized patients alongside a vast range of needs associated with the society.
Based on what is captured within the case scenario, it focuses on an organizational development response to the occurrence of both strategic and structural change that is likely to be encountered within a given National Health Service organization (Worren, Ruddle, & & Moore, 1999). On very many occasions, being able to manage an organizational change usually refers to a fundamental process of mapping out and even going as far as enforcing change related conditions across all the boundaries of an organization to recognize a variety of strategies and processes with a sense of appropriately satisfying some of the customer’s needs by ensuring that the employees are able to welcome all the proposed ideas that are related to change. This should be able to take place with minimal resistance levels (Alvesson, 2015). Additionally, change of perceived to be a vital part of any successful organization that is concerned with addressing most of its goals and objectives at the right time, as a variety of customer needs has proved to be constantly evolving, failure to implement different change-related issues can always lead an organization to lose its competitive edge (Burnes, 2012). Moreover, organizations that are in a position of addressing organizational change inappropriate ways without receiving adverse reactions from different employees have got the capability of exploring a wide range of business-related operations, thus emerging to be very competitive about the products and services that they can introduce across their target markets (Cummings, 2015).
As far as the case study is concerned, it postulates that in 2010, the British Government decided to make an announcement regarding certain plans which were all geared towards introducing some mode of substantial changes to the entire local management of health services across different parts of England (Buchanan, “You stab my back, I’ll stab yours”: Management experience and perceptions of organizational, political behaviour, 2007). Moreover, nearly all the proposed changes during that time would see a variety of Primary Care Trusts being replaced by different types of new Clinical Commission Groups that were to emerge within the local health authorities across the entire region. (Chen, 2018) These changes were not just happening for the sake, but instead, they were all triggered by a good number of environmental factors whose major aims were all geared towards addressing a variety of objectives as far as the whole situation was concerned. As it has always been, the entire public health has always been the whole responsibility of local managers who are spread across all the 151 PCTs within the internal boundaries of England.
Organizational change is also regarded as the movement of any organization which provides an opportunity of shifting from one state of affairs to another (Cummings, 2015). Moreover, a change in the environment normally requires change at the internal part of the organization that is found within the environment (Axlerod & Axlelrod, 2017). Interestingly, change in almost every aspect of an organization’s mode of operation can always be attained with certain levels of resistance where different cultures are in a position of encountering different reactions to the whole change together with the means to scale up the change itself. To appropriately facilitate the required changes, a variety of steps are always considered most so the ones that have been proved to lower the anxiety levels of different employees and even go as far as easing the whole transformation process (Buchanan, “You stab my back, I’ll stab yours”: Management experience and perceptions of organizational political behaviour. , 2007).
On a good number of occasions, the simple act of being able to include employees in a variety of change processes within an organizational boundary can try as much as possible to scale any mode of opposition to a lot of new methods. Unfortunately, there are some organizations where this level of inclusion appears not to be possible, and as a result of this, a good number of organizations normally end up recruiting a small number of opinion leaders with an intention of promoting some of the benefits of all the coming changes (Buchanan & Badham, Power, Politics and Organizational Change. , 2008).
The external environment that is linked to almost every business should always be taken into consideration by the top management officials of the organizations with an intention of adequately modifying all their current strategies for them to be in a position of perfectly reflecting the one that is associated with the types of changes that are occurring in a given environment in which the whole business is in a position of carrying out its operations (Chen, 2018). When much attention is not given to a variety of changes in the external environment of any given organization, there is a high probability that an organization will be able to conduct most of its operations based on assumptions thereby ignoring any opportunities or even threats thus leading towards the weakening of the organization’s level of competitiveness which will further hinder the exploration of a series of goal targets (Glenn, 2016).
Moreover, a good number of advanced models which might entail things like the PESTEL model that is known to be having the potential of focusing on various factors can be very essential when it comes to the identification of different opportunities together with risks that a given business or organization is likely to be subjected to when conducting a variety of business-related kinds of operation across the industry (Alvesson, 2013). In relation to the information within the case study, there were a variety of reasons as to why it was considered there was a need to take into consideration organizational change, and probably, some of these needs were among the major triggers for the entire change to take place.
Firstly, one of the major triggers for the entire change was that the entire PCT organizational structure was in a position of being viewed by the whole department of health as lacking, this was majorly in terms of its overall large administrative presence alongside its failure to deliver the expected value based on being able to meet the localized patient together with a variety of community needs. Again, the PCTs, together with the regional bodies that are majorly referred to as Strategic Health Authorities, have been in a position of being phased out. This is known to have taken place over the last few years, with a variety of funding responsibilities currently being directed towards the side of all the general practitioners (Wenger, 2000).
Secondly, another cause of the whole change was as a result of the strategic objective that was linked to the Government, which was geared towards developing local healthcare service which was to be more patient and community-focused based on all the services that were to be offered within the facility by trying as much as possible to involve various G.P.s in terms of the overall clinical spending alongside healthcare provision kind of decision making (Alvesson, 2013). Furthermore, it was postulated that they would be able to attain these results with the input that was supposed to be brought on board by quite a number of stakeholder groups which included the specialist clinicians, the entire public sector, a variety of voluntary organizations together with different types of patients and also the local community (Wenger, 2000).
The NHS reform resulted in a major change of structure within, with primary care trusts being abolished and replaced by clinical commissioning groups. Although the replacement of PCTs by CCGs has been generally incremental rather than radical, there are significant changes in organization, funding, relationships, and responsibilities. The Government’s vision is of a patient-centered NHS. Clinical commissioning groups will play a pivotal role in delivering this vision (Wart, Roman, & Wang, 2019). These new organizations were given the responsibility of commissioning health services from G.P. practices and other providers, enabling more integrated care. The NHS Commissioning Board (NHS CB) is now responsible for overseeing these arrangements.
policymakers make strategic decisions on behalf of patients.
a great deal of pampering and centralization of professional power and influence.
overall commissioning budget and target outcomes.
the accountability system for healthcare, financial capability and transparency, and public accountability.
responsibility for public health and social care to these groups
immediate contact within local networks
Communities with higher levels of social capital.
Change in the Communication channels
no longer a legal requirement for them to be constituted as companies limited by guarantee.
public engagement and
workforce health They are intended to bring the NHS closer to patients and make services easier to understand and use.
structural reform measures include both service regulation, governance, Health safety and regional laws
There are a variety of changes that were encountered based on the information that is captured within the case study. In this modern world that is dynamic, change is something that is not a fact of life but very fundamental when it comes to survival purposes. A lot of new organizational developments together with priorities normally take place at a faster rate to a level that an organization is not up to date, it will be lagging behind in terms of how it is conducting most of its operations (Dundon, 2010). A lot of trends and technology have been able to evolve to greater levels; this is a clear indication that the needs of various customers will be able to constantly shift. (Wart, Roman, & Wang, 2019) Also, a lot of information is transmitted at a faster rate, and organizations that are not able to deliver on speed are likely to deliver to the ones that are capable of delivering. The following are some of the major organizational changes that were encountered within the case study;
The report explores the organizational, social, and cultural implications for achieving integrated care for a wide range of conditions by using primary care trusts, clinical commissioning groups, and multi-agency partnerships. It focuses on the perspectives of health and social care professionals, Local Strategic Partnership staff, patients, and voluntary organizations, who are involved in developing or delivering services as a part of these structures. Primary care trusts (PCTs) and local authority public health have taken different roles inequalities, drawing on an “equalities within” or “equalities across” distinction. Four divisions of equality from PCTs to clinical commissioning groups (CCGs) were identified: advocacy joined by service redesign; prevalence linked to commissioning; prevention led by policy development; research addressing inequalities as a field (Smircich, 1983). Local authority public health was more “equalities across” than advocacy in the first three but not the final two dimensions (Leonard, 2019).
Theoretical concepts were derived from (Dundon, 2010) vision of organizations as communicative and social texts which can be analyzed as conflicting narratives. Specifically, we considered how official representations and related news coverage that were made available to the public, at different points in time, constitute multiple and conflicting narratives of change. A rhetorical approach was taken to specifically analyze narrative structure, representation, and inter-relationships between texts (Stead & Elliott, 2013). We identified the following five dimensions of discourse in this area: dominant professional discourses, official or institutional discourses (from primary care trusts [PCTs] and clinical commissioning groups [CCGs]), media discourses (in national newspapers), and multiple local discourses (disseminated through social media), 5) patient discourses. Both PCTs/CCGs and newspaper coverage focused on policy issues linked to efficiency, effectiveness, and competition (Smircich, 1983).
The Government has reformed health spending to ensure that it is much more focused on prevention and the public good (Jackson, 2011). Primary care trusts and strategic health authorities were abolished or reorganized, and the commissioning of health services passed from local Government to newly established clinical commissioning groups. The changes to primary health care systems where policymakers make strategic decisions on behalf of patients. Their findings are intended as aids to help shape strategies for influencing change within the organization (Nistelrooij & Sminia, 2010). The current legislation allows for PCTs to be replaced by a new “clinical commissioning group” that represents local clinicians, with an overall commissioning budget and target outcomes.
The context of the role has changed fundamentally, concerning power, professional boundaries, and relationships with commissioning groups and providers. The boundary-spanning skills following from knowledge of commissioning processes and structures are a necessity but require support to enable them to be implemented in practice (Alvesson, 2013). Political context also differs from that applicable to primary care trusts (PCTs) and commissioners will need support to disentangle local political complexities from reality. It explores the perceived power of local actors, as well as the formal powers that exist within the surrounding political and organizational architecture. It identifies important sources of influence on policy change, including staff morale and capacity, public engagement, external stakeholder pressure, partisan advocacy groups, ‘new’ media, and lobbying agencies (Marchington & Wilkinson, 2012). It starts by explaining the organizational changes resulting from the introduction of the NHS reforms, focusing on the way these reshaped relationships within and among health services, patients, policy-makers, and service-users. It then explores four key areas: primary care, public health, social care, and workforce. These are seen as key areas in which governance conditions need to give greater clarity over who is responsible for what to enable effective decision-making to avoid risks of governance failure and build trust in how public services are run (Jackson,2011).
In order to lead and manage an organizational change, there is the need for various leaders to try as much as possible to be transparent in all their actions. When the change is likely to be a major one, it is very vital to be transparent with all the employees even if you are not in a position of providing them with all the details. This will enable the organization to go a long way in terms of its development and also in terms of making the employees feel more comfortable to be part of the whole working environment. Secondly, it is also very fundamental to take into consideration high levels of employee engagement (Wart, Roman, & Wang, 2019). A focus on delivering high-quality commissioning services will be essential to its success; this means G.P.s’ ability to plan responsibly and fund flexibly while working together with their colleagues in local CCG teams. Clinical commissioning groups (CCGs) provide a local focus for taking decisions about NHS services and ensuring that they are carried out effectively (Georgalis, Samaratunge, Kimberley, & Lu, 2015). They are at the frontline of providing health care for many people in England and have a central role in making sure that NHS services are no longer duplicated across an area as well as making sure that patients’ views about local services and treatment are sought. There will be one or more CCG for each local authority in England, and these will be expected to have full responsibility (Watson, 2010).
Although the replacement of PCTs by CCGs has been generally incremental rather than radical, there are significant changes in organization, funding, relationships, and responsibilities. This project showed mixed results on the effects of O.D. on change from a PCT to CCGs. The findings suggested the contribution of both the PCT and CCG factors in relation to change, but also offer a considerate, structured and systemic approach in terms of O.D. It found that O.D. strategic interventions created a stronger sense of organizational identity but had a modest influence on changing PCT to CCG relationships. Clinical commissioning groups have been given powers to manage the budgets of the primary care trusts that previously delivered local health services, but this change in who is responsible for what may not necessarily lead to changes in outcome (Axlerod & Axlelrod, 2017). This is a major opportunity to improve the health of local communities. Communication and engagement will be vital for success. It is vital that all professionals communicate together and engage with their relevant commissioner to ensure there is a joined-up approach to healthcare. The provision of primary care has been devolved through ring-fenced funding to newly created clinical commissioning groups that consist of local G.P.s, who take responsibility for making decisions about which services are commissioned locally based on strategic priorities and need (Emmott, 2015).
Clinical Commissioning Groups (CCGs) are responsible for commissioning healthcare services in their local areas. They are the link between patients and frontline staff, who provide healthcare in their local community. CCGs take on many roles and responsibilities including: developing the arrangements to commission services; deciding which types of services to commission; agreeing with the budgets, and making sure that the services that have been commissioned are appropriate for their local population (Wart, Roman, & Wang, 2019).
With clinical commissioning groups getting the funds for G.P. services, it means that G.P.s have to compete for funding. They begin to develop more of a business mindset and many now treat patients as patients but also customers as well. In order to get better services, people have to start paying for them if they can afford them. The only ethical way of charging is by using an NHS-approved invoicing system so that the public purse is reimbursed and nothing more is charged. It will be interesting to see how the NHS develops over the next few years and whether it will remain free as it has been up until this point in time. The transfer of commissioning of health care from primary care trusts to clinical commissioning groups is a divisive issue (Turner & Mavin, 2008). It is a policy stated within the NHS Mandate for the next Parliament and represents a challenge for clinicians and a potential threat to the NHS.
Clinical Commissioning Groups (CCGs) are now responsible for putting local decisions about the health and care services you receive. Your local CCG will commission a range of different health and care services, including those that help you to stay healthy and independent, as well as the care and support you need if you’re ill or have an ongoing health condition. Each CCG has its own priorities and how it commissions services is a matter of local decision-making. The new NHS Commissioning Groups are being established to lead the implementation of NHS Commissioning and play a key role in transforming the way that health services are commissioned (Ely, Ibarra, & Kolb, 2011). This includes taking responsibility for improving health outcomes for their population by commissioning health services from providers, deciding how the money is spent, and holding providers to account for the quality of care that they provide.
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