Case Study on "Nhs Change: Analysis of Nurse-Led Practice Setting"

Case Study 11 pages (3444 words) Sources: 10

[EXCERPT] . . . .

NHS Change:

Analysis of Nurse-Led practice setting strategy

The 2002 merger between three hospital institutions in the United Kingdom, to form the King Edward Hospitals, National Health Systems (NHS) Trust was responsive to increased pressures on Britain's healthcare system to meet new mandates for allocations. In Barsoux and Gilmartin (2007) Leading Hospital Change: Improving Hospital Performance, the case study of the efforts of Executive Director of Nursing, Tracey Burns in her leadership of the new organisation in redirecting strategic performance of the admission-to-discharge chain prompted a series of change management initiatives and opened debate on the scope of current protocol for hospital institutions, and specifically Nurse-Led administration within NHS.

The foregoing analysis reviews the case study, and looks to contemporary organizational leadership behavior models from the perspective of J.P. Kotter's (2002) Transformation Management theory. Consecutive to the evolution of the NHS case study, is the emergence of change management solutions in the interface of human and artificial intelligence in the last decade; where knowledge-based collaboration through healthcare management information systems (HMIS) now serves as a core point perspective like that of the Trust's 'reinvestment' strategy implemented by nurse executives for reduction of admission-to-release inefficiencies.

Operational inefficiencies are the number one culprit in hospital fiscal waste. The case study outlines the shift in NHS policies prompted by the UK Parliament in the Labour Government NHS reforms in 2002. Issues of fiscal waste clearly reflect systemic inadequacies and where competence is in question, leading to allocations restrictions institutions and even investigations. The King Edward Hospitals NHS Trust offered participating institutions a chance at reconfiguration of current systems with forward thinking approaches to long standing problems.

SECTION a: Case Study & Kotter's 8 Steps

The case study opens with a history of King Edward Hospital NHS Trust merger, and discussion of change management challenges presented to Executive Director of Nursing, Tracey Burns on behalf of consortium under her supervision for assessment and feasibility of reduction of patient admissions retention. Actions items to the preliminary strategy included study of patient admission and retention within the Trust's institutions. Initial review of procedures to patient discharge revealed that patients were subject to extended admission due to waits on tests or other outpatient treatments. Other issues pertaining to records and referrals to Social Services and other third party interveners added to the inexpedient process. Patient journey management were so ineffective it was determined, that institutional over capacity was at an all time high.

Theoretical consideration to the case study employs Kotter's popular '8-Step' Transformation Model for organizational change. Concurrent to other organizational theories where the breadth of interest engages both the leadership strategies and mechanistic logics of institutional change management practices mentioned in Hiatt's employee based, ADKAR, Bertalanffy's systems theory, and Burke's transformation leadership models, Kotter's transformation thought offers perhaps the most apt interpretive framework for constructive, explanatory insight into the King Edward Hospital NHS Trust and its potential as a national healthcare consortium to truly serve patients according to professional best practices.

If benchmarking conclusively states the level of participatory adherence to national recommendations to institutional risk management and its impact on both finance and patient care, then the process by which improve is achieved may be narrowed to the efficacy of an institution's logic model. Behind those abstract transformations, however, is real professional expertise and well intentioned thought. The capacity building strategy deployed by the executive management in nursing at the Trust is an almost seamless facilitation of Kotter's transformation thought. Grounded in iterative decision making, the following outlines the theory to practice evidenced in the step-by-step response by Burns' and her colleagues.

Transformation management is the culmination of team-based, reflexive practice in change management. In Strategy for Change Management, Kotter adopts an 8-step process for risk management planning. Guidelines to the transformation model are illustrated in Table 1.

The '8-Step' Strategy or Change Management

1. Establish a Sense of Urgency -- Examine market forces facing the organization and the impact of these forces. Identify and discuss the impending crises.

2. Create a Guiding Coalition -- Establish a team of leaders that are credible, have authority and expertise in the area of focus.

3. Develop a Vision and Strategy -- Establish the target vision and strategies.

4. Communicate the Change Vision -- Develop a communication plan to present and re-enforce the change vision.

5. Empower Broad-based Action -- Identify and remove barriers to change.

6. Generate Short-Term Wins -- Plan milestone achievements.

7. Consolidate Gains and Produce More Change -- Build on past successes so that change becomes permeated throughout the organization.

8. Anchor New Approaches in the Culture -- This must be done after the prior 7 steps are completed (Kotter's study, as cited in Leading Change, 2007).

Table 1. Kotter's '8-Step' process Transformation Model (Kotter, 2007).

Prelude to the case study with the King Edward Hospital NHS Trust merger opens with Kotter's key identifier of the instigative force behind the acknowledgement that for many transformation organizations change is inevitable, and this is: 1) established with a sense of urgency, which led to the formation of the Trust's collaborative efforts amidst widespread retractions of institutional allocations. The embodiment of the Trust as evidence of: 2) creation of a guiding coalition was established through the professional credibility, authority and expertise of the Board of Directors; and 3) enacted by way of institutional policy and the directive of committees led by key staff like Tracey Burns, in support of the Trust's larger vision and sustainable strategy. Burns was brought on board to steward the admissions-to-release project within the institution's reinvestment strategy plan, as a voice for: 4) communicating the change vision to a consortium of stakeholders, including nursing staff and partner hospital administration within the trust toward development of a viable transformation. To this end, Burn's fulfills Kotter's theoretical proposition, in her capacity to delegate authority to peers, thus: 5) empowering broad-based action and inciting those actors to assist in the identification and removal of barriers to change.

Short-term wins within Burn's strategy served as a foundation to: 6) milestones for change in the design of a training and database sharing network where integrated information could serve as a: 7) long-term consolidation of gains to produce more change. Rectification of inefficiencies in patient care during the hospital journey demonstrated outcomes consistent with the impetus of Burn's original strategy. While not all goals were attained without obstacles, the reduction of fiscal waste is a signal that the Nurse-Led project had positive impact, and may serve as a replicable model for evidence-based practice in forthcoming Trust rehabilitation initiatives, and externally at other NHS institutions in the UK.

Review of what healthcare institutions are doing from a fiscal perspective is critical in that risk prevention is a 'total' change management concept, and one obviously not listened to at times with exception of the cost to national healthcare and to institutions where competitive capitalization is taking place (i.e. research). Review of the complications faced by Tracey Burns and the King Edwards Hospitals NHS Trust, and underscores the global transformations taking place between policy and patient. Impetus to better systems of business intelligence and specialist intervention, knowledge management as a strategy within this transformation offers much for healthcare institutions and their leaders; connectivity in management of practice and patient care.

Evaluation of the hospitals soon into the organizational assessment revealed that the inefficiencies were leading to three (3) iterative problem areas verging on crisis: 1 poor communications; 2) increased incidence of hospital associated infections leading to longer admission beyond original diagnosis or intervention; and 3) overcrowding to the point of backlog. Discussed more extensively in Section B, the framework developed out of the organizational assessment was loosely based on the three issue areas. Poor communication was the subject of internal stop-gaps, where patients were being held for testing or results. External communications issues were lengthening time of patient journey in response to waitlists to social services and other aftercare admission in other healthcare institutions. The remainder of the case study is dedicated to the development of the Trust's Nurse-Led change management strategies and the process by which decisions and partial implementation was achieved.

The Kotter Transformation Model is most applicable to organizational initiatives emphasizing long-term change. Highly compatible to systems theory, where organizations of scale increase capacity for longitudinal assessment and results, Kotter's transformation model presents the most comprehensive leadership-centric approach. Where leaders are responsible for different nodes in the operating system of an organizational system or knowledge database, the recommended process employs the most thorough engagement in expert change management planning. Successful systems change processes are typically subject to meticulous oversight, and are the subject of new or re-articulated decisions within the management chain and may be momentary to long-term.

Liability to malpractice was of course an important consideration to the appointment of CEN, Burns to the reinvestment strategy. The range of detriments posed to staff and hospital institutions, while discussed briefly, certainly set the format for decision making at the executive management level. Accountability to issues of liability are… READ MORE

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