Team Relationships and Performance Evaluations in the Public Sector: Focusing on the NHS Trust Essay

Team Relationships and Performance Evaluations in the Public Sector:

Focusing on the NHS Trust

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!


order now

The NHS Trust and the Merging Process: Building Effective Teams Amidst Change

Merging is the process wherein two organizations join together and review existing organisational arrangements. In the industry of healthcare, the merging of organizations should not be confused with any changes affecting patient services, which could possibly be the subject of full public consultation. The decision of merging comes from the realisation of the organisation’s need to modernize the way they work, and to guarantee the efficiency and affectivity of this endeavour for continued quality in healthcare services, the organisations must pursue their healthcare delivery goals more efectively, irrespective of any organisational change.

NHS Trust was launched on July 5, 1948 by Aneurin Bevan, was founded out of a strong stand to provide healthcare services to all people regardless of wealth. Presently, it is recognised by the World Health Organization as one of the best health services in the world. The 21st century has brought demands which triggered the NHS Trust to have improvements in order to cope and keep the pace with the changing time. They are now changing the way they work with the patients, making sure they come first above all. In line with this undertaking is facing the fundamental changes in the structure of NHS Trust and in the way the various organisations relate internally with NHS Trust, and come July, 2000 was the launching of a full-scale modernisation program in which new principles were added (The NHS Plan, 2000).

In recent years, many mergers and reconfigurations have taken place in NHS Trust. From 1997, 99 trusts mergers took place; 14 of which are in London (Department of Health,  2001). The mergers include horizontal mergers of mental health trusts, community health services trust and acute hospitals. Alongside this the merging of primary care groups in order to create primary care trusts. The reconfigurations are often politically debatable, which even focused one constituency in the 2001 general election. This has led to the formation of the panel of independent reconfiguration, which intends to arbitrate the proposals on mergers and reconfiguration in order to take out the politics in the organisation’s decisions (The NHS Plan 2000).

Behind trust mergers are a wide range of driving forces. One is the target to achieve economic gains, by making the most of economies scale and scope, especially in terms of management costs. And second is the reduction in excess capacity to treat patients as a result of rationalizing the provision of services (Ferguson, 1997). Some other factors include the belief of the people that clinical quality improves as usage of specialised units increases, the medical training quality increases and the recruitment and retention of staff will become more effective (Ferguson, Sheldon & Posnett 1997).

On the other hand, the mergers are also driven by political drivers, such as facilitating hospital or closure of services, securing the financial viability of smaller units, ensuring the increase in negotiating power and a survival strategy by pooling of resources and expanding the organization as a response to the challenges brought about by the purchasers of services. For mental health services, the idea of having single focus can provide services of higher quality (Department of Health, 1998).

The skeptics of the mergers disagree that the evidence for the merits of mergers is inconsistent, clashing and often based on the manager’s idea of benefits. Unintentional consequences and the possible drawbacks of mergers were given less attention. For Garside (1999), these include the disruption of services as a direct consequence, problems with staffing, diseconomies of sale, service and system integrations and practices of work and issues in equity and access to the services.

To determine the benefits and drawbacks of the merging endeavor of NHS Trust, a cross-sectional study has involved in-depth interviews and documentary analysis was done, wherein nine trusts are involved. The participants were interviewed; these participants were board members, senior and service managers, clinicians, health authorities’ representatives, regional office, health council of the community, local authorities and other primary care and trust groups (Fulop 2002).

This analysis involved the impact of trust mergers and the overall change process of the NHS Trust which correspondingly involved the focus on drivers and objectives of trust mergers. The range of advantages included the objectives of the merger, while the disadvantages encompassed the unintended consequences.

NHS’ Service Delivery

The mergers created benefits for the larger organisation, which include the visibility of a larger team of professional staff, which enabled the organizations to create large teams of specialists. This then allowed the achievement of clinical excellence. Formerly disjointed specialist services then become unified and enhance. Managers in community trusts thought that greater attention was given by local authorities when trusts become larger. With regard to mental health trust, the size increase was deliberated to ease cross fertilisation of ideas. The increased in opportunities for staff training were an immediate and tangible benefit, and the increased in the number of professionals enhanced the professional networks (Fulop 2002).

The drawbacks incorporated the actuality that staff sensed that senior managers had become distant, and service managers felt left behind from the services that they were assigned to. Staff in the acute trust felt that senior managers did not allot enough time to them and that their needs for help from the managers were overlooked. Staff from the smaller trusts believe in the loss of the familiarity and informality of the former organisations and a decline in local decision making and the autonomy of services. Larger trusts were observed as slow to make decisions and unresponsive. The external stakeholders were apprehensive about the capacity of large trusts to administer continued quality of patient care and services (Fulop, 2002).

The agencies which used to having direct access to senior management had to deal primarily with middle management, this then had the strategic developments compromised in certain areas of service. There was an increased traveling time among sites for managers in larger geographical area covered by the merged trusts. The process of communication was perceived as slow and incoherent in merged trusts, and internal communication was negatively affected (Fulop 2002).

NHS’ Management Structures

Tensions within staff groups and between clinical staff and management were created due to the changes in the trusts’ management of structures. Even though the competition for management posts has followed the NHS guidelines, the new senior management team tended to consist mainly of staff from one of the trusts’ constituents, and this created the “taking over” impression for many staff. In terms of the positive side, the mergers have provided each staff and service the opportunity to surface from the constraints of formerly languished management and services organisations (Fulop 2002).

NHS’ Recruitment, Retention, and Morale

Some findings have not exposed a considerable improvement in staff recruitment or retention during the early years of the mergers, in spite of this being a major stated driver. Benefits to staff of mergers included the improvement in systems of clinical supervision, more consistent professional management, and the returns of program of training, appraisals and development in that have been put into practice. Clinical and managerial staff, nevertheless, highlighted the stress rooted by the apparent imposed changes and uncertainties and the workload increase related with the merger process (Fulop, 2002).

It was an apprehension that this constant period of change and uncertainty may weaken the performance and morale of staff. Poor change management can result to employees feeling concerned, about their employment status, new managers/work teams, new work responsibilities, new hours, working further from home or in a new environment. If this happens it can pilot to staff turnover, increased sickness absence, and people in work with poor performance for the reason that they work under too much pressure (Fulop 2002).

To assess the risks and find solutions, trusts should have themselves committed to openness with their staff with regard to merging and consequent restructuring and introducing some measures. First is to conduct staff training wherein the importance of feedback to effective management is emphasized. Second is to have an available staff hotline, which is a 24-hour private service wherein staff can confidentially raise their views on their working conditions, and then feedback on such will be raised on a weekly basis. Shared leadership is also implemented in which decisions can be made by a committee or staff from across grades and organization.

Information exchange is also of importance especially in the period of merging and restructuring, the CEO should call for regular meetings with staff to answer questions regarding Trusts and the future. Lastly, social events should be organized which are geared towards promoting a concrete and strong bond between staff among previously separated organisations (Fulop, 2002).

According to Carmazzi (2008), through the use of directive communication psychology, the management can discover how to take off their colored glasses and teach, learn, lead, persuade, and cultivate greater productivity in their work and personal life. The colored glasses model is based on the 4 different genetic processors that are foundations for the way people communicate. The education, career, and environment are manifested through the color of the glasses. Through awareness of how people and others process information, the management gain greater insights on how to learn better, how to develop talents not natural to their genetic ability, and how to appreciate to bring out the best in the people around in the workplace.

Mary Parker Follett upholds that the manager cannot share his power with division superintendent or foreman or workmen but he can give them opportunities for developing their power. On her “circular behavior theory”, which is based on integration and conflict resolution, Follett meant that people are interdependent, managers cannot work without his workers, and workers depend on their managers. The interaction in their relationship means that people belonging to different levels of the organisation hierarchy are influencing each other all at the same time (Makamson, 2000).

The Impact of Mergers on Organisational Culture

Staff used the term “culture” to emphasize the differences between the organizations and to give explanation on conflicts of priorities and values. Differences in culture associated to attitudes to innovation and risk taking is an outcome or process orientation and patterns of communication (Fulop, 2002).

Edgar Schein argues that the pattern of basic principal assumptions has the role as a cognitive defense mechanism for individuals and the group, resulting to cultural change difficulty, and to being both time consuming and anxiety provoking. Cultures are deep seated, all-encompassing and compound and it can be very complex to emerge. For him, the key issue for leaders is that they should become marginal in their own culture to an adequate degree to identify what may be its maladaptive assumptions and to learn new ways of thinking an introduction to changing their organisation (Josse-Bass, 1992).

Financial Issues and Management Cost Analysis

Finance managers pointed out that the clearest basis of possible savings from the merger was the £500 000-£750 000 that was related with diminished numbers of members of management boards in the merged trusts. Finance managers were not totally convinced that other savings were attained within the initial financial year, and they had no proof that savings were reinvested into services. As an alternative, they thought the mergers emphasized unseen financial problems in the constituent trusts and exposed disparities in staffing and funding of services transversely from the merged organisations (Fulop, 2002).

Conclusion

The restructuring of large organisations in the course of mergers had benefits and drawbacks. The benefits were mostly acknowledged objectives of the mergers; however drawbacks took place in the period of the process of merger and were not measured when the decision on whether to merge was made. In the course of merging, drawbacks like reduced accessibility for external stakeholders are considered necessary to be set on by the people executing the merger (Fulop, 2002).

For all four groups of impacts, the merger has resulted to an organisational restructuring and demanding introspection period that makes them look back in terms of developments in the organization and services at least 18 months ago. The quantity of time required for restructuring was miscalculated by the people who sets off the mergers and by those who executed them. McClenahan (1999) said that such delays are imperative and inadvertent consequences of mergers that should serve as priorities in plans of reorganization in the future.

Davies and Nuttley (2000) have said that, diversities in cultures among merging organizations appear to be a key barrier to getting organizations jointly through a merger. Specific characteristics of organizational culture such as attitudes to modernization and risk taking and if an organization has process orientation and communication patterns are stressed out as keys to the direction of health services in the future.

Larger organisations were anticipated to have the capacity to offer better opportunities and provide facilities for staff, and this was anticipated to resolve problems with recruiting and retaining staff. The execution of mergers required more management support than what has been projected and resulted to low savings in management costs, specifically in the first year after the execution of the merger. Merged organizations therefore need to set realistic objectives with regard to savings in management costs by prioritising the amount of managerial input required for the merger implementation (Fulop, 2002).

If an organization is in the process of implementing a major organizational change, staff is aptly to be anxious about their employment stability, probable relocation and changes to their job terms and conditions. It is significant that all new improvements are fast communicated and that staff are provided the chance to voice out their concerns and opinions and be able to ask questions before, during and after the change.

Even where change is unavoidable, systems can be jointly developed to make sure that the process is controlled smoothly and with minimum degree of disruption. There should be shared responsibility for managing change, spearheaded by staff from all levels together with their representatives, can help to determine possible issues and act on to address them. It is essential to understand and to act upon the unintended consequences of the merger and to set realistic objectives for the reorganisation.

Improving the NHS’ Performance Appraisal System

The increasing public concern about the quality and clinical safety is the reason and the context that have been operational in the introduction of the appraisal of consultants in the National Health Services (NHS). A rather crucial example of public concern is the inquiry into the management of the care of children who had undergone complex cardiac surgery at the Bristol Royal Infirmary between 1984 and 1995. The managerial systems had failed to prevent tragic events at the Infirmary, and this is where the focus of the inquiry lay. Two more inquiries: the Royal Liverpool Children’s Inquiry that was concerned with the practice if removing an retaining organs after autopsy, and the clinical audit concerned with Harold Shipman’s clinical practice, questioned clinical performance and the more, apparently, professionally-unrelated issue of personal behaviour. In the Royal Liverpool Children’s Inquiry, there are statements about Professor Van Veltzen’s behaviour reporting of exaggeration, falsification of financial and human-resource accounts and fabrication of post-mortem reports (Redfern et al, 2001). In Shipman’s case, it was a direct result of his criminal behaviour.

The findings of these reports showed other things that were common to each other: an important section of the recommendations in the Shipman report were concerned with monitoring the records of the consultant. It talked about Shipman’s reluctance to undergo any review of his clinical performance during his career, which indicated an unacceptable lack of accountability. The Bristol Royal Infirmary report has many recommendations that belong to a category referring to being a competent healthcare professional and suggests the notion of widening the scope of the idea of professional competence. The same section then goes on in slight detail about the idea and its regulation (http://www.bristol-inquiry.org.uk/index.htm). What one can infer from the above example is that a tool like appraisal at the organizational level could perhaps have helped identify these events a little earlier, or maybe could even have helped prevent them from occurring.

 An interesting point of observation here would be that public concern about the undesirability of a possible adverse outcome of clinical practice is not a phenomenon characteristic of Britain alone. It is found that in the USA too, there is a growing concern among the people about the possible avoidable mistakes that could lead to a wide range of harmful complications. For example, the Institute of Medicine’s 1999 report To Err is Human: Building a Safer Health System (Institute of Medicine 1999) was popularly seen as confirming what most already feared: that medical interventions were accompanied by unacceptably high levels of preventable harm (Barach & Small 2000). However, this report emphasized on how the healthcare system functions and suggestions are made as to how its processes could be re-engineered to reduce the risk of harm to patients.

In response to these concerns, there have been several policies, changes directing towards reforms in structure, and new agencies with specific responsibilities have been set up. All these are aimed at ensuring high quality of care and a high degree of accountability. These include the National Institute for Clinical Excellence (NICE), National Service Frameworks (NSF) clinical governance, the Commission for Health Improvement (CHI), the NHS Plan, the National Patient Safety Agency and the National Clinical Assessment Authority (NCAA). A short note on NCAA here, since it is not so well-known among the ones mentioned above. It was formed in 2001 with the aim to support and aid the implementation of systems for assessing the performance of the doctors in the NHS and deal with those whose performance formed a cause for concern.  Another development which occurred in the wake of the findings of the Bristol Royal Infirmary inquiry, and the recommendations it made, is that the Council for the Regulation of Healthcare Professionals was set up. While the relationship between this council and the General Medical Council is not clear, it is obvious that vital developments have taken place in the space that defines the idea of the autonomy of the professions.

Appraisal of senior doctors can be better understood in this context. Medical practitioners- senior doctors, consultants and general practitioners were considered independent or semi-independent practitioners, with no supervision in place that they worked under, before these events were reported. However, with the increasing popularity of the deterrence approach used in the public sector in the United Kingdom (Wilcox & Gray 1996), NHS has transitioned to such an approach. Primarily, the use of regulatory standards and inspection necessitated many detailed and explicit written standards, often with statutory force; with approach to inspection and enforcement highly focused on standards. In the past, NHS may have detailed written standards and policies often accompanied by guidance on implementation; with standards playing a less prominent part in interactions with regulated organisations (The NHS Plan 2000). There has been a perceived need to install within the socio-organizational mechanism, an open, transparent system or an arrangement to restore and promote public trust and confidence in professionals, managers and politicians. For medical practitioners, this resulted in a change in the arrangements for the registration of doctors by the General Medical Council. Thus by putting in place an appraisal system for a medical professional so that their performance might be evaluated and that the outcome of such an evaluation be the factor determining not just whether or not they retain their registration , but also provides vital input to help raise the overall standard of the medical services people receive, the establishments that are executive in introducing such regulations had just found a way that could lead them to curbing the popular suspicion that had begun to plague the profession of medicine.

References

Barach, P., & Small, S. D.,  2000. Reporting and preventing medical mishaps. Business Management Journal, 320: pp. 759–763.

Bristol-inquiry, n.d. Available at: http://www.bristol-inquiry.org.uk/index.htm [accessed 1 April 2008].

Carmazzi, A., 2008. New training methodology makes a difference in learning results. Available at: http://www.submityourarticle.com/syndicate/synd_author.php?w_id=150 [accessed 1 April 2008].

Davies, H.T. & Nutley, S.M., 2000. Organizational culture and quality of health care.  Quality Health Care, 9: pp. 111-119.

Department of Health, 1997, Strategic review of London’s health services. Report of the independent advisory panel. London: Stationery Office.

Department of Health, 1998. Review of London health services: Government Response to London Review report. London: Stationery Office.

Ferguson, B., ; Goddard, M., 1997. The case for and against mergers. London: Royal Society of Medicine.

Ferguson, B., Sheldon, T., ; Posnett, J., 1997. Concentration and choice in healthcare. London: Royal Society of Medicine.

Fulop, N., 2002. Process and impact of mergers of nhs trusts: multicentre case study and management cost analysis. BMJ Publishing Group

Garside P., 1999. Evidence based mergers? BMJ Publishing Group.

Institute of Medicine, 1999. To err is human: building a safer health system. Washington, DC: National Academy Press.

Josse-Bass, P., 1992. Organizational culture and relationship. Available at: www.onepine.com [accessed 1 April 2008].

Makamson, L., 2000. Management as cooperative values. Available at: http://www.mgmtguru.com/mgt301/301_Lecture1Page11.htm [accessed 1 April 2008].

McClenahan, J., 1999. Emerging problems with merger policy. London: King’s Fund.

The NHS Plan, 2000. A plan for investment. A plan for reform. London: Stationery Office.

Redfern, M., Keeling, J. & Powell, E. (2001). The Royal Liverpool Children’s Inquiry Report (The Alder Hay report). London: Stationery Office.

Wilcox, B., & Gray, J., 1996. Inspecting schools: holding schools to account and helping schools to improve. Buckingham: Open University Press.

 

x

Hi!
I'm Larry!

Would you like to get a custom essay? How about receiving a customized one?

Check it out