Case Study: Nhs Toolkit Analysis of Hospital

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NHS Toolkit

Case Study analysis of hospital assessment

The case study of King Edward Hospitals, National Health Systems (NHS) Trust reviews a 2002 change management strategy to reduce tenure of admissions-to-release patient journeys by way of Nurse-Led administration. A critical priority to the UK NHS in its effort to control fiscal waste and hospital acquired infections (HAI) incurred during unnecessarily extended patient stays in Britain's healthcare institutions, the Trust merger was a large systemic transformation in response to retraction of earmarked legislative allocations, and new internal programs followed this mandate. Barsoux and Gilmartin's (2007) review of this history in Leading Hospital Change: Improving Hospital Performance, retraces the steps to organizational change through the leadership efforts of Executive Director of Nursing, Tracey Burns. Appointed to the position by the Trust's CEO and Board of Directors, Burn's flexible approach to the value chain and the existing faulty network of procedural systems at the hospitals was a mammoth undertaking.

The results of her innovative analytic solutions to the overcrowding debate are discussed in the following study of a NHS hospital institution under duress, through: 1) improved healthcare management information systems (HMIS); and 2) nurse training as managers to the process (Tan and Payton 2010). Theoretical prospectus to the project is provided by J.P. Kotter (2002), in his work, Strategy for Change Management and the Heart of Change, and guided by the wisdom of organizational strategists on methodologies to praxis (Harrison, 1972, and Goffee and Jones, 2000). My own interest in incorporation of global assessment tools for organizations, Six Sigma approaches provide interface to analysis of the case study. If we are to calculate the effectiveness of leadership intelligence as business strategy an essential source from which all other decision making is manifest, then we should find sufficient objectivity in outcome.

Section a

Transformation management, a core interest to organizational theory, offers a sustainable model of analysis to describe the change culture presented in the King Edward Hospital NHS Trust case study. Transformation cultures are traditionally team-based, with dedication to reflexive strategies in a process oriented model institutional growth. Applied to the Trust case study, Kotter's (2007) illustration of the core concept 'transformation thought' offers apt scope to discussions of the period of merger in the Trust hospitals mentioned in the case. At the time, UK NHS was undergoing significant transformation as a government oversight organization to a well recognized national health system. Significant to study of the NHS in the last decade, have been studies of the agency's commitment to systems optimization.

This is in part to trends in patient capacity, whereby UK hospitals are forced to rethink former process models of treatment and managed care. The more global aspect of this trend relates to nursing shortages, and/or inadequate use of nurses as 'managers' on the frontline of patient intervention. Where both phenomena spark national debate, are the very same sites of confrontation where solutions may be found: 1) systems integration; and 2) horizontal remapping of responsibility. Additional 'symptoms' to the existing systems failures, are discussed as challenges to Burns' Nurse-Led strategies, not the least of which is the high incidence of healthcare acquired infections (HAI) in British hospital institutions and their impact on length of patient journey.

Solutions discussed in the King Edward Hospital NHS Trust case, sync well with Kotter's (2007) proposition of an 8-step process to organizational Transformation. Outline to Kotter's model is illustrated in Table 1.

Table 1

The '8-Step' Transformation Model

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

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

3. Develop a Vision and Strategy -- craft a target vision and strategies.

4. Communicate the Change Vision -- implement a communications plan toward change.

5. Empower Broad-based Action -- find and eliminate barriers to change.

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

7. Consolidate Gains and Produce More Change -- incremental success reinforces a change organization.

8. Anchor New Approaches in the Culture -- subsequent to prior 7 steps

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

Section B

Organisational theorists like Harrison (1972) and Goffee and Jones (2000) developed cultural analysis based on a 'Questionnaire' framework. Harrison's Questionnaire is based on four organisational ideologies: 1) power; 2) role; 3) task; and 4) person using a common set of doctrines, myths and symbols, this fourfold typology serves as a model to design of depth instruments, rather than a data collection tool. Goffee and Jones offer a contemporary model designed as a flexible set of Core Questions used in modular questionnaire construction, where questions are ascribed to five (5) key drivers: 1)Vision & Strategy; 2) Leadership; 3) Processes; 4) Culture and; 5) Physical Work Environment.

In consideration of organisational strategy in the hospital setting, a number of similar issues addressed in the King Edward Hospital NHS Trust reinvestment strategy to assess the feasibility and implement new systems integration in the three (3) hospital institutions partner to the Trust toward risk reduction and sustainable operations management are present in my current healthcare affiliation. The case study is pertinent to thoroughgoing overview of the types of issues faced by a global leader in national healthcare systems, the UK NHS. Reference to the case study on admission-to-discharge systems management and realignment encourages synthetic evaluation of parallel institutions from an objective position. Utilizing information drawn from the NHS Trust case, the remainder of the analysis is dedicated to consideration of both the Harrison criteria, and the Goffee and Jones recommended framework for identification of the five (5) key drivers (Saris and Gallhofer 2007). By employing a limited set of tools from Six Sigma approaches to the study, I am able to provide a partial vision on the possibilities afforded in further development of the Questionnaire assumptions through classificatory evaluation. Innovation is the certain outcome to such efforts, and as seen in the King Edward Hospital NHS Trust case, even partial provisions may lead to a reassignment of roles from vertical to horizontal management of patients.

Responsive to the national mandate for NHS hospital institutions to tighten operations management as a result of excessive allocations in areas readily addressed through corrective evaluation, the Charter to the merger of the hospital consortium formative to the Trust institution lends immediacy to one of Six Sigma's assessment tools and criterion for the framework of organisational evaluation. Vision presented by the Board of Directors served as a platform for actionable intervention on systems that had gone awry. The introduction of Chief Executive Nurse (CEN) Burns to the collaborative as supervisory lead on oversight of a forthcoming strategy to streamline the admission-to-discharge patient journey in the Trust's hospital sites points to the capacity of the organisation as a change management environment with high awareness and the competency to forge new channels of communication, administration and service delivery.

In the corporate arena, executives have become sold on constancy of R+D as the single most important dynamic to forging relationships of competitive 'capital.' In corporate organizations, the equity principle of 'value' as a price impact statement or 'proposition,' translates to customer satisfaction within the market through demonstrated performance of a product or service. The two tiers of 'value chain' analysis within organizational assessment are intended to determine the client impact on capitalization through: 1) internal organizational; and 2) external or environmental analysis. Qualitative assessment contributes insights to fiscal audit, here, and points of prevalence as discussed in the Trust case study, serve to articulate a comprehensive picture on where decision making is contributory to value, or not. Utilization of Six Sigma environmental analyses, a SWOT (Strengths, Weaknesses, Opportunities, Threats) and complimentary PESTLE (Political, Economic, Sociological, Technological, Legal, Environmental) analysis serve as a reporting instrument on the state of King Edward Hospital NHS Trust at time of the case study. Illustration of the SWOT analysis is narrated in Table 2.

Table 2

Strengths

NHS Trust hospital umbrella merged at an opportune time to respond to national reinvestment mandate

NHS support of integrated network model of practice

Strategic mission to accomplish designated rehabilitation of organizational systems

Highly competent talent in CEN staff

Weaknesses

Stodgy, outdated systems in hospital practice setting, with critical levels of mismanagement even where targeted issues had been identified

Nursing shortages contributing to delay, yet not cited as one of three (3) core competency issues within organizational review

Traditional practices and lack of enthusiasm impinging upon change management strategies

Opportunities

Nurse-led initiatives promise to serve as transformation strategy in healthcare setting where vertical leadership had failed

Ample allocations and training opportunities

Agreement to new knowledge sharing database by executive officers, for better integration into the NHS system, maintenance of individual patient records, and referral information

Threats

Internal threats proffered by serious mismanagement of data that might continue regardless of measures

Hospital acquired infection (HAI) rate exceptionally high in UK, where sizeable allocations have not necessarily resulted in adequate… [END OF PREVIEW]

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