Change Management in NHS England

This study focuses on the strategic objectives, organizational structure, and policies of NHS England in the context of change management. It discusses the achievements of NHS England in the last year and identifies areas of concern.

Change Management

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Overview of the selected organisation...................................................................................1
What are their strategic objectives?........................................................................................2
Organization / service structure..............................................................................................4
Work streams / policies under way........................................................................................5
Achievements in the last year.................................................................................................6
Identified areas of concerns....................................................................................................7
Identity a strategic problem....................................................................................................8
PEST Analysis........................................................................................................................9
SWOT Analysis....................................................................................................................10
Articulate a situation of change............................................................................................11
Context of the change...........................................................................................................12
CONCLUSION..............................................................................................................................12
REFERENCES..............................................................................................................................13

INTRODUCTION
Health and social care refers to set of clinical procedure and practices for providing treatment of
different health problem. It includes the criterion of providing appropriate medications and care
facilities in order to make an individual disease free. Meanwhile, it includes collaborative
performance of different health professionals together to deal with specific patient for providing
effective care services. It includes medical staff including doctors, nurses, specialist,
psychologist, ward boys, midwife, surgeon and many more (Dyer, 2018). However, it has been
analysed that every specific cases of patient has its own need regarding particular health and
relevant complications according to which desired professionals have to work on it. It is
necessary for medical practitioners to remain update always for facing different types of
infections and viral disease to treat them in respect of maintaining better health condition of the
population. Moreover, the use of training programs and knowledge sessions should be attend by
professionals to improve their performance and accuracy of results. In context of this
assignment, it is based on the NHS which provides clinical facilities and product to people for
maintains their appropriate health condition. It has number of branches in the country in different
areas through which it delivers medications and treatment to all the citizens. This project will
focus on strategic objectives and organisational culture of the hospital with respective policies
under which staff should perform their duties. It will also include the several concerned areas and
strategic problem which is required to be solved. The external and internal factors along with
context of change related to selected care institution are given below.
MAIN BODY
Overview of the selected organisation
National Health Service (NHS) can be considered as comprehensive public health service under
the administration of government to deliver required health service for welfare of citizens. It has
number of branches in different areas of the country in order to deal with health problems of
people to improve their actual condition (Alderwick and Ham, 2017). Basically, it is observed
that these facilities delivered to people is administered in three specific groups such as general
practitioner & dental services, hospital & specialist services and local health authority services.
NHS performs in different ways to deliver medical facilities and treatment to every single
individual living in the country. However, the NHS is founded in the year around 1948, almost
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71 years ago. NHS can be known as publicly funded healthcare system which provides clinical
facilities for wellbeing of citizens. It is observed that NHS is the second largest single payer
health care system in global context. This hospital was initially funded with the help of
government from general taxation. NHs is effective healthcare organisation because some of its
treatment and facilities are provide to people including visitors for free of cost such as
emergency treatment, treatment of infectious disease etc.
What are their strategic objectives?
In context of NHS, it has been analysed that effective goals and strategic objectives were
established to improve quality of clinical services. It includes number of aspects which were
focussed for specific areas like England for improving health condition. Meanwhile, it includes
the strategic objective of enhancing health education England on current and current workforce
development. It involves establishing academic health science networks on innovation and
national information board on the digital by default agenda (Rajeev Cuthbertson and Wilding,
2016). However, the strategic objectives of NHS to be focussed to improve health condition of
population by increasing effectiveness of health system. Initially, it includes enhancing
leadership and improvement capabilities for delivering services to each needy person living in
the country. Secondly, NHS focuses on improvement of quality of clinical procedures and
practices in order to make good or outstanding rating according to CQC (Care Quality
Commission). Thirdly, it will consider the strategic objective of acquiring sufficient amount of
funds and resources to deliver desired health services for making people disease free. Moreover,
it focuses to improve the operational performance by taking several actions like organising
training and learning for staff for enhancing their abilities. Furthermore, the NHS has to focus on
strategic change to facilitate improvement in infrastructure and equipment’s used for increasing
quality as well as speed of providing treatment.
The strategic goals or given organisation is completely focus on boosting up the overall potential
of healthcare system to provide quick as well as accurate facilities. It includes the criterion of
adopting number of changes like technology, equipment and management policies which are
favourable to increase efficiency of health system (Allsop, 2018). NHS focuses on five aspects
for improvement such as leadership & improvement capability, quality, finance & use of
resources, operational performance and strategic change. These factors have their relevant
strategic objectives which are mentioned here.
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Quality objectives
 Objective1: Reduce to zero the number of providers in special measures.
 Objective 2: Two thirds of inspected providers will be operating at CQC ‘good’ or
‘outstanding’ levels of quality.
 Objective 3: Support providers in the roll out of seven day hospital services, working
with NHS England.
 Objectives 4: Implement patient safety initiatives in priority areas.
 Objectives 5: Deliver guidance and tools for providers to make safe staffing decisions
(El‐Kateb and Davenport, 2016).
Finance and use of resources objectives
 Objective 6: Achieve and maintain sustainable financial balance for the provider sector
from 2017/18.
 Objective 7: Deliver with providers a 2% efficiency improvement year on year, including
through the implementation of the Carter Review recommendations.
Operational performance objectives
 Objective 8: Consistently meet NHS Constitution standards over the period, with a
particular focus on the aggregate A&E standard, while improving quality and efficiency.
 Objective 9: Deliver mental health waiting standards in aggregate every year (currently
defined as 50% of people experiencing a first episode if psychosis seen within two
weeks; 95% of people referred to improving access to talking therapies treated within 18
weeks).
Strategic change objectives
 Objective 10: Implement new care models, including chains.
 Objective 11: Change to a sustainable pattern of care in the most challenged health
economies (Jones and Ham, 2018).
Leadership and improvement capability objectives
 Objective 12: Develop, maintain and enhance effective boards including both people and
ways of working.
 Objective 13: Expect every provider board to reflect the diversity of the people it serves
including gender balanced boards.
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 Objective 14: Expect every provider to implement effectively a recognised continuous
improvement approach.
Directly delivered objectives
 Objective 15: Decision makers in providers have access to high quality information
(including income and expenditure information and benchmarks such as those proposed
by the Carter reviewed recommendations).
 Objective 16: Focus on high value interactions with providers and minimising any low
value or disproportionate regulatory burden (Siau and et. al., 2018).
Organization / service structure
Organisational structure plays an important role to manage all the clinical procedures and
methods which facilitate to deliver better quality of services. It is necessary to maintain the
structure of organisation which is suitable to quickly provide treatment for patient’s wellness.
Basically, the structure of organisation make employees feels interesting work with focus
whereas inappropriate structure is responsible for developing factor of demotivation among
them. It has been analysed that effective structure is helpful to reduce extra burden and work
stress of staff members which provide support to deliver appropriate clinical facilities (Swift,
2016). The structure of NHS England includes its strategy of working in branches with sufficient
employees which is helpful to cover different geographical areas and localities of the country to
fulfil health needs of every citizen in the nation. However, the given organisation has specific
structure through which effective medical services and treatment are provided to make people
disease free.
Organisational structure of NHS England consist ‘tripartite system’ which has been establish
with the help of several services that are mentioned here. It includes hospital facilities which are
organised into regional hospital boards that remain in charge of administration. Meanwhile, it
consist another service of primary care that involves general practitioners, dentists and opticians
who are responsible for working as independent contractors besides of salaried staff members of
the government. Moreover, the final element of structure is community facilities that consists
maternity, child welfare, and vaccination and ambulance services respectively. The structure
includes following different guidelines of providing accurate care facilities and reducing
occurrence of complications. For example, NHS England follows structure including several
units such as The Department for Health, NHS England, Clinical Commissioning Groups
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(CGCs) and NHS Foundation Trusts. The structure of NHS England is much effective as well as
efficient which give potential to professionals for easily deliver medications and treatment for
welfare of citizens living in the country.
Work streams / policies under way
The NHS England has number of policies and strategies according to which employees perform
their duties in order to improve patient experience. It includes number of policies that are helpful
to reduce chance of occurring complications. Meanwhile, it is necessary for healthcare
organisation to establish and implement specific policies which are favourable to provide
appropriate treatment for wellbeing of people. However, it has been analysed that effective
policies should be followed by staff because it will facilitate their efforts in correct direction that
results into positive clinical outcomes (Turnbull and et. al., 2018). NHS England focuses on
number of priorities to improve their performance regarding better health of individuals. Initially,
it includes the criterion of enhancing out of hospital care and develops safest as well as high
quality of services. It consists to put efforts to maintain and increase regular performance against
core standards while achieving financial balance. Secondly, it is necessary to boost up efficiency
and productivity of health care system and preventing ill health & supporting people to spend
comfortable lives.
In addition to this, it includes the way of supporting clinical investigation; innovation and growth
which facilitate develop more effective vaccinations and medications for non-curable problems.
It consist the effort of enabling people as well as communities for making decisions in relation to
their own health and care. However, it involves the criterion of establishing and development of
work force by increasing them along with increasing their skills by providing training sessions
for them (Dowling, 2017). It contains the way of boosting up facilities via the utilisation of
digital technology, data as well as transparency. There are several domains of improvement
which are considered by staff that are mentioned below.
Domain 1: It includes the prevention of dying state among people in premature manner.
Domain 2: It consists to enhance the quality of lives of people who were suffering from long
term conditions.
Domain 3: It involves the criterion of supporting citizens in order to recover from episodes of ill
health or following injury.
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Domain 4: It is necessary to make sure about the fact that people have positive experience of
care.
Domain 5: It includes that treating and caring for people in a safe environment as well as
protecting them from avoidable harm (Iacobucci, 2018).
Achievements in the last year
In context of NHS England, it has been analysed that this organisation was considered as first
healthcare system that is responsible for providing medical services for free of cost. It includes
their accountability related to eliminate the fear among citizens to pay expensive treatment to
remain healthy. Basically, they have an achievement of putting limitation for external influence
on patient and staff due to which overall treatment procedure can be conducted effectively and
gain positive outcomes (Klein, 2019). It is necessary for a healthcare system to make health
facilities available in every locality so that every person will access them easily that is achieved
much by NHS England. It is observed that clinicians are not burdened by external forces which
help to deliver accurate services to actually needy person. NHS England is responsible for
providing comprehensive childhood vaccination programme that is effective to protect children
from different types of dangerous health issue including polio, small pox etc., which are
considered to be almost all but completely eradicated. They have put efforts in terms of raising
the status of anaesthetists because anaesthesia is known to be single speciality in NHS England
that is required to be widely recognised for being forefront regarding safety of patient as well as
improvement in quality.
In addition to this, it has been evaluated that staff of NHS England is working for common good
as employees perform together for wellbeing of ill people which is known as central tenet
guiding facility provision in the organisation. It includes the criterion of focussing championing
evidence based medicine while making decision related to treatment for improving effectiveness
of the same. It will facilitate increase patient outcomes because it is based on clinical expertise,
preferences of individual and best possible evidence (Christie, 2016). Meanwhile, the
achievement of NHS England includes their status of leading the work in terms of providing cost
effective healthcare that was developed by Cochrane Collaboration, Centre for evidence based
medicine, both funded by NHS research and development programme. It has an achievement in
regards to providing free contraception for all the women to save them from dangerous sexually
transmitted disease (STD). This facilitates to empower women to take control of their fertility
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along with supporting in prevention of transmitting STDs. However, the promotion of patient
centred care is helpful to develop knowledge level and skills for managing informed decisions
regarding health of people.
On the other hand, it has been analysed that access to in vitro fertilisation which is helpful for
couples to solve their relevant problems and have babies due to availability of IVF treatment. It
involves the effective effort of NHS England about to encourage and support investigation as
well as research to provide more effective clinical facilities and treatment for wellbeing of
people. It is favourable to develop effective vaccination and treatment for severe disease which
are non-curable (Moberly, 2016). However, the achievement of NHS England includes their
different types of clinical practices and additional efforts towards welfare of people in order to
increase their quality of lives. Moreover, NHS England is effective organisation for poor people
because they offer treatment for free of cost so that unable individuals can get desired treatment
to become disease free.
Identified areas of concerns
NHS England has various types of healthcare programs and schemes through which they provide
services to improve health condition of entire population. It includes their efforts to focus on
different fields such as child care, women care, old age care etc. which is helpful to maintain
their health status in proper manner. The concerned areas can be defined as sections which need
extra attention and efforts in order to improve the same. it is observed that there are different
types of fields like use of technology, insufficient staff, lack of quality standards etc. that are
responsible for reducing patient experience. Hence, these areas are known to be concerned
aspects which need improvement for delivering appropriate medical services for welfare of sick
individuals (Traynor, 2017). Basically, it involves the number of aspects that can be considered
as concerned areas related to NHS England. It is necessary for the organisation management and
administration to focus these factors in respect of encouraging relevant development for
increasing potential of healthcare system.
In addition to this, the primary concerned areas include the factors of unsafe patient care which is
must to be raised for boosting up patient outcomes. Secondly, it consist the criterion of carrying
out poor clinical practices by nursing staff or other malpractice that are responsible for harming
sick individuals gaining treatment in the hospital. Thirdly, it is necessary to consider
improvement procedures in regards to failure in respect to safeguard patients. Meanwhile, it has
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been evaluated that maladministration of medications is major issue which develop severe
complications that is required to be improved for welfare of people respectively. However, it is
observed that problem of untrained staff and unsafe working conditions develop challenges for
employees as well as patients regarding effective medical facilities. It involves the problem of
lack of updated policies which reduce discipline among medical staff that impact negatively on
respective outcomes. It limited advanced technology in hospital for increasing speed of
treatment. Moreover, it consist the bullying culture that is accountable for reducing the patient
experience and some of individuals remain in fear that impact negatively on treatment results
(Rao, 2018). Furthermore, it includes the concerned area of NHS England including staffs that
are unwell or stressed and not seeking help because they cannot perform in appropriate way. It
will develop problem due to which performance of employees reduced that facilitate to decrease
the effectiveness of carried out clinical procedures affect patient negatively.
Identity a strategic problem
The NHS England has various healthcare schemes and procedures in order to provide clinical
facilities to enhance health status of entire population. It includes the different concerned areas in
which specific issue is required to be concerned on priority that is about to adopt innovative and
advanced technology in organisation. It is must to have advance health technologies which
provide support to reduce the extra burden of nursing staff that facilitates improve patient
outcomes. However, it has been analysed that strategic problem of NHS England is advanced
technology that is helpful while referring patient from one hospital to another. It is necessary to
for management of NHS England to purchase different technological software, applications and
equipment for delivering quick treatment in accurate way. Moreover, it is essential for healthcare
organisation to adopt advanced technology which is favourable to provide number of benefits in
terms of managing patient records and monitoring of severe cases in proper manner.
On the other hand, it has been identified that there are different types of patients visit hospital
like children, women, aged person, middle aged individuals etc. In context of NHS England,
adoption of innovative and advanced technology is beneficial for greater patient care, improved
public health and ease of workflow. Meanwhile, it includes the advantage of lowering healthcare
cost that is favourable for poor people (Gent, 2017). It consist the benefit of better and safe
storage of patient data that can be securely processed along with used as per specific need.
However, the NHS England can gain technology of improved access to bid data to gather
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specific information in accurate way for providing effective treatment. In addition to this, it
includes the advantage of making all the data centralised which is favourable to use it for further
treatment of sick individuals.
PEST Analysis
The external environment of a business organisation includes pestle analysis which helps to
establish effective practices in order to deliver desired services to satisfy need of clients. It
includes analysing the factors such as political, economic, social and technological to make
relevant decision regarding improvement of medical services as per desired requirements of
patients.
Political factor: The political environment includes the regular established by government
which are responsible for influencing operation of NHS England. It includes that manger of the
organisation are not able to focus on long term goals because of changing political atmosphere
(Walker and et. al., 2016). Meanwhile, changing regulation due to changed government impact
negatively on NHS strategies that influence clinical outcomes accordingly. It is observed that
government of the nation affect NHS England to a large extent. However, the changed political
parties in government impact on policies of healthcare organisation due to which management of
get disturbed. Manager of NHS England remain stressed due to unfavourable political
environment of the country.
Economic factor: This can be described as movement of funds from or to the organisation that is
accountable for causing changes in the atmosphere. It includes several factors such as inflation
rate, interest rate. Taxation etc. which are responsible for influencing the management of money
to run the business organisation. In context of NHS England, the requirement of staff members
are increase continuously which increase the labour cist drastically that develop difficulties for
institution to spend more. However, it had been analysed that increased cost create problem to
manage clinical procedures which impact negatively in delivery of services (Ham, 2017).
Moreover, economic environment is responsible for increasing profit or loss of NHS England
which helps to analyse actual need for applying required changes.
Social factor: The social atmosphere of the country is considered in which NHS England is
operating their organisation for providing care services. It includes the social values and norms
of the people according to which care professionals should remain little bit careful so that values
of individuals will not hurt. However, it has been analysed that NHS England is required to
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consider ageing people who requires extra efforts for satisfying their needs; hence, it is required
to boots up hospital capabilities. Social environment impact negatively on employees which
influence their then management of NHS England should make sure that they can spend enough
time with their families. The social factors have ability to increase or reduce patient count and
employees linked with given healthcare public organisation.
Technological factor: This can be defined as utilisation of more effective as well as efficient
technological equipment and software. It will provide support to reduce extra work pressure of
staff and improve their treatment accuracy in order to deliver better care facilities for wellness of
sick people. However, it includes that lack of technology impact negatively on surgical areas
mostly for suing old equipment which affects the entire procedures and respective outcomes. It is
very risky to carry out surgery with out-dated instruments for the patient. Technology is
beneficial to track patient who will be visiting hospital to manage the clinical procedures. The
use of innovative and advanced technology improves efficiency of NHS England and data can be
stirred more accurately at specific storage.
SWOT Analysis
The intern factors are required to analyse for improving several aspect and utilise strengths
which are helpful to make hospital more efficient. It includes the utilisation of swot analysis
including strengths, weaknesses, opportunities and threats respectively. However, it is favourable
to improve weakness and threats and use strength & opportunities by NHS England in effective
manner. Moreover, the swot of given organisation is given below.
Strengths
 Although, it cannot said a monopoly of the selected organisation but it can be considered
that there is no real competitors observed in the market for NHS England.
 It is observed that there are number of private hospitals that are available in United
Kingdom but a service related to accident as well as emergency in NHS England has its
unique identity (Jones, 2018).
 It has been analysed that it is the fact related to continual monitoring of waiting lists is
proof regarding the high demand outstrips supply respectively.
 It is observed that the NHS organisation was established in the year around 1948 form
when it has a direction of growing and expanding itself in continuous way in regards to
its services as well as facilities.
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Weaknesses
 It includes the inability of NHS England in order to cope with the demand due to
increased population facilitating extra pressure of sick individuals.
 They have huge infrastructure and employees working throughout the country but still
people have to wait for gaining clinical facilities accordingly.
 It involves that possibility in relation to management of the linkages of the chain per the
resources analysis.
Opportunities
 The NHS England has an opportunity to utilise more effective as well as efficient
marketing strategies in terms of raising the profile of the given organisation.
 It includes another opportunity which can be used in order to private investment for
improving their funding regarding improvement of services.
 It is observed that NHS England can collaborate with local care trust and care homes
which are suitable to address health problems of more people in the nation.
Threats
 In context of NHS England, it has been analysed that there is a threat of reduced goodwill
of organisation which get affected due to work of contractors.
 It includes the criterion of high turnover of staff which impact negatively on regular
routine work in hospital.
Articulate a situation of change
The change is required to be adopted in NHS England which helps to boost up efficiency of the
organisation to fulfil its weakness while providing care facilities. It includes the criterion of
adopting different types of strategies to acquire innovative clinical activities as well as
procedures in respect of improving patient outcomes. However, it has been analysed changes
should be implemented by using effective theory of change in proper manner. It is necessary to
use theory of change for implementing desired change effectively. In context of making specific
changes of improvement in NHS England, the appropriate theory of change is Lewin’s change
model by considering its elements in proper manner.
Unfreezing: This is known as initial stage in which specific need should be conveyed between
employees to avoid their natural resistant reaction by making them aware about level of desires.
It includes the criterion of explaining staff about the specific change and its need by explaining
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several aspects including benefits to motivate them for easily accepting the respective changes in
the given organisation.
Changing: This step can be considered as transitioning or moving because of implementation of
the change. It consist the use of effective way to apply desired changes into organisation for
increasing potential to make medical facilities efficient.
Refreezing: This is considered as final stage when the action of reinforcing, stabilising and
solidifying that new state after the change. It is necessary to make stable the changes applied and
its relevant outcomes received after the implementation.
Context of the change
In case of NHS England, it has been analysed that innovative and advanced technology is
required to be applied by changing it via replacing the old. It will facilitate to reduce extra work
load of nursing staff so that they can perform in more effective manner. However, the adoption
of advanced technology is favourable to maintain accurate storage of patient data records and
easily gain specific information to make quick decision of providing treatment. Effective
technological software and applications are helpful to track the location of patient according to
which staff can manage their duration of time to manage patients for dealing with in appropriate
manner. In addition to this, the employee turnover is major problem in given organisation which
is required to be improved by making changes in working condition and policies of the company.
It is helpful to reduce the employee turnover and save funds that can be used further for
improvement of facilities or providing services free of cost for wellbeing of citizens of the
country.
CONCLUSION
From the above report, it has been concluded that health & social care sector exist to provide
healthcare services and care to needy people to improve their health condition. It includes
different types of hospitals which put efforts to deliver better quality of services. However, it has
ben analysed that pest and swot should be conducted to make decisions about clinical operations
for managing delivery of medications on time. It is necessary to make changes about to improve
problematic condition by using Lewin’s change theory.
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REFERENCES
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Allsop, J., 2018. Health policy and the NHS: towards 2000. Routledge.
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