Leadership and Change Management Analysis on Frimley Health and Social Care UK

This is a change management analysis conducted on Frimley health and social care UK. Organization decided to implement transformation change to improve service delivery to local people, enhance emergency care system by enabling digital technology. This was a major change in coordination with several other partnership organizations. Major drivers for change include changing industry environment increased cost, consumer demand and dissatisfaction from present healthcare system.

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Leadership and change management
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Executive summary
This is a change management analysis conducted on Frimley health and social care UK.
Organization decided to implement transformation change to improve service delivery to local
people, enhance emergency care system by enabling digital technology. This was a major change
in coordination with several other partnership organizations. Major drivers for change include
changing industry environment increased cost, consumer demand and dissatisfaction from
present healthcare system. However, digital change require a shift in mindset and behavior of
staff, therefore it attracted huge resistance. To implement change successful effective leadership
teams were formed, engaging leadership style was implemented at various levels, clarity of
vision, and outcome and steps were set. Successful change implementation require effective
management from initial planning stage to evaluation stage, continuous motivation and
communication is required, so that change participants feel engaged and participate effectively.

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Table of Contents
Introduction......................................................................................................................................4
Purpose of the report....................................................................................................................4
Background information..................................................................................................................4
Concept of change........................................................................................................................4
Objective of change program...........................................................................................................5
Type of change and change theory with objective..........................................................................5
Power of stakeholders......................................................................................................................6
Shareholder analysis matrix.........................................................................................................6
Lewin’s Force Field Analysis..........................................................................................................8
Drivers for change........................................................................................................................8
Dissatisfied customer...............................................................................................................8
Increased cost...........................................................................................................................9
Healthcare complexity..............................................................................................................9
Access and digital technology..................................................................................................9
Changing culture and market expectations............................................................................10
PESTLE Analysis...................................................................................................................10
SWOT analysis..........................................................................................................................10
Leadership approaches to change..............................................................................................11
Resistance to change..................................................................................................................13
Change implementation process................................................................................................14
Conclusion.....................................................................................................................................15
Bibliography..................................................................................................................................17

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Introduction
This is a change and leadership paper written on Frimley digital change management. It includes
in-depth analysis on recent change management plan within organization. Change is a
continuous and inevitable for organizational success.
Purpose of the report
This paper include analysis on the company, its change program, the way it impact its
stakeholders, leadership used, change management strategies, key drivers and barriers to change,
therefore a complete comprehensive analysis on company actions and its outcomes.
Background information
Frimley health and care aims to improve health care services for more than eight lakhs people in
local area, it is formed with partnership of organizations that aims to work towards a shared
vision for optimum utilization of combined resources to help community development,
healthcare, patients etc. Key partners include CGS such as East Berkshire, North East Hampshire
and Farnham, and Surrey Heath, acute care providers, mental health and community foundation
trusts and GP federations. It aims to provide integrated primary and acute care systems vanguard
in North East Hampshire and Farnham NHS 2016. Key objective of Frimley Health and Care is
to operate in coordination with local stakeholders to develop better healthcare system for future
so that holistic services can be provided to local people. It aims to provide proactive treatment
NHS 2016.

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Concept of change
Leadership is an interactive process that facilitates in fostering healthy work relationship within
organization, whereas leaders are the one who ensure smooth functioning of all departments,
coordination and performance through motivation Banfield & Kay 2012. Culture is a societal
context which helps in differentiating group of humans on the basis of values, beliefs, norms,
assumptions etc. it varies according to culture, individual, organizations etc. Deal & Kennedy
1982. A successful change requires strong leadership to ensure positive outcome and successful
implementation Giuliani & Kurson 2005.
Objective of change program
Frimley implemented sustainability and transformation change management plan. It aims to
develop a network of integrated hubs that can serve around 50000 people, it aims to provide
connected out of hospital services so that teams from best health and social care can looked to
patient without constraints of organizational boundaries. This change plan aims to enhance
patient experience, increased satisfaction among hospital employees. It aims to develop an
integrated healthcare system with following objectives;
 Enhanced coordination
 To make emergency care system assistance easy and simple, patient should clearly know
whom to contact and offered care and support can be organized at home.
 Increased service providers skills and confidence, enhanced use of technology for easy
access to information
Type of change and change theory with objective
Different authors have defined different types of change. Different types of change according to
Kotter are Formal reengineering, Restructuring, Programmed, Mergers and acquisitions,

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Strategic change and Cultural change. However, Grundy 1993 defined change according to its
speed of transition that is smooth incremental, bumpy incremental or discontinuous change
Burke 2010. Todnem By 2009 defined type of change on three parameters that include rate of
occurrence, how it comes about and scales Goncalves 2007.
Selected change management case in Frimley is a strategic change that includes partnership with
healthcare organization and technological development with objective oveef customer
satisfaction. It is a revolutionary change that would radically impact organizational culture and
management system. Potential approach that Frimley management is trying to opt is smooth
incremental change by setting deadlines and stages of change development.
Power of stakeholders
Stakeholder analysis is a key step in change management, it helps in understanding every
individual that needs to be involved in the change process, time, resource and commitment
required. It helps in enhancement of Process Improvement for Strategic Objectives that helps in
including users into problem solving process. It also facilitate in seeing projected outcome of
system change and resistance that might come Bordia, Hobman, et.al 2004. Technological
development causes redesigning of activities involving people and therefore change might cause
resistance. It includes direct the one who are directly affected by the change such as patients, GP,
clinicians, employees, secretary etc. another is indirect stakeholders who include both outside
agencies and decision makers. There are also interface stakeholders, the one who work as a
facilitator to change management.

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Shareholder analysis matrix
Stakeholde
r
Stakeholder attribute Stakeholder
influence
Changes
Power Legitimacy Urgency
Patient High NA High Dependent Given choice
Clinician Low NA High Dominant Role changes
New program of work
Public High NA Medium Definitive Gove choice
New program of work
Staff Medium NA High Definitive Decision making
Target to change
Voluntary Low NA Medium Definitive Decision making
Target to change role
change
According to change management plan it ensures full involvement of clinicians across all the
initiatives but also ensure ongoing communication with all stakeholders. Key strategies to
manage stakeholders include priority setting workshop, wider leadership, wider stakeholder
event, continuous work updates etc. to deal with workforce issue, it is planned to brainstorm with
managers and staff to find new and better roles. Workshop was organized with key stakeholders
such as staff, clinicians to confirm priority areas as they are the one who are in direct contact
with patients and their needs. For Health and Wellbeing Boards and Health Watch it aims to

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become system with a collective focus on the whole population that does not differentiate patient
on sector or service.
Lewin’s Force Field Analysis
Though there are several model of change management implementation, Lewin force field
analysis is widely accepted. It can be defined as a situation when there is imbalance between
change driving and change restraining forces. Author gives three steps that can be implemented
to balance it that include unfreeze, change implementation and re-freeze. This model facilitates
in finding factors that drive towards and away from change, it can help in making informed
decision and also adequate leadership to shape desired behavior.
Drivers for change
There are external and internal factors that impact the need for change, to understand key
stimulants to change it is crucial to understand strengths and weaknesses of the organization,
further there is also need to evaluate industry scenario in which it is operating. Objective of
Frimley healthcare transformational change was to putting local people first and to ensure
availability of holistic healthcare services by providing right services at right place and time. It
also aim to launch digital technological changes to ensure better information sharing and
providing interoperability between the various different systems share across the area through
snapshot.
Dissatisfied customer
There is high percentage of dissatisfied patients in UK market, almost 70 percent consider that
healthcare is moving in wrong direction, there is rising cost of drugs, long wait time and rising

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customer grievances. Further, patients also think that healthcare is being adversely affected due
to Brexit; there is increased waiting time and lack of funding Boseley 2017.
Increased cost
Another market issue is ageing population in UK market, the average age is 40 years and it is
expected to rise by 6.1 years by 2024. Therefore, increased need for chronic medical assistance,
which is forecasted to be 2.9 million by 2018 end BBC News 2018. Such condition imposed high
cost pressure on healthcare system, it is expected that average cost of hospital and community
health services for ageing population will be three times greater than young people
kingsfund.org.uk 2018. Another problem is raising cost of medicines, which is creating a domino
impact; there is need for funding to promote value for money in medicine purchase.
Healthcare complexity
There is enhanced complexity in healthcare delivery system. The specialist work focuses on only
one issue of body; it causes lengthy and costly process of treatment, long paper work Iacobucci
2017. There is need for enhancing coordination, proactive care, self-care and prevention.
Access and digital technology
Thee is rising expectation in terms of digital technology, information sharing. There was need for
developing a digital technology that enables information access across different services such as
primary, acute or mental. There was need for developing a technology that helps in sharing
records among different healthcare organizations Fulopa, et.al 2012. Information sharing must
be in accordance with role of individual access the record. Further there is need for transparency
in system so that patients are well informed regarding information shared and their preference for
the same. Digital technology will help in uplifting service delivery and enhance employee
performance.

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Changing culture and market expectations
There is cultural shift in UK market that enforces decentralization of power and enforces the
need for user involvement. Presently patients have different level of expectations from policy
makers, they need to consider both social and cultural environment before deciding on new
strategies. There is also rise in patient autonomy and expectations from service provider and they
have access to global information. This drives the need for enhancement of responsiveness by
clinical practitioners White 2010. External changes such as awareness, enhanced customer
demand enforced changes such as need for new delivery system, changes for staff and patient
with greater use of technology.
PESTLE Analysis
If external market analysis is conducted to evaluate key drivers to change, Brexit has strongly
impacted funding of healthcare system, there is lack of attention. Socially there is ageing
population, rising need for chronic health services, need for global information sharing that
highlights need for new transformational system that gives engaging healthcare service with
partnership between clinician, GP and patients.
SWOT analysis
Through UK has strong healthcare system but there is lack of coordination, emergency service
are difficult to get access, process is complex. Though the hospital is market competitive but
overall process is complex for general public.

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Leadership approaches to change
It is not possible to implement successful change without adequate leadership and management.
Leadership is a continuous process of developing relationship between people who aspire to lead
and the one who follows Cummings & Worley 2009. Leaders have the power to shape employee
behavior, motivate them, it is not only limited to controlling and managing behavior rather it
aims toward empowerment, collaboration, diversity, humility and higher purpose Avery 2004.
Leadership style has strong impact on the way leader behave and employee react. Therefore
leadership traits and characteristics such as intelligence, drive, motivation, persistence, and
extraversion are of key importance to implement successful change Bhindi & Duignan 1997.
In Frimley healthcare, they use leadership and management as one term to denote the actions and
principles that are being implemented to improve the design and implement transformational
changes. Leaders also intervened at broader level such as project designs, accountability, key
values and challenges that were encountered by staff. Senior management level involvement in
change management system helps in generating interest and support within organization, it also
communicate other staff regarding change management importance.
Leaders encountered several cultural issues in bringing different organizations together to work
due to history of competition and lack of trust. According to management, successful leadership
depends on good relationships; it should not be limited to any single type of professional or
department. Therefore face to face meetings were organized to keep clarity regarding joint
responsibility and foster healthy relationships. Further, Frimley compiled a group of high
performing providers, commissioners and systems to ensure successful delivery of change plan.
To achieve the goal of becoming an accountable care organization a governance system was also
formed. Below is system wide leadership group of Frimley healthcare.

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NHS 2016
Above diagram shows, Frimley has three leadership groups and the system wide leadership
group brings all members from these groups together to ensure collaborative, cross system
support and relationship building. Another is Frimley system leadership reference group that was
held by Andrew Morris who works on behalf of all three major leadership groups and lead the
delivery of transformation change plan. Another was executive delivery group who was held
responsible for programme management and support to work teams, it includes executive
directors representing the localities and they report to leadership reference group. Apart from
this, Frimley also tries to implement wider stakeholder engagement plan by electing member
from volunteer segment.
Key objective of leadership model within Frimley was to define a clear sense of purpose and
contribution by explicitly mentioning needs of patients and interpreting wider environment and
impact. Second objective is to motivate organizational team and staff to work effectively, this
was done by clarifying goals, building commitment, encouraging staff involvement in change

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process, managing improved performance, two way communications. Third was to ensure
adequate focus is given on system improvement by initiating new process and structure,
assessment unit performance, practice continuous improvement.
Analysis shows need for redesigning collaborative leadership to get innovative ideas; there is
need for creating a holistic environment that encourage collaboration, independence and trust so
that leaders can work beyond targets and hierarchies. To achieve this target, Frimley launched
Frimley Health and Care System and Transformation Partnership’s Leadership 2020 Programme
aims to break organizational barriers and help clinicians and managers across the clinical health
care system to engage with communities and fulfilling the needs of local population
(tvwleadershipacademy.nhs.uk, 2017). Analysis shows need for delegative leadership style that
work according to Adair action centered model that states that task can be done in teams, teams
can successfully accomplish task when every individual is fully developed and task facilitate in
challenging and motivating individuals. Therefore, leaders play key role in successful change
implementation, there is no more applicability of heroic model of leadership, rather there is
presence of turnaround chief executive and engages form of leadership.
Resistance to change
Further there were factors causing hindrance in implementing transformation change and digital
technology within healthcare organization. To implement an integrated care system there was
adoption of American slant, there was orders that include everything that nurse do such as blood
tests, chest x-rays, drugs. Therefore, there is need for complete Shift in mindset of al clinical
staff and it attracted huge resistance initially. Further digital change also impact autonomy of

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patient and staff, there was issue to disruption to complex clinical workflow, it also raises
concern for privacy and interoperability causing challenges.
It was difficult to implement digital change as there was resistance due to digital adoption,
perceived usability of the new system and support from patients as well. According to literature,
resistance is caused by intertie as regardless of ideal method of individual decision making, the
process people rely upon is not rational, this cause gap between descriptive and prescriptive.
Author also claims that decision maker fails to understand full complexity of implementation
which includes technical, emotional and political resistance to change. Further, there is challenge
of initiating; sustaining and resigning change as it require lot of time, clarity, consistency, fear of
isolation, fear of negative review etc.
With implementation of integrated and STP there is a cultural shift in healthcare that require
huge coordination, it will cause shift in roles and responsibility of health practitioner and also the
way patient get access to services. There is fear of change among employees, security
challenges; patients might not agree to share their data on digital platform.
Change implementation process
To deal with change successfully, a proper change implementation plan was made that include
priorities that new change aims to achieve. Frimley health and care made substantial change to
improve wellbeing, improve long term healthcare outcome, frailty management, reducing
healthcare inequalities and offering integrated care system to coordinate all activities. To
implement it with minimum disruption first skill analysis was conducted so that all participants
have confidence, skill and power to accept new changes. Integrated decision making hubs were
formed to foster a single point of information access. A support workforce was design to manage

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and support the new change, implement shared care record that is accessible to all professionals.
A clear change plan was communicated to all stakeholders by Frimley leaders that include
objectives, deliverables, scope, exclusion, benefit from the change and outcome measures. To
mitigate risk change team ensured maximum engagement, continuous updates to system leaders,
two way open communication and strong return on investment NHS 2016.
Key enablers to ensure successful change management include forming local digital roadmaps
that include information sharing system and patient portal. To ensure financially backup a model
has been developed that include size of financial challenge in relation to change introduce. Key
challenges encountered include achieving clinician ownership, it was achieved by involving
clinical staff and GP in design and implementation; intensive mandatory training programs were
held to bridge conversation nice.org.uk 2017. Performance was improved by redesigning care
pathways, proper cost and time scale was maintained for the implementation process with key
evaluation criteria’s. Focus was given on user engagement by giving them chance to design an
shape the technology that impact their daily lives, it enhances sense of ownership; it helps in
reducing wide variation of attitude due to past experience. Change management team at Frimley
healthcare provided continuous feedback to share regular outcomes through workshops,
meetings to provide adequate voice to raise concern, questions and suggestions.
Conclusion
Health and social care is an important pillar to nation stability. Due to ever changing and
developing external and internal environmental needs, change must be adapted. Change is a
broad term associated with several themes such as need, time, rate etc. It is difficult to change set
behavior in healthcare setting due to complexity of relationship shared between different

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organizations. Leadership is one factor that helps in boosting change by focusing on improving
patient care, motivating employees. Change requires clarity of purpose and evidence based
implementation system. Factors that encouraged change are mainly external such as increasing
dissatisfaction, rising cost, complexity etc. however, it was not easy to implement change as key
barriers to change include lack of awareness, knowledge, fear of unknown, problem is digital
adoption. However, Frimley health and social care adopted a slow and step by step process by
setting small, time bounded realistic goals with definitive teams and expected outcome. Proper
management and leadership were maintained with adequate budget, training, feedback and
continuous assistance that helped in reaching set target successfully.

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