Leadership and Change Management in Mid-Staffordshire NHS Trust

This report discusses the leadership and change management at Mid-Staffordshire NHS Trust in UK. It includes organizational overview, stakeholder analysis, sources of power held by stakeholders, drivers for change using Kotter’s 8 Step methodology, leadership approaches responsible for changes, and barriers to change.

Running head: LEADERSHIP AND CHANGE MANAGEMENT
Leadership and change management
Name of student
Name of University
Author note

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Table of Contents
Introduction......................................................................................................................................3
Organizational overview..............................................................................................................3
Stakeholder analysis........................................................................................................................4
Sources of power held by the stakeholders..................................................................................5
Identification and analysis of the drivers for change using Kotter’s 8 Step methodology..............6
Kotter’s 8 step model...................................................................................................................6
Leadership approaches responsible for changes..........................................................................9
Identify and evaluate the barriers to change..................................................................................11
Conclusion.....................................................................................................................................13
References......................................................................................................................................13

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Introduction
The report is prepared to discuss the various aspects of leadership and change
management at the health and social care organization named Mid-Staffordshire NHS Trust in
United Kingdom. The health and social care organization has managed two hospitals in
Staffordshire, England and even has provided the best quality care services to the people all over
UK for a long time. The organization manages two hospitals including the Stafford Hospital and
Cannock Chase hospital with 3560 beds and 115 beds respectively. There are more than 320000
people who are provided with services by the hospital and this has improved their health and
well-being (Shekelle et al. 2013).
Organizational overview
Mid-Staffordshire NHS Trust has undergone significant changes and improvements in the
last few years, because there have been reports regarding the excess death statistics in the final
prepared Healthcare commission report. Due to this, the company’s reputation deteriorated and
the Foundation Trust’s status was de-authorized as well. Based on various researches conducted
and enquiries, it was found that the trust would get dissolved and most of the staffs would be
transferred to the North Staffordshire Trust to ensure that the emergency services could remain
open and the consultant dependent services should move to the University hospital
(Midstaffs.nhs.uk 2018). Other changes that were made with the help of proper leadership
included recruiting the permanent replacements for making sure that the elective surgeries could
be stopped during that time and more focus should be placed to focus on the utilization of
resources on emergency care. The cost of changes incurred over £300m, and the remaining

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amount of money was used to renovate the A&E department at the NHS trust to prevent issues
like overcrowding, long queue and lack of space for filling the patients (Mendenhall et al. 2014).
Stakeholder analysis
The stakeholders are the individuals who are concerned with the management and
functioning of the organization at various levels such as investors or shareholders, employees,
customers, customers and suppliers of the organization. Knowledge could be used as power to
produce the best quality services and at the same time, facilitate the management of intellectual
capital for gaining a competitive edge over its competitors. The stakeholders hold different kinds
of power and responsibilities at various levels of the organization to ensure that the team
members, individuals working at the NHS trust and various departments could possess enough
knowledge and information to advance the interest of the organization with ease and
effectiveness (Goetsch and Davis 2014). The stakeholders are also responsible for controlling the
resources as power and furthermore enable proper availability, accessibility and utilization of
resources to ensure that the issues regarding resource scarcity can be overcome. The managers
are other stakeholders who play integral part in managing the workforce and make decisions and
due to this, they hold the most responsibilities and power to resolve the cultural differences and
even maintain successful business functioning. Some stakeholders do hold the power of forming
effective networks as power and manage accessibility to information, furthermore assist in
proper resources’ utilization and making decisions accurately for the business benefits at Mid-
Staffordshire NHS Trust. Thus, it could be clearly understood that the stakeholders in business
hold enough power and authority to manage changes within the organization and bring out
positive outcomes in terms of enhanced service delivery, better customer satisfaction, higher
revenue generation and competitive advantage in business too (Van der Voet 2014).

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Sources of power held by the stakeholders
There are three different kinds of stakeholders considered within the health and social
care organization including the internal stakeholders, interface stakeholders and external
stakeholders. The internal stakeholders are the individuals who work within the organization and
few of them are administrators, staffs, nurses, doctors, safety service personnel, housekeeping
staffs, etc. The interface stakeholders of the health care are the individual who work both
internally and externally for the organization and they are the Board of Directors, medical staffs,
etc. whereas the external stakeholders provide inputs to the organization to bring out the desired
positive outputs (Bolman and Deal 2017). The external stakeholders of the organization are
patients, third party payers, suppliers, material vendors and other individuals who have specific
interests in the business functioning related to economic growth and development, proper
management of resources, etc. The power is hold by various stakeholders of the NHS Trust such
as the patients who have the power to make decisions while receiving the care services, trainees
such as pharmacists and foundation doctors associated with the combining of services and
training sessions and trusts that enable clinical risk management and safety of individuals by
reducing the adverse effects of drugs. The Deaneries or School or Pharmacy are associated with
the training and development programs provided to the individuals while the wider NHS has
distributed the good clinical practices through the BTBC pilots (Cameron and Green 2015).
One of the most effective theories could be the four Rs theory that should assess the roles
and responsibilities, rights, rewards and stakeholders’ relationships with the other groups at
Mid-Staffordshire NHS Trust. The power source for the internal stakeholders at the organization
were organizational hierarchy or structure that provided the managers of the NHS Trust to gain
authority and power to influence the formulation of policies and ensure successful business

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functioning. The management of strategic resources helped the leaders to gain power to
formulate strategies and implement those while the knowledge, skills and expertise of the staffs
had been considered as the power sources of the top management level (Beck and Cowan 2014).
The power sources for the external stakeholders were dependence on the resources such as
obtaining funds and loans from banks and deriving power to manage changes. Being a highly
authoritarian organization, it became easy for obtaining links, which had created more scopes
and opportunities to enhance the effectiveness of the strategic management process. By
maintaining power, it became easier for the organization to meet the safety and legal health
service requirements and even helped in maintaining the quality standards to become one of the
high performing hospitals in UK, according to the Care Quality Commission report (Nandan
2017).
Identification and analysis of the drivers for change using Kotter’s 8 Step methodology
Kotter’s 8 step model
There are various drivers for change at the Mid-Staffordshire NHS trust and changes
have been done to improve the business functioning and overcome the issues that are faced by
the health and social care organization. The eight steps of the model are to create an urgency,
forming an effective coalition, creating a vision for change, communicating the vision and
mission of the organization, creating short term wins, developing the changes and finally
implementing the changes within the corporate culture of Mid-Staffordshire NHS Trust, United
Kingdom (Renz and Herman 2016).
Step 1: Creating urgency

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The hospital was facing some major issues related to the excess numbers of deaths and
large queues made by the clients due to lack of beds and space within the hospital. Due to this, it
was important to formulate change management strategies, which helped in improving the
functioning of the organization as well as allowed the hospital to maintain re health, safety and
quality standards according to the Care Quality Commission. Investigations were made and there
was immediate need to change to improve the quality of care services provided to the service
users of Mid-Staffordshire NHS Trust, UK. As soon as the urgency was created, the potential
threats were identified and the opportunities had been evaluated to provide reasonable
explanations about the current scenario (Lachman, Runnacles and Dudley 2015).
Step 2: Forming an effective coalition
The stakeholders of the organization were informed and communicated about the
necessity of change, which was further facilitated with the support of good leaders and skilled
staffs. The leaders were identified with the most effective skills to make decisions and there was
more focus on developing teams to identify the areas of weaknesses and at the same time,
communicate the roles and responsibilities that should be managed by the various stakeholders.
Step 3: Creating a vision and mission to enable change
To create a vision, the values were determined along with a perfect strategy for executing
the vision, furthermore ensured that the change coalition to practice the effects of change that
would be experienced afterwards (Finkelman 2015).
Step 4: Communicating the vision

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The vision was communicated by the leaders of the organization to the concerned people
of the organization to address the people’s concerns and preferences along with the management
of operations such as training sessions and performance appraisal techniques.
Step 5: Overcoming obstacles
The issues were mainly related to the long waiting queues, lack of enough beds, improper
quality of services and lame culture within the workplace. Communication was managed
properly at Mid-Staffordshire NHS Trust to maintain a positive culture where people managed to
work as a team and consider the views and opinions of the other team members before coming to
a conclusion. The managers also listened to each of the team members and discussed about the
approaches and leadership rationale. It not only helped in managing the channels of
communication properly to gain feedbacks and information, but also allowed to encourage
change management at the hospital. The infrastructure was improved with the management of a
good hierarchy, which further created more space for allowing more clients to visit the hospital
and obtain the relevant health care services (Carter et al. 2013). More investments were made to
improve the organizational functioning and provide relevant training and development programs
to the individuals for improving their skills, knowledge and expertise level. This was how the
obstacles were overcome at the hospital to maintain the quality standards and ensured safety and
wellbeing of the individuals who availed the services of the organization (Midstaffs.nhs.uk
2018).
Step 6: Creating short term wins
Nothing other than success motivates and encourages the business functioning the most.
With the achievement of short-term success, it became easy for the organization to understand

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the feasibility of the entire project and even the project costs were reduced to a certain extent.
The advantages and disadvantages of the targets to be achieved were analyzed thoroughly and
the changes were built (Kuipers et al. 2014).
Step 7: Building on the changes
At Mid-Staffordshire NHS Trust, change was brought with the development of a patient
centered culture with proper consideration of compliance with the fundamental standards for
ensuring transparency and openness. It was necessary for the NGS to examine the financial and
clinical standards to form a positive culture and at the same time, overcome the issues related to
communication.
Step 8: Implementing the changes within the corporate culture
The changes were implemented by creating a patent centered culture, where the needs
and preferences of the patients were prioritized on the most. Communication was established
between the staffs and the clients to know about their needs and provide services accordingly to
fulfill the standards of meeting the health and safety of the individuals admitted to the hospital
(Williams 2013).
Leadership approaches responsible for changes
Another important driver for change is the leadership at the organization, which ensured
implementation of successful changes and making the staffs accustomed with those to achieve
business success and long term profitability. The leadership approaches were managed properly
to ensure that the people could work as an unit and enable team work to facilitate the
improvement of customers’ services and best quality services provided to the service users. With
the support by NHS Leadership Academy, leadership model was developed for the NHS trust to

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develop programs and intervention techniques for enabling changes in the culture through the
involvement of multiple delivery partners. There was better professionalism in leadership along
with NHS funded services, which further maintained a consistent approach in maintaining good
leadership skills at various levels of the organization (Buller 2015). The leadership model or
framework was created to improve the patient safety and well being along with better care
services’ delivery to meet the standards and requirements of the Care Quality Commission. The
behavioral standards and technical competence and skills were further combined together to
provide the leaders with necessary information and knowledge about the management of proper
values, ethics and an appropriate culture within the health and social care organization in UK.
The leaders were much aware about monitoring the license conditions to strengthen the corporate
accountability within the health and social care as well (Hammer 2015).
A proper leadership approach could not only contribute to the achievement of goals and
objectives, but would also transform all the workers at the hospital in pursuit of a better and
collective purpose. There was lack of communication and coordination among the staffs, due to
which, the leaders made sure to engage the staffs and managers altogether while practicing
transformational leadership (Midstaffs.nhs.uk 2018). This promoted the establishment of trust
and loyalty and even focused on the concerns of the employees, furthermore implemented
changes to improve the level of safety and wellbeing of patients at the hospital. The leaders
conducted frequent negotiations with the staffs to respond to the changes occurred due to the
external forces and made sure to secure their commitment to the organization (Grohar-Murray,
DiCroce and Langan 2016). Knowledge was shared and the tasks were allotted to the employees
based on their level of skills, knowledge and expertise, which assisted in bringing out a
transforming effect through the development of work hour policies and proper time scheduling at

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Mid-Staffordshire NHS trust, UK. To balance the business efficiency and performance of staffs,
the leaders also provided them with good working conditions and established a good culture,
where the workers could feel secure and encouraged to perform better. The training and
development programs were arranged by the leaders to enhance their knowledge level and
allowed them to perform to their potential too (Van der Voet, Groeneveld and Kuipers 2014).
Identify and evaluate the barriers to change
There were multiple barriers associated with the implementation of changes at the
concerned health and social care organization. The barriers were mainly caused due to the lack of
proper standards maintained at the hospital in terms of quality and effective service delivery
along with long waiting queues. The service delivery was delayed and even the quality of care
services deteriorated with time, which further created difficulty in maintaining the standards of
the Care Quality Commission and many patients died too. Questions started arising regarding
the lack of efficient services provided by the hospital and so there was immediate need to
implement changes at Mid-Staffordshire NHS Trust. But changes were not as easy to implement
as it seemed to be and there were multiple barriers, which hindered the successful application of
changes (Bolden 2016). Other barriers associated with the changes implemented could be the
prevention of healthcare assistants to provide care services to the patients without being
registered. The budget was another factor that acted as barrier prior to the management of
changes at the organization. Statutory obligation imposed for managing the duties related to care
services’ delivery could also be a major barrier to change at Mid-Staffordshire NHS Trust
(Midstaffs.nhs.uk 2018). Due to the deaths of many patients, the hospital had to pay more than
£1.1m as a compensation amount, which resulted in huge loss as well and lack of sufficient
financial resources. Before managing the changes and improvements within the organization, the

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medical staffs and doctors failed to blow the whistle on the patients receiving poor care services.
The managers did not properly supervise the junior doctors due to which the targets were not
achieved within he assigned time too (Hornstein 2015).
Other barriers to change at the hospital were lack of employee engagement, an
inappropriate culture, lack of proper communication and organizational complexities faced due
to inaccurate knowledge and information sharing. The engagement of employees lacking in the
organization can be considered as one of the major barriers to change management. The
employees felt afraid to adjust to the changes and due to the organization’s poor functioning, the
engagement of employees further deteriorated. They even failed to embrace the new culture and
enough resources were not available to drive them towards the management of changes at Mid-
Staffordshire NHS Trust, UK (Osiyevskyy and Dewald 2015). There was lack of effective
communication strategy and due to this, the leaders and managers also were incapable to adjust
to the new development. A bad culture shift planning was another barrier to change, which made
the team fail to make decisions properly based on the intuitions and feelings. There was no
proper planning administrative structure and the staffs were not allotted with the right roles and
responsibilities to provide the best care services to service users. The organization developed
complex processes, which created complexity during the planning and implementation of
changes at the hospital. To overcome this barrier, it was important for the hospital to manage
employing meticulously considering the skills, knowledge and expertise of the staffs and bring
out enhanced quality and efficiency in the change management approach too (Cummings,
Bridgman and Brown 2016). Therefore, these were the major barriers to change faced at Mid-
Staffordshire NHS Trust in United Kingdom, due to which its reputation deteriorated and the
care services’ efficiency declined resulting in lesser profit. It had been important to implement

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changes and ensure improving the business functioning and creating positive mindset among the
service users too (Lozano 2013).
Conclusion
The report was prepared to analyze the concepts of leadership and change management at
a health and social care organization in United Kingdom. The report included the concepts of
providing an organizational overview, which showed that Mid-Staffordshire NHS Trust managed
significant changes and improvements due to the emergence of multiple issues including higher
numbers of deaths of individuals, long waiting queue of patients and lack of appropriate culture
and leadership, which hindered the communication and coordination among the employees. The
stakeholder analysis was done to determine the level of power and interests of the various
stakeholders while sources of power were both internal and external. Kotter’s 8 step model was
used to identify the drivers for change and how changes were made possible at the organization.
The leadership approaches were considered as relevant and effective for bringing out changes
and improvements within the organization, furthermore overcome the barriers to change
experienced at Mid-Staffordshire NHS Trust.

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