Factors Driving Change in Health and Social Care: RUH Trust Report

This report investigates change management within the health and social care sector, focusing on the Royal United Hospital Bath NHS Trust (RUH). It identifies key factors driving change, including patient care, technological advancements, and service improvement, while also examining the challenges associated with change, such as conflicts, poor communication, and leadership issues. The report explores the importance of a sound change management framework to support individuals, including the use of surveys and feedback to assess the impact of changes. It also details various methods for measuring change effectiveness, such as collecting feedback, measuring performance, and consulting experts. The report concludes that healthcare organizations must regularly adopt changes to improve services and foster innovation, emphasizing the need for careful and intelligent implementation to achieve objectives efficiently.

FACILITATING CHANGES
IN HEALTH AND SOCIAL
CARE

EXECUTIVE SUMMARY
Changes are essential in every industry including the health and social care. Changes
occur because of some unidentified factors and aspects. This research report is in context with
the investigation performed on RUH trust in UK. The purpose of the research is to learn the key
factors that drive changes in the health and social care services. It also helps in understanding
how the impact of changes can be measured. Impact of changes can be positive or negative.
Some things can reflect resistance to change and a mismatch can be seen in the existing
conditions and in the conditions which are predicted. The study concludes that health and social
care firms needs to adopt changes at regular intervals because it helps in improving their services
and bringing creativity. The transformation is required to be adopted with utmost care and
intelligence and in this manner the objectives of the change will be achieved efficiently.

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................4
LO 1 ................................................................................................................................................4
1.1 ................................................................................................................................................4
1.2 ................................................................................................................................................5
LO 2.................................................................................................................................................6
2.1.................................................................................................................................................6
2.2 and 2.3 ...................................................................................................................................7
2.4.................................................................................................................................................9
LO3 .................................................................................................................................................9
3.1.................................................................................................................................................9
3.2...............................................................................................................................................10
3.3...............................................................................................................................................11
CONCLUSION..............................................................................................................................12
REFERENCES .............................................................................................................................13

INTRODUCTION
Every organization encounters with change in its operational activities. That change is
adopted for the betterment of the services and to improve the operations. Change can be seen in
health and social care bodies also. This report aims towards developing effective understanding
and skills in facilitating change in health and social care sector. It will identify the factors that
drive these changes. The study will help in understanding the principles of change management.
For that purpose, CQC report published on Royal United Hospital Bath NHS Trust (RUH) is
taken into context.
LO 1
1.1
Changes occur because of some unidentified factors and aspects. These factors are as follows:
Patient care - The utmost responsibility of the health and social care firm is to keep good
care of its patients. Failing to perform that can result in criticism and bad publicity for the firm.
The CQC reports suggested that RUH is not providing adequate services during the peak times
(Blake and Bush, 2008). The patients were placed into day care unit in the absence of appropriate
facilities and there was lack of privacy for the patients. Elective surgical procedures were being
discarded and people have to wait for long time for surgery. There is an issue with the respect
and involvement of the people also (Cameron and Green, 2009). Hence these types of factors
drive changes in the services of the trust as it is related with the health of the patients.
Technological aspects - The demand for treatment equipment and ailing procedures keep
on changing from time to time in health and social care sector. These hospitals are required to be
well equipped with the latest technology so that they can treat their patients in more valuable
manner (Carnall, 2007). Presence of appropriate treatment instruments will also provide safety
and assurance to the patients.
Improvement in services - When patients come to avail treatment in the hospitals, they
expect highly satisfied services from the organization. But if the health care bodies fail to
provide that, the need for change arises. In the CQC reports, RUH was criticized for delivering
poor level of services to their patients (Cloud, 2010). For instance, the demand for trust services
was very high but they did not have the sufficient capacity to handle the emergency admission of
the patients. Hence bringing improvement in the level of service also leads to drive the change.

SWOT factors:
STRENGTHS WEAKNESS
1. High level of performance in patient's care
2. Strong local brand
3. High level of clinical expertise
4. High level of capital investment
1. Difficulties in recruiting efficient medical
experts
2. Further investment is needed for
3. development of medical facilities
4. Limited previous marketing activities
OPPORTUNITIES THREATS
1. Development of new models of care
2. Ageing population seeks for non-elective
and elective care
3. Mergers with private sector
1. Competition from private sector
2. Rising patient's issues
3. High level of patient expectations
4. operational barriers
1.2
The Care Quality Commission Report suggested some areas where improvement was
required in Royal United Hospital Bath NHS Trust. These were as follows:
 Respect
 Care
 Prevention
 Quality of service provision
 Records
The service providers can face different types of challenges which are as follows: These
challenges are discussed in relation to RUH case study:
Conflicts – It may arise among existing and new employee once the change is incorporated.
Cited company is facing problem of conflict due to poor relationship among the staff member.
From this, level of coordination and integration at the workplace is very less. This is a common
issue associated with the change. It is possible that new and existing employees carry different
opinions and viewpoints (Fullan, 2007). This difference can create clashes and disagreements
over some things.

Environment – RUH is witnessing deviation in the environment as varied issues are been facing
by the company within the context of care, service and respect. Due to this, new joinees are not
able to cope up with the existing environment and hence problem arises. As a result, they feel
frustrated and aggravated towards their work and this affect the overall performance of the
organization (Goncalves, 2007).
Poor communication – Communication is one of the major problem at cited hospital. Due to
this, there are varied set of uncertainty that affects the operations. The modifications can lead to
emerging of conditions where people can hesitate to talk with each other because of lack of
interactions and discussions.
Decision making – RUH is facing problem of proper decision making. This is so because
resources take time in coming to the state of equilibrium. However, new employees need to
make themselves accommodate with existing employee base (Green, 2007). Further, this
adjustment can lead to lack of soundness and appropriateness in these decisions.
Leadership issues – All the leaders handle a team with their own expertise, experience and
knowledge. Individuals can find it difficult to adjust with the new leaders and mentors (Fiss and
Zajac. 2006). This will create clashes and conflicts.
Rules and regulations – It is required to incorporate new set of rules and regulations at cited
company. However, creation of strict rules may leads to stressful work environment which will
certainly affect the performance of employees as well. They will not be able to deliver their
maximum contribution towards their job (Gioia and Chittipeddi, 2006). In this way, it can be said
that it can be difficult to resist change.
LO 2
2.1
It is essential for RUH trust to incorporate sound change management framework in order
to enable and support individuals. It is essential to ensure that resources, skills, tools, principals
and processes must offer value. Also, cited trust need to develop proper vison with respect to
better alternative. In addition to it, proper environment must be developed by the company in
order to enhance the competency and skills of each employees. Through this, negotiation can be
done for unavoidable changes within the operations. Additionally, it is required to support more
of team work as with the help of it, better services and care can be offered to customers (Hudson,

2012). This also helps in building healthy relations among the staff member from which chances
of conflict gets reduce. However, it is essential to assess the impact the change on every
individual so that better strategies can be developed within the context of management of
resistance to change. In this context, company can undertake different sort of techniques for
assessing the impact of change. This includes feedback, interview and survey from patients and
employees. Based on it, proper amendments can be taken by the management. In addition to it,
proper record needs to be maintained of each activity so that it can be reviewed for the purpose
of identifying the loopholes in the procedure. Based on it, new set of policies and regulations can
be developed (McMurray, 2006).
In order to effectively analyze the need of change within organization and to develop an
effective plan for the same, a well structured survey will be developed by the organization. It will
help in analyzing the effectiveness of services and acceptability of same by the service users.
Following questionnaire will help in measuring the need for the change within firm:
QUESTIONNAIRE FOR SERVICE USERS
Specific Information
Name:
Age:
Occupation:
General information
Have you visited Royal United Hospital Bath NHS Trust before?
Yes
No
How did you find the services of RUH?
Excellent
Good
Average
Below average
Not good
How did the care takers respond to the needs and requirements of patients?
Highly satisfactory
Satisfactory
Neutral
Non satisfactory
What is the level of communication in organization?

Excellent
Good
Average
Below average
Not good
How did you find the environment of hospital?
Excellent
Good
Average
Below average
Not good
Are you satisfied with the professional support provided?
Yes
No
Will you choose RUH again in case of any medical guidance needed?
Yes
No
Kindly recommend the changes you wish to see in future for your better support.
2.2 & 2.3
The changes in health and social care can be measured by adopting different types of
approaches and techniques which are as follows:
Collecting feedbacks - It is one of the best approaches of measuring the impact of
change. Surveys and questionnaire methods can be adopted to analyze the opinions of the people
influenced by change (Welch and Fernandes, 2010). In the investigation of Care Quality
Commission, survey has been taken by the staff member. From this, it has been evident that
engagement level of staff is bottom 20% of trust. Due to this, another survey is taken in order to
assess the level of services that been offered to patients so that proper modifications can be
incorporated (Robinson, 2000). This aids in incorporating improvements on the areas which are
lacking.
Measuring performance - It can be done by recording the performance of an individual
before change and after change. The variations and fluctuations can be noticed for the two
different periods. It is possible that the people, who were performing well before, are showing

bad results after the change (Martin, 2012). Hence in this manner, the change impact can be
recorded. This will help in knowing whether the desired objectives of change are being achieved
or not.
Guidance from experts and professionals – Through this, suggestions and advices are
taken from panels which comprises of experts within the context of change management process.
Their contribution can bring some valuable discoveries for the organization. As professionals,
they will be efficiently able to find out the impact of change (Reeves, Lewin and Espin, 2011).
CQC people make interaction from medical staff, pharmacists, therapy staff etc. for the purpose
of assessing whether the proposed changes are been implemented or not in the RUH.
Preparing reports – It is essential to manually record the data so that same can be review
in future. From this, effectiveness of change can be measured and it also aids in assessing the
issues that been facing by staff member from it. With the help of report, trend analysis can be
done with the help of charts, bars, trend line and other related (Glasby and Dickinson, 2009).
Conditions before the change
Impact of changes can be positive or negative. Some things can reflect resistance to
change and a mismatch can be seen in the existing conditions and in the conditions which are
predicted. In the health & care sector, the levels of expectations are always high from the
organization; after all it is related with the health and safety of the patients (Henderson and
Atkinson, 2003). As discussed earlier, conflicts can arise among the staff and management
related to new policies and procedures. Lack of communication can arise between new and
existing workers. According to the CQC investigations, these were the areas which require
improvements in RUH.
 Respecting and engaging people
 Care and welfare of people
 Prevention of people from abuse
 Identifying and controlling the quality of service provision
 Maintaining of records
The trust was also criticized for being neglecting old age persons. Now care of older
people has become their main priorities. The documentation of the patients was not being done in
proper manner. The people were complaining about the loss of their privacy and dignity.

Conditions after the change
In respect with the above changes required in the organization, the RUH adopted
significant steps in this direction. In respect with the care and welfare of the people, they adopted
approaches to make sure that the major nursing documentation is appropriately completed when
patients have been assessed to identify the care that they need and when that care has been
provided (Blake and Bush, 2008). For that purpose, they have designed a new Combe Ward
having all the valuable facilities especially for the old persons. The staff makes sure that
documentation of the patient has been done completely such as nutrition and hydration records,
discharge papers, comfort rounds etc are being completed in accurate manner (Fiss and Zajac.
2006). This is their major step in the maintenance of records. Now they had started taking
privacy and dignity of the patients in serious manner and the records of the patients are being
kept in confidential manner. This is done in respect with maintaining respect for the people.
2.4
They have to focus majorly on their key stakeholders who are customers, managers and
employees. Managers can be invited to suggest their valuable opinions and ideas for surviving
with the change. Employees can be motivated to match up with the standards demanded by the
transformation (Cameron and Green, 2009). Motivation can be assured through recognition,
rewards and incentives for the contribution given by the workers.
It is to be ensured that customers that are the patients must not be affected by the change in
negative manner. Additionally, further improvement in services can be attained with the help of
sound communication methods. It is evident that communication is essential for developing
healthy relations with patients. In this context, effectual leader can be appointed for the purpose
of attaining goals and objectives of the company. Through leaders, employees can be motivated
to work with full zeal and hence can able to offer quality services. This will even aids in
reducing the chances of conflicts and disputes among staff member. However, conflicts can even
be removed by developing complainant cell in which varied sort of complaints can be registered
by employees. From this, experts can be held responsible for resolving the conflict among varied
employee base. In addition to it, decision making in this context can be enhanced with the help
of intranet, MIS or decision support system.

LO3
3.1
The key principles of the change management are required to be followed by Royal
United Hospital Bath NHS Trust. Change is a crucial part of the organization in order to attain
effective results and care services for the parties. Lewin's change model will help the firm in
implementing effective change measures and in attaining the valuable results for business. Unfreeze: Change is widely accepted and welcomed by the employees, staff members
and management authorities as well. Implementing change is a sensitive measure which
demands a process of gradually developing employee opinion in favour of upcoming
alterations (Henderson and Atkinson, 2003). RUH will focus on preparing its employees
for the upcoming change by developing a strong communication base. RUH possesses
some issues with respect to leadership and culture. In this organization, leaders fail to
address the culture in context of cultural resistance or in making cultural support.
Moreover, organization will develop and train a team of managers who will work on
minimizing resistance to change and prepare employees for changing policies and
regulations (Gioia and Chittipeddi, 2006). This will help company in developing a
positive environment within firm. Change: Once employees are trained and prepared for change, new policies and
regulations will be implemented in business. This stage will be the practical
implementation of all changes (Welch and Fernandes, 2010). RUH will focus on
analyzing the set targets with actual performance and develop strategies for growth as
well. This stage of change focuses on creating actual change in policies, strategies and
work routines of the firm (Reeves, Lewin and Espin, 2011). All doctors, nurses, care

takers and supportive staff will be communicated with new policies and trained for the
same in order to attain the targeted results. This stage will work in a collaborative manner
where every team will work towards changing scenario.
 Freeze: The final stage of change will focus on making alterations and modification
permanent for the firm. RUH will stabilise all the policies, procedures and alterations for
business. The changes will be made permanent for the organization and thus, creating
effective response. By including employees in decision making process, valuable
suggestions and responses can be attained that will help in incorporating the change in an
effectual manner. In addition to it, this also aids in taking sound decision by considering
the perception from each side (Reeves, Lewin and Espin, 2011).
3.2
In order to implement effective change, an organization need to consider variety of
strategies and principles which will help in creating an effectual and well developed impact on
business. While planning the business growth, effective change strategies which RUH will
implement includes: Stakeholder analysis: Every business decision has a direct impact on the stakeholders of
company. These stakeholders include employees, consumers, investors, suppliers, public,
etc. (Henderson and Atkinson, 2003). In the present situation, analyzing crucial
stakeholders by RUH is important. It will help in developing effective strategies to keep
the stakeholders satisfied and supportive for at the time of implementing. In the present
case, shareholders, employees and management will be the key stakeholders for company
and developing effective communication will help in meeting the objectives of change for
business. Communication: Here, the connections will be established in order to gain support and
encouragement from different stakeholders (Goncalves, 2007). It is important that
stakeholders should show their support in the change process. Well developed means of
communication strategies will be implemented by the business in order to attain their
support. Bottom up approach: The key people who can help in the growth and development of
business are the employees at lower level (Cloud, 2010). They form the majority and
thus, effectiveness of change plan depends on their support and contribution. Hence,