RUH Trust: Facilitating Changes in Health and Social Care Services

This report investigates the key factors driving changes in health and social care services, focusing on the Royal United Hospital (RUH) Bath NHS Trust in the UK. It examines how the impact of these changes can be measured, addressing both positive and negative outcomes, including resistance to change. The report highlights the importance of patient care, technological advancements, and service improvements as drivers for change. It also discusses challenges such as conflicts, environmental issues, poor communication, decision-making difficulties, leadership issues, and strict regulations. The report emphasizes the need for a sound change management framework to support individuals and ensure resources, skills, and processes add value. Various approaches for measuring the impact of change, such as collecting feedback, measuring performance, seeking guidance from experts, and preparing reports, are also explored. The study concludes that health and social care firms need to adopt changes regularly to improve services and foster creativity, while carefully managing the transformation 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
TABLE OF CONTENTS.....................................................................................................................
INTRODUCTION................................................................................................................................
LO 1......................................................................................................................................................
1.1................................................................................................................................................3
1.2................................................................................................................................................4
LO 2......................................................................................................................................................
2.1................................................................................................................................................5
2.2................................................................................................................................................6
2.3................................................................................................................................................7
2.4................................................................................................................................................8
LO3.......................................................................................................................................................
3.1................................................................................................................................................8
3.2................................................................................................................................................9
3.3..............................................................................................................................................10
CONCLUSION..................................................................................................................................
REFERENCES...................................................................................................................................

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.
4

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.
5

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,
6

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).
2.2 and 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.
7

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
8

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. This principle can be explained by applying The Shingo model
for operational excellence (Henderson and Atkinson, 2003). The stages are as follows:
Lead with the culture - Culture of company is very essential to attain the success within the
context of change management. Culture is very significant part for any strategy that been
developed by the company. RUH possess issues with respect to leadership and culture. In this
organization, leaders fail to address the culture within the context of cultural resistance or in
making most of the cultural support (Gioia and Chittipeddi, 2006). Many a times, people may
9

fail in familiarising with existing culture and this affects their productivity as well. In this regard,
RUH must focus on this issues in order to gain most of the existing culture.
Address the human side systematically – Change irrespective of its type causes different types
of issues for the people. Due to this, jobs get changed, new skills are developed and even transfer
takes places. Due to this, resistance is developed among employees. Due to this, morale and
results are at risk (Welch and Fernandes, 2010). Therefore, RUH must incorporated disciplined
approach within the context of transformation process so that changes can be managed. In this
regard, effective collection of data, planning, examination and redesign of system need to be
taken into account.
Create ownership – As per this principle, change need to manage by ensuring engagement from
employees. 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 perception from each side
(Reeves, Lewin and Espin, 2011).
3.2
The changes in health and social care can be planned in the following manner Fullan
(2007) proposed a change management model for managing the change called The Fullan model.
Changes at the RUH can be managed by adopting the following steps of the model.
Identification of the issue - This is the initial stage of the process where the need of the change
is identified. This can be the areas where the organization is facing problems.
Evaluating the need - After the identification, the need for change is analyzed in proper manner.
It is to be checked that whether the amendment will serve the desired objectives or not
(Henderson and Atkinson, 2003).
Finding out the solutions - At this stage the solutions to that specific issue are discovered. The
form of change is decided at this level
Meeting and communication - Here, meetings are organized to decide the implementation
activities of the change. Further, a particular platform is decided to convey the message
regarding change
Developing the connections with the different stakeholders - Here, the connections are
established in order to gain support and encouragement from the different stakeholders. It is
10

important that stakeholders should show their support in the change process (Reeves, Lewin, and
Espin, 2011). These stakeholders include local authorities, CCGS etc
Communicating the benefits of change - Benefits of the change are conveyed to the
stakeholders like suppliers, creditors, employees etc. The motive behind the transformation is
conveyed in order to avoid situations of uncertainties. Change always comes with the
confrontation so the organization must show complete transparency in the approach.
Provide training - Proper training should be given to the employees before the implementation
of change (Cloud, 2010). This is a strategy to prepare them for the transformation. In this
manner, they will be able to adapt it in more efficient manner.
Implementation - At this stage, the activity is implemented. Implementation is to be done with
utmost care and intelligence and at the right time.
Monitoring - Monitoring of change is very essential so that immediate remedial actions can be
taken at situations of hurdles and obstacles. It will aid in achieving valuable results for the
organization (Goncalves, 2007).
3.3
There may be effective techniques and methods through which health and social care
organizstion can control or monitor recent changes. Followings are the key strategies which can
be adopted by RUH in order to evaluate and monitor changes in the enterprise.
Performance measurement and personal review: It is normally defined as regular
measurement of outcomes and results which generates reliable data on the effectiveness and
efficiency of new strategies (Fiss and Zajac, 2006). Health and social care organization can make
special checking process for all the employees and clients in order to implement new and latest
strategies and technologies in the business. They can measure performance of each and every
section of the firm as well as individual. It will help them in controlling and monitoring changes
effectively.
Quality management: Within the context of health and social care, quality of work is of
key importance and hence it is required to monitor the same in order to control change in health
and social care. In this regard, quality can be referred to act of overseeing each and every task in
order to maintain specific level of excellence (Welch, and Fernandes, 2010). With the help of
quality, company is able to develop new set of strategies and policies at different time interval.
11

Feedbacks through interviews & survey: With the help of it, health and social care can
able to control and monitor changes within business. By implementing new strategies and
policies, feedbacks and suggestion can be taken from management and from customer as well.
Due to this, right decision can be taken at right time.
Benchmarks and standards: With the help of it, quality of products, process and policies
can be monitored so that same set of treatment is offered to each employees. In this regard,
benchmark need to be set and performance need to be measure from it in order to check whether
work is of industry standard or not (Cameron and Green, 2009). With help of it, controlling and
monitoring of changes can be done along with its outcomes
Direct observation – With the help of this technique, RUH can calculated information
through simply observing the subject in their usual environment. It is used when goal is to
evaluate an ongoing behavior process, event or situation.
Spot check – This is unscheduled inspection that been done at random time interval. In
this, no warning is offered to any employees and hence it helps in identifying the areas that are
lacking. RUH can perform spot check at any time in order to gain idea about the issues in more
transparent manner.
CONCLUSION
From the above study, it can be concluded that health and social firms needs to adopt
changes at regular intervals because it helps in improving their services and bringing creativity.
Change is the need of time and it should be adopted to bring innovation. Culture is very critical
to the success of the change management because it opens the gate for the new opportunities.
One of the major characteristic of this process is to develop a vision for better option. 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.
12