National Health Service: Organizational Change Development Plan Report

This report provides a comprehensive analysis of organizational change within the National Health Service (NHS). It begins by outlining the causes and triggers for change, both external (political and socio-cultural factors) and internal (employee engagement and organizational development). The report delves into the cultural and social dimensions of change, emphasizing the importance of shared values and effective coordination. It examines power dynamics and organizational politics within the NHS, including the impact of government policies and the shift towards Clinical Commissioning Groups (CCGs). The report also addresses issues in leadership, management, and employee engagement, offering recommendations for organizational change. It highlights the need for cultural change, emphasizing the importance of employee involvement and psychological safety. Finally, the report discusses different types of organizational change (Evolution, Adaptation, Revolution, and Reconstruction) and concludes that the NHS is gradually transforming its culture through 'Evolution'.

NATIONAL HEALTH SERVICE
ORGANIZATIONAL CHANGE DEVELOPMENT
PLAN FOR NHS ORGANIZATION

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Table of Contents
Introduction............................................................................................................................ 2
Causes/triggers for change at NHS........................................................................................2
External cause of change...................................................................................................3
Political factor..................................................................................................................3
Socio-cultural factor.........................................................................................................3
Internal cause of change.....................................................................................................4
Cultural and social dimensions for change.............................................................................5
Power and Organizational Politics in the NHS....................................................................7
Issues in leadership & management and recommendations for organizational change..........7
Leadership issues and recommendations...........................................................................8
Issues in Employee engagement and recommendations..................................................10
Issues in Organizational development and recommendations .........................................11
Conclusion........................................................................................................................... 12
References........................................................................................................................... 13

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1. Introduction
Organizational structures and market practices change as do political and
socioeconomic issues and remedies, as well as cultural norms and beliefs. Managing
change entails dealing with the process's uncertainty. It entails assessing, preparing, and
executing activities, strategies, as well as techniques, and also ensuring that perhaps the
change is both beneficial as well as important (Kuipers et al., 2014). Organizations often
need to incorporate enterprise-wide improvements involving their systems, goods, and
personnel to keep up with a rapidly changing market environment. This could be
challenging, and people always oppose it. However, in order to foster an agile corporate
culture, businesses should take a comprehensive approach to significant change
management.
The National Health Service (NHS), also defined as NHS, is among a world's major
publicly financed health care systems. The key goal of this study is to examine how a
NHS has changed in that time in terms of strategic orientation as well as development as
a result of shifts in government terms of office. In 2010, the UK government unveiled
proposals to make significant improvements to the way health facilities are managed
locally in England. Primary Care Trusts (PCTs) will be replaced by Clinical
Commissioning Groups (CCGs) inside local medical councils as a result of these reforms
(Greaves et al., 2012).
State health managers responsible with England's 151 PCTs have historically been in
charge of public health. They were in charge of hiring municipal public health directors
and organising efforts to inspire residents to live healthier lives. Nevertheless, as PCTs
became CCGs, a responsibility had transferred to local councils.
Moreover, such study would include a critical overview of NHS organisational change,
including an assessment of organisational change factors and causes, social and cultural
aspects of change, and strategic guidelines for NHS to guide, handle, and accept such
changes.
2. Causes/triggers for change at NHS
The term "organisational environment" refers to the internal as well as external
influences that influence organisational activities as well as decision-making
(Arogyaswamy and Byles, 1987). Any company, whether for profit or not, has its own
environment. The corporate world is ever-changing and complex. Today's changes have
become so constant, and each one carries with it so many obstacles, so organisation
management as well as leaders must be alert regarding environmental changes.

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 External cause of change
PESTLE analysis is a strategic strategy tool for assessing a macro environment. The
following are some of the macro environmental cause factors for change at the NHS:
NHS Organization
Political  Short-term political interests of government
 Poor funding initiatives
Economic  Rising competition
Socio-cultural  Adverse effect on Reputation across the local community due
to low quality of care for patients
 Lack of engagement with patient and other stakeholders of
local community
There are two most important external factors that cause change at NHS are socio-cultural
factor and political factor. So NHS must analyse these factors in order to be competitive at
the market place.
 Political factor
It is the most important aspect that NHS should take into account in the most efficient way
because it has a significant impact on the company's activities. A positive business-
government partnership is critical for an environment as well as, quite specifically, to
businesses.
In the case of the NHS, the country's government has a significant impact. Politicians are
unaware regarding administration, so as a result, employees are overstressed as a result of
the constant change. On July 20, 2012, a spokesman for the NHS Confederation (showing
healthcare executives) claimed the NHS had experienced a "chronic breakdown" as well as
suggested that only the Government had been focused on short-term political
considerations. If such problems are not resolved, he believes the NHS will face financial
challenges as well as a standard of patient care will deteriorate.
 Socio-cultural factor
Business leaders must research and forecast the effect of social as well as cultural changes
upon its future of company activity in relation to addressing customer demands and interests
(Thornton et al., 2011). When PCTs are phased out, more than 200 GP-led Clinical
Commissioning Groups (CCGs) will be formed to deliver high-quality treatment in the least
costly setting possible, backed by a cohesive team of caregivers. To strengthen the
comprehensive and organised care patient's needs, CCGs and GPs can collaborate more

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closely with all care agencies (public and private healthcare consultants, mental wellbeing
professionals, public and social care specialists). Since they have daily interaction with
patients, general practitioners (GPs) may be more attentive to their wishes. According to the
hypothesis, this would increase the efficiency of the NHS and boost the standard of
treatment. It will improve and maintain NHS's public profile. It is important to stress the
importance of general practitioners engaging with their patients and groups in order to
become more attentive to person and group patient needs. The new CCGs' goals are to
recognise and prioritise targets for constructive action related to urban wellbeing
development, as well as to enhance and save money on ongoing service provision. The
CCGs, for instance, are being concerned with having a positive effect on smoking-related
disease, underage pregnancy, and obesity, to name a handful (Vize, 2013)
 Internal cause of change
Although understanding macro-environmental factors remains critical, understanding micro-
environmental issues is often critical for an organization's improvement. Internal factors
account for a majority of an organization's success; it may have the potential to consider all
benefits & threats which occur both within as well as outside the organisation (Pettigrew et
al., 1988).
Employees are one of the most important internal factors that an organisation could
successfully manage. Employees also oppose change as it happens. Employees employed
in NHS organisational design can experience higher levels of stress, since the organization's
internal consumers anticipate and desire higher service quality and better value for money.
As previously reported, the current organisation poses the additional risk of sacrificing its
own market to rivalry from outside the organisation as a result of this division.
NHS transformation is another internal mechanism that causes transition. The Department of
Health criticised the PCT organisation system for its broad administrative footprint and
inability to provide value in terms of addressing localised patient and neighbourhood needs.
Continuous change is characterised as change which reuses via a defined mechanism that
is often based on efficiency, quality management, or learning by companies which see
change as a constant as well as essential part of their success (Feldman, 2000). Individuals
with in NHS are getting increasingly experienced in addressing reform in a diverse world of
various partners, competing goals, and significant restrictions, as the NHS undergoes
continuous change in its reorganisation policy as well as relies on local authorities. An
implementation of GP commissioning continues moving at a rapid rate, with the aim of
continuous change contributing to a smooth shift of resources as well as roles from PCTs to
CCGs.

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3. Cultural and social dimensions for change
An effective organization must contains of shared values, norms and beliefs. Workers play a
critical role in sustaining a strong culture, beginning from attracting and hiring candidates
who share the company's values as well as excel with in culture, establishing training,
education, as well as quality management initiatives which define as well as strengthen a
values of the organization, also ensure that the employees that truly embody the culture get
enough praise and incentives. It established a close relationship between both the employee
and employer, helping the employee experience a sense of connection and pride with their
job, resulting in the employee's maximum potential to work for the organisation (Colin, 2004).
The NHS intends to change its culture in terms of managing organisational development
initiatives by launching a management- as well as leadership-development programme for
CCG and governing-body leaders, which will be tailored to individual and organisational
development needs as identified and supported by the organization's performance
management process, as well as ensuring "psychological safety" for its employees. When
diagnosing and acting to promote psychological protection, the psychological aspects of
sense making, belonging, and contribution should be considered
When driving cultural change, there are some key considerations to keep in mind, including
securing top management support, developing a strong business argument, keeping in mind
people's resistance to change, and having a limited team of employee members guide
culture change plans (Berry, 2004).
Effective coordination and cooperation are essential cultural characteristics for providing
high-quality treatment that is constantly evolving (Berry, 2004). General operations in the
NHS are made up of a select group of GPs, one or two practising nurses, and a practise
manager. These general practises have traditionally run as SMEs (small to medium-sized
enterprises), sometimes in isolation from the day-to-day activities of other general practises
in the region. The current CCG's representatives have agreed that it is now important for
these organisational participants to collaborate with the other general practises in order to
achieve the CCG's strategic goals. As a result, it is critical that the current organisational
structures facilitate the convergence of these disparate SMEs, putting them under the larger
CCG umbrella. Consumer satisfaction is stronger, clinical care quality is more successful,
there is more creativity in approaches to care for patients, reduced fatigue, absenteeism,
and attrition, and more consistent contact with patients as multi-professional teams operate
together. If NHS organisations want to face the obstacles ahead, they also need leadership
that ensures successful team and inter-teamwork (both inside and across organisational

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boundaries). Team success is strongly correlated with shared leadership (Davies and
Mannion, 2013).
Having a cultural change within an organisation is not just about senior management and
leaders; every employee, regardless of their position, must be a part of it (Branson, 2008).
Balogun and Hope Hailey (2008) proposed four separate types of change classifications To
that point, several organisations will benefit from an Evolution/Adaption change type, centred
on the various forms of strategic change (Balogun and Hailey, 2008) .
Source: (Balogun and Hailey, 2008)
Evolution: Interconnected programmes are used to eventually implement transformational
reform. This all is whereby cultural reform is essential, however it can be achieved with time.
Adaption Change that is introduced in a sequence of phases to realign the way the
organisation works. It can be incorporated into the local society and implemented gradually.
Revolution: Simultaneous campaigns on certain lines are used to bring about
transformational reform. It is more likely to be rushed and reactive, and it would necessitate
significant shifts in policy and community.
Reconstruction is a process of realigning the organization's operations by implementing
several programmes at the same time. It entails radical transition without a profound shift in
society.

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In the case of the NHS, we can see that the organisation is gradually changing its culture;
referring to table, this was assumed that NHS uses "Evolution" to transform its culture, since
this form of change involves gradually changing the mindset, attitude, as well as perception
of the corporation (Ashburner et al., 1996).
 Power and Organizational Politics in the NHS
After promising “no further top-down restructurings of the NHS” (Government of England), a
governing party of Conservatives as well as Liberal Democrats embarked on a massive
reorganisation of the English NHS structure since coming to power in 2010.
Professionals and suppliers would be freed from top-down regulation as a result of the
government's changes. The only way to ensure the efficiency, creativity, and
competitiveness required to optimise results is to do so. We'll delegate commissioning and
budgeting to associations of GP [general practitioner] practises, and practitioners would be
liberated from government oversight to tailor care to patients' wishes and preferences. With
a consistent regime of economic supervision and quality control to keep suppliers
accountable for the outcomes they produce, greater transparency can be balanced by
improved responsibility to patients and democratic legitimacy (Charlton, 2008).
The Government and opposition parties have clashed about the potential for these reforms
to cause further problems and damage to the NHS. Prime Minister David Cameron defended
the controversial reforms in the House of Commons on July 12, 2010, saying, "We are not
reorganising the administration, we are scrapping the system," claiming that this solution will
result in greater operation efficiencies. Despite government policies encouraging a more
autonomous NHS framework and commissioning, it's difficult to see how a scheme financed
by central taxes can be completely excluded from the political system's oversight.
Because of the structure of the UK legislative framework, any local reform in NHS facilities
could pose national political questions. Under this more fragmented government structure,
accountability for care delivery is another controversial issue. Recent public concerns
regarding emergency room (ER) visits, hospital results, and even specific patient care
problems may quickly turn into national political issues (Francis, 2013). These national
challenges show the disparities in national policymakers', regulators', and local CCGs' and
providers' roles and relationships.
In 2012, a spokesman for the NHS Confederation claimed the NHS had experienced a
"chronic breakdown" and suggested that the Government had been focused on short-term
political considerations. If these problems are not resolved, he believes the NHS will face
financial challenges and the standard of patient care will deteriorate.

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4. Issues in leadership & management and recommendations for
organizational change
 Leadership issues and recommendations
Specific team members' commitment and its well, possibility of supportive service, are aided
by successful team leadership. “By strengthening their capacity to adapt, companies will
improve their likelihood of performance, both now and in the future,” says Kotter, who
suggests an eight-step process for organisations to prevent failure and become adept at
change. Organizations cannot survive until they have the capacity to evolve on a continuous
basis.” (Appelbaum et al., 2012).
The main advantages of Kotter's model are that measures are straightforward as well as
simple to follow. They provide feedback to the operation, and he emphasises employee buy-
in as the key to progress. When implementing Kotter's method to transforming an
organization's culture, the 8 keys to leading change are as follows:
Source: (Rose, 2002)
1. Instil a feeling of urgency in the team

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This imperative must begin at the top of the organisation, with NHS management
acknowledging and reinforcing the message to their employees.
2. Assemble and manage steering groups
The NHS should use this approach to guide its teams of GPs, practise nurses, and a
practise manager, who are guided by a strategic committee who maintains the opportunity's
mission and should recognise key representatives of their workforce to promote the
message.
3. Create a clear vision
Create change strategies based on the NHS vision in order to seize the potential for
sustainable expansion. This allows anyone in the company to participate in the opportunity.
4. Obtain buy-in by communicating the vision
Such messages, if handled properly and maybe with imagination, can entice workers to buy
into the opportunity's ambition and express their loyalty to it.
5. Make it easier to move as well as take action
The top leader of NHS could then speed up progress against the opportunity by allowing the
team to collaborate on the vision and eliminating any obstacles that are impeding progress.
6. Rejoice in short-term victories
Without proof that its decision and decisions are genuinely helping the NHS, the plan to
substitute PCT with CGG would not last long. Short-term victories can show to critics that the
plan works.
7. Do not give up
Leaders of the NHS can retain a sense of urgency and continue to learn while they move.
Continue to implement existing strategies while still developing new ones in order to respond
to changing market conditions (Richesin, 2011).
8. Make it a habit
No strategic plan, no matter how large or tiny, is full before it is integrated into day-to-day
operations and ingrained in the business community. To review and control the reform
mechanism, the NHS could use a 360-degree input analysis.

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Leaders can use a "collective leadership" strategy to influence team action in order to ensure
creativity, consistency, and performance growth. To achieve these goals, tools like 360-
degree feedback sessions may be used.
NHS leaders must be aided in cultivating training and mentoring programs that helped them
to have a much more key role in the development of informal learning for promoting a
continuous learning culture. At the team or group activity stage, local control and bottom-up
customisation are critical, with workers encouraged to control the creation of learning
workbooks.
A diversity of hospital boards is critical in improving overall organisational success, with
steps needed to increase the participation of minorities, physicians, and non-executive
directors, including more open and consistent hiring procedures. Efforts can be made to
improve board members' behavioural styles, such as attending transparent board sessions,
conducting patient surveys, and modelling healthy behaviour.
 Issues in Employee engagement and recommendations
Employee engagement seems to be a workplace solution that creates the required
opportunities for all employees to provide their best every day, dedicated to their
organization's objectives and ideals, inspired to lead to organisational growth, and feeling
better about themselves (Macey and Schneider, 2008)
“It is about how we build environments under which workers can deliver more of their
capacity as well as capability says David MacLeod.
Employee engagement is dependent on an organization's members' trust, honesty, two-way
involvement, as well as collaboration. It's a strategy that helps businesses succeed by
improving organisational and person efficiency, competitiveness, as well as welfare. It is
quantifiable. It ranges from mediocre to excellent. It can be cultivated and significantly
improved, or it can be squandered and discarded (Markos and Sridevi, 2010).
Employee engagement in the NHS was not reaching its maximum capacity, as internal
service providers were demotivated by the CCG's current framework reforms. As a result,
their confidence dropped. This recent developments put a lot of emphasis on general
practitioners to interact with their patients and families in order to be more sensitive to
person and group patient needs as Lack of engagement with patient and other stakeholders
of local community was also prominent.
To address this problem, NHS leaders should promote open collaboration, implement reform
in stages or periods, delegate action and encourage commitment, make employee-focused
choices, and foster a culture of quality improvement (Bedarkar and Pandita, 2014).

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Furthermore,
organised,
organization-wide
reflective
environments for staff
to manage the
relational pressures
faced by the
healthcare context
should be given. This
may be accomplished by encouraging other types of reflective exercise, such as in-house
therapy programmes and learning packs, as well as using Schwartz Center Rounds.
 Issues in Organizational development and recommendations
A task-oriented approach used to implement a structure change in an organisation is known
as organisational development. A change of contact structures or their enabling mechanism
is used to accomplish organisational growth. Professionals may analyse and track the work
atmosphere and predict progress by observing worker's actions, which can then be
implemented to achieve sound organisational growth (Porras and Robertson, 1992).
Lewin was a pioneer in the study of organisational change (Hussain et al., 2018). His force
field analysis (unfreeze, change, refreeze) theory offers a basis for considering certain forces
that aid or obstruct change i.e. driving forces and restraining forces.
1st step in NHS organization is to unfreeze the existing attitude to prevent from resistance to
change and provide motivation to service providers and GPs to get more engaged and
committed to NHS and determine causes of change and what needs to be change
(Cummings et al., 2016).
Source: (Cummings et al., 2016)
The next step is to empower acts for converting the PCT into a CCG by obtaining employee
involvement and interest in the administrative and professional support resources to be
centralised. To achieve successful reform, New Hampshire leaders must consider and
resolve both the pushing and restricting factors that can aid or impede the change initiative.
Culture, described as "both a complex phenomenon that affects us at all times, being
continuously implemented and formed by our encounters with others and conditioned by
leadership behaviour, and a collection of processes, rituals, rules and norms that direct and
constrain behaviour," is an especially significant force that can either be a deterrent or a
existing behavior
to be motivated for
change
Unfreeze
empower actions
Change make change
permanent
Refreeze