Strategic Management and Leadership: NHS Case Study

This report provides a critical analysis of leadership approaches within the National Health Service (NHS), focusing on a case study titled "Leading Organizational Change." The report examines the leadership strategies employed by the executive director of the nursing department to addre...Read More

Running head: STRATEGIC MANGEMENT AND LEADERSHIP
Strategic management and leadership
Name of the Student
Name of the University
Author note

1STRATEGIC MANGEMENT AND LEADERSHIP
Table of Contents
Part A:........................................................................................................................................2
Introduction:...............................................................................................................................2
Critical analysis:.........................................................................................................................3
Leadership approaches in relation to case study:.......................................................................3
Conclusion:................................................................................................................................8
Part B:.........................................................................................................................................9
Evaluation of strategy of St. Jude Children’s hospital:..............................................................9
References list:.........................................................................................................................16

2STRATEGIC MANGEMENT AND LEADERSHIP
Part A:
Introduction:
The overall objective of the case study “Leading organizational change” is to offer
view on emerging consensus of what a good leadership approach looks like in the healthcare.
In this particular study, the leadership approach chosen by executive direct of nursing
department of NHS is demonstrated. Leadership approaches used by Tracey Burns have been
critically evaluated with reference to leadership theories. NSH was facing several problems in
relation to their operations such as increased wait of trolley in the accident and emergency
department, delay in discharge, increased length of stay, high admission rates and bottleneck
in the medical admission. Leadership approaches used by nursing department executive for
improving the performance of trust have been illustrated. The case study describes how
nurses are empowered to play a pro-active role in the process of discharging patients.
Furthermore, report also demonstrates approaches other than employed by Tracey that would
help in solving existing problems related to operations of NHS.
Analysis of case study has depicted that two different change aspect. In the first
aspect, there is a change process and a number of themes have been raised in the case study
that is needed to be done for the top management for gathering support, encouraging
accountability, sustaining change momentum and providing constant and consistent
communication. The content of change is the second aspect of change.

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Critical analysis:
Leadership approaches in relation to case study:
For the National Health Service, the factor that is considered pre requisite is high
quality of management and leadership. It is required to recognize the type of leadership that is
regarded appropriate for bringing change in the organization and thereby improving
performance. Leadership approach used by management plays a very crucial role in
healthcare organizations. It is regarded as key for managing increasing demand in light of
multiple pressures and rapid change witnessed by healthcare organization. In NHS,
leadership is characterized by a culture that helps in avoiding failure instead of driving
innovation successfully. Nevertheless, due to several issues faced by organization in its
operations, it is essential to make changes in leadership approach for improving performance.
The need for improve services and reducing duplications, hospitals under trust were merged
(Clegg et al. 2015). However, the reputation and performance of NHS in the community was
influenced by many glitches. Due to several issues faced by management and organization as
a whole, management team undertook the responsibility of initiating any cultural change
suitable for introducing performance.
As per the analysis of the case study of leading organizational change in National
health system trust, it can be ascertained that organization was facing several issues related to
its operations. Solving of such issues required to make considerable change by accepting
accountability and thereby improving the performance of the chain from admission to
discharge (Burke 2017). Nursing department executive employed a systematic approach
along with a plan where nurses led discharge of patient.
The path goal theory of leadership specified a number of personal oriented leadership
and situational relationship moderators and their overall impact. It has been explained in the

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model how satisfaction of followers and performance of organization influenced by behavior
of leaders. This particular model of leadership does not involve any behavioral variables and
leadership traits (Antonakis and House 2014). Such theory helps in the identification of most
appropriate leadership style suitable to any specific circumstances and situation that helps in
maximization of job satisfaction and performance. Leaders according to path goal theory are
responsible for increasing the motivation of followers that helps in attainment of
organizational and personal goals. Motivation among employees and other staff members is
increased by efforts taken by leaders to make clarification of what needs to be done by
followers for rewarding them and for increasing rewards that are desirable and valuable. It is
indicated by path clarification that leaders work in association with their subordinates and
followers for learning behavior and identifying them that help them in gaining organizational
rewards and successfully accomplishing the task (Avolio and Walumbwa 2014).
Analysis of case study depicts that Tracey Burns has employed path driven approach
to leadership for bring required change in operations of organization. The issues surrounding
discharge of patients was solved by undertaking the initiative of discharge planning
(Northouse 2017). Scope of initiative was outlined in the form of improving performance of
discharge and changing culture. She was responsible for motivating nurses of NHS by
nurturing the plan for the introduction of nurse led discharge. In this plan, nurses were
responsible for making final decision to discharge patients. Moreover, discharge process of
patients was reviewed by burn initially at the time of interviewing assistant director for
nursing position. In this regard, a pledge was secured by Burn that empowering nurses for
taking responsibility of discharging patients would relieve matrons from their onerous bed
management duties as general management can take it up (Godbole et al. 2017).
From the path goal theory, for dealing with any particular situation, leader can select
most appropriate leadership style (Barr and Dowding 2015). Such style can be directive,

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achievement oriented, participative and supportive. Burn by undertaking the planning of
discharge and authorizing nurses to take discharge responsibility can be said to employ
achievement oriented leadership style. In this style, leaders set achievable but difficult goals
and expect followers to perform their duties at their highest level so that they can be rewarded
for their efforts. Nurses led discharge plan entitles nurses to take responsibility so that they
contribute in lowering long stay of patients in hospital and delay in discharge and ultimately
removing the bottlenecks in hospital admission (Ghrccatrain.wikischolars.columbia.edu
2018). Idea of such plan was to underline that nurses have authority and expertise for sorting
out the production line. Burn also employed directive style of leadership when setting goal of
organization for improving its performance. It was when she identified that the main reasons
associated with creating blocking of patient for releasing are poor communication and
inefficient practices. When followers prefer autocratic leadership, directive leadership is
regarded as appropriate. Burn took the initial step in planning for dealing with operation
issues of organization. Moreover, the needed information system by organization was
developed that helped in monitoring progress provided by base line data. Path goal theory of
leadership helps in identification of most appropriate leadership that helps in maximization of
job satisfaction and performance of organization (Henson 2016).
All the efforts taken by Burn can be regarded as achievement oriented because he
thought that ability of followers or subordinates such as nurses were high and have external
locus of control. Furthermore, it can be seen that NHS management required to adopt a
broader turnaround strategy and the prevailing situation within the organization required
Tracey Burns to take lead for dealing with situation and making improvement. Therefore, it
means that Tracey Burn being the executive director of nursing was raised to another level
for taking the lead for bringing change and making improvement. Hence, this particular form
of leadership employed by management of NHS can be treated as transformational

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leadership. This is so because leader is being raised to higher level of motivation and
morality. Such leaders appeal to higher moral values and ideal such as liberty and
humanitarianism. Transformational leadership can be exhibited in any type of position and by
anyone in organization. As per this theory, leadership is defined as evolving relationships
stream in which leaders are continuously modifying their behavior and evokes motivational
responses from followers in a ceaseless process of counter flow (Bolman, and Deal 2017).
Case study depicts that utilization management exercise was launched by Burn in an effort to
assess the rate of patient admission to hospital. It was the efforts taken by management to
ascertain that whether there was any suitable alternative available to community. Moreover, it
can also be said that burn posses the trait of charismatic leadership who deliberately fracture
the organizations as a mean for bringing change. The reinvestment plan in association with
social services drew special attention for keeping the discharge project on top priority.
Analysis of case study that Burn adopted a shared leadership approach that is regarded team
level management empowering staffs within the process of decision-making. Such leadership
style helps in improving job satisfaction and working environment and offering individual to
manage and develop team (Campbell and Leeson 2015).
The metrics identified by Burn was not successful in establishing clear baseline data
for determining length of stay in hospitals and rates of re admission and thereby making it
difficult for progress assessment. The leadership approach used by was found to bring
complex organizational change that was difficult to get adapted by organization. It was so
because consequence was parallel running of variety of processes. In this regard, it was
ascertained from the analysis of case study that a better job for matching the change process
could have been undertaken for avoiding duplication process. Entitling nurses with patient
discharge responsibility or shifting them in other departments requires staff consultation.
Therefore, it can be said that the leadership approach involve problem solving faced by

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organization that was not so effective. However, there were no such efforts taken in training
the staffs when accommodating with different responsibilities. Despite the efforts taken by
Burn to bring change within the organization, NHS lost its star rating in the annual ratings
(Ghrccatrain.wikischolars.columbia.edu 2018). Nevertheless, considerable improvements
were made across a broad range of measures relate to discharge of patients. Such downfall in
annual rating would make her job difficult. Therefore, nursing staffs should have been
monitored for measuring job satisfaction.
From the analysis of case study of leading organizational change, it can be seen that
Burn has adopted different leadership approach for bringing change within the organization
in terms of improved discharge and admission process of organization. There should be
proper formulation of strategies that will lead to optimal utilization resources of healthcare
that would help in managing variations in discharge and admission process of organization.
However, for measuring the appropriateness of current discharge and admission process is
dependent upon control of management team and leadership. Management in association with
local partners for promoting cultural change should take efforts through training of staffs and
strong leadership. Apart from employment of problem solving and path theory approach to
leadership, discharge planning should be made continuous process. The leadership
cooperation requirement was considered as intra organizational and therefore, for ensuring
the effectiveness of organizational change in contributing to performance improvement
requires the integration of social and health care services. First attempt for introducing
development of collaborative leadership was relatively small and positive impact was not
witnessed. Collective leadership development should have been undertaken that would help
in improvement of organization as a whole.
Moreover, it was also found that the amount of support needed by staffs in making
discharge decisions was underestimated by Burn. Therefore, efforts should have been taken

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to place support structures in place before starting training. Managers should provide
leadership that leads to coordination and supervision of employees. It should involve
adoption of formal method for supporting staffs to embrace change such as providing
continuing education in technical as well as clinical fields and creation of employee relations
that are of high involvement.
Conclusion:
The report is prepared to present critical review of leadership approach employed by
one of the leaders or managers of NHS as discussed in the case study. From the analysis of
the case study “Leading organizational change”, it was ascertained that one of the executive
of nursing department was entitled with the responsibility of taking the lead to introducing
change. Two forms of leadership approach were employed by path goal theory and problem
driven approach. The leadership approach used by Burn was not appropriate for bringing
change within the organization. The reason is attributable to the fact that such change was not
backed by support structure before initiating training. Moreover, there was lack of training
provided to staffs such as nurses. Work of nurses should be integrated across all three
hospitals and they should be motivated for their work. The overall performance of trust was
dragged down by poor performance of hospital on several metrics (Mendenhall et al. 2017).
Nevertheless, various considerable improvements were experienced in discharge measures,
although such gain in the form of improvement was not reflected in the opinion of public.
Losing star in the annual ratings was the worst experience of NHS despite efforts taken on
management front for bringing change to manage the issues. Burn leading the management
decision was based on ongoing situation of NHS that called for making changes for
improving operations of organization. Efforts and leadership initiative taken by her was

9STRATEGIC MANGEMENT AND LEADERSHIP
appropriate to some extent and lacking on some other front that led to losing of its position in
healthcare market.
Part B:
Evaluation of strategy of St. Jude Children’s hospital:
Strategy of an organization is regarded as an action plan for achieving the pre-
determined objectives. Operations and strategic planning in accordance with plan is a
relatively new process of management. I have come to know that strategic management is a
dynamic, ongoing and sequential process that helps organization in adapting to changes in
external environment and utilizing the existing potential of business. The strategic plan of
organization helps in establishment of realistic, enduring and measurable objectives that
provide focus, guidance and priorities for purpose of decision-making. Such plan helps in
proper allocation of available resources that is consistent with the capacity and mission
implementation. The goal of strategic plan of my organization is to improve lives of youth
along with reducing residential treatment utilization. Therefore, the progress of youth is
tracked for ensuring that they have safe lives and their lives are being improved.
This particular section is about critically evaluating the strategy of hospital of
organization where I am working that is St. Jude Children’s hospital. Evaluation has been
done by using the knowledge of strategic planning and analysis. Strategic plan of
organization is prepared for period of 2016-2021 that has an exciting blue print on which
future of institutions is build. The goal of organization is to create right things for kids. I
have come to known while working at hospital that the new direction set in the strategic plan
would mean some difficult adaption by residential care providers, however, they have
responded in a very constructive ways and work is being done for making transition. The

10STRATEGIC MANGEMENT AND LEADERSHIP
change that will be brought through the implementation of strategic plan would provide best
things for children (Reichenpfader et al. 2015). Moreover, dramatic change is undertaken in
work of case managers and front line investigators.
The strategic plan of St. Judge Children’s hospital 2016-2021 will help in providing
goal for determining area of focus and priority over the next five years. Such strategic plan
acts as a living document that will be actively used to guide priorities and decisions over a
particular time period. Strategic plan formulated will be shifting towards strength based,
family practices, and approach of informing trauma compared to only compliance based that
would help in addressing the needs of families and children on first priority. While analyzing
the strategic plan of organization, I have become acquainted with the fact that such plan is not
just implemented for the sake of bringing change in overall operations of organization. The
plan is the implementations of knowledge of many people who have spend time in collecting
data and studying challenges (Miner 2015). Tremendous leaders in the system of child
welfare support the plan. The strategic plan has been formulated into a continuous and highly
visible process comprising of voices from faculties and staffs.
From the analysis of documentation of organization, it can be ascertained that Jude
hospital have written strategy plan. The six-year plan of organization is centered on specific
goals. Such specific goals are related to research programs of organization, clinical care
properties and global leadership position. The strategic goal of hospital is to enhance care of
campus by increasing the number of new patients treated every year on campus of Jude
hospital. Strategic plan of organization represents the work of staff and faculty across the
institution along with senior leadership and board of governors. Written strategic plan of
organization is in the form of document that serves as a roadmap for journey growth for
period of six year. Such plans have been set for enhancing treatment of children at St. Jude.
Efforts taken for strategic planning serves an implicit goal was to make beginning of

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development plan. Culture of organization incorporates formation of formal strategic
planning. Strategic planning of St. Jude has been formalized into a continuous and highly
visible process that comprise of voices from staffs and faculties (McCormac and McCance
2016).
An organization according to Henry Mintzberg can consist of maximum six parts
comprising of middle line, operating core, support staff, techno structure, ideology and
strategic apex that is top management. With reference to this, strategic apex of Jude hospital
consists of governors and board of directors. Board members govern organization by setting
objectives and policies establishment. It also involves reviewing chief executive officer
performance, approving annual budgets, sufficient financial resources availability and
accounting for compliance, ethics and performance of organization as a whole (Seto and
Sarros 2016).
In financial year, 2016, a new office of decision support and strategic planning was
established for conducting detailed studies. It has been found that such plan was effective in
introducing change that would be beneficial to patients and their families. While working in
the organization, I have been able to found that new out patients facilities would be
incorporated with the designs of family and patient time square. A standard for experienced
patients and their families can be set in association with family centered care established
culture and family advisory council. During the first five year of strategic plan, the main
priority of organization will be to appoint new leaders in both the department. An additional
laboratory space will be needed by hospital near the end of process of strategic planning for
accommodating growing laboratory efforts. Strategic planning process helps in identification
of the initiative taken for starting new laboratory that helps in building coordinated program
(Dinh et al. 2014).

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Such innovation and strategic planning will develop a set of standardized tool for
external and internal recommendations. I have come across eleven strategic goals on which
strategic plan for 2016-2021 is centered while going through the documented strategic plan
draft.
Research programs- I have listed below three specific goals of research programs of
this particular strategic plan of St Judge hospital.
 ST. Judge is intending to enhance its infrastructure and research program that would
provide them support in advancing cures and running high complexity protocols.
 Focus is placed on pediatric cancers by developing program of world-class cancer
immunotherapy.
 Usage of precision medicines for diagnosis in pediatric oncology by establishment of
benchmark.
 For the treatment of pediatric patients with solid tumors, brain tumors and Hodgkin
lymphoma, the optimum allocation of proton beam therapy is determined.
Clinical care priorities- I have listed three strategic goals under the program of
enhancing clinical care priorities.
 St. Judge will advance clinical care programs of organization for children with non-
malignant hematological diseases.
 In order to accelerate the progress of advancing cures, total number of patients treated
on clinical trials both around the globe and on campus should be increased.
 For experienced patients and their families along with delivery of pediatric cancer
care, organization has taken steps for setting the standard (Stjude.org 2018).

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Global leadership position- I have disclosed the detail of programs of this particular
strategic goals that are listed below.
 Taking effort in terms of development of global clinical research consortium for
rapidly advancing therapeutic trails for pediatric cancer.
 Leading global efforts by expansion of International outreach program for ensuring
that pediatric cancer patients are cured and ensuring that treatments are available
throughout developing world.
 Addressing high priority scientific questions collaboratively by organizing global
teams of scientists (McCleskey 2014).
From the analysis of specific goals of organization, I have seen that strategic plan of
St Judge hospital is stretched to different programs and policies of curing cancer diseases
among kids. During next five years, focus of organization is to put its efforts in advancing
cure rates of infectious diseases, non-malignant hematological diseases and pediatric cancer.
While analyzing the strategic plan draft of St, Judge, I have come across the point that
hospital will continue to remain global employer of choice for achieving its strategic goals. In
order to maintain legacy of company of being one of the best place to work with, it will be
required to foster an environment that allows employees to deliver their best. Management of
organization is required to retain, recruit and develop the brightest talent within the
organization (Bratton and Gold 2017). It is required on part of leaders to create competition
among employees for assessing the benefits and making them strive towards achievement of
common strategic goals. In order to achieve the mission of organization together, I think that
it is important for organization to trust the assessment and work along as partners. Highest
level of institution will generate such philosophy. The chief executive organization of St.
Judge hospital would have been shocked by strategic plan 2016-2021 of organization as he

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had an extraordinarily expansive vision for cultivating and fulfilling smart people for
bringing about it (Stjude.org 2018). Strategic plan was started as part of vision and it
developed as massive efforts.
Nursing role in the St. Judge hospital is analyzed in terms of role of pediatric acute
care nurse practitioner. Such nurses would work in collaboration with researcher and other
physician who will help in creating comprehensive care plan for patients. Such plan would
enable everyone in organization to ensure overall well being of patients and leads toward
attainment of common goals. The patient care and its outcome is impacted by considering the
role of nurses as they will be entitled to treat and diagnose the conditions of patients,
obtaining necessary consuls, prescribing medicines and assisting in interpreting test results.
As the organization is adapting to change in policy, it is required to revisit their
governance style and structure of management that would help in driving change and
implementing strategies for accomplishment of their mission (Waldman and Jensen 2016).
Since, there are numerous professional groups in organization such as hospital; role of
leadership needs to capitalize on the diversity within the organization.
Organization such as St Judge hospital would require employment of collaborative style of
leadership that is a cooperative process as employees work together for mutual benefit. A
synergistic working environment is required for collaborative healthcare leadership. Such
collaborations provide stakeholders with multiple benefits such as it helps in facilitating
integration, promoting different culture understanding and creation of interdependency
among healthcare professionals (Willcocks and Wibberley 2015). Such collaborative efforts
would help in effectively treating an expanding number of patients at hospital. Some of the
pressing scientific problems in the field of pediatric catastrophic diseases can be addressed by
working in collaboration.

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On other hand, management can also adopt transformational style of leadership as
such style of leadership places importance on working effectively if an organization have a
sense of mission. Such leaders are able to influence attitude and motivating performance of
employees beyond expectations. Such leaders should be capable of communication their
information that creates unity and excitement among members (Tourish 2014).
After evaluation of strategic plan of St. Judge Children’s hospital, I have come to
conclusion that implementation of such strategies would require change in management
structure and employment of leadership style. Since, the efforts is to improve the quality of
lives of children suffering from cancers, the entire developed plan would require
collaborative efforts of employees. Healthcare environment is becoming increasingly
complex that cause leaders to struggle to keep them well known with changes in framework
of providing services (Gopee and Galloway 2017). In order to place developed capabilities
for meeting future demands, clear strategy is required to develop. In accordance to my view,
healthcare practitioners and leader’s needs to continue evolve by changing leadership style
and management structure.

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