King Edward Hospital NHS Trust's nurse-led change management strategy

NHS Toolkit

Case Study analysis of hospital assessment

The case study of King Edward Hospitals, National Health Systems (NHS) Trust reviews a 2002 change management strategy to reduce tenure of admissions-to-release patient journeys by way of Nurse-Led administration. A critical priority to the UK NHS in its effort to control fiscal waste and hospital acquired infections (HAI) incurred during unnecessarily extended patient stays in Britain's healthcare institutions, the Trust merger was a large systemic transformation in response to retraction of earmarked legislative allocations, and new internal programs followed this mandate. Barsoux and Gilmartin's (2007) review of this history in Leading Hospital Change: Improving Hospital Performance, retraces the steps to organizational change through the leadership efforts of Executive Director of Nursing, Tracey Burns. Appointed to the position by the Trust's CEO and Board of Directors, Burn's flexible approach to the value chain and the existing faulty network of procedural systems at the hospitals was a mammoth undertaking.

The results of her innovative analytic solutions to the overcrowding debate are discussed in the following study of a NHS hospital institution under duress, through: 1) improved healthcare management information systems (HMIS); and 2) nurse training as managers to the process (Tan and Payton 2010). Theoretical prospectus to the project is provided by J.P. Kotter (2002), in his work, Strategy for Change Management and the Heart of Change, and guided by the wisdom of organizational strategists on methodologies to praxis (Harrison, 1972, and Goffee and Jones, 2000). My own interest in incorporation of global assessment tools for organizations, Six Sigma approaches provide interface to analysis of the case study. If we are to calculate the effectiveness of leadership intelligence as business strategy an essential source from which all other decision making is manifest, then we should find sufficient objectivity in outcome.

Section a

Transformation management, a core interest to organizational theory, offers a sustainable model of analysis to describe the change culture presented in the King Edward Hospital NHS Trust case study. Transformation cultures are traditionally team-based, with dedication to reflexive strategies in a process oriented model institutional growth. Applied to the Trust case study, Kotter's (2007) illustration of the core concept 'transformation thought' offers apt scope to discussions of the period of merger in the Trust hospitals mentioned in the case. At the time, UK NHS was undergoing significant transformation as a government oversight organization to a well recognized national health system. Significant to study of the NHS in the last decade, have been studies of the agency's commitment to systems optimization.

This is in part to trends in patient capacity, whereby UK hospitals are forced to rethink former process models of treatment and managed care. The more global aspect of this trend relates to nursing shortages, and/or inadequate use of nurses as 'managers' on the frontline of patient intervention. Where both phenomena spark national debate, are the very same sites of confrontation where solutions may be found: 1) systems integration; and 2) horizontal remapping of responsibility. Additional 'symptoms' to the existing systems failures, are discussed as challenges to Burns' Nurse-Led strategies, not the least of which is the high incidence of healthcare acquired infections (HAI) in British hospital institutions and their impact on length of patient journey.

Solutions discussed in the King Edward Hospital NHS Trust case, sync well with Kotter's (2007) proposition of an 8-step process to organizational Transformation. Outline to Kotter's model is illustrated in Table 1.

Table 1

The '8-Step' Transformation Model

1. Establish a Sense of Urgency -- assess market forces facing the organization and the impact of these forces. Identify and discuss the impending crises.

2. Create a Guiding Coalition -- forge a team of leaders that are credible, have authority and expertise in the area of focus.

3. Develop a Vision and Strategy -- craft a target vision and strategies.

4. Communicate the Change Vision -- implement a communications plan toward change.

5. Empower Broad-based Action -- find and eliminate barriers to change.

6. Generate Short-Term Wins -- announce milestone achievements.

7. Consolidate Gains and Produce More Change -- incremental success reinforces a change organization.

8. Anchor New Approaches in the Culture -- subsequent to prior 7 steps

Table 1. Kotter's '8-Step' process Transformation Model (Kotter, 2007).

Shareholder / stakeholder needs / demands

Allocations were critical to mandate of the NHS 'reinvestment' strategies. NHS hospitals like King Edwards Hospital Trust were realigning strategies in an effort to curb spending.

While stakeholder interest included traditional interests of CEO/CFO and political representative, 'value' was placed on patient care and long-term institutional sustainability.

Nurses are seen as the solution to the crisis.

H

24+

P

Critical

Economic - SWOT

Home economy situation

Home economy trends

Overseas economies and trends

General taxation issues

Taxation changes specific to product/services

Seasonality/weather issues

Market and trade cycles

Specific industry factors

Market routes and distribution trends

Customer/end-user drivers

International trade/monetary issues

Disposable income

Job growth/unemployment

Exchange rates

Tariffs

Inflation

Interest and exchange rates

Consumer confidence index

Import/export ratios

Production level

Internal finance

Internal cash flow

The challenges faced by the NHS Trust staff were driven by patient and fiscal drivers.

The institutions were under duress to respond to overcrowding.

Change management strategies were met with varied support, yet all participants agreed that despite imperfect solutions that something had to be done.

Productivity was halting in the hospitals due to a number of informatics mismanagement errors or inefficiencies. The current legacy architecture would be upgraded in accordance with NHS standards of data management, but the time lapse between proposal and actual database reconfiguration, not to mention training put the hospital institutions on a slower than desired plan of action.

H

24+

P

Critical

Social - SWOT

Consumer attitudes and opinions

Media views

Law changes affecting social factors

Brand, company, technology image

Consumer buying patterns

Major events and influences

Buying access and trends

Ethnic/religious factors

Advertising and publicity

Ethical issues

Demographics (age, gender, race, family size,)

Lifestyle changes

Population shifts

Attitudes to work

Attitudes to people doing certain types of work

Occupations

Earning capacity

Staff attitudes

Management style organizational culture

Changes to education system

The social inferences to decision making in the NHS Trust were largely defined by social policy enforced by Parliamentary legislation.

Legal changes were a key external factor, and demographic elements of population growth and increase in patient waitlists in certain areas of clinical treatment have prompted attention to the forthcoming changes with the NHS policies.

Staff attitudes were reflective of older values attributed to standing NHS organizational culture. New values must be incorporated into the Nurse-Led change management initiatives which will ultimately transform the procedural strictures of how patient journeys are managed.

M

24+

P

Important

Technological - SWOT

Competing technology development

Research funding

Associated/dependent technologies

Replacement technology/solutions

Maturity of technology

Manufacturing maturity and capacity

Information and communications

Consumer buying mechanisms/technology

Technology legislation

Innovation potential

Technology access, licensing, patents

Intellectual property issues

Global communications

Inventions

Innovations

New discoveries

Research

Energy uses/sources/fuels

Communications

Rate of obsolescence

Health (pharmaceutical, equipment, etc.)

Manufacturing advances

Information technology

Internet

Transportation

Bio-tech

Genetics

Waste removal/recycling

Email

M-learning

E-learning

Collaboration tools

Software changes

Technology emerged as a key concern to the rehabilitation strategy that lay before the NHS Trust hospitals.

Still struggling with legacy systems, hospital staff were also subject to a range of procedural complications that delayed patient processing in the system..

Better it systems architecture and software was recommended as solution, yet with obsolescence in healthcare informatics comes responsibility in other areas.

Operations, research and innovation, logistics, partnership referrals, patient record and education, and the entire scope of intra-hospital communications must be changed in order for legacy systems issues to be transformed in actual practice.

H

24+

P

Critical

Additional split of information if doing a PESTLE analysis rather than a PEST analysis:

Legal - SWOT

Current legislation home market

Future legislation

European/international legislation

Regulatory bodies and processes

Environmental regulations

Employment law

Consumer protection

Industry-specific regulations competitive regulations

Legal factors are legislative policy mandates, with certain regulatory compliance to follow.

Legal interests are precursor to the case.

H

24+

P

Critical

Environmental - SWOT

Ecological

Environmental issues

International

National

Local

Environmental regulations

Customer values

Market values

Stakeholder / investor values

Staff attitudes

Management style organizational culture

Staff morale

Staff engagement

Global factors

EU-based factors

Environmentalinterests are two-fold and relate to risk management: 1) Environmental Health; and 2) Impact on Value.

Hospital Acquired Infections (HAI) presented a significant challenge to the admission-to-discharge initiative. HAI are a distinct area of concern within HAI policy presently, and the UK expends approximately £1 billion annually combating infectious risk.

Patient-client value as asset to the Trust was at a critical state, with complaints of delayed admissions and confusion regarding testing and aftercare.

1)

2) Environ

H

24+

P

Critical

Table 3. Pestle/SWOT analysis of King Edward Hospital NHS Trust (RapidBi, 2010).

Summation to the findings of the King Edward Hospital NHS Trust SWOT informed PESTLE analysis is as follows:

Political - implications fostered by forthcoming restrictions to Allocations were critical to mandate of the NHS 'reinvestment' strategies. NHS hospitals like King Edwards Hospital Trust were realigning strategies in an effort to curb spending. While stakeholder interest included traditional interests of CEO/CFO and political representative, 'value' was placed on patient care and long-term institutional sustainability. Nurses are seen as the solution to the crisis;

Economic - challenges faced by the NHS Trust staff were driven by patient and fiscal drivers. The institutions were under duress to respond to overcrowding. Change management strategies were met with varied support, yet all participants agreed that despite imperfect solutions that something had to be done. Productivity was halting in the hospitals due to a number of informatics mismanagement errors or inefficiencies. The current legacy architecture would be upgraded in accordance with NHS standards of data management, but the time lapse between proposal and actual database reconfiguration, not to mention training put the hospital institutions on a slower than desired plan of action.

Social - inferences to decision making in the NHS Trust were largely defined by social policy enforced by Parliamentary legislation. Legal changes were a key external factor, and demographic elements of population growth and increase in patient waitlists in certain areas of clinical treatment have prompted attention to the forthcoming changes with the NHS policies. Staff attitudes were reflective of older values attributed to standing NHS organizational culture. New values must be incorporated into the Nurse-Led change management initiatives which will ultimately transform the procedural strictures of how patient journeys are managed.

Technology - emerged as a key concern to the rehabilitation strategy that lay before the NHS Trust hospitals. Still struggling with legacy systems, hospital staff found themselves subject to a range of procedural complications that delayed patient processing in the system. Better it systems architecture and software was recommended as solution, yet with obsolescence in healthcare informatics comes responsibility in other areas. Operations, research and innovation, logistics, partnership referrals, patient record and education, and the entire scope of intra-hospital communications must be changed in order for legacy systems issues to be transformed in actual practice.

Legal -- factors are legislative policy mandates, with certain regulatory compliance to follow. Legal interests are precursor to the case.

Environmental -- interests are two-fold and relate to risk management: 1) Environmental Health; and 2) Impact on Value. Hospital Acquired Infections (HAI) presented a significant challenge to the admission-to-discharge initiative. HAI are a distinct area of concern within HAI policy presently, and the UK expends approximately £1 billion annually combating infectious risk (Aziz, 2009). Patient-client value as asset to the Trust was at a critical state, with complaints of delayed admissions and confusion regarding testing and aftercare.

Conclusion

At a time when UK NHS has done much to promote artificial intelligence as viable solution to informatics flow in Britain's healthcare institutions, it is not surprising that since the error of the King Edward Hospital NHS Trust case study on knowledge-based collaboration in its practice setting, channels affecting admission-to-release of patients have been refined for better service delivery through Nurse -- Led change management strategies. The arrival of HMIS on the scene in the UK was rather early, and the NHS in its constructive leadership in this is area had already accelerated its capacity by leaps and bounds where other national healthcare models were only just beginning. The existence of informatics and high quality network systems architectures, however, did not automatically translate into competence in comprehensive patient care, nor operational efficiency. What NHS institutions faced was an incoherent structural disaggregation between ICT developments and knowledge management at the national level, and an absolute fiefdom of procedural complexities at the institutional level where there was no other solution but well planned steps toward grounded evolution in transformation.