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Picture: simple example of the creation of public value (public park+bank+table+water fountain+public parking) (7)
To write this assignment I took inspiration from the workday events that ignite my emotions and fuel my motivation (6). The concept that I used as the final aim of my project was the creation of Public Value.
I always like to make it very well defined from the beginning what my final objective is, giving a basic and clear definition about my aim. Hence, I used “Public Value” as coined by Professor H. Moore, which is the value that an organization contributes to common good in society. It is, as he explains, the equivalent of shareholders value but in the private sector. (1)
The situation that will be dealt with here is still a work in progress and part of it is a progress loop that should never end. This ever-improving cycle, the analysis of the process and measurement of the outcomes, is better than I expected for my joy and my team’s joy. During this project the most important force behind my challenging work was certainly the “progress principle” as, of all things that can boost emotions and motivation, making progress and the concept of winning small battles kept me focused and determined to look for the best way to create public value. I believe that I accomplished this with the strong feeling of achieving goals which I and my team internalized, producing positive feedback to nourish our feelings. We had and have the reassurance that we are doing meaningful work in the public dental health field. (6)
I am a Senior Dental Officer and sometimes locum manager working for Queensland Health. I am based at the Oral Health Centre which is the biggest and most modern public dental centre in Australia. It is there where the Oral Health Alliance was formed just over two years ago. The Oral Health Alliance is the amalgamation or cooperation agreement between Queensland Health Oral Health Services and the University of Queensland Dental School.
This Alliance has had since its early stages difficulties as the coordination of two big organizations with their own values and visions and objectives was a titanic task. In its short but shaky life it has consumed or devoured so far one Chief Executive Officer, three Directors, and some few general managers and senior project managers in different departments.
The Missions for these two organisations are different due to the distinct business they are in: Education and Public Health Services.
The Visions are also different, based on what each organization wants to achieve: good teaching with the aim of forming reliable professionals versus care of the population oral health.
The Objectives are different, as one is focused on achieving repeatable strong educational outcomes for students and the other continually looking for ways to work more efficiently to reduce the dental waiting lists for patients.
Hence the obvious strategic differences. (5)
Analysis of the situation:
By nature, my organization (the Alliance) produces Public Value through the provision of general and specialist dental health services to the people of Queensland, interstate patients and Pacific region patients, as the Oral Health Alliance has become a centre of reference in this part of the globe for its size and “quality”. The quality of the specialists’ services is undeniably very good, and the experienced general dentist service is adequate as well but the big mass of students which make the Alliance big in size is not sufficiently well trained to meet the demands inherent in the organisations perceived reputation.
I used the inverted commas for “quality” as this is one of the situations I have addressed in my current project. The reason is the big variation of quality of service that our patients receive from the dental students that are currently not clinically ready to confront the demands of the modern dental services.
In my first project (first assignment for ASCI), where the aim was to innovate and generate change at the operational level, I was able to achieve results. The hard effort in communicating the ideas of the project, created a sense of community with a common objective among all the service providers (students and dental officers). However, the momentum of this force had to be tested and the motivation that has to persist in time through encouragement was and is not an easy job. The idea that in an organization, once the belief and energies of a critical mass of people are engaged, conversion to a new idea will spread like an epidemic, actually occurred here to a considerable degree. (Kim, W. C. & Mauborgne, R. A. (2003). Tipping point leadership. Harvard Business Review 81(4), 60-69.). This allowed me to increase my ambition, and in this second stage of the project with the increased support from the operational level/front line people, I raised the bet to infect the leaders of the organization and influence upwards, reaching the Corporate and Business levels. (5)
We had to fix the problem of poorly trained human resources (dental students) that are stakeholders in two ways, in the sense that they are here for their professional training and to acquire skills (coming from the University of Queensland Dental School which is also one of our main stakeholders), and as dental services providers.
In actioning change for one objective, other gains have been made in the way of better governance and more efficient use of money. These side effect benefits will increase the support of the government for this project.
Addressing the issues:
To address this matter several staff with influence and many years of experience at the operational level agreed with me, and subsequently this project was presented and discussed with line managers and finally the Director himself.
To start this wave moving upwards in the organization I utilized in a particular way each side of the strategic triangle which firstly make us agree in what public value we produce by treating dental ailment and improving the quality of life for many people, and at same time providing training for the final year dental students. Secondly the involvement of experienced and influential staff with many years of experience with Queensland Health gave legitimacy and support. Thirdly, we as operational service providers offered our full support for any changes needed as part of a strategic plan (1)
Fortunately, the new Director (that has been in the position for just two months) did listen to our concerns and recommendations and utilized the input given in an adequate manner that is already benefiting all our stakeholders.
Since the beginning however not everything was smooth along the way, I had resistance and even opposition from the Dental School as one of the major stakeholders. It has been a mix of ongoing progress and also some setbacks.
Description of the plan and its implementation:
Part of my proposal was about governance and sources of revenue for the different areas of the Oral Health Alliance. Being both public organization (Queensland Health-University of Queensland) they rely on public money to finance themselves. However, resources come from different coffers, namely the Department of Education for the University of Queensland Dental School, and from the Department of Health for Queensland Oral Health Services. Noticing a lot of double-dipping as a problem, my proposal was to separate the clinical services from the teaching services of the Alliance and show to the government that our expenditure became more efficient, saving money and increasing the return on investment for each dollar expended. This was actioned and proven to be true, which I am sure made the Chief Executive Officer of Oral Health Services happy and more likely to support future proposals. (1)
This proposal was resisted by the University of Queensland because it had to dig deeper in its own pockets to pay for teaching expenses that were previously “shared” in partnership with Queensland Health. I am glad that our Director believed in our proposal and supported us to implement this part of the project.
Because the Dental School did not want, or could not spend, more money than they already were spending, the second stage of the proposal landed on the Executive Committee table. It was the further engagement of Queensland Health in the training of the dental students from an earlier stage in their career. This gave Queensland Health more power of decision in what and how to teach students from just before they start treating patients and until the end of their studies while in 4th and 5th years when the training is mostly through placements with clinical provision of treatment for Queensland Health/Alliance patients.
In this way the strategy of influencing up the corporate level created a new focus, and enabled the project to get closer to achieving the goal of producing more public value for as many stakeholders as possible. This translates into producing the greatest good for the greatest number (1)
In this way a kind of ambidextrous organization was created, but not in the complete classical sense. In our case, the tightly integrated head formed by the Dental School authorities and Queensland Health Executive Officer working together works to direct two distinct bodies with different goals and focus: clinical teaching and treatment of patients influenced by Oral Health Services, and on the other side the theoretical teaching depending of the University of Queensland Dental School. (4)
For what has been explained until now, it can be seen that there was a need for a change initiative that created innovation in the processes and services delivered. These changes were perceived by some of the stakeholders but the lack of a strategy to action change and innovation and a framework to implement these changes became the problem. Achieving this tipping point was reached by consciously alerting stakeholders to the need for change and particularly how it could be achieved with the limited resources we had. This became a movement that employees not only recognized but also wanted to be part of. I believe that I have been an influencer inside the organization acting like a kingpin in bowling as I managed to get all pins toppled, and this has saved time and money from having to motivate everyone. (3)
Another option for strategic change could have been the request to utilize the help of external strategy consultants which offer in most cases supposedly less bias. In this instance their work could have been complementary to the work already achieved by my project, or a completely different alternative decided by the Oral Health Alliance Director. I pointed out to the Director during some of the meetings that the risk of this consultancy approach is the usage of an off the shelf project logic, which could prove ineffectual as it may lack an understanding and ability to negotiate the culture and internal bias which has grown because of the Alliance’s novel structure and functioning. Ultimately the decision to go ahead with our internal suggestions was accepted. (2)
At the end of the day and according to Harvard professor Mark H. Moore there are two sources of public value:
1) value that results from improving the government itself as an asset to society, and
2) value that results from the delivery of specific benefits directly to persons or groups.
I will explain why I believe that we at the Alliance achieved successfully these two sources of public value.
Basically, in point 1, we improved the governance of the Oral Health Alliance and increased its value as an asset to society. This better, more responsive governance system can be measured through the periodical reports from the directorate where we can see the number of patients served has increased, and the waiting lists have had a noticeable reduction. The amount of dental services per appointment have also increased, reflecting more productive operators (dental students working faster because of different focus in their training), the oral health services have not been able to reduce the money allocated to the Alliance but has neither made any increase in the money allocated meaning that we are doing more with the same. Point 2 can be evident in all and each stakeholder’ groups as follows:
a) Queensland Health: reduction of waiting lists for oral health treatments hence more, or at least the same level of support from the funding bodies and politicians as they can show public value created for their electorates.
b) Students: improved opportunities to develop critical thinking skills as a crucial tool for future work when they will be expected to perform without supervision, and better clinical skills developed earlier in their careers allowing them to embed real experiences in their clinical practise before ending their training and graduating as dentists. This will ensure their ability to be able to deliver “quality” work.
c) Patients or citizens: less time to wait for their treatment, faster treatments, “quality” treatment received with the consequent reduction in returning to fix poorly performed work, which was sadly often the case in the past.
d) University of Queensland Dental School: The only stakeholder somewhat unhappy as they have to invest more money in the Alliance after making the share in running costs of the Alliance fairer between the two organizations. Also because of the loss of influence in dental students training. However, they have accepted the reforms so far and continue to observe how these changes evolve, recognizing that the first evaluations are positive.
I cannot avoid mentioning that the more defined structure of the Alliance makes for easier tracking of results and as a consequence accountability has become easier to determine. The creation and application of the key performance indicators for all staff has been made more user friendly and put online which makes it more transparent and line managers cannot hide anymore potentially preferential treatment to some employees. Supervising dentists are now more openly and easily auditable in their teachings to the dental students. (1) (2). All these changes and innovation have reduced the significant levels of uncertainty that previously restricted the work carried out by the Alliance, and the new strategy designed for the Oral Health Alliance now gives a sense of direction that is easily perceived by staff and students, and supports a sense of stability throughout the organization.
Proposed measurement processes for ongoing evaluation
a) At Oral Health Alliance level (Queensland Health and University of Queensland): we will keep using the monthly reports obtained from the current patient management system which provide the number of patients seen, the length of the waiting list, etc. This data will give measurable data sets over time, providing evidence (if keeps on the positive side) to support the maintenance and continued improvement of the newly implemented system.
b) At Students level: monthly assessments of their clinical outcomes can be measured on our computer systems, including measurable data such as: times spent for each treatment, feedback on treatment decisions from supervising dentists, and number of repeat visits to conclude a particular treatment. The introduction of requiring them to participate in staff meetings, and the request to complete regular feedback forms examining their recent clinical experience (anonymous or not) will give information to make a picture of their situation.
c) Patients or citizens: Feedback/compliments/complaint forms will be readily available for patients to complete.
This project has brought many changes to our organization, many linked to each other which have had consequences across all stakeholders. This has created Public Value that is slowly giving the first measurable results, the majority of which have come back positive. The “quality” improvement in dental students training that was the first objective to deal with has also brought many follow-on benefits. The behaviour of staff has improved, not because they feel controlled in the new structure, but because of the new transparency standards and the feeling of integration and the desire to be a part of the change. The punitive methods for policing behaviour used in the past (stated in my first assignment), such as “explain why” letters to staff have not been necessary anymore, which is another indicator that the innovations are working. If we describe this process in the same way as monitoring the progress of a dental patient, most of the parameters were in red at the beginning and at the moment, they all have turned green, but there is not time to celebrate yet as these results have to persist in time and that will be a matter of further analysis in the future. For sure constant monitoring will show ups and downs in the future results but the trust placed in this new strategic direction that we all can see is the fuel to keep us going and improving.
2) Petris, S. (2010). The nature of strategy in the public sector. The Australia and New Zealand School of Government and Victorian State Service Authority. Occasional Paper No.7. QUT Readings.
3) Kim, W. C. & Mauborgne, R. A. (2003). Tipping point leadership. Harvard Business Review 81(4), 60-69.
4) O’Reilly III, C. A., & Tushman, M. L. (2004). The ambidextrous organization. Watertown: Harvard Business School Publishing Corporation.
5) (Johnson, G., Whittington, R., Scholes, K., Angwin, D., & Regner, P. (2014). Exploring Strategy: Text and Cases (10th ed.). Harlow, UK: Pearson Education Limited).
6) Amabile, T. M., & Kramer, S. J. (2011). The power of small wins. Harvard Business Review 89(5), 70-80.
7) https://pxhere.com/en/photo/882813 add name of website and name of the photographer if available. Also date you downloaded the photo
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