Change is a process of transitioning from a current situation to a desired future condition. Whether we like change or not, we are all caught up in a never-ending cycle of change in our organizations. Some people welcome change and enjoy the uncertainty it often brings, thinking that it offers a new challenges and opportunities at work. Others are cautious about change, fearing that something valued will be altered or lost or that risk brings unnecessary stress. In care, health and social care services are essentially about people, both those who need to use services and those who provide services. People are sensitive to the impact of change and as a manager I have a particular responsibility to take care over how changes in services that are intended to deliver care within the organization.
One of the reasons why change seems to be constant is that there are many potential stimuli for change and there are several factors driving change. The stimulus for change may come from inside an organization but it is more usual for it to come from outside. Change initiated within the organization is often a response to a force outside the organization that triggered the change. For example, factors that have a significant impact on health and social care services include government legislations and policies. Many aspects of health and social care are subject to legislation. New legal requirements emerge constantly as government seek to improve health and social care, often through introduction of systems to set standards and to control or modify service provision. Like the Health and Safety at Work Act 1974, this was enacted because of increasing numbers of accidents and incidents that happened in the past related to work. Its main purpose is to protect and minimize people from harm. It places a general duty on employers to ensure health, safety and welfare of all employees as far as is reasonably practicable. This legislation situates an impact not only on health care industry but all kinds of work. That is why until now it was expanded its scope, clarified responsibilities and responded to new circumstances as they have arisen without changing the overall principles of the original Act.
Legislation also affects service provision though legislation relating to employment, health and safety, use of public funding and through related services including education and housing. Recently, the government commence key modification which affects the eligibility of all non-EU workers who wants to work in the UK. Those individuals must ‘earn’ a minimum number of points. The new rules state the less points will be given for employees earning lower salaries in UK and no points to those who are paid less £20,000 per annum compare to the old rules that give a minimum points for those workers having £17,000 salary per year. It means the employer will have to pay new workers at least £20,000. In addition, the care providers were enormously concerned about the present government removing the senior carers from shortage status because it might cause damage on the quality of care and in the business.
Moreover, new technology is also a reason that is why change arises in health care setting. One great example is the development of internet. It change the way of sending information to the multi-disciplinary team through e-mail. Making it easier for senior staff to send and receive relevant information from GPs and other professionals and vice versa regarding service user’s condition while promoting privacy and confidentiality. It also change our ways of using records and libraries. Staffs in health and care services have access to an increasing range of information that is available to practitioners in health and social care. Service users expect us to make use of evidence in making decisions and database of best practice models are increasingly available. In my workplace, the management use the internet to provide trainings for staff which is more suitable and can be done in our own convenient time. For residence and relatives, it’s a fact that most of the relatives of our service users are far away from each other. However with the utilization of the internet, distance is not a big deal anymore. For relatives and services user who have personal computers or laptops can make conversation and see each other with the use of webcam and chat rooms through the internet.
Service delivery is also influence by use of new developments in equipments. Like the new equipment acquired by Barts and The London NHS Trust the two state-of-the-art Lifeport organ transporters. It endow with a valuable sustenance for patients needing a kidney transplant. It stores healthy kidneys after they are removed from the donor before being transplanted into the recipient. This is a critical period for ensuring that the organ does not deteriorate and become unusable. Unlike before that they rely on ice to conserve the kidney, the new equipment maintains the organ in a fluid rich in nutrients and oxygen, which significantly extends the storage period. For the new equipments, it does change the old method to a new way that allows hope for more patients to have successful kidney transplants. In care home settings, the acquisition of new equipments like the air pressure mattress is indispensable equipment for anyone at high risk of developing pressure ulcers or who have existing pressure ulcers. The alternating pressure of the mattress depends on the weight of the service user allowing relieved on a regular basis and trim down the number of times a person needs to be turned, greatly enhancing the comfort of the very poorly or terminally ill.
In addition, economic factors also drive change. These factors include the general prosperity of the country and its neighbourhood, the rate of unemployment, areas of poverty, the level of inflation and exchange rates in relationships involving other countries and currencies. The state of the economy affects the level of demand for goods and services, the prosperity of communities and the availability and cost of raw materials and labours. The economy tends to move in cycles, but these are not easy to predict. All services, whether public services, private services or charity provision, are affected by changes in the economy.
At present, there were lots of changes in the health and social care sector due to the recent financial crisis that affects the economy of United Kingdom. As a result, the coalition government have wasted no time to save money in reshaping parts of the health services. According to the health secretary, the popular NHS direct services will be substitute with cheaper alternative. Under the government’s plans, some strategic health authorities and hundreds of primary care trust are to be abolished affecting thousands of employees and service users. Examples of recent cost-cutting measures cited by professionals are hospital bed closures, pressure to give patients cheaper, slower-acting drugs, cuts to occupational health support, and reductions in community health services. Furthermore, according to a study, it make known that for the most part of job losses it involved frontline staff as patient services are withdrawn. Along with mounting numbers of patients are being deprived of treatment for conditions such as loss of sight, arthritis and infertility as the NHS increasingly rations healthcare in order to save money. But, the spending cuts done by the government does not only affect the health and social care sector but the life of Britons as a whole. It affects the sick, the disabled and Britain’s poorest families. Among the biggest cuts are only allowing claimants to have the replacement for Incapacity Benefit, the Employment and Support Allowance for one year, Cutting Disability Allowance for those people in care. Cutting Council Tax benefit by 10%. Reductions in the help given for childcare to working families, and slashing housing benefit for the under-35s by paying them the “shared room rate” instead of enough to live on their own etc.,
To be able to facilitate change in health and social care, as a manager I need to be able to understand the principles of change management. According to John Kotter, an authority of leadership and change, change has both an emotional and situational components and methods for managing each are expressed in his 8 step model. To value his model, as a managers there must be an understanding about the suppression and to cause employees emotion. During any period of change, a manager must deal with feelings of complacency, anger, false pride, arrogance, panic, exhaustion and anxiety among staffs. These are all emotions that can challenge and undermine attempts at promoting change. As managers I need to be able to turn these negative feelings into positive and proactive feelings such as faith, trusts urgency, hope, passion and enthusiasm which are emotions that promote change.
On the first phase the model explained the phase of creating a climate for change. As a manager, there is need to develop a sense of urgency to staff. That action is needed regarding a foreseen difficulty. This can be done during meetings by explaining the situation through showing related videos and sharing stories. As the urgency grows among the staffs, as a manager, there is necessity to develop a guiding team that guide the change throughout the remaining steps. Members of the guiding team could be unit managers, senior carers or persons who have a relevant knowledge about the changes that occur in the organization, the ability to establish credibility and trusts to peers, the formal authority associated with managerial skill and the leadership. With the manager, alongside with the guiding team, must develop a vision expressed in a clear, concise statement about the direction in which the organization is headed.
Engaging and enabling the whole organization is the second phase of Kotter’s model. Here, anxiety, anger, panic, among staff will rise because the manager or guiding team announces the impending change. Whenever, change is about to take place, people begin to wonder. That is why the guiding team needs to communicate to the individual or groups that are to be affected by change. And need to address these feelings and help staff to think and act in accordance with the new direction. An effective way to communicate the vision is to develop an engaging story that catches the attention of the change initiates. If there is a resistance to the staff at certain point, a dialogue between the guiding team and staff initiates a question and answer session. Staffs displays understanding when they realized the advantage, rewards and perquisites that they will gain once the change is completed. As the pathways to change are cleared, staffs must need to carefully choose and complete tasks that clearly show that the change is succeeding. Tasks completed provide further urgency and momentum among the organization and lessen the impact of negative comments.
At the final phase, the action plan is implemented fully allowing staff not to let up of the change. Collaboration occurs when staffs are willing to endorse or stand behind the change and displays commitment. As managers, at this phase, should sustain the change. It is done when a new way of operating has been shown to staff to succeed over the some minimum period of time Staffs at this point, displays advocacy that maintains the attitudes and behaviours supporting the change..
To relate this in my work, in my care home, there are recent changes that were implemented due staffs failing to do proper documentation. Firsts, the home manager scheduled a meeting and consultation to all the unit managers. At the meeting, to develop a sense of urgency among staff, she used a video based scenario regarding right documentation. The video shows the positive and negative effect of proper documentation to staffs, residents and management. In the meeting, everyone was asked about the ways to improve the situation. Then, decided that every staff should be knowledgeable and competent enough to do appropriate documentation at work through trainings and observations to make sure that they have the awareness, understanding and collaboration about the agenda of the meeting. On the other hand, the unit managers are to be the guiding team to lead, direct and show the proper way of documentation to unit staffs. Before the meeting ends, she makes sure that everyone understands about the directions in which the organization is headed and there would be recognition as the best unit that could implement the change.
Finally, now every staff is confident regarding answering the forms in the care plans of every resident and certain to do the right documentation. The as proposed the guiding team use appraisal and supervision to measure the change. Plus the home manager monitored the change by evaluating the care plans of the residents with the help of a unit manager every end of the month for this change to become a culture in the care home.
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