Healthcare Case Study
Patient care at the Mid Staffordshire hospitals
The board of the Mid Staffordshire General Hospitals NHS Trust (the Trust) embarked on a major change programme directed towards achieving the elite status of a foundation trust. Foundation trusts have greater autonomy than other hospitals, are less dependent on government funding and have the right to borrow money from banks.
In order to achieve this sought-after foundation trust status, the Trust was required to prove its financial competence, balance its books and achieve a range of government targets such as those relating to waiting times.
As the push for change gathered momentum, the Trust set itself the target of £10 million savings (8% of turnover). It achieved this by pursuing a tough top-down change strategy (see Chapter 16) that involved eliminating 150 jobs, some restructuring, an 18% reduction in the number of beds and a range of
other cost-cutting measures.
The Healthcare Commission, the NHS watchdog in England, became aware that death rates for patients admitted as emergencies at the Mid Staffordshire hospitals were significantly higher than at comparable hospitals and initiated an investigation. Attention was focused on the accident and emergency (A&E) department, the emergency assessment unit and the surgical and medical management of emergency admissions.
The problems that were identified are documented in the Healthcare Commission’s report (2009). Problems were found at every step along the emergency care pathway.
For example:
• Because of a shortage of nurses, when patients arrived at A&E, the seriousness of their condition was assessed by a receptionist who was not clinically trained.
Patients were then moved on to a reception area that was out of sight of reception staff.
• There were shortages of essential equipment such as cardiac monitors.
• Because of the shortage of doctors and nurses, assessment and treatment were often delayed.
• Junior doctors were pressurized to make decisions quickly.
• Doctors were diverted from treating seriously ill patients to deal with more minor conditions in order to avoid breaching the government-imposed target that 98% of patients arriving at A&E should be seen and either admitted to a ward or discharged within four hours.
• Another tactic to ‘stop the clock’ and avoid breaching this target was to move patients out of A&E to the emergency assessment unit. Once there, because of staff shortages, they were not properly monitored.
• Nurses had high workloads, and many were under trained. Cases were reported where nurses turned equipment off because they did not know how to use it.
• Because of staff cuts there were too few consultants to supervise junior doctors.
• There were too few operating theatre sessions at weekends.
• Patients had to wait for medication, pain relief and wound dressing and sometimes the wrong medication was administered.
• The care of post-operative patients was so poor that signs of deterioration were missed or ignored.
• Relatives reported that patients were left for long periods in soiled bedclothes and were left without food or drink (there were even reports of thirsty patients drinking water out of flower vases).
The top-down change strategy targeted at winning foundation trust status was successful, but only in so far as it delivered this narrowly prescribed outcome. The trust was awarded foundation status but this ‘success’ was short lived. The publication of a damming Health Commission report led to further investigations into the quality of care delivered by the Trust. The last of these was a lengthy public inquiry that led to the eventual dissolution of the Trust. The Stafford Hospital was renamed and taken over by
a newly constituted NHS Trust.
Jeremy Hunt, the Minister for Health, stated in his introduction to the government’s response to the public inquiry that ‘a toxic culture was allowed to develop unchecked which fostered the normalisation of cruelty and the victimisation of those brave enough to speak up. For far too long warning signs were not seen, ignored or dismissed.’
(Patients first and foremost, 2013, p.5). Senior managers prioritized cost-cutting and cascaded orders down the hierarchy that failed to support patient care. Systems designed to draw the board’s attention to clinical issues failed to function and senior managers paid little or no attention to concerns expressed by staff, patients and relatives about the quality of patient care. ‘Targets and performance management … overwhelmed quality and compassion.’ (Patients first and foremost, 2013, p.21).
Patients, their families, nurses, junior doctors, former employees, the local community and the NHS were all let down by irresponsible managers who were pursuing their own agenda.
TASK
To ensure that the top management achieves success, you are expected to produce a 3000-word report. In this report you will be required to evidence the following with reference to the issues highlighted in the case study above:
Task 1 :
Evaluate and recommend a model of change that might be utilised in order to develop an environment that would allow the organisation to be competitive.
Task 2:
Analyse what might be the major resistance from employees on the recommendations made above and, using appropriate change models and interventions, how might the CEO mitigate this employee resistance?
Learning outcomes assessed
2. Explore and critically appraise strategies and methods used for the planning and management of change
4. Develop a plan to effectively manage a specified change.
Hospitality Case Study
Company background
The Palm Riviera Resort (The Resort) is a hospitality organization, a subsidiary of a global resorts group headquartered in Europe. The group serves a diverse array of patrons with highly skilled chefs and other staff. The group’s strategy is the high focus on exceptional customer care, and smooth customer experience. The Resort is one of the flagship brands and sites of the group.
The resort has been established 12 years ago in the suburbs of Shanghai to serve the Group’s clients in the quickly growing Chinese market. Thanks to global key accounts and cheaper airfares, the business grew fast, and the Resort quickly became profitable and was more profitable than the group’s similar sized resort in Cappadocia, Turkey.
Things were going well, until the competitive pressure started to erode profits. The management and stakeholders looked towards the General Manager (GM) who was now looking more anxious than ever.
The was consistently failing to meet the profitability expectations of the owners. The ownership eventually lost confidence in the management at the time and decided to make a change.
The GM was replaced with a younger GM. Clients wanted a wider range of services but at competitive costs. Costs of doing business were increasing; staff cost was increasing; while holiday and normal sales were shrinking, causing the resort incur losses. Two previous GM’s have already failed to make the turnaround and got fired. Now it is the third General Manager, who is hired with the mission of making the turnaround. Failing to make profits in the last three years made the owners cautious about further investment, so the turnaround should be achieved with a low budget.
Why is the Resort in crisis?
Based on the industry and economic factors, the Resort should still be profitable. Why is it in the red then? According to the HRD who has been hired one year ago, it was caused by bad leadership, by top management complacency, neglecting continuous improvement and development for many years.
Realizing the ineffectiveness of top management, the owners made a major personnel change one year ago, replacing not only the General Manager, but also most of the Directors. The new Management Team – the GM and the Directors – agree that change is needed, and it is needed now. Plans for the turnaround
The Management Team discussed about and decided the following changes:
• The workforce will be reduced to 600 (250 people will be laid off);
• Staff will be trained to handle more positions, so that they could be deployed more efficiently
• Business processes will be streamlined; there will be more detailed new KPIs introduced; P/L will be calculated for each service offered, and managers will be hold accountable for them
• Currently, overtime fee is a “standard employee benefit”, regardless of the actual need for overtime. This practice will be changed: overtime pay will be reduced to the necessary minimal.
The other changes must be implemented within the next 12 months, but there is no detailed schedule yet.
Current situation and challenges
According to the HRD, there are major roadblocks standing in the way of successful transition:
• The Management Team has consensus about the direction, but the new business processes and the future organizational structure have not been clarified and worked out in details, and it is not sure whether they will be able to come up with a convincing solution.
• The Middle Managers are not supporting the change. It seems they don’t want to understand the new direction. They are passive in the meetings, and skeptic or opposing one-on-one. They started as porters in the company for 10-12 years ago and have been gradually promoted to become managers.
According to the observations of the HRD, many of them show very low managerial and leadership
competencies. Many of them show little capability for independent thinking and decision making in general, and don’t have much influencing power with their staff members. Some of them may lack the potential to adapt to their expanded future managerial roles.
• The General Manager and the Directors are all task focused people with low “people” awareness and communication skills. They underestimate the resistance of the people. They don’t recognize the competency gap of the Middle Managers.
They don’t think much about the communication strategy and the human aspects of change management.
• The morale is already very low in the entire resort. The planned changes would put higher demands on staff, while their income would decrease, or in best case equal their current income. This will very likely further undermine their motivation and productivity.
TASK
To ensure that the top management achieves success, you are expected to produce a 3000-word report. In this report you will be required to evidence the following with reference to the issues highlighted in the case study above:
Task 1 : Evaluate and recommend a model of change that might be utilised in order to develop an environment that would allow the organisation to be competitive.
Task 2: Analyse what might be the major resistance from employees on the recommendations made above and, using appropriate change models and interventions, how might the CEO mitigate this employee resistance?
Learning outcomes assessed
2. Explore and critically appraise strategies and methods used for the planning and management of change
4. Develop a plan to effectively manage a specified change.
