Factors that drive change in health and social healthcare services
The main objective of healthcare is to reduce the risk of infection, cross-infection, and secure the delicate lives of the sick. Factors that have to ensure that these changes occur are political, social, environmental, technological, economical, and legislative in nature. Generally, it is important to come up with a PESTEL analysis of the social healthcare environment in order to approach the situation at hand in a holistic manner.
Political
The political factors relates to laws and regulations required in order to run a healthcare. Government plays an important role in regulating the activities carried out in social healthcare institutions (Clouston & Westcott 2005, p. 27). These factors include tax policies, which have an effect on the number of companies investing in healthcare industry. RUH adheres to the policies and the procedures outlined by the Nursing and Midwifery Council (NMC). The policy ensures the healthcare offers effective clinical services to the patients to ensure delivery of the quality services within the industry. Moreover, NMC requires only registered nurses to carry out midwifery duties. Most of the activities conducted by the healthcare are subject monitoring by the relevant professional body like Clinical Governance Committee. With the intervention of the government, changes are occurring in the sector as most healthcare institutions fight to ensure they comply with state requirement.
Enactment of certain legislation like NHS and Community Care Act 1990 ensures that services offered within the healthcare sectors meet the requirement by the patients. Moreover, Health and Social Care Act 2001 states the right of every person to access healthcare services. These factors tend to shape the management and services offered within this field. The government also fund healthcare projects depending on the urgency of need and the number of patients handled. RUH offers efficient and reliable offers as required by the state. Changes in the government also influence the activities in the healthcare, as every government tends to amend the already outlined laws (Harris 2006, p. 138).
Social
The RDU report does not focus on many social factors such as the demographic and psychographic profiles of the patients. Socio-cultural beliefs affect the quality of services offered within the healthcare. The perception of some communities about medical treatment influences the rate as they visit heath facilities. Some communities depend on herbal medicine to cure them while others completely do not understand the existence of healthcare. This is mainly due to lack of adequate information regarding healthcare services. The minority communities are those living below the poverty line. It is difficult for such communities to save money for visiting hospitals at the same time providing food for families. This is one of issue, which accelerates change in the healthcare. Living a proper lifestyle is a sign that one has the ability to afford payment for healthcare services. Therefore, lifestyle factors determine the number of people visiting healthcare facilities.
Economical
RUH trust implemented systems that require financing. Most of the systems aim at monitoring and evaluation of service quality, others help in risk management and assessment. Economic factors involve both macro and microenvironment. It covers areas of inflation and availability of disposable incomes. Inflation always leads to increment in the prices of goods and services. Increased price and tax reduces the amount of money available for disposal. As a result, this reduces the number of patient seeking medical attention in healthcare. The social healthcare services mostly depend on finances from philanthropic organisations or public hospitals. It becomes very difficult to sustain the risk management plans especially without a clear source of income.
Environmental
Environmental factors relating to the surrounding in which the healthcare offers services. It focuses on issues like weather and geographical locations. Certain weather condition reduces the number of patients visiting health facilities. For example, heavy rainfall and harsh season discourages patients from visiting healthcare. Geographical location relates to the environmental condition of the area or the distance to the healthcare facility. In order to ensure safety environment, RUH need to offer services in a cleaner and safer environment.
Technological
Technological advancements including the electronic risk management incident recording system help in needs assessment, planning, and delivery of services to the users of the social healthcare work place. Keeping data electronically ensures easier retrieval of information through portals that uniquely identify patients. With enhancing level of technology, patients are able to communicate with a medical practitioner in the healthcare as a result, reducing time wastage if the patient does not require injection. Technology has also made work easier through introducing equipment for treating and assisting patients. After technological intervention, it became easy for the theatre operators and the surgeons could conduct surgeries in the social healthcare facility, computer mediated communication made it easy to facilitate the influx and exit at the waiting space. Through the hydration bundle policy, the hospital has the capability to carry out visual assessment of fluid flow through a hydration system.
Legislative
Legal factors affect both external and internal aspects of the business. External factors are state laws while internal factors relates to policies developed by the healthcare. Legal processes are very important in managing organisations especially when it involves direct services to the people. The RUH trustâs record keeping policy adheres to the regulations of the Nursing and Midwifery Council. NMC reinforces on the importance of technologically mediated record keeping, communication, and efficiency in delivery of midwifery services. The National Institute for Health and Clinical and Healthcare Excellence (NICE) also reinforces the significance of the National Health Service policies that promotes holistic healthcare to adults. Without NHS regulations, it becomes very difficult to trust in social healthcare service for both personal health and community health.
Therefore, without certification from legal frameworks, it takes time for the social healthcare services to believe in service delivery from hospitals or caregivers (Kotter 1996, p. 128). The same applies to the control fluid experience in which the hydration machines have to adhere to the regulations of the hydration policy. In essence, legislative certification coupled with licensing from the NHS and the institution has to follow the due processes of health and social care Act of 2001.
Challenges that key factors of change bring to health and social healthcare services
Merits
Considered inevitable, change requires commitment, monitoring, and involvement of the concerned parties for it to be positive and effective. The health sectors experiences several change factors emanating from either inside or outside the organisation. The key factors challenging RUH organisational change are demographic, social-economic, and technological changes. With continuous increasing population, the health sector has a responsibility of shifting its managerial techniques to reach every segment of the population. Moreover, this is in line with fulfilling the Millennium Development Goals, which focuses on improving health status. Social factors like employeesâ attitude and level of trust might push workers to resist change. Self-confident is an important factor as it determines the attitude of the health practitioners (ĂztĂŒrk 2012, p. 84). In RUH, the workers are committed to providing quality services, thus they are motivated to effect a positive change. In order to realise a positive change, it is important to integrate financial factors. Without adequate finances, realisation of the desired change within RUH might not materialise. In additional, stakeholder and public involvement is significant. Stakeholders should offer their managerial support to ensure efficiency and reliability of the desired change. The management of RUH offers support and encourages change initiatives to offer better and reliable health services.
Technology is very important for purposes of facilitating communication within the trust boardâs hierarchy. The trust board consists of the clinical governance committee, non-clinical governance committee, and the audit committee that make major decisions within the social healthcare services (Biech 2007, p. 63). The committees meet twice each month, and without communication, it becomes impossible to operate. Technological challenges might also interfere with delegation of duties, management of risks and incidents, and collating.
Demerits
Technology is very important for purposes of facilitating communication within the trust boardâs hierarchy. The trust board consists of the clinical governance committee, non-clinical governance committee, and the audit committee that make major decisions within the social healthcare services (Biech 2007, p. 63). The committees meet twice each month, and without communication, it becomes impossible to operate. Technological challenges might also interfere with delegation of duties, management of risks and incidents, and collating. Social factors also present challenges especially when the institution fails to recognise the socio-cultural needs of the patients (ĂztĂŒrk 2012, p. 84). The social services workplace fails to deal with patients across diverse demographics including age, income levels, and education levels, but they only have the welfare needs assessment programme.
Measuring changes in health and social healthcare
The trust should have a website, a portal for different patients, and social network accounts through which they can receive feedback in relation to the experiences of different patients in the facility. For privacy purposes, the patients and other users of the facility including staff members can assume anonymous statuses on social network accounts in order to suggest on further improvements (Helin & Sandström 2008, p. 288). They can also launch complaints through the human resources manager directly if they feel that the best way to handle the problem is through direct communication. The users also have an option of writing letters to the management and concealing their identities by posting such mail on the suggestion boxes of the RUH trust.
Criteria for measuring the recent changes
Waiting time
This mainly deals with the duration taken to receive a response upon notification. If the patients take much time waiting for the response from the health practitioners, then the quality of service offered is lower and the credibility is questionable. There is need to change on the duration of waiting for response. In order to note a change within an organisation, there can be improvement in waiting time. This shift in time might be an increase in the duration or reduction, however, to ensure positive feedback, the healthcare must respond to the need of patients fast.
Service delivery
It plays an important role in determining the efficiency and reliability. Some organisations offer services slowly and do not meet the expectation of the patients. Such organisations tend to lose clients to those, which offer services very fast and maintain proper public relation. In order to identify change in these organisations, the approach used in offering services usually change. As a result, they attract more customers through improving public relations.
New technology
Globally, technology is one of the factors, which plays an important role in shaping up the whole market. Old technology use offers unreliable services. It also serves very few people leading to congestions within the health facilities. Involvement of a new technology, there will be improved quality of services offered and the number of patients served by the healthcare.
Respect to dignity and privacy
Many organisations lose clients due to their inability to keep the confidential information about the clients. It is important to keep confidential information about the client as this encourages transparency. Every organisation that does not share customersâ information wins their trust. Principles of measuring change vary from one organisation to another. In this case, the principle is âFrom to-down to emergent.â The principle focuses on only information required from those in top management. This information is analysed until one emerges with information relating to the organisational change. The principle does not involve the public. It employs the measuring tools discussed below.
Survey
Surveys are good for measuring the value of service improvement especially among the staff. The surveys will incorporate structured and semi-structured questionnaires, observation, and interviews. The structured interviews seek to establish the importance of increased funding in the facilitation of activities. The structured interviews target the board and the committee of the trust while the questionnaires target the staff to determine their satisfaction levels. To them an important issue to address is the significance of emerging technologies in improving efficiency and reducing workload. Technology is also on the limelight for improving communication between the staff and the trustâs board.
Focus groups
The users of the trustâs service have to respond to the efficiency and effectiveness of the introduced services. Initially, patients had to wait for a long time at the recovery unit before going to the ward. The trust dealt with the waiting problems but did not solve socio-cultural factors such as the significance of introducing cultural elements such as acupuncture and yoga for overly religious and cultural patients.
The impact of recent changes on health and social healthcare services against set criteria
Users
The patients commonly known as the users of the RUH trust services have different opinions concerning the social healthcare services in the facility against the set operations. The hydration chart is one such service that follows the trustâs criteria of operation regulated by the hydration bundle policy. To the patients, it offers the only opportunity for the patients to talk and share ideas while the facility electronically assesses fluid intake. The users feel that the institution should offer diversified services based on demographics such as religion, income levels, and cultural beliefs among other factors.
Staff
The staffs have an easy communication channel ever since the introduction of electronic data management. The electronic risk management incident recording system also makes it easy to understand the flaws in the facility including the mitigation measures the trust will put in place to manage the risks. The technological services improve efficiency, and the staffs have an easy time to delegate duties (McSherry & Warr 2008, p. 49). However, financial statuses of the trust only discuss ways of improving service delivery with limited concerns for the economic welfare of the staff through promotions or pay increase. The patients have the staff managing their welfare needs, but the same does not apply from the institution to the staff.
Board
The board has an easy opportunity to organise bi-monthly meetings since technological advancements at RUH trust. The members also have an opportunity to make triennial assessment of the trustâs progress while filling in the existing gaps in management while delegating duties. Arguably, they carry out the job of monitoring and evaluation to mean that the trust requires new expertise to handle such duties while leaving the board with the responsibility of budgetary approval.
Overall impact of recent changes in health and social care
Compliant with NICE and NHS policies enables the RUH trust to operate without the fear of apprehension from the authorities. As a result, it offers efficient and reliable services to the patients as outlined in the policies. Diversification of services from DSU to 23-hour ward has increased the accessibility of the healthcare as required by the Millennium Development Goals. Appointment of the nurse responsible for reviewing and supplying the relevant documents ensures accountability within DSU. Moreover, risk assessment within DSU would ensure identification potential threats before occurrence; thus, giving the organisation an opportunity to formulate mitigation strategies. Theatre monitoring by the managers ensures that the organisation identifies risks patients are exposed to. Communication of these risks helps to improve the services offered by the organisation. It is from this background that RUH designed Strategic Framework for Risk Management and integrated it with its governance and duty allocation methods for provision of quality assurance to the Trust Board.
Besides, employing qualified registered nurses assists the organisation to offer quality services and effective clinical decisions. This is important as improves the image of healthcare. Most of the activities undertaken by RUH are beneficial as they help improve organisational image and efficiency. However, the healthcare needs to increase the amount water it offers to the recovering patients as a way of improving their welfare.
Appropriate responses to recent changes in health and social healthcare services
To respond to the changes in the health industry, RUH focuses on training its employees to offer services that meet the satisfaction of the public. With trained personnel, RUH can offer better and competent services. Managerial structure might also result in a negative change within the healthcare. Therefore, there is need to change management structure for quality and efficient services. Moreover, there is need to change service delivery technique to ensure it meets the required standards.
Service delivery, the structure, and equipment are some of the most important elements of the CQS that make RUH trust functional. Clearly, it makes no sense to change the three, but training, recruitment, and appraisal of remuneration packages is very important. Motivated staff members will work well in comparison to the ones that operate without the possibility of monetary compensation, promotions, team building exercises, and pay rise. RUH should consider increasing employing new staff with new ideas to ensure the services offered by the healthcare are sustainable and up to standard (Ojo 2012, p. 1716). Technological change and cropping unique diseases are also becoming a challenge within RUH, as a result, there is need to change the equipment to meet the current standards.
Key principles in change management
Kotter (1996, p. 125) established that for organisations to implement different strategies successfully, they must execute eight stages of change management as discussed in relation to the CQC provided. Considering a case study from Baylor Health Care System (BHCS), it used the model to improve its performances. BHCS was losing clients at a greater rate; therefore, it had to find an effective solution.
Creating a sense of urgency
BHCS management informed all employees of the urgent need to effect positive change to remedy the prevailing situation. The RUH requires a sense of urgency at the recovery centre. This is because of poor services offered at the recovery centre, which might portray a negative image of the healthcare. Moreover, it is important that the stakeholders shift their perception of change and urgently embrace the opportunities of change (Biech 2007, p. 26).
Building a guiding coalition
In BHCS situation, it delegated most the responsibilities to the management who acted professionally and tireless (Emswiller and Nichols, 2009, 25). In RUH, delegate six memberâs committee monitors the activities conducted at recovery centre bi-monthly. Moreover, the team also monitors the response of the risk assessment unit of the trust. This phase encourages the RUH to gather people with power to offer leadership as well as full support to change initiatives by the health facility.
Forming a strategy vision and initiatives
In order to realise a positive change, BHCS integrated the views of the public while making decision as its strategy of ensuring achievement of a positive change. RUHâs strategy follows the principles of NICE and the NHS (Kotter 1996, p. 123). The six-member team should initiate the eight policies of management framework at the facility to assist in steering the desired change.
Enlisting volunteer army
Upon creating awareness on the need to effect change, BHCS had a pool of volunteers from within the organisation and the public. RUH has no clear source of its volunteering financiers, surgeons, or other medical experts. As a result, it should raise a pool of people ready and willing to drive urgently the change.
Enabling actions by removing barriers
Both BHCS and RUH experienced similar barriers; however, RUH should ensure there are communication, effectiveness, and efficiency in service delivery. In addition, evaluation and celebration of short-term achievements ensures correlation of the results.
Sustaining acceleration
BHCS sustained its accelerating change monitoring the change factors and allocation of sufficient finance for the activities. The RUH should increase the integrity of its change system and policies, which do not align with its vision. Hiring, promoting, and developing workers with implementation vision will ensure acceleration of sustainability.
Instituting change
Once BHCS realised that developing change strategies would help improve the quality of services offered, it did not procrastinate. RUH must integrate change factors in decision-making process to realise whether it is developing or not. Even though the principles of the model are complex, there is need to ensure integration of all the steps in developmental activities.
Planning changes in health and social healthcare
In order to ensure reliable and a positive change, it is significant to plan critically for achieving the desired change. Planning also helps to eliminate the gaps likely to occur during execution process in the health care. Planning methods aims at clarifying problems and issues, examining spatial relationship, and discussing the future. While planning organisational it is important to consider the views of the public, the budget required to execute the plan, and duration for realisation of change (Gibson, Ivancevich, Donnelly, & Konopaske 2003, p. 36).
Stakeholder analysis ensures integration and consideration of all the views of investors in the health industry as this care creates a sense of belonging among the stakeholders. Consulting stakeholder like the managers and state organ responsible for healthcare services warrants provision efficient and effective communication in the health industry. While planning change, it is crucial that the desired is complaint with the required laws. For example, to ensure provision of quality services, the organisation must employ qualified health practitioners recognised by Clinical Commissioning Groups (CCGs). For accountability in planning, the RUH must apply bottom approach of planning in which formulation of all planning activities begins with consultation of the public. Public involvement ensures incorporation of community needs in the desired change, therefore assisting in improving the quality of services healthcare services offered. Moreover, planning a change requires adequate finance. Availability of finances encourages implementation of ensure execution of all planned activities.
How to monitor recent changes in health and social care services
Changes can have a positive or negative effect on the efficiency of the organisation. In order to ensure that undesired changes do not affect the organisation, it is crucial to monitor these changes. Certain changes causes deterioration in the efficiency of the healthcare, as a result, analysing cost-benefit will help identify whether the change negative or positives affect the cost of management. Within the healthcare, monitoring techniques like spot-checks, surveys, interviews, feedbacks, observations, and shadowing methods are applicable.
Spot-check method involves conducting an inspection on the RUH activities randomly. It reduces the level of biasness, therefore, offering credible and effective information on the change in question. Considered a direct of monitoring changes, observation involves identifying specific desired change and evaluating it using human common sense. In observation, there are no experiments or professionals involved in monitoring the identified change. Since observation employs direct data collection method, it offers precise and reliable information.
Conducting interviews involve composing a series of question relating to the desired change being monitored and asking the questions to the potential proponent. It involves approaching the employers at RUH healthcare with interview questions and noting their comments on the desired change. Feedback method of monitoring relates to the views of the both the workers and the public. The only requirement from them is to give their views on whether they like the desired change or not. These techniques are important; nevertheless, they have demerits like the higher cost of execution. In addition, some of the techniques are unreliable since some interviewed public may give wrong information (Ojo 2012, p. 1719).
In conclusion, the techniques are the best in monitoring organisational change; however, there is need to ensure transparency during the exercise. Stakeholder and public participation are crucial factors in ensuring efficiency and effectiveness the techniques.
References
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