Recent or Forthcoming Organisational Change - Case Study Example

1. Introduction. Change management refers to a systematic process of dealing with both planned and unplanned change in the organization. (Law, 2006). Managers need to take special care when dealing with the major part of change management, which is dealing with fear of or resistance to change in the workforce. (Law, 2006).The best strategy for dealing with resistance is usually one of communication, participation, encouragement and support. (Law, 2006). Esuke et al (1993) asserts that “attempts to carry out programmatic continuing change through isolated efforts are likely to fail because of the effects of system context. Organizations are systems, which mean that anything more than trivial and surface changes need to be seen as rooted in myriad features, and ultimately is an expression of the organisation’s character”. Consequently, the complex, intertwined nature of organizations makes change a difficult endeavour. (Esuke et al, 1993). The organisations character, or culture, therefore appears to be a critical element in determining whether change can occur. (Esuke et al, 1993). According to Kanter et al (1992) as cited by Esuke et al (1993), “bottom-up” change is more likely to succeed in the long-term than “top-down” efforts. If we combine the concepts of organisational archetypes and the stickiness of existing practices, it appears that some types of organisations may be more conducive to change than others. (Esuke et al, 1993). In particular, highly bureaucratic organisations are more resistant to change than alternative structures. (Esuke et al, 1993). According to Kotter and Heskett (1992, pp. 44, 50) as cited by Esuke et al (1993), “…nonadaptive cultures are usually very bureaucratic. People are reactive, risk averse, and not very creative. Information does not flow quickly and easily throughout the organisation. a widespread emphasis on control dampens motivation and enthusiasm.. In the firms with more adaptive cultures, the cultural ideal is that managers throughout the hierarchy should provide leadership to initiate change in strategies and tactics whenever necessary to satisfy the legitimate interest of not just stockholders, or customers, or employees, but all three”. This study is aimed at identifying a current or upcoming change in a selected organization in this case the UK National Health Services and analyse how the organization is managing the change using the force-field analysis. The study is organized as follows: Section 2 presents a general overview of Tesco Plc, its major stakeholders and their various demands. Section 3 presents a description of the force-field analysis, section 4 lays out a discussion on how the force-field analysis can be used to manage the current or upcoming change in The UK NHS. Section 5 presents a conclusion of the paper. Having said this, the study will now present a general overview of the UK National Health Services and its major stakeholders. 2 Overview of the UK National Health Services: Mission and Main Issues The UK National Health Services (NHS) remains one of the largest public sector bodies in the world and the largest public sector organisation in the United Kingdom. The NHS was established in 1948 by the post-war labour government and it was the first health system in any western society to offer free medical care to the entire population. (Goodwin, 2000). Its objective was to be universal in its coverage and comprehensive in terms of the services to be provided, available on the basis of clinical need and not based on income. It has been financed through taxation. (Goodwin, 2000) Unfortunately, however, funding crises have resulted in the introduction of prescription, dental and ophthalmic charges. The social conception of health care has lost and two issues have dominated the UK NHS ever since. These include financial resources and politics. (Goodwin, 2000). Major challenges for the NHS include the persistent push for structural reform in state health provision, within the UK. The NHS operates today in an economic climate that is faced with escalating costs thus making it difficult for it to meet diverse patient and community needs. (Hill et al, 2001). According to Chang et al, (2006) other challenges for the UK Health Services today include: keeping a long-term health and well being perspective as a priority across all policies; managing and paying for patient and public expectations, planning workforce issues in the context of social, economic and technical change. Despite large increases in the NHS’s budget in 2002, only 2.5 to 3% is realised as surplus funding taking into consideration the increases in costs of goods and services (Chang et al, 2006). There are also debates over the impact of the increased funds considering the fact that productivity did not increase between 1997 and 2003. (Chang et al, 2006). It is also believed that increases in health service productivity as evidenced in increased life expectancy, reduced infant mortality, reduction in circulatory disease, cancers and respiratory diseases are attributed to other factors and not to efforts by the NHS. (Chang et al, 2006). The NHS’s external environment is constantly changing. For example, there is an increase in the number of women in the labour market today, family values and household structures are constantly changing, the number of people over the age of 16 living alone has increased from 26.3% in 1991 to 31% between 1991 and 2002 and half of the people living alone are elderly pensioners (Chang et al, 2006). Income inequality is at the rise. An income gender gap continues to exist in the United Kingdom with the poorest tenth of the population experiencing minimal enhancement in real income levels compared to 25 years ago. (Chang et al, 2006). Chang et al (2006) specifically notes that 2 million children live in households with no jobs, single parent families and couple households where both parents are jobless are particularly at risk, about 6% of the population accommodate houses with no heating and 12.3% live in an overcrowded house. More than 1 million people of working age earned wages below £4.4 per hour in 2002, unemployment rate among young adults aged 16 to 24 years was 10% in 2003, which is double the rate among older workers. In addition, the UK is witnessing an ageing population which might have a significant impact on the UK NHS. The number of people above 60 years has since 2001 outweighed that below 16 years and the dependency ratio is constantly rising thus implying a decreasing workforce. (Chang et al, 2006). This has led to an increase in the number of health and care workers sourced from abroad. For example two thirds of the new registrants on the general medical council (GMC) register were from abroad. (Chang et al, 2006). This might have significant impacts on the services delivered by these workers considering the fact that they are foreign-trained and as a result might not be able to properly understand the needs of patients in the UK. This in the long-run will result to inefficiencies. Major Stakeholders of the NHS Like any public sector organisation, the major stakeholders of the UK NHS include Government, Suppliers, Customers, the Community, Employees, Management, Minority Groups, Patents (Customers), and creditors. The diagram below lays out the various stakeholders of the UK NHS and their expectations. The figure speaks for itself. As one can observe, the major stakeholders of any organisation like the UK NHS include the government, employees, customers (patients in the case of the UK NHS), suppliers, the community, shareholders, creditors, minority groups and managers. Each of the stakeholder groups have got its its unique interests. The interests might be common between some of the stakeholder groups, for example managers and employees are both concerned with fair compensation, minority groups, government and community might have a common interest concerning employment and preservation of the environment. Creditors and shareholders are concerned about safe investment. As some of the interests are common among stakeholders, so too are there some conflicting interests. For example, the managers’ interests are in conflict with those of shareholders as well as those of the government. Managers will normally not provide shareholders with all information concerning the profitability of the company since this will mean higher dividends, managers will also not release enough information to the government for it will mean higher taxes if the company makes more profit. Figure 1.: Stakeholders and their Expectations Source: Brignall and Ballantine (1996). Having identified the major stakeholders of the UK NHS, we will now look at the fore-field analysis. 3. The Force-Field Analysis Kurt Lewin (1951) as cited by Cameron and Green (2004) developed his ideas about organizational change from the perspective of the organism metaphor. He developed the force-field analysis, which examines the driving and opposing forces in any change situation. (Cameron and Green, 2004). The underlying principle of the force-field analysis is that for change to happen, the driving forces must overpower opposing forces in any change situation. (Cameron and Green, 2004). For example, consider a situation where the manager’s desire is to speed up the executive reporting process, then either the driving forces need to be augmented or the resisting forces decreased for the desired effect to take place. (Cameron and Green, 2004). Under certain circumstances where the opposing forces are very strong it might be necessary to increase driving forces and at the same decrease opposing forces for the desired change to take place. (Cameron and Green, 2004). Increasing driving forces might require the manager to ensure that those responsible for making the changes to the executive reporting process are aware of how much time it might free up if they are successful and what benefits this will have for them. (Cameron and Green, 2004). Reduction of resisting forces might require spending some time managing customer expectations and supporting them in coping with the new process. (Cameron and Green, 2004). The figure below presents a pictorial view of the force-field analysis example discussed above as developed by Lewin (1951) and recited here by Cameron and Green (2004). Figure 2.: Lewin’s force field analysis 4. Current and Upcoming Changes in the UK NHS According to a document titled a workforce response to local delivery plans: A challenge for the NHS Boards, one of the objectives put forward was that the NHS needed a step change in working differently. (DH, 2005). The NHS agreed that it now had sufficient evidence and examples of working differently to deliver a step change in care. (DH, 2005). It also has a framework to deliver this through pay reform, regulation reform and modernization of education and training. (DH, 2005). The NHS also planned some national programmes including rapid roll out of new roles in radiology. (DH, 2005). Also, increase investment in health services after 2008 may not continue at the same rate. (DH, 2005). Therefore maximizing efficiency and productivity are very important. It is expected that 6.5 billion pounds yearly efficiency gains will be delivered by 2007/2008, equating to approximately 2.7% cumulative yearly improvement. Productivity gains will need to deliver objectives such as 18 weeks waiting times. (DH, 2005). Through working differently, staff will have the opportunities to develop their personal growth. It is evident that the above planned changes cannot be achieved without some resisting as well as driving forces. Some of the resisting forces might be a protest against the reduction in investment, a protest against the rapid roll out of new roles in radiology, workers might not be willing to go for further training and education. Also, some workers might be skeptical about the pay reforms that it might not be in their favour and thus the step change in working differently may not be achieved. The figure below presents a force-field analysis for working differently. The major upcoming change identified above is the fact that investment in health services may be reduced as from 2008. The impact on the UK National Health Services is that in order to cope with such a change it must manage its resources effectively and efficiently in order to meet up with its financial obligations. The driving forces towards this change would be greater accountability, increase in disclosure of information, Further training in Public Service Management for the managers, increase internal control and auditing. The resisting forces will include reluctance of managers to go for further training, fear by managers that they might loose their jobs to other competent employees who can deliver greater value, reluctance by accountants to cooperate with internal auditors, increase in time and cost to process information. Figure 3. Force-field analysis for the “Improved Management Efficiency” in the UK NHS As stated by Lewin (1951), the UK NHS may achieve its step change by increasing the driving forces and making efforts to reduce the resisting forces. To make sure that the above change is successful the driving forces must outweigh the opposing forces. This can be achieved by doing one of the following: increasing the driving forces, reducing opposing forces or trying to increase the driving forces while trying to reduce the opposing forces simultaneously. For example, if managers are not willing to go for further training, their resistance can be reduced by providing them with incentives to train such as scholarships and other training benefits. Increase accountability can be achieved by providing accountants with bonuses for meeting targets and increasing internal control. Also the organization must make sure that the relationship between the accountant and the internal controller or auditor are in good shape. In addition, further segregation of duties is necessary to avoid collusion between accountants. Also, accountants need to carry out training in sophisticated accounting information systems and these systems should be put in place. This will enable them produce more financial reports at low cost and time. 5. Conclusion. This study was aimed at examining an upcoming or current organizational change and how the change can be managed by using the force-field analysis. The study made use of the UK NHS, which is one of the largest and oldest public service organizations in the United Kingdom and the world. The study identified a current change, which involves increasing management and organizational efficiency given the fact that government subvention is likely to reduce as from 2008. For this change to be successful, we found it necessary for the managers of the NHS to go for further training in New Public Management. To motivate managers to carry on with this training, we saw it necessary for the NHS to provide them with incentives to do so such as granting the scholarships. We also identified the need for increase in the use of Accounting Information systems so as to increase the processing of information that needs to be disclosed to major stakeholders. We also found it necessary for accountants and internal auditors to have a good working relationship so as to avoid conflicts of interest. Finally, it is also necessary for the NHS to increase segregation of duties so as to maintain a self-check in the accounting system. BIBLIOGRAPHY Brignall S., Ballantine J. (1994). Performance Measurement in Service Business. International Journals of Service Industry Management. Vol. 7(1), pp 6-31. MCB University Press 0956-4233. Cameron E., Green M. (2004). Making Sense of Change Management. Kogan Page London and Sterling. Chang L. R., Garside P., Wait S., Morris Z. S. (2006). Policy Futures For UK Health. The Nuffield Trust For Research and Policy Studies In Health Services. Downloaded from http://books.google.com/books?vid=ISBN1846190037&id=ME4wtnKmmywC&pg=PA37&lpg=PA37&ots=POFk7Og6Jb&dq=business+environment+of+the+UK+health+Services&sig=Xlkvh6-qJ2D4p_P31oZC1e7j3vk#PPP1,M1. Department of Health (2005). A workforce response to local delivery plans: A challenge for NHS Boards UK NHS www.dh.gov.uk/publications Esuke K. J., Lebas M. J., McNair C. J. (1993). Performance Meaurement in and international setting. Management Accounting Research. Vol. 4, pp 275-299. Godwin N. (2000). Leadership and the UK Health Service. Health Policy. Vol. 51 Pp 49-60. Law J. (2006).."Change Management"  A Dictionary of Business and Management. Oxford University Press, 2006. 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