I work for Abertawe Bro Morgannwg University Health Board. ABMU Health Board was formed on 1st October 2009 as a result of a reorganisation within the NHS in Wales and consists of the former Local Health Boards for Swansea, Neath Port Talbot and Bridgend. The Health Board covers a population of approximately 500,000 people and has a budget of £1.3 billion. Around 16,500 people are employed by the Health Board, 70% of whom are involved in direct patient care. The Health Board has four acute hospitals providing a range of services; these are Singleton, Morriston, Neath Port Talbot and Princess of Wales Hospitals. There are a number of smaller community hospitals primary care resource centres providing important clinical services to our residents outside of the four main acute hospital settings. The Health Board acts as the service provider for Wales and the South West of England in respect of Burns and Plastic Surgery.
In addition, Forensic Mental Health services are provided to a wider community which extends across the whole of South Wales, while Learning Disability services are provided from Swansea to Cardiff. A range of community based services are also delivered in patients’ homes, via community hospitals, health centres and clinics. The Health Board contracts with independent practitioners in respect of primary care services which are delivered by General Practitioners, Opticians, Pharmacists and Dentists. There are 77 General Practices across the Health Board. Our purpose is “To improve the health of our community and to deliver effective and efficient healthcare in which our patients and users feel cared for, safe and confident.”
I work for the Medical Directors Department as a Clinical Audit & Effectiveness Co-ordinator. The purpose of my role is to support the Clinical Audit & Effectiveness Manager in their role, to offer specialist knowledge and advice to individuals, clinical and multi-professional groups, and to offer supervision to the Clinical Audit & Effectiveness Assistants and Clerks. I am responsible for the collation and analysis of data on mortality, providing a statistical base to support clinical audit, inform the research agenda and to aid the development of services. I produce monthly, quarterly, annual and specialist reports to the Medical Director and key individuals and forums across the Health Board e.g. Quality & Safety forum and Committee for information, discussion and action planning. I am liable for contributing data to the Health Board’s monthly Performance Report which is reported onwards to Welsh Government. My main duty is to analyse, correlate and interpret complex data, utilising statistical knowledge to present findings and evidence to the best advantage for the purpose of reporting local issues.
Understand innovation and change in an organisation
Organisation change is a deliberate attempt to improve organisational performance by changing one or more aspects of the organisation, such as its technology, structure or business processes. I was first employed by ABMU Health Board in 2010 and have worked in 4 very different departments, I have noticed that the NHS is constantly changing and developing. The local NHS (ABMU Health Board) needs to change to meet current challenges. Some of the current challenges include; growing population, there is a higher number of babies being born and also people are living longer these days which means a vast increase in frail elderly patients that require care. Long term illnesses, there is a rise in people suffering with long term illnesses like diabetes and chest conditions. Poor Lifestyle; obesity, smoking and drinking too much alcohol is currently a challenge for ABMU. Funding is also getting tighter in the current economic climate.
Innovation may be linked to positive changes in efficiency, productivity, quality and competitiveness, among other factors. Benefits of innovation could be the improvement in the workforce. By improving the workforce an organisation will benefit from increased productivity and improved morale and lower staff turnover. Employees will feel more valued which therefore increases motivation. This is beneficial to employers because it provides the organisation with knowledgeable, reliable staff who will have a more positive contribution to the needs of the organisation. Staff are a valuable source of innovation, even if it is not expected as a major part of their job. An innovative work environment means being creative and try new techniques.
As Albert Einstein said “if you always do what you’ve always done, you will get what you’ve always got.” A benefit of change in the organisation would be it promotes creative ways of thinking, so that ideas can be developed to keep the organisation fresh and exciting. Change breaks monotony so that people are re-energised and so the interest in the job increases. Change in the workforce brings out the true colours of employees. Those that have a positive attitude and work hard to cope with the differences in their work environment are people that a company wants to keep so that overall objectives can be achieved. Another benefit of change could be employees mastering new skills. This is so that they can take on new duties. By providing the necessary means for people to learn new software for example or methods for completing particular tasks, if there are incentives, like reimbursement for a course to teach the skills needed, then a benefit of this would be a completely knowledgeable workforce and ultimately aid the expansion of the organisation.
The most common barrier to innovation in organisations is a leader or manager that is not open to new ideas. This negatively impacts the team by discouraging creative thoughts. Employees won’t be motivated to come up with new ideas if nobody is going to bother listening to them. There are also managers who listen to ideas but are reluctant to take them any further, resulting in lost opportunities. Managers are also guilty of shooting down ideas before they are given a chance. If employees come up with new ideas, they should at least be given a chance to explain and justify them, rather than have a manger who immediately says ‘no’ based on past experiences. Just because something hasn’t been done before doesn’t necessarily make it a bad idea.
Time and resources are also significant barriers to innovation. Employees are often so busy with just doing their regular work that there is insufficient time and incentive to generate new ideas. When ideas are generated, they are not taken any further due to the potential risks associated with developing the idea. Staff are often a barrier to change in an organisation. Often not knowing enough about the change itself, for example, no clear vision, direction or priorities is enough to make an individual, team or department resistance against the proposed change. Change is very tiring and is often something that requires extra effort.
When it seems resistance to change or no buy-in is present within the department, one method is to use the ‘Enforce’ method. This is quite a drastic way of enforcing change. It is very direct and confrontational and is likely to cause people to resist more. Another way of overcoming barriers is to use the ‘nudge’ method. Nudging people is a more gentle way of getting people to do something different. Nudging is less threatening and disruptive. It is indirect yet tactical and less confrontational than the ‘enforcing’ method. I would much prefer to use this approach and in my opinion it is much more likely to have a successful outcome.
Coaching is another method to overcome these barriers. Like enforcing, coaching is a direct approach. However, rather than telling/ directing people, it is more persuasive and sells the idea regarding the change. By using closed questions and persuasive statements to influence the direction that the employee should go in. Once on board, the coach then uses open questions to actively listen but also questioning and re-phrasing what the employee has said or asking what they could do to provide the right environment, it then comes across as non-directive and direction for change is more understood without resistance and is more likely to sustain the change this way.
Understand how to plan, monitor and review the implementation and communication of innovation and change in an organisation
A technique that can be used to plan, monitor and review the management of innovation and change is the PDCA cycle – Plan, Do, Check, Act as shown below.
This cycle encourages the planning phase to be methodical in problem solving and implementing a new solution. It ensures the best quality outcome of what is aimed to be achieved. In the ‘Plan’ phase the aim is to identify what the problem is by looking at the current situation and to determine a goal. As part of this phase, ‘SWOT’ analysis is a tool that could be used. So by looking at strengths and weaknesses, opportunities and threats, or by using ‘5 Why’ analysis tool to get to the root cause. Once the root cause is established it would then be appropriate to map the current process that is currently the root of the problem. In order to map the current process a flow chart diagram would be a tool I would use to show how the steps in a process fit together, and in a flow chart format it helps to clarify the understanding of the process. This flow chart can then be used to define and analyse processes, build a step by step vision for analysis and discussion and ultimately defines areas of improvement in a process.
In the ‘Do’ phase it would be appropriate to explore possible solutions. In order to select the best of the solutions an ‘Impact Analysis’ tool could be used which brainstorms the major areas affected. There are two methods which could be used to analyse – the organisation approach, which is; impact on departments, impact on different business processes, impact on different customer groups and impact on different groups of people. Or here is the popular McKinsey 7’s approach to looking at the things important to an organisation; strategy, structure, systems, shared values, skills, styles and staff. Once all the major areas are identified, a brainstorm should be done to identify the different elements affected. Then the impact needs to be evaluated, for example, by listing all the positives and negatives on a decision. This is to then estimate how big the impact is and what the consequences will be.
Managing the consequences would be to weigh up whether to go ahead with the solution that has been decided and if it is worth it, after looking at negative consequences caused and the cost of those consequences. In order to move onto the next phase ‘measure’ it could be suggested to set a small project similar to the nature of the problem. Whenever I have made any big changes at work I have always done so in ‘pilot phase’ first. By giving a new process a go on a smaller scale can help identify the pros and cons of the change and may help provide reassurance that the change will work as intended. The ‘Check’ phase is to measure how effective the pilot project has been and to see what improvements could be made to make it even better. Depending on the success of the pilot project, the identified areas of improvement like the ‘Do’ and ‘Check’ phase could be repeated several times to incorporate the additional requirements. This phase is good to check if the costs are outweighed by the benefits and if so then the final phase can be moved onto.
The final step is to ‘Act’ or implement fully the final solution. Because the PDCA is a cycle, the Act part does not necessarily mean that it needs to stop there. It is a way of striving for continuous improvement and again going to ‘plan’ phase to seek out further areas of improvement. Another technique that could be used would be DMAIC technique. DMAIC is a data driven improvement cycle used to improve, optimise and stabilise processes. The first step is to ‘Define.’ This would be to clearly express the problem, goal, potential resources, project scope and project timeline. It is to define the problem, the target process, project or target goal and project boundaries. The second step is to ‘Measure.’ The purpose of the measure step is to base any future decisions on facts and data. It is to determine the start part of the process and look for clues to understand the root cause.
This is usually the longest phase as it takes time and effort to consider both of these and a map should be made of the current process. Once the measure phase has been explored, the ‘Analyse’ will come next which is to review the data collected. The next phase is the ‘Improve’ phase and coming up with a solution to fix the problem. Improvement ideas are likely to be suggested throughout the whole process but a structured effect could lead to innovative solutions and implementing the right solution requires careful planning, logistics, training documentation and communication must be considered. Once the improve phase is done, the ‘control’ phase is next which is another measuring phase. At this stage standards and procedures should be developed and statistical process control measures implemented, within ABMU this is something that would likely be added to the performance report to be monitored.
Communication is important because organisations and leaders need to be able to get different views and ideas in order to be creative. Once an idea or solution has been shared all levels of staff within the organisation need to be communicated to on a regular basis. Communication creates awareness so that staff are conscious of the change. It means a good understanding and a shared meaning of the change. People are more likely to accept the change and be more positive about it. When change is communicated throughout the organisation all appropriate leaders are then able to support the change. Lastly, people are more likely to be committed and it will be a sustained change.
Understand the effects of innovation and change on people and teams in an organisation
While some people embrace change, others resist change. According to Paul Bangs ‘60% of people resist change, 35% accept change and a small 5% welcome change’(Bangs, 1996). Resistance to change can take many forms and it is often difficult to pinpoint the exact reasons. The forces against change in work organisations include: ignoring the needs and expectations of members; when members have insufficient information about the nature of the change; or if they do not perceive the need for change. Fears may be expressed over such matters as employment levels and job security, de-skilling of work, loss of job satisfaction, wage rate differentials, changes to social structures and working conditions, loss of individual control over work, and greater management control (Christy, 2010). Our response to change is neither simple nor predictable. Elizabeth Kubler-Ross (1969) argued that we deal with change by moving through a series of stages, each characterised by a particular emotional response.
The coping cycle has been used to understand responses to organisational change, which can sometimes be particularly traumatic and stressful. The five typical stages in the Kubler-Ross response coping cycle are: denial, anger, bargaining, depression and acceptance. We may not all experience the same five sets of responses. We may omit particular stages or pass through them more or less quickly than others. (Buchanan, 2001) If people’s issues/barriers to change are not defined and no actions have been made to address them then it can lead to low engagement, low morale and it is likely the individual will revert back to the old ways. If there isn’t any engagement or ‘buy-in’ from the individual the effect of this is a failed attempt at analysing the individual’s needs and preferences. A communication and engagement strategy has not been put into place by management to enable this. If individual successes are not recognised or celebrated, the effect is the rate of change is decreased and individual commitment isn’t likely to be gained. As change can require a lot of effort, individuals need to see the effort pay off and hat their contribution is valued.
For teams within an organisation if policies and procedures are inflexible and there is a culture to playing by the rules, it stifles creativity and creates an oppressive environment on teams to accept rules which hinders creative thinking and new ideas. Extra work is another effect on the team, if a team has to put in a lot of effort and time to produce results they do not want to devote the necessary time due to other daily commitments. This results in negativity taking hold before a project has the chance to get up and running. Lack of leadership can be detrimental to a team. A team needs a leader to create an environment that nurtures their own individual skills as well as highlighting team successes, motivate and keep them engaged to move the team forward.
Bangs, P. (1996). Managing Change Interact.
Buchanan, A. H. (2001). Organizational Behaviour:An Introductory Text (4 ed.). (F. T. Hall, Ed.) Pearson Education.