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Facilitating Change Essay

Measuring change in health care organisations needs critical analysis and examination, using a PESTEL analysis template would be the first thing that a manager could use to measure recent changes that have taken place in the company. Devising a strategy within health care can be local or national level, incorporating a different size of area or concentration upon a particular area or aspect of health will allow managers to asses more resourcefully, articulating a stratagem can be via a individual or cross-departmental agency or cross-government programme. “Most of the government strategies are currently being developed with inter-departmental; consultation which would be aspects like the Healthy Weight, Healthy Lives. Cross-government strategy for England and this approach is also undertaken at a local level e.g. Children and Young People Plans”. – Health Knowledge, (2010). Strategy communication and strategy implementation in relation to health care. [Online]

Benchmarking is an essential criteria and strategy to use when measuring quality as it allows you to compare and analyse the critical information between two companies and make a decision as to who is succeeding in the two different types of changes made. Data is also a quality and change measuring method as the information that is fed into the indicators are anonymous and without context and comparators, data has infrequently significant meaning. A dashboard is a indicator od the most relevant indicators for managers to be able to measure the quality of the recent changes. Also a summary measure targets to aid define in a few numbers as much detail as conceivable about a system to help recognize, relate, forecast, develop and invent.


Any set of data is also an indicator, it identifies issues that may be worth of further investigation which will help to make sure that future problems are seen ahead and dealt with before it becomes a challenge in the quality of the change. Outcome, is a quantifiable change in health status, sometimes attributable to a risk factor or an previous interference. Lastly, a quality measure is a mechanism used to allocate a quantity to a quality of care, doing this by comparing to a benchmark. As measuring quality and recent changes in companies is important then understanding the bond between standards and indicators is vital to be able to put theory into practice. The indicators of the outcomes used to measure the change should be linked clearly to practice norms, audit data and clinical assessments.

– Evidence- based norms of care provided and the associated benchmarks are together agreed with the appropriate investors.
– Criteria is recognized before certain indicators are determined, and appropriate methods of measurement required.
– A small amount of essential legal indicators may underwrite to the national quality agenda, however, local specific indicators drive quality improvements in practice.
– Decent indicators are those suitable to their intended determination, are relevant, legal, dependable, achievable, and useful in supporting change.

2.2 – Measure the impact of recent changes on health and social care services against set criteria
“Are services at this trust well-led?”

• “The extent to which implementation of the Barnet, Enfield and Haringey (BEH) strategy had consumed the trust’s activity, planning and vision over the last year cannot be underestimated. At the time of our visit, the trust was still undergoing refurbishment to fully implement the effects of the BEH strategy. We found that staff were clear about what was happening in relation to the implementation of the strategy but felt that the trust had not fully recognised the impact of this on the workload within the current services. Trust staff were unable to share with us a vision for the future. Some of the senior team were relatively new in post but it appeared that the senior team had a good working relationship and commitment to drive through improvements.

However the recommendations from the KPMG review of governance was still to be rolled out and embedded. We saw a team who were fire fighting issues, but found that there was a lack of planning for the future. The trust had not significantly engaged staff, patients and other stakeholders in the development of services. Governance processes were not sufficiently developed or robustly challenged.” – CQC Report For North Middlesex Hospital Date of inspection visit: 3-6 June 2014 & 23 June 2014 – Date of publication: 21 August 2014

• This section of a report that is made up of 15pages of inspection report it is commenting on how well the trust is led. This means they are making judgements depending on the comment received and collected from staff members and service users. “but felt that the trust had not fully recognised the impact of this on the workload within the current services” – this points out that there is a shortage of internal resources to lead change initiatives which could lead to the change process to become challenging as there may be a shortage of staff or resources that are invented to be effective for improved quality care.

• “We saw a team who were fire fighting issues, but found that there was a lack of planning for the future. The trust had not significantly engaged staff, patients and other stakeholders in the development of services.”this comment also mentions that staff members are not fully professional as they do not have an understanding of what the future of their job is awaiting and they are not aware of any changes that are taking place such as the BEH link up in the hospital.

“Review the impact of the Barnet, Enfield and Haringey strategy, its impact on staff and its potential impact on quality of care.” -this quote is taken from the CQC report for North Middlesex hospital (2014July), shows and evaluates that the trust is not being thoughtful and are not aware of the change that joining the BEH trusts into one hospital has lead to. The amount of work and the overload is effecting the staff and the quality of care that is provided by them. The impact of the recent change in this situation will be negatively affecting the direct users and also the families of the direct users due to the quality of care that is going to be provided.

These types of impacts will also affect the front-line staff in a major way as before any issues get dealt with via management, front-line staff have to deal with first hand issues as like dealing with patient satisfaction, person-centred care plans, and having to agree with the patients needs and desires no matter how busy the ward may be or what the workload is. “Take action to ensure that the outpatients department is responsive to the needs of patients in that appointments are made in a timely manner, those with urgent care needs are seen within the target times, cancellations are minimised and complaints are responded to.”- this quote from the report

outlines and highlights that the certain departments for outpatients should be considered and concentrated on more as there are complaints and the complaints are not being responded to, not responding to complaints could result and impact the insight of the hospital through service users points of views, this could also lead to families of service users to be pre-judgmental about the service that the hospital provides. Giving patients with urgent treatment needs a time mannerly appointment is very important as this plays a big role in the way patients feel like they are treated fairly.

2.3- evaluate the overall impact of recent changes in health and social care

• Every single change in a organisation should have a positive or a good outcome, the overall amendments and changes could be the way the staff have improved to work, cost-issues benefiting, the rates of referrals and things like improving waiting hours and responses from laboratories. Productivity of a workplace mean how well the organisation is to reach the goals it has set for themselves. No matter what type of change the organisation has organised to such as ; Organizational change, structural change or even administrative change it should always be more effective after.

Organisational proficiency mostly links to the use of the assets to achieve to greatest outcome which refers to the number of aspects an organisation has used to produce a amount of output. A well-organized organization is one that can maximise to production or services without deteriorating resources. An example could be the NHs and the General Practices are currently not allowing patients to cancel too many appointments, only a certain amount of missed appointments and cancellations are allowed otherwise they are taken of the register and may need to re register which is costly. This represents that both service provider and user is responsible for making sure resources are not wasted.

2.3 – continued…

“11. Crime and Disorder (Prescribed Information) Regulations SI 2007/1831 •

Impact of change

“The regulations specify the sets of depersonalised information that relevant authorities (which include local authorities) have a duty to disclose to each other if held by them. In the health context, this includes information on, for example, hospital admissions resulting from assault, substance misuse, and domestic abuse.

This information will be held in future by the NHS CB and CCGs, and in some cases by public health LAs.” www.gov.uk/government/uploads/system
This part of the Guidance on the Health and Social care Act: Changes to Public Health functions that affects local authorities outlines the impact that the Crime and Disorder has amended the information hold about the users. It highlights that the personal information held about services users are now going to be passed in to other sectors without the permission of the person as the act now requires and allows this to take place.

The information they are allowed to pass on now is the; hospital admission, assault, substance misuse and domestic abuse the service user has been in connection with. This amendment might not be favoured by every service user as it allows information that is personal to be passed on without their permission and this might lead to them thinking that they do not have any privacy and respect from the service that is being provided and this can discourage service users. As a result of this, the impact on this act could lead to many negative outcomes.

2.3 Continued…

• The NHS is a very big sector that plays a role in many peoples life’s; staff, service users, tax payers and students. As a result of this every recent change that is taking place in the sector somehow effects and impacts peoples routine. Recently due to the coalition government there has been a slight reformation programme following the 2010 general election. The act that is the centre-piece of the reform is The Health and Social Care Act 2012; it has announced large changes to the way that the NHs is being structured in England. Experts are engaging with the reform agenda via research programmes and debates.

“The Health and Social Care Act 2012
The Health and Social Care Act introduces a number of key changes to the NHS in England. These changes came into being on 1 April 2013. The changes include:
• giving groups of GP practices and other professionals – clinical commissioning groups (CCGs) – ‘real’ budgets to buy care on behalf of their local communities;
• shifting many of the responsibilities historically located in the Department of Health to a new, politically independent NHS Commissioning Board (this has now been renamed NHS England);
• the creation of a health specific economic regulator (Monitor) with a mandate to guard against ‘anti-competitive’ practices; and

• moving all NHS trusts to foundation trust status.” – http://www.nuffieldtrust.org.uk- (Online) There are many impacts to the changes that the coalition has made to the act some examples are; – Charging patients from over-seas that have can not provide a certificate for free healthcare in the U.K. This will affect the judgments that the people or in this case tourists will make towards the hospital. This can also affect the families of the service user as they may feel that their family member is being mistreated due to the fact that they are being asked to pay for the treatment or care they are being given.

This makes the society to think that the NHS is not fair or does not care about the care for patients but is more interested in the financial sector of it. From my point of view I believe that charging patients from overseas is not a very effective thing to be undertaking the NHS is around for people that NEED but cannot afford private care, people from overseas might not be able to cope paying a certain amount for their treatment as the financial misplace for paying a treatment may disturb their journey in the country and they may reject to pay and end up having to return to their country in a really bad health position.

As well as not paying for the treatment for an overseas patient the NHS has the right to not be registering person for treatment that is not necessary or emergency which I believe is very useless thing to do as patients form overseas are paying for their treatment and if they wish to register then there shouldn’t be a good enough reason for the trust to not register them.

Going back to the CQC report for North Middlesex Hospital June 2014, I believe that the hospital has many major improvements that need to be done in order to be able to provide good quality care. The trust is lacking in staff and is need of being able to understand the future of the hospital as well as organising the structure and the overload of work. There has been 6 deaths in the hospital in the recent years due to neglect in the care. This is a big number that needs urgent attention as people come to hospitals to be coming out treated and purified from infections or diseases. Recently there has been a very big neglect related death in the hospital that is named in the CQC report.

A 3 year old child has been told to have chicken pox when he was taking into A&E with a very high temperature, the waiting time was 6 hours and after the 6 hours wait the doctor had a look at the child and prescribed some Calpol and told to parents he was having chicken pox, then they got discharged. Following a night of pain and very high temperature the family called and ambulance and the child died on the way to the hospital. The death report outlines that the child died from suffering of meningitis.

Although the family was not aware the child had meningitis the doctor at the A&E could have done some blood or urine test to understand what was wrong with the child rather than just having a look and prescribing a pain killer. These types of neglects can have very big impacts on the civilization and the judgments and pre-judgemental comments made towards the hospital.

This is a very big issue and the hospital should make sure that the highlights made in the report should be taking into urgent consideration and improvements in the structure and staff at the hospital should be improved as soon as possible.

2.4- Propose appropriate service responses to recent changes in health and social care

– Many changes depend on people (staff members) in hospitals as the changes can only be taking place with the help of them and the attitude they have towards these changes that need to be taking place. Relating to this education is very important and some service responses that can be proposed are that the education system and the experience of staff members is very important and that the attitude towards becoming the best in the work that is done is very vital for changes to take place. Employment facilities and education should be widened in the country. There are many staff members that are traveling to the U.K to be able to find work. Certificates and diplomas should be analysed and examined to see if the criteria’s match before offering jobs in the NHS as staffing is a very vital sector of the NHS that plays a huge role for changes.

Also it has been proven that unemployment rates amongst older people is becoming higher and they are more likely to leave their jobs early which can then lead to depression in life. Older people can then spend most of their times at home doing nothing which could lead to illness. This leads to them having to be treated and he National Health Service to end up paying for their treatments. Rather than this happening changes made in organisations could be effective and make more opportunities for older people to work and achieve things that younger staff members might not be able to due to their experience rates. Things that can attract older workers to find work and succeed in the changes that are brought to the NHS could be things like; good salary, friendly work environment, support whilst at work and better pensions schemes can increase their employability chances.

References ;
– Google.co.uk, (2015). health and social care – Google Search. [online] Available at: https://www.google.co.uk/search?q=health+and+social+care [Accessed 29 Apr. 2015]. – Google.co.uk, (2015). Google. [online] Available at: https://www.google.co.uk/? gfe_rd=cr&ei=Ib5AVcTnB8vH8gfV6YAo&gws_rd=ssl#q=service+responses+to+recent+cha nges [Accessed 29 Apr. 2015].

– Cqc.org.uk, (2015). North Middlesex University Hospital NHS Trust. [online] Available at: http:// www.cqc.org.uk/provider/RAP [Accessed 29 Apr. 2015].
– NMUH, (2015). Hospital welcomes CQC report and will use it to help improve
services. [online] Available at: http://www.northmid.nhs.uk/Media/Latest-News-PressReleases/ArtMID/587/ArticleID/69/Hospital-welcomes-CQC-report-and-will-use-it-to-help-improveservices [Accessed 29 Apr. 2015]. – Gov.uk, (2015). Welcome to GOV.UK. [online] Available at: https://www.gov.uk/ [Accessed 29 Apr. 2015].

– Nccmt.ca, (2015). Assessing the public health impact of health promotion initiatives. [online] Available at: http://www.nccmt.ca/registry/view/eng/70.html [Accessed 29 Apr. 2015].
– Betterevaluation.org, (2015). Measuring health promotion impacts: A guide to impact evaluation in integrated health promotion | Better Evaluation. [online] Available at: http://betterevaluation.org/resources/guide/measuring_health_promotion_impacts [Accessed 29 Apr. 2015].

= Gov.uk, (2015). The health and care system explained – GOV.UK. [online] Available at: https://www.gov.uk/government/publications/the-health-and-care-system-explained/the-health-andcare-system-explained [Accessed 29 Apr. 2015]. – Ihi.org, (2015). Measures. [online] Available at:

http://www.ihi.org/resources/Pages/Measures/default.aspx [Accessed 29 Apr. 2015]. – DEVRIM

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