Managing the National Health Service - Essay Example

Managing the NHS Table of Contents Executive Summary The NHS is suffering from several issues of which the primary issue is management bloat that is caused by a large number of middle managers. The problem can be solved through the effective applications of three main solutions. The solutions are firstly to increase the level of empowerment within the organisation so that employees at lower levels and higher levels can take more of the decisions made by middle management. Secondly, to improve the use of technology to help communications and the chain of command within the NHS as well as the delivery of the services provided by the NHS. Finally and most importantly, to make the NHS behave like a small company by bring about changes in its structure and its mentality. Introduction The National Health Service (NHS) is one of the central institutions of Britain which makes it a proud welfare state. However, as one of the older government institutions of the UK, it is also suffering from over management and a high level of bureaucracy which is affecting its efficiency. This affect has considerably damaged the opinions about the NHS leading some analysts to wonder if it can continue to provide the level of service that it has in the past. However, it is difficult to find recommendations that the NHS should be privatised or that it should be abolished altogether but it is possible to find solutions regarding the problem of having too many managers or a deep layer of middle management within the NHS. Solutions While there can be a wide variety of solutions given to the NHS, private industry and businesses often give the best cases which could be replicated for the NHS. These solutions include the ideas of empowerment, changing the organisational structure, efficient use of technology and thinking like a small company since all of these ideas have helped large companies in the past. In fact, many of these companies have been emulated by others in terms of how they govern themselves and how they manage profitable businesses spread across the world. The NHS on the other hand, only has to deal with one nation. Empowerment Interestingly, even if the sayings of the ancient Chinese philosophers, the idea of empowerment figures largely as Confucius was focused on the empowerment of the individual so that s/he could improve his/her own life rather than take guidance from outside sources (Legge, 1893). In more recent times, Employee empowerment has been considered as one of the ways in which decisions can be made by the employees in an organisation which wishes to share some of the responsibilities of management with the employees thus taking a lot of the burden off the management’s shoulders. This is certainly not a new idea since more than ten years ago, Beard (1993) had become disillusioned with the concept to the extent that he considered empowerment to be one of the ideas which some people take as just a fad, while others consider it to be the answer to all their problems. Still others might say that empowerment is something which they have been doing with their employees for years. However, Beard did suggest that there may be something more meaningful to the idea since engaging workers in any field with regard to management is known to make them happy. However, in the case of the NHS empowerment will probably not be used to make managers happy but to reduce the level of management which required by the NHS. Thus when employees are empowered, middle management can be reduced to a great extent as recommended by Beard (1993). Of course empowerment can also help other business processes and objectives such as Total Quality Management, increased employee satisfaction and improving employee motivation for greater service levels (Welch, 2005). However, the reality of empowerment may be quite different in an organization where government interference is quite possible. An Issue of Trust There are many reasons for that and the primary reason is that governments may not trust their employees to make decisions. There can be communication gaps between what the government wants the employees of the NHS to do and what they feel that they should be empowered to do which necessitates a layer of middle management (Heller, 2007). For bodies like the NHS, this gap does not come from differences in what the government wants and what the professionals in the NHS want but from the policies and rules that have been enacted by present and previous governments. In various organizations around the world, manager might make plans to empower their employees but the plans fail because the understanding of empowerment, between the managers and the employees, is often at odds (Heathfield, 2007). For example, while the NHS has the primary objective of serving the nation’s health needs, real power remains with ministers and other policy makers who establish the means by which layers of management can be created for the NHS. A perfect example of empowerment comes from GE in terms of their reward system called Quick Thanks. In this system, employees are empowered nominate other employees throughout the company with a gift certificate in appreciation of their hard work. These rewards are only given for exemplary performance and the employees are not free with their power of giving rewards. As described by Kerr (1996), the employees have high personal criteria for giving these rewards than the management of the company. In terms of empowerment, it does seem strange that employees are being asked to reward others, which is often a function reserved for management. This shows that companies like GE which have such reward systems are looking to empower their employees with whatever means they can (Welch, 2005). The NHS can take a lesson from this in terms of employee management and performance evaluations as tools such as 360 evaluations and peer evaluations can help reduce the need for many managers within the organization. Empowerment and Size While this would lead to making the NHS a smaller organization, that step would most likely also make the company more efficient. As noted by Burlingham (2003) the size of a company becomes an important consideration for making it a complete bureaucracy or a lean organisation. In fact, even more than size, it is the culture of an organisation which makes it act like a small company even if it is spread across the world and has thousands of employees. A bureaucratic system dissolves any positive affects that employee empowerment might have since it leads to issues of red tape and employees questioning the decisions made by each other (Welch, 2005). A unit which is seeking to empower employees has to learn to respect the decisions made by them even if those decisions turn out to be disasters. However, if the culture of the organisation is strong enough and the people knowledgeable enough to make the right decisions, empowerment of employees can only lead to more and more benefits. This idea is highlighted by the example of the Zingerman’s Community of Businesses which is one of the best small companies in America. The company takes empowerment to heart and has built the focus of the company around the idea of empowerment and creating a sense of belonging for the employees. There is a long standing trust relationship between the employees and the owners, established management protocols and a high drive amongst the employees to provide great services to the customers (Burlingham, 2003). This is because company was able to adapt and change to the needs of its stake holders and create an entrepreneurial culture which supported the ideas presented by the employees through a peer review system. The innovations and inventions of the company employees were freely discussed with other individuals within the company and employees were allowed to become entrepreneurs to establish their own products under the Zingerman brand (Burlingham, 2003). In a similar manner, it is difficult to see why the NHS cannot create a system for reviewing and working on the good decisions which are presented by its employees and include them in the decision making process even if it is as the local level rather than the national level. As it is made clear with the examples of GE and the Zingerman Community of Businesses, it is possible for both small and large companies to empower their employees in a variety of ways. This empowerment changes the culture of the organisation to a large extent and it is certainly a practice which can help the NHS become more proactive and productive. Most of all, such practices allow the company to work with fewer managers and that allows it to lower costs while improving efficiency and productivity. However, it seems that there are not too many people who will jump on this solution since empowerment without a change in culture or without benefits to the employees could be a disaster. Employees must be held accountable to others within the organisation and undoubtedly there would a certain level of complexity that is generated through empowerment if the middle tier of management is removed too quickly. Employee may start thinking that they can do whatever they want to do but that would not be empowerment at all. Both the managers within the NHS and the employees of the company have to be clear about what they can and cannot do even as the employees take on some of the responsibilities of the management (Heathfield, 2007). Such a development in the thinking patterns of the NHS may be difficult to see in the immediate future but empowerment is a solution to the problems of the NHS which can be handled without increasing the load on managers. Certainly this would be a difficult change for a body like the NHS to experience because it throws out years of work and systems which the NHS has worked with. However, since those systems are obviously showing their age, it is perhaps best that the NHS move towards a different working model willingly before it is forced to go into the same unwillingly. Even though the process and nature of empowerment may appear to be complicated, it is just one of the basic concerns of the NHS when it comes to reducing middle management. Undoubtedly, the empowerment give to the employees could make the functioning of the organisation much simpler if individuals are not empowered by random numbers but selected and given authorities as their relationship develops with the NHS. As time progresses, the empowerment relationship would also move forward as the NHS moves forward taking her employees along with her. The Use of Technology As the NHS steps into the 21st century, technology in terms of medicine becomes very important for them as continued use of the latest health research allows them to be better performers when it comes to keeping the health of the nation. However, in terms of management, the use of technology can help them reduce the number of middle managers and also help them become more efficient. In terms of size, large companies are often more pervasive users of technology but small companies in the real world can also use technology to gain competitive advantages (Margulius, 2006). The NHS can use the internet to provide online services to its employees and reduce the burden on management. Margulius (2006) presents several ideas by which health companies can improve their supply chains through the internet as pharmacies and other health product suppliers can be work online. This is only one way the NHS can use the internet since much smaller organisations have used the blanked of the internet to present their image of being larger than they are. The NHS can provide quite a few health services and related information online to reduce the number of visits it has to its service locations and in turn reduce the burden on itself. Technology to the Rescue Even small companies such as Oriel Wines have shown us that the internet can be a useful tool for businesses that need to be in touch with a lot of customers at the same time (Chozich, 2005). Oriel wines has a client base which runs from the far end of the united states to Germany and it delivers them wines from around the world simply by being online and being sensitive to the needs of its clients. The clients are given automatic recommendations when they make one order and are given reminders when the company thinks their wine supplies might be running short. There is no reason why the same approach cannot be taken for pharmaceuticals and medicines which are handled by the NHS. For an organisation which is the size of the NHS, switching to the pervasive use of technology can be difficult but it also allows for better management and even remote medical assistance in some situations which means that the load on one particular doctor could be shared by many experts. However, Information Technology and its use must be justified with a cost benefit analysis before the NHS starts to invest billions of pounds in a system which no one is ever going to use (Johnson et. al., 2005). Changing the Structure Historically, the basic structure of many large organisations in the previous century was founded on a linear and hierarchical pattern. During the 50s, companies created management structures with several lines of command that were present in both the public and private sectors. However, by the middle of the last decade of the 20th century they went out of fashion since they were expensive to maintain and hindered the flow of information between various levels of management (Ashkenas et al, 1995). To make companies more efficient, managers around the world tried to make their companies leaner and smaller in structure. Many of these companies found new economies in terms of a reduction in the scale of management as bureaucracies became entrepreneurial companies which were more flexible and business savvy. It was also a period which was highlighted by the acquisition of smaller companies to emulate their models and management techniques and the utilisation of a range of approaches which helped companies in understanding the changes which were coming in terms of technology and society (Ashkenas et al, 1995). At the same time, many organisations connected with government services missed out on such opportunities and today suffer from over management and inefficiency. As one such example of an organisation, the NHS remains a bloated entity but that bloat may be justified by the structural requirements of the company. The NHS severs millions of people which are in turn connected to thousands of organisations and it serves the critical duty of maintain the health of the nation. There are clusters of people which are arranged in various groups according to their expertise as nurses, doctors, managers, administrators, executives and liaison officers for different departments of the government which means that some management bloat can be easily expected of a company of this size. However, this justification falls apart when we consider that having so many managers and the thick layer of middle management may actually be hampering with the mission and the duty of the NHS. For example, while Buchanan and Huczynski (2004) accept that certain levels of hierarchy may be necessary for any organization which needs to have a command structure, overly vertical chains of command or a middle management layer which is too thick can have negative effects on the operations of a company. The NHS managers have to understand that as they continue to improve the services they provide to their clients, they also have to examine their own roles within the organisation and make an honest evaluation of whether the company would be better off by having fewer managers and more money for doctors and nurses. Structure and Efficiency As noted by Buchanan and Huczynski (2004), organisations and organisational structures are made to achieve specific purposes, the propose of middle management in the NHS can possibly be achieved with fewer managers if structural improvements are brought about in how the NHS governs itself. Essentially, as recommended by Mullins (1993), the top management of a company may need to change the relationships it has with the lower orders of the company whereby a lot of the responsibilities of the middle managers can be divided structurally between senior management as well as the rank and file. If the NHS does this structural adjustment, it would mean that a lot of the middle management can be made redundant for the NHS. As early as 1962, Burns and Stalker had discussed the idea of the external environment influencing the internal structures of various corporate bodies and suggested that as the external environment changes, the internal structures of the company must also change if the company is to remain efficient. This change in structure comes with changes in responsibilities and leadership roles. This goes to show that any organisation like the NHS which seeks to reduce the number of middle managers within itself has to establish new lines of management or new methods of managing individuals before it starts removing managers left and right. Drucker (1989) takes the argument one step further by saying that organisational improvements depend on structural improvements since companies which do not have efficient structures will not have efficient systems. He clarifies by saying that an organisation with a good structural foundation may not necessarily be a good performer but an organisation which has poor foundations in terms of structure may find it impossible to give any level of performance. The NHS may have had excellent foundations in the past but at the present moment, there appears to be a bloated layer of middle management which is throwing off the whole structure of the organisation in terms of service and productivity. Big Organisations Small Structures For the NHS, GE can serve as a good example of a company since the structure of the company as well as the procedures of setting up the structure of GE seem to be following the Functionalist Paradigm. The paradigm suggests that individuals as well as large organisations can be expected to act in rational ways and their behaviour can be understood with observation and evaluations (Burrell, 1979). This paradigm could be useful because while GE acts in a manner which is very rational for the most part while the NHS seems to be seeking rationality while keeping a thick layer of middle managers. The NHS needs to follow the recommendations made by Mullins (1993) who recommends that company structures should work towards improving the way in which individual and teams are arranged to achieve specific tasks that they have been assigned. GE creates project teams and project groups from across its various companies to achieve the corporate vision and company goals while making sure that the lines of communication between them remain open (Welch, 2005). This kind of approach is heavily supported by Bartol and Martin (1994) who say that organizational structure is little more than formalized patterns of interactions which are designed by top management. In the NHS, the huge number of middle managers seems to be a hindrance to the structure which in turn becomes a hurdle on the path to meeting organisational goals of improved service. Without effective structures in the NHS and good structural management for NHS teams, the organisation and teams within the organisation could end up with bad leadership and bad leaders will bring down their own productivity as well as the productivity of those who work with them (Armstrong, 1999). Removing People to Change the Structure For example, Welch (2005) describes a case at GE where high turnover was observed in their international communications department. Even though the department was not a primary unit of the company, high junior level turnover caused the executive management team to take notice of the situation. After making inquires and going through exit interviews, the management team found out that the middle manager within the structure of the department was making life difficult for his junior teammates. To return the department to productivity, that manager had to be removed from service (Welch, 2005). The company saw an immediate turnaround as employees started being more productive and the same evaluations were carried out throughout the company where they could be applied. The company discovered that it could restructure a few departments which led them to greater efficiency and it led them closer to their mission (Welch, 2005). It is perfectly understandable that removing people from service and more or less eradicating a whole layer of middle management can be an important issue for the NHS. As described by Proctor (2001), such changes can have a negative effect on the knowledge contained within the company and can also harm workforce structures in connection with the skills that some of the employees have. Additionally, it must be noted layoffs and removing redundancies can be a part of the restructuring experience but it can also lead companies and their employees to have issues concerning work overload, high stress levels, loss of company vision/values, poor decision making and even corporate in fighting (Thomas and Coe, 1991). The health industry is a people’s industry and such threats can make employees of the NHS to see their jobs to be less secure and less rewarding. They may have less loyalty, lower morale and a loss of motivation to work. A company like GE understands these problems and manages them by making the company structure emulate a small company and by making it informal when it comes to managing people (Welch, 2005) Informality in this case is not an informality of policies but an informality of management structure. GE does not ignore the issue when employee discipline is concerned but it also looks for deeper causes which could lead to conflict. As far as the workings within the company are concerned, the idea of informality is applied with line managers and the environment of the company supporting a company structure where senior members of the management act as coaches, mentors and full supporters of the employees. This informal structure of GE is highly regarded by Byrne (1998) who says that: “Making the company informal means violating the chain of command, communicating across layers, paying people as if they worked not for a big company but for a demanding entrepreneur where nearly everyone knows the boss (Byrne, Pg. 1, 1998)”. Undoubtedly, such behaviour within the NHS could only help the organisation in achieving its goals of being better in terms of service and better in terms of the burden it places on the treasury. Conclusions Britain prides itself to be one of the few real welfare states left in the western world and that pride owes a lot to the services provided by the NHS. However, the NHS has a lot of issues it needs to correct since the calls for privatisation of this institute as well as other changes to be brought to the structure of the organisations have been made. As far as it can be seen, the NHS has two options, it can either change itself to be in line with the changes that have come to society or it can be forced to change through government regulations and the demands of the people. The better course for the NHS is certainly internal change since they should be able to control that to a large extent. Private industry and commercial businesses have done so in the past and turned themselves around from failing companies to success stories. If the NHS can change its structure, become more efficient in the use of technology and utilize the idea of empowerment to its fullest advantage, it can certainly improve its footing. Such steps would take care of a lot of issues faced by the organisation and allow it to become a wholly better managed organisation. Works Cited Armstrong, M. 1999, A Handbook of Human Resource Management Practice, Kogan Page. Ashkenas, R. et. al. 1995, The Boundary less Organization, Jossey -Bass. 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