United Kingdom health service - Essay Example

Managing the United Kingdom Health Service 2007 Managing the United Kingdom Health Service How do you understand the problem of management in the United Kingdom National Health Service What organisational factors have contributed to these problems Healthcare has recently turned into perhaps the most critical aspect of public policy in the UK due to two major issues: the finance and provision of health care. On the finance side, there is currently recognition that health care in the UK has been underfunded in comparison with most other Western European countries for at least the last two decades (Dixon & Mossialos, 2002). On the health care provision side, the National Health Service (NHS) admits lack of workforce and, what is even more important, insufficient quality of service and targets to effectively rectify these problems though the improvement initiatives are perceived by many as barely achievable in the timescale set by the government (Timmins, 2001). Although majority of the challenges facing the UK healthcare system are perceived as the result of economic factors, poor funding is not the sole factor to be held responsible. Vast economic, social, technological, and economic changes occurring in world nowadays seem to contribute to the difficulties experienced by the health care industry too. The key feature underlying these modifications is increased attention to human resources. Managerial effectiveness is one of the core factors that determine effectiveness of modern organisation, including the National Health Service. The National Health Service (NHS) is the common name of the publicly funded health care systems of England, Scotland, Wales, and Northern Ireland. These four health systems operate in the United Kingdom, and though they developed within different legislative framework, operate collectively on the UK territory. Currently, the NHS has approximately 1.3 million employees including almost one million full-time personnel (BBC, 2006). Although these impressive figures make the NHS one of the largest employers in the world, it has not been until recently that the managerial aspects of its operation drew serious public and expert attention. The existing research in the field of health care management allows to identify several major challenges facing the average NHS manager. 1. External Pressure NHS managers have recently become one of the most favoured objects for public and media criticism (Preston & Loan-Clarke, 2000; Case Study). Furthermore, the government also contributes to the external pressure. The reforms initiated by the government over the last years require the managerial staff of HNS to dramatically and immediately change control, efficiency and accountability of their work in order to justify and reduce the amounts of funds spent for the NHS annually. However, the time-frame set by the government to achieve this goal is clearly too short granted the organisation's size and previous operation (Buchanen & Preston, 1992). Evidently, the requirement to achieve the new levels of performance effectiveness formulated by the government can hardly be met under such circumstances. Consequently, frustration, anxiety, and perceived inability to properly do their work became the characteristic feature of NHS managers these days. Thus, the general perception of the managerial profession by NHS managers is highly pessimistic: "the middle manager occupies the most uncomfortable position in the NHS. The managers feel that their role is unrecognised by patients,... the public and the government" (Case Study). 2. Internal Pressure Increasingly high internal pressure is another problem facing NHS managers these days. Perhaps the most essential factor contributing to this sort of pressure is "... the need to manage professional staff with equal or higher status... [and] ... a high degree of autonomy" (Case study). In light of the current requirements to improve the quality of performance by exerting stricter control and introducing the special Code regulating professional behaviour of NHS manager, this factor seems to have major implications. Since the emergence of organisational science in the late 19th - early 20th century, the scholars have been sharing two dominant views on organisational culture. Apologists of one attitude led by Frederick Taylor and Harrington Emerson (School of scientific management) believed that organisational culture was just one of the means exercising greater control over employees. Partisans of another approach (Human relations school) such as Elton Mayo, Abraham Maslow and Douglas McGregor argued that organisational culture on the contrary develops and motivates the employees without excessive and rigid control (Schultz, 2002). The Taylorian model employs the principle of 'presumption of guiltiness' believing that average employee is by default lazy, ignorant and passive. Therefore, employees are to be controlled in order to demonstrate greater working efficiency. Taylor (1911) suggests the following principles of organisational control over the employees: Ceaseless control over the work of each employee through organisation the system of supervisors, inspectors, quantity-surveyor, etc; Control over the work of the workshops; Promotion of stimulating and competitive organisational culture which may provide excessive control over the employees These ideas were further developed by Harrington Emerson who has formulated twelve major principles of scientific human resource management. Emerson believed that: Discipline and permanent control over the employees serve the keys to organisational success; Norms and schedules serve perfect instruments in organisational control over the employees; Organisational environment may provide perfect control over the employees guiding employees' activity, forming employees' dependency and commitment to a company, and punishment of the workers in case of failures (Drucker, 1985) One may notice that this obsolete autocratic paradigm bears suspicious resemblance to the management principles the government attempts to establish within the NHS. However, the problem is that the approach embodied in the Taylorian model is the product of earlier epoch when employees were believed to be almost the same resource as machines or tools. Such belief implied that the increase in the productivity was to be achieved only through pressure on the employees and their permanent control. A good illustration here may be example of a car: the more you push the accelerator the faster you go. This traditional view is in conflict with the modern perspective on human being and organisational culture. Strict and rigid organisational culture diminishes company's abilities to adapt and change facing external and internal challenges. As Collins and Porras (1994) argue the idea of strict culture is not at all irrelevant; moreover, it is often beneficial for modern business, but in modern organisations, characterized by swiftly changing environments need to be less pervasive, instructive, controlling, and prescriptive. Although the NHS is not a typical business organisation that tendency in management practices has probably affected it too. Furthermore, the specifics of medical profession made the tendency even more influential in the NHS than in many other companies. Medical profession was traditionally distinguished by high degree of autonomy due to the specific knowledge and skills possessed by the health care professionals. The importance of this factor is brilliantly worded in a statement of one senior NHS manager: "We are not an organisation that works on an autocratic management style, we are managing highly professional people, who are highly qualified, and themselves highly skilled, they do not respond very well to being told. They all think for themselves and work with a large degree of autonomy. I think sometimes that is underestimated" (Preston & Loan-Clark, 2000: 106). 3. Lack of Relevant Information and Specific Knowledge NHS managers often lack the information necessary for effective performance. This problem is especially topical for middle and junior managers, who are supposed to implement a certain strategy, but do not have sufficient information to perform this task effectively: "As the implementers, rather than the creators, or organisational strategy, the middle and junior managers ... actually feel that they themselves do not have all the information they would like, despite the fact that their staff fully believed that they were withholding information from them" (Preston & Loan-Clark, 2000: 105). In reality, NHS managers enjoy much less autonomy and involvement in key decision making than their staff, public, media, and government assume. Evidently, the course toward increasing control over the managerial performance proclaimed by the government only turns the situation worse for NHS managers. Lack of knowledge about the specifics of managerial profession represents another common problem. A number of NHS managers have moved into management from a clinical background or perform the managerial functions as an element of their primary occupation/position (Preston & Loan-Clark, 2000). Evidently, such managers have serious problems meeting the increasing performance requirements. The typical nature of these problems is formulated by one middle manager of the NHS: "They tend to forget that I'm a health professional and they just see me as a manager. So when you look into sort of moving things forward, changing practice of whatever, they view it as a management thing rather than looking to expand the profession" (Preston & Loan-Clark, 2000: 106). 4. Absence of the Evaluation Framework While the reforms require from NHS managers to modify their traditional practices and achieve new levels of effectiveness the adequate framework for evaluation of their effectiveness is absent. The research scholarly literature does not provide "...empirically-based standards against which to judge and compare managerial behaviour" (Willcocks, 1997: 181). Evidently, the traditional criteria do not apply to the highly specific conditions in which the managerial staff of NHS is forced to perform these days because they do not consider the changed role of managers. Willcock (1997) perfectly summarises this problem in the following statement: "A central problem is that the researchers have neglected the manager's role demands or expectations and concentrated on role performance or behaviour" (p. 181). The above overview suggests that the route cause of the problem of management in the United Kingdom National Health Service may be the following. Under the intense public pressure the government attempts to justify the funds spent for the NHS using the simplest method suggested by Taylor in 1911: ceaseless control over the work of each employee through organisation using the system of supervisors, inspectors, and quantity-surveyors. Evidently, some believe that this method will improve accountability and help 'quantify' the managerial work in the similar fashion they calculate the number of doctors and nurses per 100 beds. Although the drawbacks of this approach have been identified and illustrated in thousands of credible studies the government seeks to implement it in the NHS probably due to one key reason: the more you push the faster you go principle is incomparably more understandable than sophisticated (though absolutely correct and repeatedly proved) explanations that the shortest way is not always the right one and it is hardly possible to quantify things that are qualitative and unquantifiable in nature. The NHS seems to be exactly the case when satisfying the public demand to maximise 'efficiency' and minimise tax expenditure is perceived as more important than strategic long-term improvement in the quality of service, the need to adjust to the changing environment and numerous challenges associated with it such as keeping the qualified workforce, cultural diversity, etc. 2. Do you think that it is possible to successfully control an organisation without managers Support you answer with examples from organisations with which you are familiar. The question whether it is possible to successfully control an organisation without managers does not have a simple answer and perhaps no wrong one: either answer may be considered correct depending upon the perspective the respondent adopts on the phenomenon of management and the job of manager. Nowadays, management is perceived as a multilateral and complex process, but when F. Taylor published his famous book The Principles of Scientific Management, which was the first attempt to analyze the process of managing people in detail, it was almost synonymous to routine controlling the employees' performance and instructing them. In other words, positional authority of the manager and the task of getting the job done were the most distinct features of the management process. Evidently, this perspective does not leave any possibility that controlling an organisation is possible without managers. However, later studies greatly advanced out knowledge about the process of management, its basic constituents and mechanisms. One of the most essential features of management is to bring order to an organisation, and the larger is the organisation the more it is requires that management is in place to ensure effectiveness of its operation. The core functions of management are supervising, planning and organizing, controlling and coordinating, and problem solving (Young, 2002). Supervising is commonly considered to be almost synonymous with managing: it is defined as the overseeing and administering of subordinates in the performance of their duties and responsibilities or improving the performance of subordinates by working with them to evaluate their strengths and weaknesses, the scheduling of their work, and the setting of their work goals and objectives" (Yukl, 1994: 28). The essence of planning is setting of short-term goals and objectives, establishing sequential steps and milestones, and allocating resources (financial plan) to execute the plan. Organizing involves the staffing and assignment of tasks, communicating the plan to staff, developing policies and procedures, and monitoring implementation. Controlling and coordinating includes the managerial processes of checking or confirming scheduled target dates, assuring the quality of services and products, assessing system effectiveness, coordinating efforts of varying participative and/or affected groups, addressing or reconciling disputes, and problem solving in general (Young, 2002). At the first glance, this perspective also implies that it is impossible to effectively control an organisation without managers. However, one essential difference between the simplified understanding of management and the modern theories is that less attention is paid to the so-called positional authority of the manager. In other words, it can be assumed that the core functions of the manager should not necessarily be performed solely by the person in the managerial position. Evidently, in the modern practice managers are always in charge of performing these functions, but the theoretical opportunity that they are not necessarily associated with the positional authority does exist. To certain extent, such distribution seems to be present in the NHS due to traditionally great autonomy associated with the medical profession and specifics of healthcare as such. For example, in supervising it may be difficult for a manger to improve the performance of subordinates because the manager often does not have sufficient knowledge and in many cases it is impossible to schedule their work or set goals; establishing steps and milestones and planning in general is difficult too due to the nature of healthcare. While in a typical for-profit business organisation the manager typically has no problems performing these and other core functions, in the NHS the situation is entirely different: this may be one additional reason for the difficulties currently experienced by NHS managers. From this standpoint the governmental efforts to reform the NHS can be viewed as an attempt to again link the distributed managerial functions to the positional authority of managers. Yet, despite the theoretical possibility that the managerial functions are not necessarily associated with the position in practice it seems hardly possible to effectively control an organisation, especially as large as the NHS, without managers. However, the statement that it is possible to successfully control an organisation without managers in the traditional sense seems to be difficult to argue. The changing environment, coupled with the new requirement make it necessary to update the traditional functions and responsibilities of modern managers. The function of leading may be one important element of this potential update. The existing research in the field of management and leadership convincingly proves that the role of the management group must be very essential otherwise the organisation will not respond properly to the reforms. Moreover, this role itself should undergo dramatic change: to be effective a contemporary manager is supposed not only act within the traditional framework of responsibilities (e.g. supervision, performance control, etc) but also act a true leader within the organisation. Defining what makes a great leader in the health care industry is not a simple task first of all because leadership is another exceptionally complex phenomenon. The recent explosion of scholarly literature covering various aspects of leading and managing people is one logical outcome of this complexity. Despite huge amount of books and articles dedicated to the issue, there is still a great deal of ambiguity surrounding the true meaning of effective leadership in contemporary organisational environment. However, the fact is that effective leadership plays a key role in bringing about any change in the organisational culture, while inadequate or inappropriate leadership has been identified as a central factor when such attempts fail (Schien, 1995). In psychology the phenomenon of leadership has traditionally been associated with in-group dynamics of social interactions. In any group, regardless of its size, members differ in their degree of social influence over one another: " the person who exerts the most influence on the rest of the group thus affecting group beliefs and behaviour is usually addressed as leader" (Hollander, 1985: 492). This definition of leadership allows the reader to grasp the essence of leadership, but it is only one of the numerous of definitions that have been proposed in the literature. Thus, the classic edition of The Handbook of Leadership by Bass lists more than 130 definitions of leadership (Bass, 1990: 12). Yet the best account of the role the management group should perform these days to facilitate the ongoing change in the health care industry is the visionary approach. The central idea of the visionary leadership is about envisioning the organisation's position for long-term future, conveying this vision to other members of the organisation, motivating individuals to share and commit to this vision, and aligning resources and processes to accomplish it (Young, 2003). From this perspective the lack of information on the organisation's position and long term goals cited by NHS managers prevents them from becoming the real leaders. This seriously undermines their effectiveness as managers because the positional power is often not enough to effectively manage such highly professional staff as they have in the NHS. By contrast, the chances of a leader to act as an effective manager are substantially higher. Thus, the first role of a visionary leader - direction setter - implies that a leader should presents a clear vision, a convincing image or target for an organisation to achieve in the future, and involves the employees. The second role - change agent - requires the leader to be capable of implementing change; this ability is vitally important for the NHS these days granted the urge for reforms. A visionary leader - spokesperson is central for effective sharing of the leader's vision (goals, objectives, intentions, etc) among the subordinates. And finally, an effective visionary leader should also be capable of acting out as a good coach (Young, 2003). Evidently, these roles largely coincide with the basic functions of a manager. Effective management is critical to the success of organisations both in the private and public sectors. However, the challenges facing organisations these days make the issue of extending the traditional managerial functions not less important than qualification and skills of the managerial staff. Thus, the brief overview of leadership demonstrates that this process involves some practices that are likely to be very essential for successful management in the NHS these days. References Bass, B. M. 1990, Handbook of Leadership: Theory, Research and Managerial Applications, New York: The Free Press. Buchanan, D. A. & Preston, D. 1992, 'Life in the cell: supervision and teamwork in an 'manufacturing systems engineering' environment', Human Resource Management Journal, Vol.2, No.4, 1-25. Collins, J. C. & Porras, J. I. 1994, Built to Last: Successful Habits of Visionary Companies, New York: Harper-Business. 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