Shortcomings in WHP Management Style - Essay Example

1 Introduction National Health Service (NHS) of UK is famous for its comprehensive health services provided throughout the UK. It delivers this service through what are known as NHS Primary and Secondary Trusts. In primary care treatment is given for routine injuries and illnesses by healthcare professionals, including GPs, nurses, dentists, pharmacists and opticians. All Primary care trusts are responsible for managing these services in a specific area and are also responsible for purchasing (or commissioning) many other services from the NHS as well as from the independent healthcare sector, which will benefit the health and wellbeing of their local population. Our Trust, the West Hull Primary Care Trust (WHP) serves the local population at Hull East Yorkshire by offering all above services including assistance in tobacco control. The management is required to follow the guidelines laid down by the Healthcare Commission. Some of the highlights of the commission’s recommendations that are followed here are sound clinical and organisational management, and assessed and managed risks; supporting staff to raise any concerns about the quality of care or services provided to patients; having systems in place to support all staff in their development, including the minority groups; storing, using and dissemination of information about patients; to make sure that healthcare staff are appropriately recruited, trained and qualified; making sure that staff continue to develop their professional skills and to make sure that national guidelines for carrying out research are followed throughout the organisation. The management is through a committee of ten medical practitioners that is headed by a Chairman who is the manager of the facility and policies are framed according to normal NHS guidelines outlined above. WHP scores a fair result in the services that it offers to its captive population and it appears that it is perceived as an average performer in its services. The pursuit of this report is to find the shortcomings in its management style and to make recommendations to overcome them. 2 Management Styles Management Styles are of three kinds; Autocratic, Consultative and Democratic. As the names suggest, the first is where the leader independently declares policy and the organisation has no choice but to follow it. In a Consultative set up the leader seeks opinions from all departmental heads and then formulates policy. In the Democratic setup opinions from the rank and file have a bearing on the final policy and the leader is more like a guide and mentor. The NHS, it has been argued by the Labour politician, writer and journalist Michael Foot, is the greatest Socialist achievement of the Labour government (Foot 1973). It was the first health system in any Western Society to offer free medical care to the entire population. It was, furthermore, the first comprehensive system to be based not on the insurance principle, but on the national provision of services available to everyone (Klein 1989). Back in the 1980s it was recognized that older organisational forms that prevailed in modern societies were no longer appropriate, especially those categorized by hierarchy, centralised control systems and specialised division of labour (Reed 1992: 226). Therefore new and flexible forms of organisation identified as flexible specialization or post-bureaucratic (Heydebrand 1989) where recognised as transformations from the pre-existing bureaucratic forms flexible specialist forms (Clegg 1990; Reed 1992). The management style was Autocratic where the leader was at the top and dominated the policy. The previous concern was with efficiency and effectiveness (Albrow 1970) and now flexible - organic forms are considered as appropriate; management of giving up control to keep control (Bums and Stalker 1961; Fox 1974). Despite the strong centralized structure, the balance of power has not been unambiguously in favour of the Department of Health (e.g. Ham 1985: 122). In fact, the case is in reverse. It has been stated that almost 80 percent of all health costs are generated by doctors medical decisions (Dohler 1989: 178). Although modern principles of organisational reason are applied, yet the doctors have always been able to use their professional autonomy to avoid carrying out policies with which they did not agree (Ham 1985: 153-156; Dent 1994). All these point to the dominant role of physicians in the organizational shaping of health-care delivery. However the government puts pressures in many states to introduce mechanisms to limit this role to contain the cost of medical technology and services. The prevalent management style and the dominance of the doctors had one problematic affect on the whole system and that was costs. Since the service was intended for the whole population, control of cost became primarily important. Between 1989 and 1991 there was just about a threefold increase of managers in the NHS (Ranade 1994: 73). This is a clear signal of a move from an administered to a managed system. The government passed on increasing responsibilities to the hospital managers with the intention of building them up as a countervailing power to doctors (Robinson 1994: 6). The growth was also, no doubt, part of the general histrionics of the new kind of management with a purpose to ensure eventual acceptance of the new organizational order (Cox 1991: 99). However none of these moves add up to a growth in bureaucracy, rather it has meant growth in number of managers. 5 Critique Control of escalating cost was the first reason of introducing market mechanism into the NHS, and, through this development, NHS was able to wear down the long-standing dominance of the biggest spenders, the doctors. These changes have substantially reduced the procedural rules and replaced them with more practical ones of getting things done (Heydebrand 1989: 343). The rationale of planning and priorities within an integrated service has been replaced by consumer demand in the context market of various competing hospitals, clinics and general practitioners. Through the enactment of the NHS and Community Act of 1990 market principles were explicitly introduced into the new decentralized model of the health system. Under this new system, two acting forces have been identified. The Health Authorities, called consumers, are responsible for identifying the health needs of the community and purchasing from hospitals and clinics who are the providers, called producers, of the services. The General Practitioners are also intended to become purchasers (consumers), on behalf of their patients, within this marketplace. This new system is based on a distinct separation of functions between the purchaser and provider of health services. The purchaser is the health authority who, on behalf of the citizens, or General Practitioner on behalf of her/his patients, has the duty to obtain the best price/quality of health service. This is done through contracting out the service to different hospitals who become competitors against each other, just like companies in a market. Hospitals have now become self-governing trusts operating just like independent commercial corporations within the internal market of a specified area. These new enterprises or trusts are required to be managed by teams of business managers and health-care professionals and are headed by senior doctors in the capacity of clinical directors. These newly planned hospitals are intended to reflect the new patient-centred culture and in this scenario the focus of the services and the fiscal administration is directly linked to the individual patient and her/his care. The system is totally co-ordinated and centrally integrated through sophisticated software system. A new set of objectives, like that of a company, has been created which has transformed the relation between patient and hospital/clinic from supplicant to consumer and with this has changed health-care provision from being a citizens right to a customer service (Johnson 1972; Strong 1979). To achieve these objectives, the state administration has pursued a strategy of actively transmuting the NHS culture (Ranade 1994: 82-99). What was dominated by professionalism and rational paternalism has changed with the expression s of market jargon (Klein 1989). The new NHS system now has much in common with a system of franchising. Hospitals and clinics are like franchises of the Department of Health to sell health-care services and they comply with detailed quality standards as set by the Department. Very much like Benettons or any other Retailer, these NHS hospitals are required to have IT systems that provide itemized details, including costs, of each patients treatment and hotel-type services (Clegg 1990: 120-125). 6 Conclusions & Recommendations The efficiency level at WHP has been reported to be fair generally but we have failed to adopt all the practices of the modern enterprise. We need to look into areas where we are still weak and they are mostly technological. Our IT system needs upgradation and we need to train our staff better in this direction. WHP follows an Autocratic management style despite having a consultants committee. The reason is that the committee is not committed to daily consultations and it is left to the Chairman to take effective decisions. It is recommended that we adopt the Consultative style of management for better results. Of course the Chairman as leader of the organisation has to play a decisive and forceful role to achieve this. He also needs to bring in change management policies to supervise the change of culture that will be required for the organisation to become more technology friendly. Managing for results is never easy but there are tried and trusted change strategies that can be adopted to overcome our shortcomings in a phased and regulated manner. We will need the cooperation of the workers and a suitable change management programme has to be initiated and implemented. Bibliography Albrow, Martin 1970 Bureaucracy. London: Macmillan.. Burns, Tom, and G. M. 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