Managing people in ill health study

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Contents Page
Task 1 Page 3
1.1 Page 4
1.2 Page 5
References Page 6
Appendix A Page 8
Appendix B Page 14
Task 2 . Page 19
2.1 Page 20
2.2 Page 22
2.3 Page 23
References Page 24
Appendix A Page 26
Appendix B Page 31
Appendix C Page 36
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Task 3 . Page 38
3.1 Page 39
3.2 Page 41
3.3 Page 42
References Page 43
Appendix A Page 45
Appendix B Page 50
Appendix C Page 57
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Task 1
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1.1:
See Appendix A
It is clear the process of recruitment and selection can become the make or break of
a business. You can find a candidate who is like-minded, who shares the organisations
vision and able to fit into the organisation. Recruiting a candidate can have too many
negative impacts such as wasting time, money, and resources as they would be unable
to retain the staff and the recruitment process can be lengthy. Nevertheless, although
the process can be long, the overall long-term benefits can help the organisation with
its strategic visions, it is able to open doors of opportunity whilst delivering the
corporate objectives. The process, if successful, can reduce absenteeism and retention
figures due to being able to select the right person for the right job.
Although, the process heavily relies on each stage to be fulfilled and correct for
example the job specification, if this is incorrect then a potential candidate will be
selected and not be able to fulfil the role they needed to. In being able to select the
person who fits best, an organisation can provide good quality care as they are able
to select a candidate that has the competencies required for their role. Recruiting
methods selected for the interview process can be positive, it will allow a series of
ways potential employees can be selected, the art of psychology can ensure decisions
are based on the actual role, rather than being able to perform on the day. The
negative aspects could include a one-sided approach if only an interview is carried out,
whereas this allows an organisation to see the individual in a range of scenarios which
cannot always be planned for.
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1.2
See Appendix B
The Equality Act (2010) makes it illegal for organisations to discriminate against
candidates and current staff because of a protected characteristic. The recruitment
and selection process should be as impartial as possible with individual opinions,
ones own attitudes and prejudices not influencing the choices made. Therefore,
considering how ratings are applied when screening candidates. Using preconceived
judgements about experience or skills, which could limit those who are young or old,
could possibly stereotype, they should use an approach that is fair such as the
candidates performance. When a job is advertised it should be written with care and
attention so it does not seem as though employers are discriminating unlawfully, they
should use interviewing methods that are available to all, for example not just through
means of Skype but other methods that could suit other potential candidates.
It is unlawful and discriminatory to decline a candidate a job because of a protected
characteristic, unless the refusal of employment came for reasons that were justified.
Such as if the role required particular abilities, for example a candidate applying for a
role as a nurse if they are profoundly deaf. Actions such as this would be suitable since
the candidate would need to acquire this sense to a degree in order to provide patients
with a client assessment. Candidates that are expecting a child should not be refused
employment for reasons relating to the pregnancy, a decision not to employ them
would be illegal. Similarly, it is unlawful to reject the candidate due to their age, unless
the organisation can justify their reasons for not offering the position.
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References
(1) CIO: Employee Retention. https://www.cio..html Accessed 15/04/2020
(2) Boxall, P. and Purcell, J. (2011) Strategic and Human Resource Management. 3rd
edn. UK: Palgrave Macmillan.
(3) Musgrave: A People Brand (2008- 2009) The Irish Times – Business 2000 Twelfth
Edition Available at:
http://www.business2000.ie/pdf/pdf_12/musgrave_12th_ed.pdf Accessed
15/04/2020
(4) The Aston Centre for Human Resources (2008) Strategic Human Resource
Management: Building Research-based Practice. London: Chartered Institute of
Personnel and Development.
(5) Henderson, I. (2011) Human Resource Management for MBA Students. 2nd edn.
London: CIPD.
(6) Talukder, H. (2014) ‘Perceived Importance Of Job Analysis Influencing Motivation
And Competencies Among Blue-Collar And White-Collar Employees’.
http://iba.edu.pk/Business_review/business_review_VOL-9_No_1_JanJun_2014.pdf#page=83 IBA Business Review, 9(1), pp. 79-91, Business Source
Complete. Accessed 15/04/2020
(7) Human Resources (2018)
http://textbook.stpauls.br/human_resources_student/page_01.htm Accessed
15/04/2020
(8) Equality and Human Rights Commission.
https://www.equalityhumanrights.com/en
Accessed 15/04/2020
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(9) Home Office (2019) An Employers Guide to Right to Work Checks.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attac
hment_data/file/773780/An_employer_s_guide_to_right_to_work_checks_-
_January_2019.pdf
Accessed 15/04/2020
(10) Safe and Fair Recruitment (2017)
https://www.skillsforcare.org.uk/Documents/Recruitment-and-retention/Recruitingfor-potential/Safe-and-fair-recruitment.pdf Accessed 15/04/2020
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Appendix A
According to Pickett (1) of Nfrastructure,
“Retention starts right from the beginning, from the application process to screening
applicants to choosing who to interview
Recruitment processes are crucial to finding the right staff and developing a business.
HR tasks in recent years have developed to ones that are proactive, descriptive and
executive, whereas in the past it was reactive, prescriptive and administrative. (2)
Within health and social care, (HSC), organisations must have a tactical human
resource department that is looking to the future with employment trends changing
drastically. Traditionally, individuals accepted a job for life, whereas in modern
society people have career goals and are motivated to move from position to position
to meet them (Musgrave 2009) (3). At Present, the recruitment and selection process
is ongoing and can consume ones time, in comparison to it being as and when
required. The recruitment and selection process of an organisation is crucial to its
success. Services such as the NHS would continue its recruitment and section
processes regularly due to the size of organisations such as the NHS. This could be due
to factors such as staff not being retained and therefore need their positions filling.
Recruitment processes are designed to decrease figures of turnover, although it could
never eradicate them. Such processes aim to select the right candidate for the role.
The vision of these processes would enable organisations to provide high quality
practice, good standards, and team work to meet organisational objectives. It is
important to understand how the recruitment and selection processes differ, since
each carry their own tasks. (4) The initial process in recruitment would be to identify
the role required within the organisation and to advertise it. Whilst the selection
process can take much longer, requiring candidates to be selected for the position, it
will eliminate candidates in order to find the right person. The process is illustrated
below:
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https://www.locusassignments.com/solution/unit-14-recruitment-selection-processassignment-help.
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According to Skills for Care (2017) (10)
The sector has a national vacancy rate of 110,000 (8.0%) at any one time, with
390,000 (30.7%) staff leaving their job in the last 12 months.
https://www.skillsforcare.org.uk/Documents/Recruitment-and-retention/Recruitingfor-potential/Safe-and-fair-recruitment.pdf
The recruitment and selection process can be very advantageous for an organisation
in the modern day, since it can drive economic performance and influence on the
efficiency of an organisation. It is crucial to be mindful of the decisions made at the
initial stages of recruitment and selection as this will influence the strategic vision of
the company (Henderson, 2011, p.84). (5) The recruitment process is the initial phase
in establishing a successful employee. If decisions are incorrect, organisations could
see many disadvantages including hiring staff that cannot perform, which would affect
organisational goals and reputations of the business. In health and social care this
could be detrimental, since often individuals may not be suited to a care role at all and
may experience safeguarding concerns around their practice.
Recruitment planning involves examining the role that is required within an
organisation and its requirements, this can be detailed as a job description, whilst
the requirements would form a person specification. Having such processes are vital,
since without them you are not able determine who would be suitable for a role based
on their experience and qualifications. Advantages of a job description and person
specification mean potential candidates are able to self-assess whether they are able
to fulfil the role due to their qualifications, experience and skills. During the initial
stages, consideration is also given to the salary (grading) and location of the role. It is
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imperative for an organisation to decide appropriate capabilities in order to prepare
to develop their employees. Companies that decide which job best suits their needs
and objectives, would look to recruit and select the best candidatesin an effective and
timely manner. This would help staff to progress in their future jobs,since this is a new
shift in the modern-day workforce (Talukder, 2014, p.84) (6).
Recruitment strategy is the next step, now organisations are clear on the type of
candidate they may require, the natural progression would be to decide how to seek
out their candidate. Types of recruitment are considered here since roles within the
health and social care sector can vary in their nature, for example for a role of a
paramedic you may want to consider the use of psychometric testing, these can
identify an individuals skills, personality and knowledge. The advantages of using such
methods allow recruiters to make decisions on potential job performance.
Psychometric tests can vary which means they are able to be adapted depending on
the role organisations are recruiting for. Often personality and aptitude tests can
assess whether an individual is right for the role. However, this can only be of use if it
is clear the results organisations are hoping to find prior to the process. Staff that will
action such tasks is also important, since a team of individuals will need to be selected
to form a panel, this can be crucial to the process as individuals within this team need
to be clear on who it is they are searching for and how they will fit into the organisation
with the current workforce. Group tasks can be another way of recruiting staff, for
example in social care, candidates can be observed in group situations in responding
to given scenarios. Observations in these circumstances can ascertain whether
candidates are able to work well in situations, such as working under pressure and
within time constraints which can often affect their performance in the real working
world.
Seeking the right candidate through attracting the right candidate is critical to recruit.
Consisting of ensuring the job description and person specification are correct, and
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reflect the position to be filled. Advertising the post would also help towards seeking
the candidate, therefore how and where to advertise is critical to allow potential
candidates to know about the vacancy and apply. Decisions on where they hope to
recruit from will depend on how this process will work, since candidates that
organisations may consider could be internal to the organisation itself. However,
external advertisements may involve professional associations, media, and
employment agencies. This is a critical part of the process because an organisation
wants to attract the candidates to make them aware there is a vacancy within the
organisation, limiting the advertising methods will limit the number of candidates that
apply which could be negative to the process and halt it altogether. Organisations can
consider where to advertise by evaluating pros and cons.
http://textbook.stpauls.br/human_resources_student/page_01.htm. (7)
Once candidates start to respond to the vacancy, the panel is now able to filter
through the applications received in order to start shortlisting their potential
candidates. If this part of the process is not carried out effectively, organisations may
miss potential candidates or spend longer interviewing people that did not meet the
initial criteria, and therefore waste time. The process will sieve through applications
and create a pile of successful candidates that meet the job specification and seem
competent to be able to do the job. Screening applications for their experiences,
skills and personal attributes will allow the list of potential candidates to be
populated. After a process of short listing, potential candidates are now ready to be
interviewed, ensuring enough notice has been provided. Organisations must ensure
sufficient notice has been given to the candidate to prepare. A poor choice of
candidate could mean an organisation is putting themselves in a situation where they
hire someone who is not performing in contrast to the right candidate, who is able to
make a difference to the business. Through a process of elimination, the right person
should be appointed, it does not always guarantee they will accept the terms of the
contract being offered.
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The final stage of the interview has its pros, as you are finally able to meet the
candidate you have read about and they too are able to get a feel for the ethos of
the organisation. This level of opportunity allows the panel to get acquainted, you
can see how candidates are able to respond in person allowing both parties to
determine whether they are suitable. The interview process allows the panel to ask
questions which may not be listed or outlined in the application, this process could fill
the gaps. This process can take many forms, interviews are generally formal, but can
involve a structed one to one interview, group interviews and panel interviews.
The final stages will involve checking the candidate possesses all that they say.
References should be checked, verifying their experience and character. The reference
received should include an employees past information regarding their conduct,
behaviour, attitude and work performance. In health and social care a medical
examination is also required, forming an essential part of selection. The physical and
mental health of the candidate is assessed to see if the candidate is fit for the
role. Final Selection means they have passed all the stages and can be appointed. An
appointment letter is usually sent out outlining the job description, title, role
responsibilities, salary and benefits associated with the role. The companies
employment policies may also be included.
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Appendix B
Evaluate the recruitment process with links to legislation and policy.
Although the recruitment process can be complex, factors an organisation will need
to consider include legislations and policies within the UK. Health and social care
providers will need to adhere to these when going through the stages. The Equality
Act (2010) is the most single powerful legislation that protects individuals from
discrimination. The single legislation was formed in October 2010 from several
discriminative legislations in existence at the time, and still refers to those groups of
people in previous legislation labelled the protected characteristics. The protected
characteristics are made up of; age, disability, gender reassignment, marriage and civil
partnership, pregnancy and maternity, race, religion or belief, sex and sexual
orientation.
Discrimination of these protected characteristics can create many issues for an
organisation which could result in a number of negative consequences such as poor
reputation, fines or even closure of the service or business. It is therefore crucial
businesses understand the types of discrimination that form as part of the Equality
Act. Direct discrimination is when an individual has been disadvantaged or treated
less favourably than others because they have, or are thought to have a protected
characteristic. Indirect discrimination can occur if an individual who has a
protected characteristic is disadvantaged due to a policy, rule, or procedure in place.
Discrimination by association can be an issue if an organisation directly discriminates
against someone because they are associated with a person who possesses a
protected characteristic. Perception discrimination can occur if an individual feels they
are treated less favourably because others feel they have a protected characteristic
(this type of direct discrimination is still relevant, even if the individual does not really
possess that characteristic). Victimisation is when an employee has maliciously made
or supported an untrue complaint, the organisation is not protecting them.
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Victimisation may occur if they have raised a grievance under the Equality Act or,
because they are alleged to have done. Harassment can occur if an employee has
unwanted conduct related to a pertinent protected characteristic. Harassment is
conduct that violates an individuals dignity or fosters an environment that is hostile,
intimidating, degrading, offensive or humiliating for that individual.
Implications of the Equality Act for the recruitment process
If a candidate is rejected for employment related to their disability, this is viewed as
disability discrimination, if the candidate has the correct qualifications, skills and
experience, they can build a case of direct discrimination. The organisation in this
instance can be taken to employment tribunals to hear their case, unless the
organisation has justification that is a proportionate means of a genuine intention. An
interview panel should be aware of the Equality Act and ensure questions about health
and disability are not asked, unless there are grounds to do so, especially before a role
is offered to a candidate. Prior to the legislation, health related questions would
appear on application forms, however, if a person is deemed to possess the skills and
knowledge, their health or disability should not matter. Employers have a duty to
make reasonable adjustments to the premises or working practices in order to
accommodate individuals with health or medical issues, which may be identified once
a role is offered.
During the process of the recruitment and selection stages, organisations should take
notes that are clear and transparent, this could start with the rejection list of those
candidates that are not short listed. It would need to extend to the performance of
the candidates that are invited in to map across what parts of the job specification
individuals are matching inline with the skills, experience or knowledge.
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If a candidate does believe they have become a victim of discrimination at any stage
of the recruitment and selection process, they are able to take their case to a court
or a tribunal. This will only present an issue for the organisation if they are able to
prove that discrimination has taken place. If they are, a court or tribunal will uphold
the complaint except if the employer is able to evidence an alternative credible
explanation for its treatment of the candidate, which is nothing to do with a protected
characteristic.
Equality and Human Rights Commission
Organisations need to be aware of the Equality and Human Rights Commission (8)
whilst they are not an Act or legislation, they are a service that:
promote and uphold equality and human rights ideals and laws across England,
Scotland and Wales.
https://www.equalityhumanrights.com/en
Organisations would need to ensure they are working in a manner that does not put
their company and working practices into dispute. A consortium on this level imposes
equality legislation on gender, race, disability and health, age, religion, sexual
orientation and transgender status, and encourages compliance with the Human
Rights Act 1998. Organisations such as these can support working practices, they are
able to commission help and guidance which can result in ensuring working practices
are legal and fair. This can provide organisations with confidence and clarity when
embarking on the recruitment and selection process. Having knowledge and
understanding of such organisations means they can provide organisations ideas on
how they can make reasonable adjustments and consider new ways of working. They
provide information and updates of the law which can help organisations and their
employees to understand discrimination and rights in a transparent way. Use of the
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website provides a breadth and depth of areas of the law and how employers can
comply with them. The information provides examples to employers of how working
practices can be adapted to provide for all employees regardless of their protected
characteristics.
Various policies can form part of the recruitment and selection process which include
necessary checks as part of organisational policies, this can be due to the requirements
of the Government. Therefore, some policies can impact upon the selection of
candidates, since policies such as the pre-employment policies involve a number of
checks to ensure the candidate selected is appropriate for working in the organisation,
especially in health and social care where employees should possess certain skills,
knowledge and qualities. If an organisation has offered a candidate the job because
they meet all criteria, they must legally complete the necessary checks including the
Right to Work check. An employer, or those who hold a responsibility to recruitment
and employ individuals, must understand their responsibility to carry out a right to
work check, and ensure they are complying with the law. This check should be
completed whether a candidate has been offered the job orally or in writing. (9)
Criminal record checks are also required to be undertaken by employers as part of the
pre-employment checks. As previously mentioned, it is essential that recruitment
practices are effective, fair and robust whilst focusing on the need to safeguard
vulnerable people. Organisations have help and guidance around recruitment and
how to retain a suitable workforce without discriminating against those who may hold
criminal convictions. HSC employers are required to carry out criminal record checks
as part of their organisational pre-employment vetting policies. It is often a
preconception that if you have a criminal record it is an automatic barrier to working
with children or adults at risk. Despite this, employers may have recruitment policies
or practices in place that inadvertently exclude people with criminal records, creating
a barrier to open recruitment. According to Skills for Care (2019):
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There are more than 11 million people in the UK with a criminal record which is
more than 20% of the working-age population .
Organisations must ensure their recruitment and selection policies do not
disadvantage all candidates. Instead, employers should consider a range of low level
offences they consider to be low risk and also focus on reasons of the offence and
when it actually took place, for example, if a candidate committed a shop lifting
offence 22 years ago, this may be considered as minor when a person was young and
foolish. (10)
The recruitment and selection process can be very daunting if you are not familiar with
legislation and policies. As the employer, you can be liable for a civil penalty if you are
not adhering to the laws and policies. Court and tribunal cases could expect to want
to see justifications as to why individuals were not employed and how the decision
was made. Various organisations are available to provide guidance on how to ensure
recruitment practices are legal and transparent. ACAS, is an organisation that too
provide employers with guidelines, suggestions and advice.
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Task 2
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2.1
See Appendix A
Forming involves the group of people coming together for a common purpose, the
goal and reason may not be obvious at this stage. The initial success of the group will
depend upon the clarity of the mission assigned to them, their experiences prior to
this and their familiarity with each other.
Storming due to varying opinions and thoughts of the task. This stage can see
disagreements on the vision of the task and how to approach the project. This stage
is inevitable, since practitioners have a ray of expertise, knowledge and skills they
could clash on how to agree.
Norming stage has allowed the team to work together. This enables progress on the
teams objectives, whether this notion is consciously or unconsciously. Entering the
forming stage means members of the team have agreed amongst each other to abide
by the group norms that act like ground rules.
Performing is the stage where teams can really progress well and work towards
achieving objective and goal(s). A fully functioning team observes relationships and
team processes that are synchronised towards working to their mission as a successful
team. Any conflicts and problems are pre-empted and dealt with in an appropriate
and timely manner.
Adjourning Throughout this stage, team members may look at other opportunities
that are available to them and want to pursue these. With the team meeting their
purpose, a new team or objective may be available and involves different
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practitioners, allowing the process to start again. Eventually many teams will reach
this stage and then be disbanded.
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2.2
See Appendix B
Within some health and social care services a common type of team is formed, such
as a function work team, where teams work together, and a leader oversees the
work. These are permanent teams, functional teams who share a shared goal. For
most of the time, members manage themselves and work independently and can
manage matters. The team leader is there to brief, direct and update team members
of their targets. This could for example be in an Accident and Emergency Triage.
Inter-professional collaboration is when multiple professionals, service users and their
families work together to achieve a common goal. For example, if a needs assessment
for a patient was being undertaken, it would include the involvement of all identified.
In cases such as these, practitioners involve the patient and the relatives to input their
thoughts and opinions, and draw up a management plan based upon the health needs
of the individual. This approach is commonly used in in modern day health and social
care, as a person-centred approach is one that puts the service user at the heart of
the service.
Task Force are teams that are formed to focus upon a specific critical problem. Teams
of this nature are formed for specific purposes and work to find solutions. Teams such
as these can be generated when research or statistics have presented an issue that
the current services cannot handle, for example, the current pandemic of Coronavirus,
the threat of the virus has meant various specialists, researchers, government officials
and organisations such as the WHO coming together to look at how to handle the
situation.
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2.3
See Appendix C
An appraisal provides an opportunity for feedback to an employee in a constructive
way. A manager may discuss their strengths and how these are applied whilst
discussing why other parts of the performance were not so successful. By highlighting
areas for development, an individual can recognise how their contribution and
performance fits into the wider strategic plan. Appraisals can therefore help improve
their performance and organisations may reward this with pay increases or rewards.
Setting clear actions in the appraisal allows an individual to remain motivated and
trust in the team they are part of. It also opens a window of opportunity to move on
in the organisation if that what the employee desires.
Appraisals can improve team development because all individuals are able to reflect
on their performance, whilst receiving feedback on how a manager or other
stakeholders view their contributions. If all members of the team received appraisals,
whether this be individually or collectively, they would all be rejuvenated to achieve
more. They would be more conscious of their behaviours which may bring the team
down and want to work to change this. In turn, this would ensure that members
individually are able to have clarity and direction towards the goals and purpose. This
would allow teams to stay within the performing stage as employees may receive
ideas and constructive advice on how to achieve their full potential. (10) If appraisals
can allow one to understand how their role is making a difference, employees can see
value in what they are doing which would benefit all they do towards their team goals.
The appraisal will allow employees to re-connect with the strategic plan providing
clarity on activities and priorities, for example, NHS staff may be benchmarked against
the Knowledge and Skills Framework.
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References
(1) NHS England: Building Collaborative Teams.
https://www.england.nhs.uk/improvement-hub/wpcontent/uploads/sites/44/2019/01/Building-Collaborative-Teams-workshop-guide2014-1.pdf Accessed 16/04/2020
(2) Cambridge Dictionary (2020) Teamwork.
https://dictionary.cambridge.org/dictionary/english/teamwork Accessed
16/04/2020
(3) Anon. (2017) Team Management: Tuckman.
https://www.businessballs.com/team-management/tuckman-forming-stormingnorming-performing-model/ Accessed 16/04/2020
(4) NHS: Team Working and Effectiveness.
http://homepages.inf.ed.ac..pdf Accessed
16/04/2020
(5) Green, B., Johnson, C. (2016) Interprofessional collaboration in research,
education, and clinical practice: working together for a better future.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360764/ Accessed 16/04/2020
(6) National Health Executive (2019) NHS: Taskforce aimed at young peoples mental
health, learning disability and autism care.
http://www.nationalhealthexecutive.com/Health-Service-Focus/nhs-taskforceaimed-at-young-peoples-mental-health-learning-disability-and-autism-care Accessed
16/04/2020
(7) National Institute for Health and Social Care Excellence. How individuals can get
involved joining a committee to develop guidance.
https://www.nice.org.About/NICE-Communities/Publicinvolvement/Developing-NICE-guidance/Factsheet-3-contribute-to-developingpublic-health-guidance.pdf Accessed 16/04/2020
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(8) Healthwatch (2015) Advisory Groups
https://www.healthwatchtowerhamlets.co.uk/wpcontent/uploads/2015/04/Healthwatch-advisory-group-pack-15-generic.docx
Accessed 16/04/2020
(9) McLellan, H. Batemen, H. Bailey, P. (2009) cited in the Journal of Interprofessional
Care. The place of 360 degree appraisal within a team approach to professional
development. https://www.tandfonline.com/doi/abs/10.1080/13561820400024290
Accessed 16/04/2020
(10) Armstrong, M and Taylor, S (2014) Armstrongs handbook of Human Resource
Management Practice 13th Ed London, Kogan Page
(11) Bratton, J and Gold, J (2012) Human Resource Management: Theory and
Practice 5th Ed Palgrave Macmillan
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Appendix A
In working environments such as health and social care there not many jobs that
require practitioners to work alone. In fact, all roles would require professionals to
work together irrespective of their title role. Effective teamwork is therefore
important as it helps promote positive behaviours and attitudes within the workplace
when staff demonstrate a willingness to assist when required. According to NHS
England (2013) (1):
Integrated care and support… is the means to the end of achieving high quality,
compassionate care resulting in better health and wellbeing and a better experience
for patients and service users, their carers and families.
https://www.england.nhs.uk/improvement-hub/wpcontent/uploads/sites/44/2019/01/Building-Collaborative-Teams-workshop-guide2014-1.pdf
A joint approach can provide a better experience for people who use health and social
care services. Practitioners communicating work would have less duplications which
would save time and improve working relationships. Effective team working can
provide a sense of team spirit and allow them to work using their strengths. This will
also improve morale in the workplace. Teamwork has now become a necessary part
of working practices as more people working together can be productive and provide
a quality service. According to the Cambridge Dictionary (2020) Team working (2) is:
the combined actions of
a group of people working together effectively to achieve a goal
https://dictionary.cambridge.org/dictionary/english/teamwork
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Therefore, a team can comprise of a group of people with different skill sets in various
functioning roles to come together to work towards an objective. Teams coming
together and working in collaboration can take time, the bigger the team the longer
this can take, however, if individuals have the desire to want to work together
collaboratively, then through nurture and commitment, teams can be productive and
happy as a unit working towards a common goal. Teamwork is highly interactive and
empowers people to work together in times of challenge and when there may be
struggles. If teams foster good relationships, they can promote a sense of achievement
and respect each others contribution whilst providing support if team members are
struggling. Teamworking in health and social care can allow colleagues to learn from
each other and build on our knowledge and practice from more experienced
practitioners in a team. (3)
Development of teams
Psychology has played a huge role in examining the role of team development, a
professor named Bruce Tuckman was the originator of a widely used model called the
Team Development Model created in 1965. He advocated that a teams success
would be reliant upon content, process and feelings. The model initially had four
stages: forming, norming, storming and performing. However, in 1977, following
further exploration added a fifth stage called Adjourning. Tuckman believed every
team experienced these stages and, regardless of the sector, he suggested that all
teams go through a somewhat unproductive stage initially, before becoming a team
that is productive and self-sustaining. Tuckmans model, the theory, can be applied to
any team. The time taken for a team to progress through each stage is often dictated
by the knowledge, skills experience and the support given by those that make up the
team. Teams may not enter all stages, and some may stay in certain stages longer than
others, ultimately it would depend on how the team function. Ultimately, success
would rely on influencing factors such as team changes, obstacles and issues which
causes teams to work at varying speeds. At times where obstacles are in the way of
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achieving the goal, teams may regress back within the stages depending on input from
the team.
Stages of Team Development
1. Forming involves the group of people coming together for a common purpose,
the goal and reason may not be obvious at this stage. The initial success of the group
will depend upon the clarity of the mission assigned to them, their experiences prior
to this and their familiarity with each other. In this first stage goals or expectations
may not be clear. The important factor at this stage is that the team is able to set goals
and agree processes with all members of the team involved. Boundaries are usually
set and agreed. Team members get to know each other with a view that they are trying
to work together towards their common goal. The initial forming stage can raise
anxiety amongst group members, some may implement a wait-and-see attitude, as
they are uncertain how this will work. Sceptical attitudes such as these, mean people
tend to be formal to each other. Most members of the group are polite and positive.
There is a mixture of excitement to work towards the goal but a sense of anxiety due
to the unspecified tasks and uncertainty ahead. The team are getting to know
everyone and becoming more familiar, allowing them to feel at ease. The variation of
personalities could determine how long a team stay in this stage.
2. Storming due to varying opinions and thoughts of the task, this stage can see
disagreements on the vision of the task and how to approach the project. This stage
is inevitable, since practitioners have a ray of expertise, knowledge and skills, they
could clash on how to agree. There may also be an awareness and frustration about
the amount of work required to fulfil the goal. Members of the team may be keen but,
are still learning to connect with each other. Team members may react differently at
this stage, some may be raring to go whilst others may push the boundaries. Whilst
teams go through each stage, communication will be vital however, more so during
the storming stage. Teams should recognise and value differences with all members
making an effort to take part in meetings and attend where required to do so. As
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people work in different ways, members may start to show their true nature, this can
cause issues. If individuals are not seeing progress with a specific task, they may start
to take over causing conflict. Some members of the group may resist being assigned
tasks as they question the team’s goal. If members of the team have not built a rapport
with each other, they may encounter stress due to the lack of support for them to
complete the task. This stage can see teams fail if they are not able to put their
differences aside.
3. Norming stage has allowed the team to work together. This enables progress on
the teams objectives, whether this notion is consciously or unconsciously. Entering
the forming stage means members of the team have agreed amongst each other to
abide by the group norms, like ground rules, enabling the team to function together.
During this stage, members must feel comfortable with the processes and whatever
changes are planned. In members not feeling comfortable, teams can see that conflict
could easily rise again, if this occurs the team may lapse into the storming stage, the
cycle must then continue its due course. In order to minimise this, or avoid it
altogether, would enable conflict resolution. Improved involvement of members
with commitment and a stronger bond is observed amongst them. Feelings amongst
the team are greater at this stage as the team aim to move to the next stage of
productivity. This stage finally allows teams to resolve individual and team issues.
Teams realise they are in this together and want to work towards the same goals. The
norming stage can be lengthy and overlap between the storming and norming stages
as conflicts arise.
4. Performing is the stage where teams can really progress well and work towards
achieving objective and goal(s). A fully functioning team observes relationships and
team processes that are synchronised in working towards their mission in being a
successful team. Any conflicts and problems are pre-empted and dealt with in an
appropriate and timely manner. A performing team always maintains communication
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amongst its team members. This stage is when members of the team have undertaken
any training and are self-motivated, able to solve problems themselves and be
competent. The team is now well established and matured, productivity is high, and
all members of the team know their responsibility. It is important that team members
do not become too complacent and continue to receive support with their skills set
and knowledge. The hard work and efforts from the teams means individuals have a
sense of belonging and accomplishment. If members join or leave at this stage there
will be less disruption, as there is cohesion and consistency amongst the team. If a
team does not reach the fourth stage, they are not fully effective.
5. Adjourning Throughout this stage, team members may look at other
opportunities that are available to them and want to pursue these. With the team
meeting their purpose, a new team or objective may be available and involves
different practitioners, allowing the process to start again. Eventually many teams will
reach this stage and then be disbanded. Occasionally, organisations may disband
permanent teams through organisational restructuring. Teams can debrief and
examine areas of good practice. Some members may find this stage difficult, especially
if close relationships were formed with colleagues or those that like routine,
particularly if they have an uncertain future.
Show Me
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Appendix B
The NHS (4) value teamwork and have a plan of how this will look:
Old-fashioned demarcations between staff mean some patients see a procession of
health professionals… Information is not shared and investigations are repeated …
Unnecessary boundaries exist between the professions which hold back staff from
achieving their true potential.Throughout the NHS the old hierarchical ways of
working are giving way to more flexible team working between different clinical
professionals.
http://homepages.inf.ed.ac.uk/jeanc/DOH-glossy-brochure.pdf
The purpose of effective teams is to provide structure that will provide patients and
service users with quality care. However, in HSC they can be many types of teams
depending upon the nature of the task. Teams generally found within these services
include those that are permanent and temporary. Permanent teams are those that do
not dissolve, they do not reach the final stage of adjourning once the task is
complete. Teams that are permanent generally know each other well and work
together regularly. Teams such as these can be specialised, work towards long
standing goals, and want to continue improving the care for patients. Whereas
temporary teams dissolve once their goal is accomplished. Teams such as these can
be formed to aid permanent members for a short-term basis, for example, when
pressure is on the health service during the winter season.
Within some HSC services a common type of team is formed, such as a function work
team, where teams work together, and a leader oversees the work. These are
permanent teams, function teams who share a shared goal. For most of the time,
members manage themselves and work independently and can manage matters. The
team leader is there to brief, direct and update team members of their targets, this
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could for example be in an Accident and Emergency Triage. Many teams in health and
social care function this way, various departments within a hospital would have this
type of working where they are working together with an advanced practitioner. This
can be in various roles, for example a matron on the ward. Several teams work
together with a leader overseeing the operations day to day, such as teams that are
generally self-sufficient, but require input or advice. Leaders at this point should
provide clear direction to practitioners requiring clarity.
Inter-professional collaboration is when multiple professionals,service users and their
families work together to achieve a common goal, for example if a needs assessment
for a patient was being undertaken, it would include the involvement of all identified.
In cases such as these, practitioners involve the patient and the relatives to input their
thoughts and opinions and draw up a management plan based upon the health needs
of the individual. This approach is commonly used in modern day health and social
care, as a person-centred approach is one that puts the service user at the heart of
the service. Interprofessional collaboration can be a means to solve problems and
complex issues, allowing participants to achieve more than it was possible to
individually. With ICT widely used across HSC sectors, it means this practice can be
used across various departments across any level of a structure. Working in such ways
can allow businesses to work efficiently whilst being able to retain their quality of
service. Co-ordinating services can save time and allow practitioners to learn from
each other and provide their level of expertise to the case. Working in such ways in
practice over the decades has formed the acronym IPCP standing for Interprofessional collaboration in practice. (5) The World Health Organisation (WHO),
cited in Green and Johnson (2016) state:
Researchers at WHO have found that health care workers who are team players are
the ones who succeed in austere situations dealing with extremely complex issues.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360764/#i1042-5055-29-1-1-b10
Multi-agency working is a common way professionals from various services get
together and work to a common goal. Multi-agency working allows specialists from
various backgrounds to provide responses to complex cases. These teams can be
temporary or permanent, depending on the nature and complexity of the cases.
However, in these types of teams, individuals will need to be clear about their
contribution and role. Multi-agency teams can allow a variety of services to work
together to form a care package that is individual to the service user. This involves a
range of specialisms such as mental health nurses, social workers, and substance
abuse specialists. Although, these types of teams can have detrimental impacts on
vulnerable people if communication is not clear, these can form serious safeguarding
concerns and could be fatal.
Task Force are teams that are formed to focus upon a specific critical problem. Teams
of this nature are formed for specific purposes and work to find solutions. Teams such
as these can occur when research or statistics have presented an issue where perhaps
the current services cannot handle, for example, the current pandemic of Coronavirus.
The threat of the virus has meant various specialists, researchers, government officials
and organisations such as the WHO coming together to look at how to deal with the
situation and how as a country, we will respond to an invisible enemy without the
National Health Service (NHS) collapsing due to the pressure that may be placed on
the service. However, task force can used in situations that require our attention such
as the Mental Health Crisis, a task force team would be comprised of specialists such
as nurses, doctors, psychiatrists, psychologists and other professionals to come
together to work out a solution. The team can evaluate the best approach to issues
currently being experienced, such as inappropriate care, out of area placements,
length of stays and supervise the development of closer-to-home alternatives to
care. (6) Simon Stevens, cited in National Health Executive said:
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This taskforce will place a spotlight on services and care for some of the most
vulnerable young people in our society, bringing together families, leading clinicians,
charities, and other public bodies to help make these services as effective, safe and
supportive as possible for thousands of families.
http://www.nationalhealthexecutive.com/Health-Service-Focus/nhs-taskforceaimed-at-young-peoples-mental-health-learning-disability-and-autism-care
Committees are formed when there are common. The work of committees can be
temporary or permanent, depending upon the purpose and nature. These types of
teams may be formed in health and social care, if they are managing or scrutinising
work that has been conducted. Committees can be formed to discuss projects to
discuss various viewpoints and the functioning of projects to shape strategic decisions.
Members of these types of teams should be able to apply their skills and knowledge
to changing situations. Teams such as these can review policies and performance in
relation to HSC services, Public Health and Local Healthwatch. Committees can be
formed for various reasons such as to establish trends to care, help and assist with
primary or secondary care issues, and to make recommendations from a specialist
point of view on how to move forward, for example through strategies with clear aims
and funding attachments. Committees can be formed for various reasons in HSC, for
example to make services more integrated, to reduce inequalities, to safeguard
vulnerable individuals and to generally improve HSC services and access. (7)
Advisory teams are formed in health and social care to help service delivery. The
groups are formed with a purpose to make a difference and benefit service users. An
advisory group will identify key public concerns and community engagement. Teams
such as these are appointed on their special interest in that group, for example if an
individual wants to get involved in services regarding mental health, they may be able
to apply for a position to represent opinions from this specialist group. Advisory
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members provide feedback about their experiences using the service, their policies
and suggest how these could have been improved. These teams have increased in
their numbers since the introduction of the Health and Social Care Act 2012, which
required local authorities to set up a new organisation called Healthwatch in 2013.
The reform which centred around the principle no decision about me, without me,
meant service users and the community must be at the centre of service delivery.
Advisory teams encourage diverse local people to come forward to empower them
to share their views to shape services in HSC. (8)
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Appendix C
The culture within HSC is one of progression and development, striving to provide
quality care whilst being able to meet an organisations goal. To manage both
commitments, there is a need to develop staff to ensure employees are all working to
the required standard to meet organisational targets. To manage such processes,
companies use an appraisal to systematically evaluate performance, this approach can
praise, encourage and reward employees for their contribution to strategic goals of
the company. The appraisal is usually carried out by a line manager and comprises of
a formal meeting held annually to evaluate performance of employees. The meeting
may build in dates to review targets in the year, for example within three to six
months. The appraisal reviews the performance of employees and may look at setting
targets for growth. The meeting allows the employee to input into decisions that are
made in order to be supportive. Although, these yearly meetings should not be the
only tool used to provided employees with positive comments about their
performance. Generally, employees should have an idea of their performance prior to
an appraisal and there should not be any shocks for an employee. Appraisals are a
humanistic approach, they look at performance as a whole. What an individual can
bring to the organisation is important, as their personality, the culture of the
environment and how they can contribute is important.
There may be many types of appraisals within health and social care since team sizes
and organisational objectives vary. A traditional appraisal is one where a manager and
employee would meet face to face to review how the employee has performed. The
employee may be asked to complete a document or questionaire prior to the
discussion. However, this does not take the domination away from the manager, they
would still use their data and observations to form the basis of the discussion. Once
these have been discussed in a constructive way, actions may be set with dialogue
around how these can be achieved. Self-appraisal is another form of appraisal
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organisations may use, this allows staff to assess their own contributions to
achievements and failures. This approach allows the employee to self-manage their
development and take ownership of their performance. However, a modern approach
to appraisals are 360-degree appraisals, this considers the whole person and be seen
as a holistic employee review, this factors in how the team feel about the individual,
their performance and contributions towards meeting the organisational goal. (11)
This approach supports team development as it allows team members to comment on
the strengths and areas for improvement for employees, in turn allowing them to
constructively take on board the feedback and move in a more positive direction. In
doing an appraisal in this manner, team development can be supported since they are
able to make the necessary changes or work towards them to allow the team to get
stronger. According to McLellan et al (2009) cited in the Journal of Interprofessional
Care(9), early experience of this approach:
suggests that the approach enhances understanding of roles and responsibilities
and is supportive to interprofessional team development.
https://www.tandfonline.com/doi/abs/10.1080/13561820400024290
Having feedback from a variety of sources including managers, colleagues, service
users and other team members allows judgements to be more formed and gives a
broader understanding of the capabilities of the person. However, it important to
stress that feedback is anonymised which means it does not cause teams to feel they
cannot be honest, likewise it does not impact the dynamics.
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Task 3
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3.1
Change is an inevitable part of modern-day society and it is an essential part of
organisational growth and prosperity. (1) The Business dictionary defines change as:
.the process of causing a function, practice, or thing to become different somehow
compared to what it is at present or what it was in the past. Companies can undergo
changes in a specific division, such as a marketing division, or as a whole
http://www.businessdictionary.com/definition/changes.html
Changes can be either natural or reactive. Natural changes can arise routinely in the
normal way of work, for example additional services and growth within departments
of a hospital. Which may lead to changing the way departments are managed. In
contrast, reactive changes arise as an organisations policies have required a response,
for example, some hospital Trusts are replacing paper documentation with digital,
resulting in staff in these particular Trusts having to adapt how they work and cope
with that change. Reactive changes are those actions that are planned and part of a
long-term strategy or vision. Either way, changes are brought in, to improve service
provision, provide a more efficient service or respond to needs of society. In order to
make the changes identified, organisations such as the NHS or Adult Social services
would need to adapt which may influence systems, processes, structure of the
organisation and roles both individually and as a team. Organisations may manage
change in a variety of ways, some organisations are able to have a team of experts
dedicated to researching and implementing change that will be accepted in the
company. The approach of change management allows teams to see the positives in
the shift to new working practices. There could be various factors that lead to change
including external factors or internal factors.
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External factors can drive change, these are outside influences, meaning there is little
that could be done to control it.
See Appendix A
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3.2
Appendix B
Model 1: Kurt Lewin Theory of Change
Many theories have been proposed providing a framework to aid the process of
change, they provide structure to leaders and managers. Managers and leaders in
order to monitor, evaluate and plan changes to provide a quick response to internal
or external environments. The models consider change in a practical way, due to a
type of chaos that considers many variables, for example the increased frequency of
change and resistance to change. Although, critics state it merges the process of
change which stimulate difficulties in prediction but also make control difficult. A
theorist Kurt Lewin, a physicist and social scientist in the 1940s developed a model
and theory widely used today, his model, Unfreeze Change Refreeze is an
analogy which involves changing shape of a block of ice. The three-step process of
change. (6)
Model 2 The ADKAR Model
Jeff Hiatt, a former engineer and change manager, developed a model in the
1990s. The main principle of this model is that for change to be effective it will be
dependant on the people involved. The model he developed was called The ADKAR
model, which emphasises that change that is successful can only occur when
everyone in the team is able to change. The name of the model is an acronym for
Awareness, Desire, Knowledge, Ability and Reinforcement (illustrated in the
appendix). Hiatt felt, as change is directly influenced by what happens at the individual
level, employees must support the change for it to be successful. For the organisation
to change, the team within that organisation must also change.
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3.3:
Of course, staff can become defiant in the process of change and can create a barrier.
If these are not overcome, then organisations could waste time, which can impact on
them working towards their strategic goals. Barriers that can be experienced by
organisations include communication issues, since change can be daunting, if
communication is not clear then information can be misunderstood or misinterpreted.
The reasons for this may be that managers that are sending the information and those
receiving are not in any discussions at the start of the process, this could be because
they are not listening or are hearing two different messages. Reasons for this could
vary, because the information could be influenced on what an employee has heard
from another employee, or their experiences of change at a previous place they
worked, it could be linked to whether they trust or respect the person that is delivering
the advice. Either way this is a critical element on employees accepting change, so
these barriers will need to be reflected on and managers will need to consider the
means and techniques that will be the best way of communicating with the employee.
(See Appendix C)
For successful change strategies, organisations should have a project plan. The plan
should have a clear start, middle and end. In addition, it is important to have a sincere
and personal understanding of the workforce and the human aspect of change
management. Successful plans would be able to align the organisations culture and
values with that of the people. By having this understanding and addressing issues
during the change process, the results should be more constructive. There will be no
one size fits all approach that would work in all situations, since it would be unique
to staff and organisations, but if the people are genuinely considered, they will be
more open and willing to change.
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Reference
(1) Business Dictionary (2020) Changes definition.
http://www.businessdictionary.com/definition/changes.html Accessed 17/04/2020
(2) NHS Confederation. (2013) Changing Care: Improving Quality.
https://www.nhsconfed.org/-
/media/Confederation/Files/Publications/Documents/Changing-care-improvingquality.pdf Accessed 17/04/2020
(3) Dixon, J. (2019) The Health Foundation: How are the political promises for health
and social stacking up? https://www.health.org.uk/news-and-comment/blogs/howare-the-political-promise Accessed 17/04/2020
(4) Social Care Institute for Excellence (2009) At a glance 4: Changing social care: an
inclusive approach. https://www.scie.org.uk/publications/ataglance/ataglance04.asp
Accessed 17/04/2020
(5) Lewin K (1947) Field theory in social science, Harper & Row, New York
(6) Kurt Lewin’s three steps model https://www.elsevier.es/en-revista-journalinnovation-knowledge-376-articulo-kurt-lewin39s-change-model-aS2444569X16300087 Accessed 17/04/2020
(7) The ADKAR model in
context https://expertprogrammanagement.com/2018/02/adkar-model-ofchange/. Accessed 17/04/2020
(8) National Institute for Clinical Excellence NICE (2007) How to Change Practice:
Understand, Identify and Overcome Barriers to Change,
https://www.nice.org.uk/media/default/about/what-we-do/into-practice/support-
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for-service-improvement-and-audit/how-to-change-practice-barriers-to-change.pdf
Accessed 17/04/2020
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Appendix A
External pressures for example can arise from competition from a new service
provision, customers and service users, government regulations and employees.
External influences can really drive a business to have to change, whether they want
it or expect it or not. New services that place your company into direct threat can be
enough motivation for an organisation to want to remain competitive. Many health
and social services can find themselves in threat of this since private organisations,
such as some residential homes, may need to look at the service they are offering and
adapt it to make it in-line with their competition or at least create a unique selling
point of their service. The direct threat would mean the company assess and respond
accordingly. Service users may drive change due to their increasing demands requiring
services to change with them. According to the NHS Confederation (2013) (2)
Patients need to be at the heart of everything the health service does and should not
fall through gaps in the system. People are living longer today and the health service
has to adapt to caring for the needs of an older population, who tend to have more
complex long-term conditions with multiple needs for clinical treatment, care and
support.
https://www.nhsconfed.org/-
/media/Confederation/Files/Publications/Documents/Changing-care-improvingquality.pdf
Many changes are taking place to suit service users such as integrated working, more
community nursing and working practicing changing to consider the technological
advancing population. GP surgeries are changing what they do and how they do it in
response to technological advancements, some appointments can be had via Skype.
Another change now includes the MyGp app, which allows you to make
appointments, cancel appointments, see a copy of your test results, and ask for advice
when messaging your symptoms. It is important services in health and social care can
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respond to service users needs because they are at the heart of the service. Service
users have seen many changes due to their individual cases, Health and Social Care
Act 2012, required work on the principle no decision about me, without me, meant
service users and the community must be at the centre of service delivery. The change
meant services had to be adapted around the needs on the individual and how they
wanted to see their care look like. Both factors considered meant it was clear that HSC
services had to make changes to suit reforms in legislations. The new policies and Acts
meant providers had to respond to change by adapting their services. If changes were
not implemented, services will not be meeting their legal obligations.
As a result of the changes contained in the Health and Social Care Act 2012, the NHS
is implementing one of the most radical reorganisations in its history. These changes
are dominated by the abolition of old organisations such as primary care trusts and
strategic health authorities, and the creation of new structures such as clinical
commissioning groups and health and wellbeing boards.
https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/transfo
rming-the-delivery-of-health-and-social-care-the-kings-fund-sep-2012.pdf
Economic factors can dictate the changes that need to be made to businesses since
the income of the organisation is the only way to keep it afloat. Economic factors can
influence HSC organisations positively and negatively, if the cash flow is good, then a
business can expand its services, employ more staff and continue to make changes
such as buying and acquiring land for expansion. However, if the cash flow is sparse,
this can present an issue of the viability if it can continue. Many health and social care
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providers are statutory services but are all limited to cashflow, and ultimately, must
operate as a business. As quoted in the NHS Confederation (2013) (2):
It is apparent therefore that new models of care are limited by the resources that
are available to deliver them, which in a no-growth health funding scenario will be
especially scarce. One of the main challenges is often not how services should be
changed, but how the whole process will be funded.
https://www.nhsconfed.org/-
/media/Confederation/Files/Publications/Documents/Changing-care-improvingquality.pdf
Technological advancements have allowed changes to take place in service provisions
across HSC. New products and services have allowed ways of working to be
transformed including roles requiring administrative tasks. Advancements has allowed
communication to open improve across various new platforms, connecting our
services locally, nationally, and internationally. Technological advancements and
improvements in communication and computer technology have transformed the
operations of the NHS. The current shift has made way to continue the improvements
into the future and involve new technology to help services to become efficient and
economical methods to perform work. Advancements in technology forces
organisations to adapt to new ways of working. Health and social care has also
benefited from advancements since it helps to save lives through medication and
devices, for example pace-makers, scanning devices, artificial organs, wireless brain
sensors and smart inhalers. These changes and advancements mean practitioners can
change their practice according to new technology available.
Politics can influence change in HSC in many ways since funding is directly provided by
the government. Political parties influence how the services in the NHS will be changed
strategically, since each party has their own mandate which outlines how they will
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drive changes. According to the Health Foundation (2019) (3) the Conservatives
pledged in England, to build 40 new hospitals totalling 13bn. These pledges are
based on raising productivity in the UK. Whilst Labour previously committed they were
going to abolish NHS prescription charged and making personal care for adults free,
whereas Liberal Democrats had mental health on top of the agenda. (3) Politics can
drive change in many ways within HSC since they provide stability and funding, but
they also outline legislations and how care will change. Change can take place often,
as direction of a government and political parties in power will have varying views on
what is best for the services in HSC. Policies over time have changed, however, the
Elections every 5 years can determine what policies and manifesto will be chosen by
the public to implement. Legislations passed will then drive change from the top of
the hierarchy, to the bottom. Political changes can also impact the social change, as
politics focus on eradicating health inequalities and look to ways the social issues can
be improved.
Internal factors can influence change in HSC, human resource policies changing can
have an impact, such as altering times of staff working if working hours were altered.
Altering working hours could see services extended their services into unsociable
hours to create a service that could be accessible to more people. Changes from this
level are usually to maximise efficiency and save the organisation money and reduce
spending which could be used in other ways. Staff would have to change and adapt to
new ways of working. The money saved from some departments are then reinvested
and can be used to update software and systems which too can drive change. These
updates can help staff complete their jobs more cost-effectively. These changes will
mean staff would have to accept the alterations made by the organisation. According
to the Social Care Institute for Excellence (2009) (4) Change can be positive but note:
Improving and altering a service can be a rewarding and exhilarating experience for
all involved. However, it also has the potential to be frightening and challenging
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https://www.scie.org.uk/publications/ataglance/ataglance04.asp
Sometimes changes have been brought about because people who are often seen as
difficult have astute ways of looking at things They know what the barriers are
likely to be, so you can use that to learn and see how you can get round them
Structural Changes that may take place internally in an organisation can also drive
change, reasons for this are mission changes or cost saving. These changes can be
where services are delivered and how they are delivered. The number of
managements tiers in the organisation may be flattened which could impact job roles.
Services such as care homes may need to change their structure due to the lack of
funding available from the government. This could mean changes have to be rolled
out across all services. Although mergers and acquisitions could also drive structural
changes, it may mean roles are duplicated, therefore restructuring roles may need to
be the only measure organisations can take. Resource constraints could impact on
changes in organisations, for example, if staffing of community nurses is not available,
then the service will need to change. Resources can place a positive or negative effect
on companies. If resources are available for an organisation they can expand or
operate as normal. However, inadequacy of the resources may result in changes such
as services being suspended.
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Appendix B
Like many sectors, change is inevitable in HSC. To understand change and its impacts,
it is recommended to understand the schools of thought surrounding how change can
be implemented in organisations across the service provision. Theorists have
introduced models of change which aim to explain how change can be implemented
and adopted.
When external and internal forces can put pressure on an organisation to change.
Rogers developed a theory in 1962 called the Diffusion of Innovation (DOI). Rogers
theory explains how, why and at what rate new ideas and technology described above
can be utilised. Rates can be dependent on acceptance rates. During the management
of change stage it is important to comprehend the characteristics of those who will
be expected to accept or delay the change. Rogers (1971) divided the model into five
categories of change adoption, with the majority falling into the middle group. These
characteristics are: Innovation, Early Adopters, Early Majority, Late Majority and
Laggards. (5)
Innovators are those people who will try the innovation, can understand the technical
information, and apply it. These individuals appear to take more risks and are keen to
take on new ideas. Early Adopters are those that embrace opportunities for change
too, but they enjoy leadership roles. Early Adopters have an awareness that there is a
need for change and can state their opinions to others, they are therefore happy to
adapt their ways of working. These people are able to embrace change and can be
discrete about their use of new ideas, which can then be used as an advantage to
others who may ask for help and support at a later date due to the respect others feel
towards them. Early Majority are individuals that adopt ideas before the others tend
to but are not in a role of leadership or management. People in the group may need
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to be convinced of the benefits and need to see evidence of how these new ideas are
working. In contrast, Late Majority are a group that adopt an innovation that is
cautious and only decide to adopt an innovation after they have seen it is working.
Late Majority individuals question and look from all perspectives. This can be an asset
to the group as they may get carried away with change. Groups can get carried away
with the innovation and not critically analyse procedures or results. Laggards are those
groups of people are very conservative and can be bound of by traditions and are
therefore the last group to adopt change. These people continue to make comparisons
to what things used to be like, may make decisions. Individuals may be doubtful of
change and are likely to be suspicious of all aspects of change processes. These groups
are hard to accept change. The diagram below illustrates the groups. (6)
(1971) Diffusion of Innovation Theory
Diffusion is difficult to measure because humans are complex. It is exceptionally
difficult, if not impossible, to quantify what exactly causes adoption of an innovation.
Persons encouraging adoption of health behaviours or new technologies need to be
mindful of the many forces acting on an individual and his or her decision to embrace
a new behaviour or technology. Theories cannot account for all variables, and
therefore might miss predictors of adoption which can lead to inconsistency.
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Model 1: Kurt Lewin Theory of Change
Stage 1 involves the process to Unfreeze. This stage involves planning the
organisation to accept that change is required and necessary. Survival of the business
can depend upon, for example, staff to understand a new legislation has meant ways
of working needsto be adopted. It could be argued that this stage is critical,since staff
are either onboard or not. Motivation for change must be generated before change
can occur (Lewin, 1947). Or else it will be tough to break down the present
circumstances before you can build up a new way of operating. It is important that
staff realise the current way of doing things cannot continue. This stage may be
stressful and difficult since staff may challenge what is being said. Some employees
may demonstrate positive responses because they are able to see the benefits and
effectiveness of the proposal. By getting an organisation to analyse their organisation,
it can create new stability. The want and need for change has been realised with an
element of readiness to move away from a comfort zone where we are feeling safe.
In completing a critical analysis of the position, this can influence the success of
change, this stage is known as a Force Field Analysis. However, to succeed the
factors for change must outweigh the factors against change then the change should
be made. If not, then there’s low motivation to change and the change is likely to fail.
The model does not consider that not everyone will be compliant straight away,
people need to be able to understand how these changes will affect them. Managers
in the organisation will need to be clear for an employee to jump on board and accept
the changes being proposed.
Stage 2: Change is known as the transition stage, it is the middle of the process. This
part requires people and the situation to be ‘unfrozen’ and are moved towards a new
way of being. After the insecurities created in the unfreeze stage, this is the stage
where people begin to resolve any uncertainties and investigate new ways to deal with
things. People may have changes in their attitudes and behaviours as they start to
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support and accept change. They are proactively participating in the change. Although
the transition from unfreeze to change does not happen instantly. They require time
for individuals to embrace and adapt to the changes. As each person is unique, each
will respond in different ways. A level of support and backing is required, particularly
by those who are managing the change process. In this stage, it is expected that for
high impact and success those involved would share their ideas and knowledge. The
process of sharing of knowledge could be from an external or internal source such as
contracted consultancy firms or from employees who have expertise.
Stage 3: Freezing is considered the final stage of the model, this is where stability is
reclaimed, and the changes have been agreed and now become the new norm.
People have now adopted the change and formed new relationships and become
confident and comfortable with their routines. Nevertheless, this can take some time
to achieve.
Model 2 The ADKAR Model
The model recognises that it is not just a process, but people within that process. The
focus is on outcomes rather than tasks. Communication like Lewin stated in his model
is key. If staff are able to communicate with leaders to understand and interact with
them, they will find it easier to adapt to changes. Staff must have the desire to be
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flexible and
adaptable, as the
emphasis is on the
individual this model
can help calculate the
progress of the
change and make
alterations where
necessary. The
weakness of this
model it is designed for incremental change therefore a narrow focus. However,
change at a macro level all at once, without increments, may not provide a successful
outcome. There are five consecutive actions, and their outcomes within this model
that are needed for successful individual change, and subsequently successful
organisational change. (7)
Awareness is the initial stage. It requires communication, and those involved in the
change, need to have some degree of knowledge and understanding regarding the
proposed change. There needs to be justification for the change and a real sense of
why it is required and this needs to be understood. The result of this step is that
everyone has an understanding and an awareness of the need to change. People will
not have the required motivation without a full justification as to why the change is
needed, and therefore, the change may not be successful.
Individuals within the team must have a desire, therefore the change must be
appealing and inspire the people. This could be achieved by managers of the change
appealing to the logical and emotional side of employees. In order for staff to really
understand change, it needs to be contextualised to individuals, clearly demonstrating
how the change will directly relate to their current position and how exactly they will
be affected by the change, also, a sense of what is in it for them. Individuals should
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also be given the opportunity to partake and be involved in the change process if they
wish to do so.
Knowledge and communication should be accessible to all considering their specific
needs. An employer should tell employees what they need to know. Irrelevant
information should be kept out of the equation. All involved in the change should be
provided with instructions on how they need to implement the transition. Information
should be provided through various forums, including training sessions, meetings, and
newsletters. They should then have the knowledge on how to change, which naturally
brings them to the next stage of the process.
Once an individual is armed with knowledge and communication, they have the ability
to make an analysis on whether their existing knowledge and skill sets can be mapped
against what is required in the change. Staff development could be considered at this
point to fill the gaps in knowledge and ensure staff are competent to fulfil the roles
and responsibilities they are required to do.
Reinforcement is the final stage. Once new change has occurred it needs to be
reinforced within everyone. Change now needs to be sustained. It is important to
maintain drive and motivation perhaps through some form of incentive for staff. This
may be a difficult stage to implement as staff may have moved or there is a new
change imminent.
The ADKAR model is able to see the change process from the viewpoint of the
employees, and therefore this model is more applicable to change faced in health and
social care. All roles within this service rely on the workforce to be able to deliver
quality standards of care. This model recognises that if change is embraced by
individuals, then they can drive this motivation and change working practices.
Whereas the Lewin model, assumes that people will change, therefore have critics.
Critiques of this theory suggest that it now does not fit with the modern world where
changes are occurring rapidly. Today, changes can happen in a matter of weeks, or
even less where there is no time to comprehend and settle into relaxed routines. A
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large degree of flexibility is required, it is suggested that the inflexibility of the freezing
stage does not fit with current thinking about change being almost a continuous,
sometimes chaotic process, demanding that there is more flexibility within the final
stage of this theory.
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Appendix C
Some employees may be in a comfortable zone at work and are therefore resisting to
change. Resistance to change can be one of the biggest causes of barriers to change.
As well as creating prospects, change can and does create anxiety and fear. People are
comfortable with an environment of safety with knowing how things stand and
therefore may see it as desirable or attractive. The uncertainty of achievement
together with fear of the unknown can obstruct change and create a position where
people are resisting change. Emotional reactions can cause people to resist change.
However, there are other drivers that influence the resistance of change. These
include:
Fear of the unknown. Together with the lack of communication can increase
the confusion and anxiety.
The potential impact on their work. This could include a person not
understanding where their role fits into the change.
A lack of trust in the people that communicate the change could present an
issue since they may not believe what is being said to them, and therefore want
to be resistant.
Personal reasons could impact an individual wanting to accept change. If a
person is close to retirement age, they may feel they do not want to partake
in these changes. Whilst someone experiencing poor health or mobility may
not have the motivation to retrain and adapt their lifestyle in this way. The loss
of routine may make some people uncomfortable, particularly if they have
been in a role for a long time.
Individuals may not agree with the change proposed due to their own values.
According to NICE (8) a lack of trust or relationship among managers and team
members could create a barrier to change. If the respect is missing, employees lack a
sense of togetherness and cohesion which could impact on productivity, due to this
they may not work well as a team. In addition, they may not hold the person
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commanding the change in high regard, as they do not respect their authority. The
leader may be unseen and not communicate efficiently with the members, and with
this, any opposition is likely to be poorly managed. Whilst lack of Motivation can also
be a key factor in resisting change. External factors such as incentives can drive
motivation and change behaviour. Therefore, a lack of incentives or pay may create
an internal barrier of employees not wanting to conform unless they can see there is
a direct benefit to them.
The achievement of the change be dependent upon the scale of the change, this will
impact how people respond to the change and determines how the change should be
managed. Drastic change frequently introduces radical change and change that has to
be implemented swiftly. This can cause employees to be moved too far from their
comfort zone as it may not be something they are familiar with. The result will be a
resistance to change. Whilst steady change will retain some familiarity, it does not
cause too much movement too far from what they know. Therefore, may not be as
big of a barrier unless there is a radical change.
Overcoming barriers to change
Organisational changes in an ideal world would be smooth and any resistance to
change. However, it is almost expected by an organisation that someone will have an
issue and create a barrier. The implications of such events can be effortlessly dealt
with by organisations if they are able to overcome the issues, therefore knowledge
and understanding of the internal and external factors driving the change is required
in order for the procedure of managing the change to be effective.
To overcome issues, the management needs to be realistic about the organisations
readiness to change. Consideration needs to be taken into their history and capacity
to change, these should be incorporated into the programme design and planning
required at the start. Management that leads change should ensure they are proactive
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rather than reactive in managing barriers in change. This process will see less
resistance and the approach more successful due to less resistance. By engaging the
right people at the beginning, input will allow people to be considered allowing
processes to be adapted if required to do so. Involvement may start with senior
members. From a hierarchy point of view, communication and planning may start at
the top, it will become clear which managers are likely to accept and welcome the
change. Allowing the top to embrace and accept the change would enable them to be
inspired and see the strengths and needs for a change in the workplace. A positive
culture should be created to get a sense of unity, and in turn this may create role
models when discussing the changes with all other employees. Involving all
employees that will be involved may create an environment that builds trust and
openness for staff to feel that they can discuss concerns and, have their questions
answered.
At this stage, providing a rationale for the change could allow humans to question to
what extent change is needed. Consequently, providing a rationale for the change may
be needed such as a written vision statement which could be invaluable. The written
rationale should confront the reality and the articulation of a persuasive need for
change. It should demonstrate confidence that the company has a sustainable future
and the management to lead them there. It may also include guidance for behaviour
and decision making to aid employees with the change.
Creating ownership for the change to be accepted will demand ownership of who is
behind the change. In doing so, employees can see management accepting
responsibility for the change and they are able to see there is a sense of ownership.
Incentives could be offered to staff, if they can identify any issues with the plan,
allowing them to feel a sense of involvement in the process. If communication lines
are open and clear, the successful change programs strengthen core messages
through regular, timely communication channels that are practicable.
Communications flow should be both bottom up as well as top down. High profile
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input from those who are leading the change is important, this can involve regular
meetings or being seen within and around the workplace.
Before change is implemented, organisationsshould consider the speed of the process
on the people involved. As the change process continues, understanding should be
given for the culture and behaviours at each level of the organisation. This ought to
be done at the start of the process and should continue to the end. Through constant
monitoring those responsible for managing the change can evaluate organisational
readiness to change, be vigilant and bring major problems to the forefront. They can
also identify factors that acknowledge and influence resistance and conflicts when
they arise.
Finally, organisations should prepare for the unexpected. It is rare that a change
programme runs smoothly and according to plan, there may be unexpected issues.
Effectively managing change requires constant reassessment of its influence on the
organisation together with the peoples commitment and ability to adopt the next
change. This evidence will increase the efficiency of decision-making and enable the
necessary adjustments to sustain results towards success.
Involve