Nhs Change Essay, Research Paper
IntroductionChange which has been well planned can in effect be the mostimportant contributory factor to any projects eventual success. Upton and Brooks [1995] say:’ dissatisfaction alone is not sufficient to bring about change:people have to believe that the proposed change would lead to animprovement ‘All staff within the NHS in recent years have experienced change[ref], particularly change that has been politically led andtherefore experienced a process which has in effect changed theconcept and culture of the NHS with the purchaser / providersplit. Philip Hunt [1995] says that while the NHS is no strangerto change because of the rapidly changing social picture since1948, it is acknowledged that in the four years since theintroduction of the NHS reforms, staff in the NHS:’ have had to see through one of the biggest revolutionswitnessed in any part of the public sector ‘Change is therefore often viewed suspiciously among health carestaff and effort is required to ensure that change is planned,,discussed and its purpose is understood. Planning Revisitedkey stagesKey PlayersThe initial four weeks were spent collecting information andspecking to those involved, the planning of the study days wasthe first to be compromised when my planned dates were deferredbecause of:finding a suitable hotel within my budgetavailability of speakersStaff developmentIn researching the planning for change in practice there was aneed to identify the importance of staff development to anorganisation, Hardy describe a developmentas………………… Within my own organisation I explored thepresent situation that existed and what the strategic objectivesfor the Trust were. There was also the added dimension of PREPand the expectation of staff that this should be provided by theemployer, regardless of the fact that a practitioners , nursesand midwives are responsible ultimately for their ownprofessional update. [find a ref]However the Trust were happy to facilitate and promoteprofessional development but there was and is only the limitedresources available. Review showed that co-ordination andplanning was what was required. The ultimate strategy to create aculture of learning and the promotion of personal development,this would give the basis for improved patient care [ref]Traditionally access to formal education is mainly provided byColleges of Higher Education [find ref] but as PREP makes animpact upon the formal learning needs of nurses, continuingeducation is provided in many formats. The American Nurses’Association has defined continuing education as:Planned, organised learning experiences designed to augment theknowledge, skills, and attitudes of registered nurses for theenhancement of nursing practice, education, administration, andresearch, to the end of improving health care to the public’This equates closely to the objectives of my change module,continuing education is not necessarily confined to educationalestablishments but should also encompass the practicalapplication of nursing skill and technology, as well asalternative means to gain new knowledge. Dolphin and Holtzclaw[1983] support this view saying that ‘non-academic’ training /update activities have significant impact upon professionaldevelopment.To this end managers must realise that technical skills andexperience alone will not achieve competence, importanceconsiderations such as developing analytical skills and anunderstanding of the practice environment need to be facilitated. Deane and Campbell [1985] consider this as paramount todeveloping professional effectiveness. Promoting ProfessionalismThere has been a drive by nurses towards greater autonomy andprofessionalism, nurses are now educated for registration ratherthan trained, and at a higher academic level. This began with therecognition by government of accepting the principles of Briggs[1972] and the creation of the Nurses, Midwives and HealthVisitors Act 1979, this created the United Kingdom CentralCouncil, which in its turn developed Project 2000 , and isresulting in the gradual but continuous shift towards degreelevel at point of registration. Harrison 1994 discusses this as aconcept of ‘new nursing’ and as’a manifestation of ………. professionalising drive’but will degree entry to the profession secure improved patientcare? or as is my belief improved continuing education anddynamic staff development be the key? What is known that alearning culture is required within an organisation [ref] and thechange project is the first step to developing that with theTrust. roles and responsibilitiesmanaging the transitionIn Handy’s concept of ‘Cultures and temperaments’ – Frank SinatraasApollonian: ‘I did it their way’Zeusian: ‘I did it his way’Athenian: ‘I did it our way’Dionysian; ‘I did it my way’ImplementationWard Managers Study DayThere are …. ward managers within the Countess and an importantpart of the change process was ensuring that all nurse managerswhere aware and prepared for the organisation and commitment totraining and continuing education of their nursing staff. Asthere was rather a lot of information that I wished managers tohave, I decided to hold a study day for them to impartinformation and provide them with learning material that wouldbecome a resource to them and the ward. I held the day away fromthe hospital for a number of reasons:to ensure attendance [past experience has shown me that this isseen by the managers as a treat as the executive have such days,previous attendance therefore has always been high]to ensure it was seen as a study day and therefore important totheir own professional development as nursesto gain their undivided attention – there was no chance to beinterruptedI wished to provide the following:update / information on the requirements of PREP and itsimplications to the Trust and their staffthe importance of a learning culture which incorporates trainedstaff as well as studentsinformation upon learning opportunities within the Trust and theSchool of Nursing that would require no financial use ofresourcesunderstanding of professional development and the role ofAccreditation of learning and experiencean introduction to clinical supervision and the concept ofsupporting professional developmentshow them the executive nurses and clinical managers commitmentand support to professional developmentA hidden agenda was one of my main objectives of my project andthat was capturing the training /professional update activity, Iused the study day to introduce the new method of collectionpreviously agreed with the data control manager for the Trust.I considered that this study day was of paramount importance asI was targeting an influential group of staff with the beliefthat this will encourage an evidence based practice by sowing theseeds of a learning organisation. Key contactsAlthough I organised the study day, I involved the department ofprofessional development and research, again there were reasonsthe first that if an expert is available use them and second itwould either put faces to names or introduce ward managers to keytutors within the department. This would enable furthernetworking and improve communication between the two services. Afurther reason was that the department would give certificates ofattendance for the managers to put in their portfolio. AssessmentThe study days were well received by the ward managers, as it washeld on two days to allow for maximum attendance. Those thatattended on the first session gave colleagues on the second dayquestions to ask presenters that they wished clarifying or
exploring further. There is also within the Trust a couple ofward managers who do not tend to turn up to these days but relyon colleagues to fill them in, they did attend one confirming herplace twice. The evaluations showed that they felt the day gave them animproved understanding of PREP and how to help facilitate staffto comply. The clinical supervision session made them aware thatas a Trust we have not addressed this, indeed following thesedays the ward managers are favourably inclined to theintroduction so mush so that a paper by the Clinical Mnager ofMedicine has been well received with positive support for thedevelopment. Most of the ‘when will we have time’ comments wereactively discussed on the day, and I was fortunate that thespeaker spoke from a facilitator and practitioners perspectivesharing reflectively his experiences. Training DirectoryThere had been a recent attempt within the Trust to capture asmuch of the training activity as possible during a Training NeedsAnalysis, however there was a reliance that providers of thetraining would regularly update the personnel department. Therewas also an assumption that the staff development paper includingthis information would be generally available to all staff, therewas also disappointingly little information on nursing activity. The department of professional development and research send toeach ward area details of the next years provision, however thisinformation is not always readily available to ward staff.With this in mind another important aspect of my change projectwas to produce a newsletter, however it soon became apparent thatthere was also a need for a comprehensive training directory forthe Trust. As I was collating the information for the newsletteranyhow it was logical to produce this however as it was to be forthe Trust and with the objective of creating a learningenvironment throughout it would therefore reflect all training.To achieve this I wrote to all those who I knew provided trainingsessions, updates or courses and asked them to provide me withtheir next 12 months intentions, I also asked each head ofdepartment. I informed them of my intention to provide a yearlydirectory supported by a quarterly newsletter, all wheresupportive of the idea which often seems to be the case if theyare not being asked to commit more to such a project. Timerestrictions within the project however required me toconcentrate on the information I received promptly so withrespect to the medical training opportunities I only included therolling half days. The compilation of the directory took over a month to producemainly because of other commitments within my schedule, thenewsletter took about a week to produce, collated from theinformation for the directory. Cascade of InformationTo ensure that all staff are aware of the directory andnewsletter, the concept was introduced to the managers at thestudy day and at senior nursing meetings. The Director ofPersonnel was involved as proof reader and resource of trainingactivity in the professions allied to medicine. The launch of thedirectory and newsletter was at the ‘Team Briefing’ in May by theChief Executive, this information is cascaded down to all staffwithin the Trust over a period of 3 days, those staff who are not’brief’ have access to the team briefing folder. Theeffectiveness of this method of communication is audited bypersonnel quarterly. AssessmentThe impact of this document will take a period of time to assessbut within the limitations of this project the following has beenidentified which could be because of the information provided toeach area:Capturing Training ActivityOne of the first things that I had to try and address was thecapturing of information regarding training. Prior to this theinformation was either kept by trainers [including the school] orwards, to try and collate this information proved impossiblewithin the last 4 months prior to the project when the Trustcould not identify all the activity within the nursing professionof achieving PREP requirements or those nurses with varyingoncology qualifications. To this end, with negotiation with thedata control manager it was agreed that the present system[Powertec] could be enhanced to capture the activity within theTrust. The department was already looking for ways to streamlinethe documentation that ward managers were having to complete andby revising the collection of sickness and collecting trainingactivity separately, the present data collection system whichthe ward managers need to use would become a monthly task ratherthan weekly. Each month a sheet with the names of each member of staff will besent to managers and using a simple code identify all training/update activity, there will also be a ‘census’ of allprofessionally trained staff to capture all their qualifications. This is because in the past the data inputted into the Powertechas only included the qualification required to practice such asRGN or RM, all other qualifications have not been included. This information while kept centrally will be available to allward managers should they wish to identify and cost the rainingactivity within their ward. Centrally reports to the NHSexecutive will be far easier and last minute demands forinformation on training easily accessible. Improving communication with the collegeWork began upon this collaboration well before the start of thefinal module. This was because I had discussed it at the Trust’snursing issues group [of which I am a member] as it was the bestforum, and the meetings were set up promptly by the groupschairman. These meetings encompass the following:trust collegeExecutive Nurse deanclinical managers head of professional developmentresearch and development officer head of midwifery EducationWhile initial discussions have focused on the provision ofservices [particularly midwifery] useful dialogue has takenplace. Issues such as pertinence of courses and numbers of placesfor Trust staff were raised. Uptake of modules by Trust staffneeded to be monitored as well as how many staff are indexing forthe Higher Award and degree, so we can plan the facilitation oftheir courses.The tutors also brought to our attention in-service training daysfor expanded skills that staff had attended but had not completedsupervised practice. Managers had been unaware of this waseffectively acted upon in the following weeks. The meetings are to continue on a quarterly basis to continue todevelop a liaison pertinent to both parties and ultimately ournursing staff. After the change / analysis’Co-ordination’ so often used and does not sound like aparticularly dramatic activity, but as Pollitt [1994] says whencontrolled it contains two important aspects of management:informationorganisationwithout managing these effectively co-ordination is impossible. Responses to changeWas it controlled changeWAS support given to cope with the changeEffects on the organisationI was fortunate in many ways with this change project, Iidentified something that was needed for nurses and theorganisation, I had co-operation from each service within theTrust to enable its inception and successful conclusion and thesupport of the senior nurse management team in their belief thatI would be successful. In identifying the need to provide a cohesive strategy toco-ordinate the training with the Trust, I had the luxury ofworking and facilitating my ‘ideal’ in an effort to providenurses with knowledge of the opportunities available to them.staff development has had a high priority with the executivefor some time, I also believe that from this project it now has a high profile with nurses, if they are supported by their wardmanagers and encouraged by the senior nurse managers thepotential to improved patient care is certain [ref] byfacilitating informed, research based practice. Most of all ournursing staff need to know they are valued, and that thecommitment to their personal development will continue,ultimately:’The organisation that learns to learn will survive. To do thisits people must also learn to learn.’Sir John Harvey-Jones [1989]