Purpose of the report

This is a change and leadership paper written on Frimley digital change management. It includes in-depth analysis on recent change management plan within organization. Change is a continuous and inevitable for organizational success.

This paper include analysis on the company, its change program, the way it impact its stakeholders, leadership used, change management strategies, key drivers and barriers to change, therefore a complete comprehensive analysis on company actions and its outcomes.

Frimley health and care aims to improve health care services for more than eight lakhs people in local area, it is formed with partnership of organizations that aims to work towards a shared vision for optimum utilization of combined resources to help community development, healthcare, patients etc. Key partners include CGS such as East Berkshire, North East Hampshire and Farnham, and Surrey Heath, acute care providers, mental health and community foundation trusts and GP federations. It aims to provide integrated primary and acute care systems vanguard in North East Hampshire and Farnham NHS 2016. Key objective of Frimley Health and Care is to operate in coordination with local stakeholders to develop better healthcare system for future so that holistic services can be provided to local people. It aims to provide proactive treatment NHS 2016.

Leadership is an interactive process that facilitates in fostering healthy work relationship within organization, whereas leaders are the one who ensure smooth functioning of all departments, coordination and performance through motivation Banfield & Kay 2012. Culture is a societal context which helps in differentiating group of humans on the basis of values, beliefs, norms, assumptions etc. it varies according to culture, individual, organizations etc. Deal & Kennedy 1982. A successful change requires strong leadership to ensure positive outcome and successful implementation Giuliani & Kurson 2005.

Frimley implemented sustainability and transformation change management plan. It aims to develop a network of integrated hubs that can serve around 50000 people, it aims to provide connected out of hospital services so that teams from best health and social care can looked to patient without constraints of organizational boundaries. This change plan aims to enhance patient experience, increased satisfaction among hospital employees. It aims to develop an integrated healthcare system with following objectives;

• Enhanced coordination
• To make emergency care system assistance easy and simple, patient should clearly know whom to contact and offered care and support can be organized at home.
• Increased service providers skills and confidence, enhanced use of technology for easy access to information

Different authors have defined different types of change. Different types of change according to Kotter are Formal reengineering, Restructuring, Programmed, Mergers and acquisitions, Strategic change and Cultural change. However, Grundy 1993 defined change according to its speed of transition that is smooth incremental, bumpy incremental or discontinuous change Burke 2010. Todnem By 2009 defined type of change on three parameters that include rate of occurrence, how it comes about and scales Goncalves 2007.

Selected change management case in Frimley is a strategic change that includes partnership with healthcare organization and technological development with objective oveef customer satisfaction. It is a revolutionary change that would radically impact organizational culture and management system. Potential approach that Frimley management is trying to opt is smooth incremental change by setting deadlines and stages of change development.

Stakeholder analysis is a key step in change management, it helps in understanding every individual that needs to be involved in the change process, time, resource and commitment required.  It helps in enhancement of Process Improvement for Strategic Objectives that helps in including users into problem solving process. It also facilitate in seeing projected outcome of system change and resistance that might come Bordia, Hobman, et.al 2004. Technological development causes redesigning of activities involving people and therefore change might cause resistance. It includes direct the one who are directly affected by the change such as patients, GP, clinicians, employees, secretary etc. another is indirect stakeholders who include both outside agencies and decision makers. There are also interface stakeholders, the one who work as a facilitator to change management.

Stakeholder	Stakeholder attribute	Stakeholder influence	Changes
	Power	Legitimacy	Urgency
Patient	High	NA	High	Dependent	Given choice
Clinician	Low	NA	High	Dominant	Role changes New program of work
Public	High	NA	Medium	Definitive	Gove choice New program of work
Staff	Medium	NA	High	Definitive	Decision making Target to change
Voluntary	Low	NA	Medium	Definitive	Decision making Target to change role change

Background information

According to change management plan it ensures full involvement of clinicians across all the initiatives but also ensure ongoing communication with all stakeholders. Key strategies to manage stakeholders include priority setting workshop, wider leadership, wider stakeholder event, continuous work updates etc. to deal with workforce issue, it is planned to brainstorm with managers and staff to find new and better roles.  Workshop was organized with key stakeholders such as staff, clinicians to confirm priority areas as they are the one who are in direct contact with patients and their needs. For Health and Wellbeing Boards and Health Watch it aims to become system with a collective focus on the whole population that does not differentiate patient on sector or service.

Though there are several model of change management implementation, Lewin force field analysis is widely accepted. It can be defined as a situation when there is imbalance between change driving and change restraining forces. Author gives three steps that can be implemented to balance it that include unfreeze, change implementation and re-freeze. This model facilitates in finding factors that drive towards and away from change, it can help in making informed decision and also adequate leadership to shape desired behavior.

There are external and internal factors that impact the need for change, to understand key stimulants to change it is crucial to understand strengths and weaknesses of the organization, further there is also need to evaluate industry scenario in which it is operating. Objective of Frimley healthcare transformational change was to putting local people first and to ensure availability of holistic healthcare services by providing right services at right place and time. It also aim to launch digital technological changes to ensure better information sharing and providing interoperability between the various different systems share across the area through snapshot.

There is high percentage of dissatisfied patients in UK market, almost 70 percent consider that healthcare is moving in wrong direction, there is rising cost of drugs, long wait time and rising customer grievances. Further, patients also think that healthcare is being adversely affected due to Brexit; there is increased waiting time and lack of funding Boseley 2017.

Another market issue is ageing population in UK market, the average age is 40 years and it is expected to rise by 6.1 years by 2024. Therefore, increased need for chronic medical assistance, which is forecasted to be 2.9 million by 2018 end BBC News 2018. Such condition imposed high cost pressure on healthcare system, it is expected that average cost of hospital and community health services for ageing population will be three times greater than young people kingsfund.org.uk 2018. Another problem is raising cost of medicines, which is creating a domino impact; there is need for funding to promote value for money in medicine purchase.

There is enhanced complexity in healthcare delivery system. The specialist work focuses on only one issue of body; it causes lengthy and costly process of treatment, long paper work Iacobucci 2017.  There is need for enhancing coordination, proactive care, self-care and prevention.

Concept of change

Thee is rising expectation in terms of digital technology, information sharing. There was need for developing a digital technology that enables information access across different services such as primary, acute or mental. There was need for developing a technology that helps in sharing records among different healthcare organizations Fulopa, et.al  2012. Information sharing must be in accordance with role of individual access the record. Further there is need for transparency in system so that patients are well informed regarding information shared and their preference for the same. Digital technology will help in uplifting service delivery and enhance employee performance.

There is cultural shift in UK market that enforces decentralization of power and enforces the need for user involvement. Presently patients have different level of expectations from policy makers, they need to consider both social and cultural environment before deciding on new strategies. There is also rise in patient autonomy and expectations from service provider and they have access to global information. This drives the need for enhancement of responsiveness by clinical practitioners White 2010.  External changes such as awareness, enhanced customer demand enforced changes such as need for new delivery system, changes for staff and patient with greater use of technology.

If external market analysis is conducted to evaluate key drivers to change, Brexit has strongly impacted funding of healthcare system, there is lack of attention. Socially there is ageing population, rising need for chronic health services, need for global information sharing that highlights need for new transformational system that gives engaging healthcare service with partnership between clinician, GP and patients.

Through UK has strong healthcare system but there is lack of coordination, emergency service are difficult to get access, process is complex. Though the hospital is market competitive but overall process is complex for general public.

It is not possible to implement successful change without adequate leadership and management. Leadership is a continuous process of developing relationship between people who aspire to lead and the one who follows Cummings & Worley 2009. Leaders have the power to shape employee behavior, motivate them, it is not only limited to controlling and managing behavior rather it aims toward empowerment, collaboration, diversity, humility and higher purpose Avery 2004. Leadership style has strong impact on the way leader behave and employee react. Therefore leadership traits and characteristics such as intelligence, drive, motivation, persistence, and extraversion are of key importance to implement successful change Bhindi & Duignan 1997.

In Frimley healthcare, they use leadership and management as one term to denote the actions and principles that are being implemented to improve the design and implement transformational changes. Leaders also intervened at broader level such as project designs, accountability, key values and challenges that were encountered by staff. Senior management level involvement in change management system helps in generating interest and support within organization, it also communicate other staff regarding change management importance.

Leaders encountered several cultural issues in bringing different organizations together to work due to history of competition and lack of trust. According to management, successful leadership depends on good relationships; it should not be limited to any single type of professional or department. Therefore face to face meetings were organized to keep clarity regarding joint responsibility and foster healthy relationships. Further, Frimley compiled a group of high performing providers, commissioners and systems to ensure successful delivery of change plan. To achieve the goal of becoming an accountable care organization a governance system was also formed. Below is system wide leadership group of Frimley healthcare.

Objective of change program

                                                     

Above diagram shows, Frimley has three leadership groups and the system wide leadership group brings all members from these groups together to ensure collaborative, cross system support and relationship building. Another is Frimley system leadership reference group that was held by Andrew Morris who works on behalf of all three major leadership groups and lead the delivery of transformation change plan. Another was executive delivery group who was held responsible for programme management and support to work teams, it includes executive directors representing the localities and they report to leadership reference group. Apart from this, Frimley also tries to implement wider stakeholder engagement plan by electing member from volunteer segment.

Key objective of leadership model within Frimley was to define a clear sense of purpose and contribution by explicitly mentioning needs of patients and interpreting wider environment and impact. Second objective is to motivate organizational team and staff to work effectively, this was done by clarifying goals, building commitment, encouraging staff involvement in change process, managing improved performance, two way communications. Third was to ensure adequate focus is given on system improvement by initiating new process and structure, assessment unit performance, practice continuous improvement.

Analysis shows need for redesigning collaborative leadership to get innovative ideas; there is need for creating a holistic environment that encourage collaboration, independence and trust so that leaders can work beyond targets and hierarchies. To achieve this target, Frimley launched Frimley Health and Care System and Transformation Partnership’s Leadership 2020 Programme aims to break organizational barriers and help clinicians and managers across the clinical health care system to engage with communities and fulfilling the needs of local population (tvwleadershipacademy.nhs.uk, 2017). Analysis shows need for delegative leadership style that work according to Adair action centered model that states that task can be done in teams, teams can successfully accomplish task when every individual is fully developed and task facilitate in challenging and motivating individuals. Therefore, leaders play key role in successful change implementation, there is no more applicability of heroic model of leadership, rather there is presence of turnaround chief executive and engages form of leadership.

Further there were factors causing hindrance in implementing transformation change and digital technology within healthcare organization. To implement an integrated care system there was adoption of American slant, there was orders that include everything that nurse do such as blood tests, chest x-rays, drugs. Therefore, there is need for complete Shift in mindset of al clinical staff and it attracted huge resistance initially. Further digital change also impact autonomy of patient and staff, there was issue to disruption to complex clinical workflow, it also raises concern for privacy and interoperability causing challenges.

It was difficult to implement digital change as there was resistance due to digital adoption, perceived usability of the new system and support from patients as well. According to literature, resistance is caused by intertie as regardless of ideal method of individual decision making, the process people rely upon is not rational, this cause gap between descriptive and prescriptive. Author also claims that decision maker fails to understand full complexity of implementation which includes technical, emotional and political resistance to change. Further, there is challenge of initiating; sustaining and resigning change as it require lot of time, clarity, consistency, fear of isolation, fear of negative review etc.

Type of change and change theory with objective

With implementation of integrated and STP there is a cultural shift in healthcare that require huge coordination, it will cause shift in roles and responsibility of health practitioner and also the way patient get access to services. There is fear of change among employees, security challenges; patients might not agree to share their data on digital platform.

To deal with change successfully, a proper change implementation plan was made that include priorities that new change aims to achieve. Frimley health and care made substantial change to improve wellbeing, improve long term healthcare outcome, frailty management, reducing healthcare inequalities and offering integrated care system to coordinate all activities. To implement it with minimum disruption first skill analysis was conducted so that all participants have confidence, skill and power to accept new changes. Integrated decision making hubs were formed to foster a single point of information access. A support workforce was design to manage and support the new change, implement shared care record that is accessible to all professionals. A clear change plan was communicated to all stakeholders by Frimley leaders that include objectives, deliverables, scope, exclusion, benefit from the change and outcome measures. To mitigate risk change team ensured maximum engagement, continuous updates to system leaders, two way open communication and strong return on investment NHS 2016.

Key enablers to ensure successful change management include forming local digital roadmaps that include information sharing system and patient portal. To ensure financially backup a model has been developed that include size of financial challenge in relation to change introduce. Key challenges encountered include achieving clinician ownership, it was achieved by involving clinical staff and GP in design and implementation; intensive mandatory training programs were held to bridge conversation nice.org.uk 2017. Performance was improved by redesigning care pathways, proper cost and time scale was maintained for the implementation process with key evaluation criteria’s. Focus was given on user engagement by giving them chance to design an shape the technology that impact their daily lives, it enhances sense of ownership; it helps in reducing wide variation of attitude due to past experience. Change management team at Frimley healthcare provided continuous feedback to share regular outcomes through workshops, meetings to provide adequate voice to raise concern, questions and suggestions.

Conclusion: 

Health and social care is an important pillar to nation stability. Due to ever changing and developing external and internal environmental needs, change must be adapted. Change is a broad term associated with several themes such as need, time, rate etc. It is difficult to change set behavior in healthcare setting due to complexity of relationship shared between different organizations. Leadership is one factor that helps in boosting change by focusing on improving patient care, motivating employees. Change requires clarity of purpose and evidence based implementation system. Factors that encouraged change are mainly external such as increasing dissatisfaction, rising cost, complexity etc. however, it was not easy to implement change as key barriers to change include lack of awareness, knowledge, fear of unknown, problem is digital adoption. However, Frimley health and social care adopted a slow and step by step process by setting small, time bounded realistic goals with definitive teams and expected outcome. Proper management and leadership were maintained with adequate budget, training, feedback and continuous assistance that helped in reaching set target successfully.

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