Organisational Development in Healthcare

Approaches, Innovations, Achievements

Edward Peck

• Publisher: CRC Press
• Year: 2017
• Print ISBN: 9781138431515
• eBook ISBN: 9781315344515
• Topic: Business
• Subtopic: Medical Theory, Practice & Reference
• Index: Business

Organisational Development in Healthcare introduces the practical ways in which change in health services can be promoted. It includes descriptions of all of the most important approaches to change currently being used in the NHS, discussion of when they work best and details of the evidence of their impact.

Part 1

Organisational Development in Healthcare: mapping the territory

CHAPTER 1

What is organisational development?

Jeanne Hardacre and Edward Peck

Introduction

There can be no doubt that organisational development (OD) is currently in vogue within healthcare. Several crude but credible measures are indications of this. Perhaps the most obvious is the recent growth in job titles which include the term ‘organisational development’. Over the past five years, there has been a remarkable trend for human resources (HR) directors to become directors of HR and OD, for training departments to be renamed organisational development teams, and for roles such as OD facilitators, heads of OD and even OD specialists to become mainstream within the functions and structures of NHS organisations. Many NHS organisations now also have directors of modernisation or service improvement where the key responsibilities of the postholder seem to call for the application of techniques derived from OD. The term ‘organisational development’ has thus become common parlance in NHS boardrooms, in managers’ offices and to some extent, where links to service quality, clinical governance or professional development have perhaps been made, among clinical practitioners.

So what does OD mean in the NHS? With so many people talking about it, creating jobs with responsibility for it, writing strategies about it and insisting on the importance of it, one might assume that they would broadly agree what it is. And yet when the simple question is posed to many of these individuals, ‘What is organisational development?’, the responses are fascinatingly diverse. The reply often involves a wry smile, a knowing look or an expression of faint exasperation. There then follows an explanation that reshapes the question from a simple ‘what is OD?’ to a more pointed ‘what do I personally understand to be OD?’ or ‘what does OD mean in this organisation?’.

Thus, while the question may seem straightforward, the answer is very unlikely to be. Replies typically confuse rather than clarify. They are often characterised by a reluctance to commit to a universal definition, coupled with an uneasy search for just such a unifying explanation. In part, this lack of confidence in producing a definition within the NHS reflects the disparate origins of the range of interventions and approaches that have come to be known as OD within both public and private organisations. Tracing these origins is rather like unpicking different-coloured threads, which, over time, have become meshed together into a multicoloured weaving. Each thread has its own distinct colour and texture, which adds to the overall appearance of the fabric, but each one has blended with others, and has perhaps faded or softened with time, and may have lost its own original distinctive characteristics.

This chapter attempts to tease apart the threads of organisational development, separating out the different strands of thinking and practice that lie behind each. The chapter then briefly examines definitions of OD, and goes on to discuss what distinguishes OD from other approaches to change, and how this can help us to recognise its distinctive contribution. Some of the central approaches to OD are outlined, and finally some of the current issues pertaining to OD in the NHS are introduced. Crucially, by the end of this chapter, we will have established a working definition of OD that will be adopted throughout the rest of the book.

The origins of organisational development

Appreciating the number and range of threads that have shaped OD can help to build an overall understanding of what contemporary OD encompasses and why it is apparently open to so many interpretations. The main strands that have shaped its development are described in the following sections.

Human process thread

One of the central threads of OD lies in work carried out by Kurt Lewin and colleagues in 1946 (Marrow, 1969). They ran workshops exploring interactions between members of groups, which involved an observer making notes on the behaviour of group members towards each other. At the end of each day, the workshop leaders and the observers met to discuss the behaviour and interactions they had seen in the groups. While it had not been planned for group members to participate in these discussions, some of the group members asked to sit in and listen to the debrief sessions. This led to the participants contributing their own perceptions of what had happened in the groups and why, with challenging debates ensuing about how behaviours were intended and interpreted. By the end of the series of workshops, these feedback sessions had become more important learning experiences than the group work itself. The experience led to the development of the National Training Laboratory (NTL) and an approach known as T-group training.

T-group training focused on the way in which people in groups understand how their own behaviour impacts on other individuals and thus affects group processes. This focus on processes between individuals within groups remains a core feature of some OD interventions and informs some of the discussion in Chapter 6, albeit that the emphasis there is more on processes both within and between groups (and, indeed, organisations); the chapter argues that this focus on individuals is not by itself likely to impact significantly on organisational functioning.

At an individual level, OD interventions in this category would typically include activities related to personal development, including building self-awareness, enhancing personal skills and effectiveness, and ensuring coaching and mentoring. Such individually oriented interventions are underpinned by the assumption that each individual is a key player in determining the broader dynamics of human processes within a system (although they may underestimate the extent that systems determine the experience and behaviour of individuals, again as argued in Chapter 6). As a consequence, it is important that the way each person influences social processes is altered (and hopefully improved) by intervening in the way that they behave as an individual member of the system.

The tendency for activities in this category to be linked to individual development explains the trend in some organisations of associating OD with the training and development function. The relationship between leadership development and organisational development is explored further in Chapter 3, but it is sufficient to note here that the growth of the importance of ‘leadership’ (in terms of both emphasis in policy documents and proliferation of leadership development programmes) has to be viewed as a major intervention in the healthcare system. It is this strand of OD – focused on the actions of individuals – that is the source of the idea that organisational development is integral to the everyday behaviour of organisational members. This could be termed the ‘pantheistic’ view of OD; it is potentially always and everywhere.

At a team level, human process interventions are commonly evident in team building and team development activities that attempt to improve the understanding, relationship and communication between members of teams. This sort of OD intervention may extend beyond merely focusing on the human dynamics within work groups to also encompass exploration of the accountability and procedures of the team and the outputs and outcomes that they achieve together. Interventions may include process analysis to consider retrospectively what happened, why and how people feel about it (as discussed in Chapter 5), and also activities such as storyboarding (see Chapter 12) in order to surface difficult issues and make it possible to ‘discuss the undiscussable’.

The principles of human process interventions are also apparent at a wider system level, where the focus of attention is on the human processes between different groups of staff in a department, different departments of an organisation or different organisations within a whole system (see Chapter 7). Large group events (such as the ‘open space’ events described in Chapter 4) often draw on human process approaches to OD in achieving their desired outcomes.

Survey feedback thread

A key player in the emergence of a second thread of organisational development was Rensis Likert (Baumgartel, 1959). In 1947, his work in developing attitude surveys led to his undertaking an employee survey in the Detroit Edison Company. He and his team were asked to advise on how the company could use the data gathered from the staff about their perceptions and attitudes to improve the management and overall performance of the company.

They discovered that if the survey results were reported back just to the managers, and not shared more widely with employees, then little change occurred. However, if a manager discussed the findings of the survey with the staff and involved them in deciding what to do about the findings, then positive change came about. This approach became known as ‘survey feedback’ and part of its effectiveness has been attributed to the fact that it ‘deals with the system of human relationships as a whole and it deals with each manager, supervisor, and employee in the context of his own job, his own problems, and his own work relationships’ (Baumgartel, 1959, p.2).

The survey feedback thread is evident in many contemporary OD activities and particularly those associated with the HR function where the emphasis lies in integrating the aspirations of staff with organisational success as coherently as possible. It could be argued that Improving Working Lives (DoH, 2000a) is an example of an initiative that attempts to respond to such staff aspirations while seeking to enhance recruitment and retention in support of the The NHS Plan (DoH, 2000b). Similarly, the annual staff survey in the NHS involves establishing staff attitudes as a way of diagnosing the state of the organisation, and interventions emerging from such a diagnosis would typically include work–life balance initiatives, competency frameworks, appraisal processes, career planning and capacity-building activities. It is in interventions such as these that the strong link between OD and HR is created and maintained, to the extent that in many organisational hierarchies the former is subsumed within the latter. From this perspective, OD can look as though it is part of the warp and weft of the organisational procedures that seek to govern the life of its members.

Action research thread

The T-group and the survey feedback approaches described above share a common feature. In both, information about people in an organisation (whether about their behaviour or their attitudes) is discussed and analysed together with those people themselves, rather than outsiders trying to make sense of the data or observations without their input....

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Forewords
• About the editor
• About the contributors
• Dedication Page
• Introduction
• Part 1 Organisational Development in Healthcare: mapping the territory
• Part 2 Organisational Development in Healthcare: introducing the models
• Part 3 Organisational Development in Healthcare: reflecting on aspirations
• Conclusion
• Index