Successful Change Management in Health Care

Being Emotionally and Cognitively Ready

Annette Chowthi-Williams, Geraldine Davis

• Publisher: Routledge
• Year: 2022
• Print ISBN: 9780367652159
• eBook ISBN: 9781000547115
• Edition: 1
• Topic: Medicine
• Subtopic: Pharmaceutical, Biotechnology & Healthcare Industry

Change is frequent in healthcare, yet change management is often far from perfect. This book considers the complexity of change within large organisations, explores existing models of change and emphasises the vital role of emotional and cognitive readiness in successful change management.

Despite the plethora of organisational change management approaches used in healthcare, the success rate of change in organisations can be as low as 30 percent. New thinking about change management is required to improve success in service development, improvement and innovation. Arguing that emotional and cognitive readiness for change requires engagement with the people involved, and a thorough understanding of areas of friction and potential challenge, this book also delves into the neglected issue of emotion, examining emotional labour and emotion and change. It investigates how human emotion can be incorporated into Change Management Models, alongside and intertwined with cognitive approaches, to support effective change. Using the NHS as a central case study, this book incorporates examples of actual change from a range of healthcare settings from acute to primary care, enabling readers to see how Change Management Models can be adapted and utilised in practice.

This is an essential read for students, as future change leaders, and practitioners and managers leading and managing change in healthcare.

1 CHANGE AND HEALTH CARE

DOI: 10.4324/9781003128397-1

Introduction

This book argues for new thinking on change management in health care to improve its success. Continuous change is now a common feature in health and social care organisations across the globe and the National Health Service (NHS) in the UK is no different. With continuous NHS policy changes of successive UK governments and the enormous resources given to supporting service improvement, innovation and development, the evidence for improved quality, care, productivity and a happy workforce should be obvious. Rather, the evidence points in the opposite direction. The case for a shift in direction for change management could not be more urgent. We explore the failure of current change management in healthcare and how our new thinking about emotional and cognitive readiness for change could provide the energy, motivation and engagement for successful change management. We argue that the incessant policy initiatives are impacting the health and wellbeing of the workforce, the financial health and productivity of the NHS and failing to improve the nations’ health. Innovation, service development and improvement are key to improving quality health care and the nations’ health but change must be effective to be sustained.

We suggest that successful change management in healthcare is reliant on change leaders addressing the inhibitors to change management and reorientating its focus and energy on people. People are the NHS’s greatest resource and strength, and current conditions do not lend themselves to ensuring employee’s emotional and cognitive readiness for change. Leaders should consider change and complexities in the NHS and the level of effectiveness of current change management approaches. With the impact of emotional labour on the workforce already high, change is an added emotional burden. The critical role of emotion and change needs to be recognised, acknowledged and addressed. With change having a negative impact on staff, change leaders need to understand the significance of and actively assess for emotional and cognitive readiness for change prior to any change initiatives. Thus, the voices of the workforce will contribute to the preparedness plan for change and subsequent implementation thereby ensuring a smooth transition with staff feeling that they are valued, engaged in the change process and their feelings, views and opinions respected. We outline these ideas in this chapter and explore these in more depth in this book.

In the early part of this chapter, we set out examples of the enormity of policy change in the UK. We introduce some of the issues related to devolution of health care. We include examples of the outcomes and impact of these changes on the health of the nation, on the health and wellbeing of the workforce and on the financial health of the NHS, productivity and lack of sustainable improvement, to provide a background to why people might be suspicious of yet more change and reluctant to embrace change without question.

We continue in this chapter to outline the case for new thinking on how change management could potentially be successful in the NHS. In Chapter 2, we examine change and complexity. In Chapters 3 and 4, we critique some of the many change management approaches, models, theories and tools used in change management. Emotional labour and the key role of emotion and change is examined in Chapter 5. Emotional and cognitive readiness for change, which is potentially the key to successful change management, is explored in Chapter 6, where we introduce the AC-W Change Management Model. We explore the underpinning philosophy of this model and its role in ensuring emotional and cognitive readiness for change in Chapter 7, and in Chapters 8 and 9, we illustrate the AC-W model in practice. The final chapter summarises our thinking on the failure of change management in healthcare and how our new thinking could potentially lead to successful change management.

Policy and the NHS

As an illustration of just how incessant policy change has been, we highlight some of these changes in Tables 1.1–1.3. Table 1.1 demonstrates a selection of the changes to the health service from 1983 to 1997. Some of these were about changes in structure and the nature of provider and commissioner (e.g. Working for Patients, 1989; Health Authorities Act, 1995). Others focused on specific improvements in health (e.g. Health of the Nation, 1992).

TABLE 1.1 Examples of UK Health Policies over the period 1983–1997

Date	Policy/Report	Summary
1983	The Griffiths Report	Consensus management through committee was replaced by general management structure.
1989	Caring for People	Leadership of community care was given to local authorities following the 1988 paper Community Care: an agenda for action and the Audit Commission report making a reality of community care.
1989	Working for Patients	A split occurred between purchasers and providers of health. Self-governing hospital trusts and fundholding GP practices were introduced.
1992	Health of the Nation	Targets were set to improve health in five areas: coronary heart disease and stroke; cancer; accidents; mental illness; and HIV/AIDs and sexual health.
1995	Health Authorities Act	This act abolished Regional Health Authorities and replaced them with NHS Executive offices. District Health Authorities and Family Health Service Authorities were merged.

TABLE 1.3 Examples of UK Health Policies over the period 2010–2016

Date	Policy/Report	Summary
2010	Equity and Excellence: Liberating the NHS	Paved the way for the Health and Social Care Act of 2012 (implemented in 2013).
2010 and subsequently	Quality, Innovation, Productivity and Prevention. The Nicholson Challenge	Aimed for £20 billion in savings within the NHS.
2011	Commissioning Clusters	Aimed to oversee the transition between PCTs and CCGs.
2012	The Health and Social Care Act	Abolished PCTs and SHAs. Created the CCGs and NHS England and established Public Health England.
2013	Francis Inquiry Report	Report into Mid Staffordshire culture and values, established that quality and safety should be paramount, not financial responsibilities.
2013	Prime Minister’s Challenge Fund	Aimed to develop models for improved access to GPs through innovation funding.
2013	Better Care Fund (Integration Transformation Fund)	Aimed to move funding for social care to local authorities, to support hospital discharge and reduce hospital admission.
2013	Every Day Counts	Introduced standards for seven days a week hospital services.
2014	Five Year Forward View	Population health, quality of care and cost-control described as the ‘triple aim’, re-emphasis on prevention, aimed for better integration between physical and mental health, between primary and other health services and between health and social care.
2014	Parity of Esteem	Aimed for parity between funding and esteem for mental and physical health.
2015	New Deal for General Practice	Planned for seven days a week GP service by addressing workforce and other challenges.
203	NHS Improvement	Aimed to simplify the regulatory system.
2015	Sustainability and Transformation Fund	Additional funding identified to support changes in the Five Year Forward View.
2016	Sustain ability and Tr ansfor mati on Partnerships (STPs)	Aimed for joint planning of health of local populations through NHS Trusts, commissioners and local authorities working together.

The Tony Blair government reforms to the NHS extended to three areas: targets and performance management, inspection and regulation and competition and choice. There have been many criticisms of these changes with their emphasis on these areas as a means to improve health care. Considering the resources, the benefits are mixed. In the area of targets and performance there were stated improvements. There were reductions in waiting times, in health care-acquired infections, and improvements in cancer and cardiac care. While these achievements are positive, there were concerns ‘of gaming and, in some cases, misreporting of data to avoid penalties and sanctions under the performance management regime’ (Ham, 2015, p. 10). With regard to inspection and regulation, it could be argued that despite regulators visiting the Stoke Mandeville Hospital, Maidstone and Tun-bridge Wells NHS Trust and Mid Staffordshire NHS Foundation Trust, there were serious failings in patient care. The benefit of all this change was not seen. The introduction of competition and choice did not fare much better. The question remained: what was the benefit?

Between 1997 and 2009, there was considerable emphasis on primary care and community and integrating care or on introducing specific targets as shown in Table 1.2. Year 1998–1999 saw two other significant changes, the establishment of NICE (National Institute for Clinical Excellence, now National Institute for Health and Care Excellence) and the devolution of health care to the four nations of the UK. Since that time, policy frameworks in England, serving some 84.2% of the UK population (based on ONS data), have differed from those in the other three countries of the UK, creating four systems with different structures, of which NHS England appears the most complex (Dayan & Edwards, 2017). We discuss some of these differences in Chapter 2. Later policies in this period emphasised quality of care, changes in pay and contracts and increased metrics, for example aiming to measure performance through targets and results.

TABLE 1.2 Examples of UK Health Policies over the period 1997–2009

Date	Policy/Report	Summary
1997	The New NHS: Modern, Dependable	A shift of focus occurred to primary care. Clinical governance was introduced. Finance was linked to reform.
1998	Health Action Zones	Early attempts to integrate health and social care. Some 10 areas implemented strategies locally aimed to improve health.
1998	A First Class Service	NICE and CHI (later led to Healthcare Commission and CQC) established.
1999	Devolution	Health systems were devolved to the four UK countries: England, Scotland, Wales and Northern Ireland.
1999	The NHS Plan	Many targets introduced, reforms for improvement of services.
1999	Introduction of Primary Care Groups	Direct management of community services such as health visiting, local payment for services.
2000	Health Act	Joint working between health and social care supported.
2001	Shifting the Balance of Power	This focused on structural change to implement the NHS Plan. PCTs and SHAs were created. The NHS Executive became part of the DoH.
2001	Health and Social Care Act	Aimed to improve performance within the NHS. Changes were made to: regulation of health professionals; pharmacy and prescribing; payments for users of social services; funding of long-term care; CHCs, planning for these to be abolished.
2001	Delivering the NHS Plan	Shift to the notion of a regulated system. Foundation Trusts initiated, provision of services from a range of providers developed.
2002	Care Trusts	Aimed to promote integration of health and social care by introducing commission and provider-based Care Trusts.
2003	New Consultant Contract	Aimed to recognise both flexible working patterns and non-clinical and on call work by consultants, effectively increasing earnings and pensions.
2003	New GP Contract	A new GMS contract linked to Quality Outcomes Framework aimed to incentivise preventative care.
2003	Payment by Results	Aimed to increase choice. Commissioners more able to manage and influence provider activity.
2004	NHS Improvement Plan	18 week target from referral to treatment proposed, and 48 hour GP access target.
2004	Agenda for Change	Introduced streamlining of pay scales across the NHS.
2005	Commissioning a Patient Led NHS	PCTs to lose provider responsibilities (implemented 2009). SHAs reconfigured.
2006	Our Health, Our Care, Our Say	Aimed to improve support for long-term conditions, and improve choice in primary and community care.
2008	High Quality Care for All (Next Stage Review)	Aimed to improve quality and safety through quality improvement staff initiatives. Integrated care pilots introduced, with new priorities identified for primary care access.
2009	Personal Health Budgets: First Steps	Aimed to pilot personal health budgets.

Since 2010, the policy initiatives have continued their relentless pace, as shown in Table 1.3. Alongside policies aiming to promote joint working between services, improve access to care, and promote seven days a week services, are others aiming for significant savings. There are also two very dominant elements during this time. The first of these is the Health and Social Care Act of 2012, which aimed to devolve decision making and enable general practitioners (GPs) to take the role of commissioners, with greater choice and competition. The King’s Fund report (Ham et al., 2015) describes how from 2010, during the first half of the coalit...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Contents Page
• List of figures Page
• List of tables Page
• List of boxes Page
• 1 Change and health care
• 2 Complexity and change management
• 3 A critique of change management theories and approaches
• 4 Critique of change management approaches: behavioural and emotionally centred models
• 5 Emotional labour and emotion and change
• 6 Emotional and cognitive readiness for change
• 7 Emotional and cognitive readiness for change: new thinking
• 8 Applying the AC-W Change Management Model: assessing emotional and cognitive readiness for change
• 9 Planning and implementing service development, improvement and innovation
• 10 Conclusions
• Index