Facilitating Change in Health and Social Care Management

Summary

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Introduction

According to Kotter (1999), change management is a set of principles, techniques, and prescriptions embed to the human aspects of executing major change initiatives in organisational settings. It is strategic tool deploy by management to re-direct the use of resources, business process, budget allocations, or other modes of operation that radically reshape a company. The focus of this report is on Beacon Edge Care Home(BECH), a care home that provides support and care for 33 people with Dementia. An inspection was conducted on 21th and 22th of November 2016, and on the 13 of December 2016 unannounced by the Care Quality Commission (CQC) and the outcome of the inspection indicated that Beacon Edge Care Home has not made any improvement based on the recommendations of the first inspection conducted by CQC and the home does not have a registered manager on duty at the time of the inspection.  Regulatory body later found out that BECH does not even have a registered manager as stipulated under Health and Social Care Act 2008 (Edwards, 2013).

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The Act indicated that it is mandatory that registered providers of care have a ‘registered persons’. A Registered person have legal responsibility for meeting the requirements under Health and Social Care Act 2008 and has the necessary qualifications, competence, skills and experience to supervise the management of the regulated activity (CQC, 2017). The researcher of this report will be the new manager of BECH and will be responsible for implementing change within the organisation.  The manager will need to identify and make required changes before the next inspection by CQC According to Kotter (1999), to implement change in an organisation, the firm have to understand their environment, their strengths and weaknesses and identify areas of improvement that could lead to change management. Hence, to gain a clearer of pictures of the problems facing Beacon Edge Care Home, the researcher will need to conduct a PEST analysis to identify the strength and weakness and areas of improvement of BECH.

The key factors that can bring change in Beacon Edge Care Home management is be by conducting identifying the strength, weaknesses, areas of improvement as well as turning weaknesses to opportunities. The PEST Analysis and SWOT Analysis will be deployed as factors that can drive change in Beacon Edge Care Home. A PEST analysis is an analysis of the external macro-environment that affects all firms. It helps organisation to determine how political, economic, social and technology can impact the performance and activities of an organisation in the long-term (Daft, 2011).

Political Factors

Beacon Edge Care Home would assess the political factors affecting its organisation for failing to comply with regulatory bodies like Care Quality Commission. In the report, CQC indicated that their recommendations from the first visit was not implemented and BECH violated  health and safety Act 1974 by not having adequate  care plans and risk assessments to meet the individual needs of people who used their service  and medicines given to service users were poorly managed, hence people are placed at risk of not receiving their medicines as prescribed (Devorshak, 2012).BECH breaches different regulations in the BECH for not  providing adequate care for their service users. Person centred approach was not notable during the CQC visit, there was lack of good governance and staffing, servicers were given the wrong medicine and local health and social care professionals were concerned about the inconsistent of management team in the home. For the new manager to facilitate change in the organisation, all regulatory bodies and environmental issues will need to evaluated and change to meet the needs of the service users.

Economic Factors

Beacon Edge Care Home should review their employment policies and ensure that it is in compliance with health and Social care requirement of employing candidate that have the right skill set needed in the establishment (Devorshak, 2012). The report indicated that service rendered by BECH to their clients was not adequate and staff lack the understanding and the requirements of the Mental Capacity Act 2005. Training and development strategy will need to be deployed by the new manager to continually improve the skill of the workforce.

Social Factors

The manager of Beacon Edge Care Home would need to conduct critical evaluation how the organisation meet the needs of the patients Beacon Edge Care Home. The gap in service delivery will enable the manager to understand the areas that need immediate change (Devorshak, 2012). The CQC report indicated that employees of the organisation have no idea how to meet the cultural and social needs of the patients

Technology

The new manager of Beacon Edge Care Home should investigate how technology can enhance the delivery of quality service to their patients. This can be conducted by looking at current quality cycle of the service provided and factor areas that will be easier to implement with the introduction of technology.

SWOT Analysis

SWOT Analysis (Strengths, Weaknesses, Opportunities and Threats) is a strategic tool used by organisations to understand their strengths and weaknesses, and to identify their opportunities and threats (Rego and Nunes, 2010).Strengths and weaknesses analysis the internal structure of the organisation, while opportunities and threats generally relate to external factor that the business do have control of (Rego and Nunes, 2010).The researcher will focus on the internal structure of the Beacon Edge Care Home by looking at the strengths and weaknesses.

Strengths

The strength of Beacon Edge Care Home is the staff. People that were spoken during the inspection indicated that the staff were very caring, pleasant and helpful. Patients were comfortable with the staff as well as they find them very friendly helpful. Further, visitor to the home also indicated that the staff were excellent. The management is blessed with good staff. However, the management lack leadership and do not follow the regulatory bodies criteria especially noncompliance with Health and Social Care Act 2008.

Weaknesses

Beacon Edge Care Home lack leadership. CQC report on the inspection of BECH indicated that the care and service provided by the organisation is not fit for purpose. Confidential information is not kept secured and did not meet the requirements of the Data Protection Act 1998. There are catalogues of regulation breaches and there is was no registered person on the premises during the time of the inspection that can help the organisation to meet the requirement of different regulatory bodies. The two major weaknesses  are lack of leadership and skilled workers that understand the requirement of Data protection, Act, Health and Safety Act 1974 and the Mental Capacity Act 2005.

The new managers will need to evaluate the weaknesses of the organisations such noncompliance with regulations bodies, lack of leadership and lack of training for the employees in order to implement changes in the organisation. The home has good and dedicated staff, Beacon Edge Care Home can tap into by providing leadership, firstly getting a registered person on board and providing training and development for existing staff as well as employing staff with key skills to fill the gaps identified.

Opportunities

The new managers can help to turn things around in the organisation. There is opportunity to recruit and train existing staff on different requirements associated with health and social care The report by CQC on BECH highlighted most of issues the company need to resolve and this  presents the opportunity for BECH to implement these changes in order to improve their rating  health and social care rating,   customers satisfaction, staff satisfaction and other stakeholders

1.2 The challenges that key factors of change bring to health and social care services

Business organisations are faced with different challenges. The health and social care organisations are not immune from these challenges as well. The critical evaluation of the Care Quality Commission report on Beacon Edge Care Home clearly shows that the organisation is faced with various challenges such as:

• Lack of management support
• Financial resources
• Equipment
• Lack of leadership,
• Training and development for employee
• Shortage of staff with key skills,
• Maintaining quality
• Effective use of resources
• Noncompliance with different regulatory bodies.
• Lack of communication and coordination

To implement change, Beacon Edge Care Home must address these issues.

1.2.1 Lack of leadership

The CQS report on the home shows that the organisation lack leadership. Daft (2011) describe leadership as individual that have the ability to inspire, mobilise and encourage people to achieve the goals of an organisation. A leader has to be organised, have the ability to delegate task and ensure that all the arms of the business is consistent with all the goals of the organisation. Beacon Edge Care Home lack leadership that is organised, coherent and the ability to inspire staff to meet the objectives of the home (Edwards, 2013). For instance, there was no registered manager on duty during the inspection and no senior management oversight to help ensure effective quality monitoring and improvements were carried out.  The management of Beacon Edge Care Home would need to employ a registered manager according to the Health and Social Care Act 2008. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

1.2.2 Lack of management support

Change is hard to implement without the support of the management. Shore (2012) suggested that management should be in the forefront of supporting desirable change because such change will increase the profitability of the company. It is obvious from the case study that the management of BECH is in shambles and the management do not have an idea of what is needed to improve the delivery of their services to their patients. This is one  of the main challenges facing the organisation. The managers must employ a democratic leadership that will enable all employees to cultivate a culture of quality assurance in order for BECH to meet the regulatory bodies requirement and to effectively meet the needs of their service user.

1.2.3 Financial Resources

The process of implementing change in an organisation can be affected with lack of financial resources.  Financial resources maybe recruiting top notch manager, training employee to meet the expectation of customers or fund to acquire new equipment.  In the case of BECH, the business is faced with different problems and financial constraints maybe one of them. It could be the reason why the company did not employ competent and skilled workforce for effective management of their operations and services.

1.2.4 Lack of communication and coordination

Communication at Beacon Edge Care Home was ineffective, wrong drugs are given to patients, staff are not clear on their roles and management Care plans were not focused on upon individual preferences, choices, needs and abilities, in addition, patients received inconsistent care because staff focused on tasks rather than supporting people with their individual needs and preferences. The roles of individual staff need to be defined and the quality of their work would need to be monitor by their supervisor. Supervisor should schedule meetings with staff on a regular basis to communicate what need to be achieved and the approaches staff need to deployed to achieve those goals.

2.1 In relation to the CQC report on Beacon Edge Care Home, the strategy and criteria for measuring recent changes in health and social care have to be effective and efficient.  Hence, it is essential to set up a system that will allow the organisation to know the changes made will work, how to know changes that resulted in improvement and which changes is most vital and have resulted in the most significant improvement. Thus, by collecting data before, during, and after the change have been implemented, Beacon Edge Care Home can measure, evaluate, and compare their home progress with respect to the goals set out. The process of measuring changes should be simple to implement and have immediate impact. Based on these facts, the researcher decided to deploy the use of questionnaires and surveys, interview with service users and employees and discussion with other stakeholders to measure improvement in the services provided by Beacon Edge Care Home.

According to Davis (2010), criteria is a standard set by organisation as target that is decided upon.  Setting criteria will enable Beacon Edge Care Home to identify areas that needed improvement and base line for measurement. The Home will need to consider the new and previous recommendations made by CQC which that services provided by the Home have to be effective, responsive, safe, well-led and caring in order to meet the expectations of their service users. A strategy is the direction and scope of an organisation over the long-term: which achieves advantage for the organisation through its configuration of resources within a challenging environment, to meet the needs of markets and to fulfil stakeholder expectations. The plan for strategic and measurement will need to address the factors identified by the CQO in the report and to meet the criteria of the Health and Safety Act 2008.

Questionnaire is a qualitative method that can be used to  measure gather information from service user about effectiveness of the service provided. According to Creswell (2014), questionnaire is a research instrument with a written set of questions given to people to collect facts or opinions about a study. It a relatively cheaper and efficient way of collecting large amounts of information a sample of people. In the case, the questionnaire will be design to rate the effectiveness of the service provided, if the staff are responsive and caring, also if the Home conduct risk assessment on their patients and their environment. This will provide a compressive idea of the changes that have been implemented is effective and improve the level of service to the stakeholders. Questionnaire is an effective instrument because it will provide management fast result and it can be easily quantified. It can be used to measure customer or staff satisfaction.

Interview is a qualitative approach of gathering information from participants. Interviewing involves asking questions and getting answers from participants in a study.  Interviewing has a variety of forms including: individual, face-to-face interviews and face-to-face group interviewing.  The asking and answering of questions can be mediated by the telephone or other electronic devices (e.g. computer (Wiley, 2014). Interviews can be structured, semi-structure or unstructured. The use of interview techniques at Beacon Edge Care Home to collate data from patients and other stakeholders will provide an insight into the quality of service rendered by the organisation. This can be a semi structured interview by asking patients about specific question about the quality of service and the organisation is meeting their needs in terms of caring, responsive and effective. These approaches and strategies will enable the management of Beacon Edge Care Home to measure the effectiveness of the changes made to meet the criteria of the CQO. CQC drives improvement in the quality of health and social care services. It regulates against the registration requirements set out in regulations to the 2008 Act. These are the ‘essential standards of quality and safety’ that providers are legally required to meet. These standards therefore represent the minimum ‘quality bar’ which all providers of regulated activities must meet and should not dip below.

2.2 Measuring the impact of recent changes on health and social care services against set criteria

Creswell (2014) defined data collection as the process of gathering and measuring information on variables of interest, in an established systematic fashion that enables one to answer stated research questions, test hypotheses, and evaluate outcomes. In the case of Beacon Edge Care Home, compliance and adherence report, employee engagement and participation, Issue, compliance and error logs, observation of behaviour change, employee feedbacks and employee readiness assessment results were used to measure the recent changes against the set criteria.  Observation of employee engagement with service users, issue, compliance and error logs as well as the employee feedbacks provided crucial information about the changes made at Beacon Edge Care Home against the recommendations made by the CQO.

The changes ade by the manager of BECH has enhanced the communication between care workers and service user, improved the provision of person centred care, the management if medicine which was a major problem before and effective care home engagement to ensure that patients are not exposed to any hazard or risk that may cause them harm.

2.3 The overall impact of recent changes in health and social care

The recent changes made by the manager and management has improved the quality of service provided by by Beacon Edge Care Home. The appointment of a registered person that understand the criteria’s and codes of conduct of health and social care, enabled the organisation to comply with various regulations and legislations. For instance, a competent and qualified person was assigned by the manager to monitor and measure health and safety procedures in the organisation. This include conducting risk assessment, reports of incident, communicating changes in operational model to management etc. The registered person on the other hand ensured that training and development are provided for employees, observation conducted to ensure staff are effective and responsive on delivering their duties and survey on patients to measure their level of satisfaction. In most organisation, changing the ways of doing things can either lead to positive or negative outcome. However, the most essential is to have management that is open to change and not afraid to implement new approaches. Hence, Beacon Edge Care Home need to continuously monitor and measure the changes that have just been implemented and also look for areas of improvement to in order to meet the ever-changing needs of their service users (Shore, 2012).

2.4 Propose appropriate service responses to recent changes in health and social care services

There many approaches and techniques BECH can deployed to response to recent changes in health and social care services The Care Act 2014 underpin the way people receive care and provide a vehicle to communicate changes health and social care services. Regarding BECH, the management can response to recent changes in health and social care services through the following:

Training: The case study highlighted BECH lack skilled employees that understand the regulatory requirement of working in health and social care organisation. This will need to be addressed either by employing skilled workers or providing training for old workforce to gain the competency of needed to be a care worker.

Compliance with different regulatory bodies requirements: There were different breaches of regulations during the inspection by CQO. For instance, confidential data were not kept secured (Data Act violation), Health and Safety of service user and staff did not comply with the requirement of Mental Capacity Act 2005. The new registered person or manager has to ensure that the cultivate a culture of quality management and effective communication of different policies, procedure and regulations of health and social care to the workforce

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Continuous quality improvement of services rendered by the organisation: BECH should continue toi improve the level of their service delivery through the quality management tools like Kaizen quality control or quality cycle of Deming. According to Coy and Adams (2012) quality Management tools help organisation collect and analyse data for employees to easily understand and interpret information. Quality Management models require extensive planning and collecting relevant information about end-users. Customer feedbacks and expectations need to be carefully monitored and evaluated to deliver superior quality products. By embracing this approach, BECH, management will be able to meet and exceed the expectations of their service users.

Embrace current best practice to treating people and supporting the specialist needs of people living with dementia:BECH provides care and home for people with dementia. It is essential the company lassie with other service providers, professional sand specialist in the field of providing care for people with dementia in order to provide appropriate and adequate service to their clients.

Monitoring and managing medicines administered in the way that meet the requirement of the regulatory body: To meet the requirement of Mental Capacity Act 2005, the manager BECH have to monitor and manage the way drugs are administered to their patients. This was one of the findings in the inspection by CQO, patients were given the wrong drugs which can make their situation worse.

3.1 The key principles of change management

In the today’s business environment, change is inevitable and understanding the principles of change is equally vital. There different principles of change that Beacon Edge Care Home can deploy to meet the expectations of their service users and the objectives of the organisation. John M Fisher and John Kotter are change management theories that have made significant contribution to the subject. Others are Kurt Lewin’s change management model, Burke-Lewin’s causal change model; action research; gap analysis and Kübler Ross transition cycle. The researcher will focus on John Kotter’s Change Model that consist of eight stages.

3.1.1Establish a sense of urgency: Beacon Edge Care Home need to implement change immediately to meet the criteria and recommendations of the CQO

3.1.2 Form a powerful guiding coalition: The organisation need to employ a registered manager that will help coordinate the process to meet the recommendations set on the report about the Home.

3.1.3Create a clear vision; The manager and management have to set a clear vision on what they need to achieve and the changes that need to be made for the survival of the business.

3.1.4 Communicate the vision; The objectives will need to be communicated to the employees and other stakeholders.

3.1.5 Empower others to act on the vision: Training and development for employees, recruitment of skilled specialist is crucial to meet the vison set for change.

3.1.6 Plan and create short-term wins: The plan to me measurable in short term and long term to know if the changes implemented is working.

3.1.7 Consolidate improvements and produce still more change: Need to conduct survey, questionnaires and interview to measure improvement and benchmark the process in order to continuously improve the quality of the service delivery.

3.7.1 Institutionalise new approaches: After measurement of the impact of change and improvement, areas with positive outcomes and improve should be institutionalised.

3.2 How changes in health and social care are planned

There are different approaches and techniques that can be deployed in health and social care setting to manage and plan change. However, it is essential to identify areas that needs change and improvement. Regarding Beacon Edge Care Home, the areas that need change and effective planning are the management style, Staff development needs, communication channel and reconditioning. In addition, changes in health and social care  have to consider the local authority, CCG, community needs, quality of care and finance available to BECH before planning can commerce.

3.2.1 Management style is the principles that underline the methods, abilities and techniques managers use in handling situations and expressing leadership within an organisation (Moss and Moss, 2012). The report on the services rendered by Beacon Edge Care Home by CQO was classified as been ineffective, unresponsive, unsafe and not well managed. The management style deploy by the organisation is not meet the needs of the service users and the goals of the Home.  The report indicated that employees do not have an understanding of their roles and duties, hence, the management are communicating with staff about what is expected of them. By embracing a paternalistic style of working the manager decide what is best for the employees as well as the organization. The policies are devised to benefit the employees and the organization. In addition, employee play a part in the decision making and roles and duties of individual staff are communicated to them. By deploying management style, employees would feel attached and loyal to the organisation.

3.2.2 Staff development needs is essential to meet the needs of the service users, in the report, CQO indicated that staff lack the essential training to be a mental nurse. And there were breaches of regulation in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, good governance and staffing. Lack of staff development through training has led to the health care provider providing inadequate care. There was also lack of effective communication channel between the management and employees which made it difficult for staff to understand their roles and duties in the establishment.  By investing in training and development, staff will be able to acquire the necessarily skills to conduct their duties appropriately and effectively.

3.2.3 Reconditioning refers to an organisation restructuring their goals and objectives to meet the criteria and regulations of sector they operate (Moosavi, 2009). Beacon Edge Care Home clearly deviated from the codes of conduct of health and social care and the criteria of the CQO. Reconditioning will enable the organisation to evaluate the regulations and legislation they have to adhere to meet the criteria of CQO in order to meet the expectations of their service users.

3.3 Monitoring recent changes in health and social care services

Effective monitoring of change in the health and social care involves the systematic and analyse of information collected to measure change and meet objectives and help management to make informed decisions (Haluza and Jungwirth, 2016). The monitoring process comprises of internal and external analysis to measure changes. Internal analysis will usually involve supervisors, managers, clinical audit team, team leaders or a registered person. While, external monitoring comprises of CQC, CCGs, Monitor, Audit Commission and Health inspectors. Monitoring is essential in an organisation because it helps to track implementation and outputs systematically, and measure the effectiveness of programmes. It helps determine exactly when a programme is on track and when changes may be needed (Haluza and Jungwirth, 2016). There are various approaches Beacon Edge Care Home can embed to monitor the impact of change in the organisation, some of the techniques are reviewing the service delivery, supervision, shadowing, observation, audits, feedbacks, interviews and questionnaires.

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