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Study of Royal Bournemouth and Poole Hospital

Introduction

In 1986, Albert Bandura modelled Social Cognitive Theory (SCT) on behaviour acquisition by emphasising significant role the cognition has in modelling behaviours. The theory holds that individual knowledge acquisition occurs in social context by interaction, experiences, and influences of social factors such as media (Luszczynska, and Schwarzer, 2005). According to Burke and Mancuso (2012), this learning process is dynamic and held by continuous exchange of information, skills, and experiences between internal factors that include thinking and processing (memory, motivation, perception) and external determinants (recognition, rewards). The theory roots knowledge acquisition on the environment one grew in, behaviour, cognition as primary factors. Ramirez et al. (2012) illustrate that one’s behaviour have an influence on his/her thinking, similar to the environment one’s lives and grew up in have significant impact on future ways of life, interaction with others, functioning, and performance in a given scenario. Essentially, an individual past (background) has detrimental influence on their present and future actions, response, and performance. It is worth noting that the theory does not apply only to an individual but can also be applied to capture organisation’s behaviour, growth, and adjusting to changes in internal and external environment as well as adoption of systems at a national levels (Rana, and Dwivedi, 2015; Font et al., 2016; Whitaker, and Godwin, 2013). As such, in order to understand current phenomena, one needs to look at three elements: identity, behavioural factors, and environment situated. In this essay paper, the focus is linking concepts of the social cognitive theory to the proposed changes outlined in the case study of Royal Bournemouth and Poole Hospital to overhaul hospital changes.

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Background of the Royal Bournemouth and Poole Hospitals

The two hospitals, Royal Bournemouth Hospital and Poole General Hospital, are both located in Dorset, England. In 2011, Dorset Clinical Commission Group (CCG), a commission responsible for overseeing healthcare in Dorset, decided to restructure Royal Bournemouth Hospital to become an emergency hospital while Poole Hospital converted into an elective centre (NHS, 2021). The decision, made following a clinical review, triggered the two trusts requesting the Competitions and Markets Authority (CMA) to change regulations that had initials implemented preventing their mergers. Following a decade of preparations and restructuring processes, on 1st October 2020, CMA confirmed the merger of the two trusts, Poole Hospitals Foundation Trust and Royal Bournemouth and Christchurch Hospitals Foundation Trust (GOV.UK, 2020). The combined trusts, now called University Hospitals Dorset NHS Foundation Trust, was finalised despite several opposition by public and challenged in courts. The commission has prohibited mergers between hospitals trusts on the basis that competition would enhance efficiency of services delivery. The authority had found the two hospital trusts to having limited incentives of competing against each other for the benefits of public health services quality.

However, following the investigation by the authority in which it found competition between NHS hospitals had little correlation with the quality of services offered. Rather, collaborations among these plays particularly the hospitals demonstrate a better way of meeting and enhancing care value (Williets 2020). Prior to merger, the campaigners against the merger proposals claimed that patients and community that depended on Poole’s A&E (Accidents and Emergency), maternity, and paediatric services would have to longer travel time for emergency, hence posing a major risk to patients’ safety. Under the overhauling plans, the A&E services would move to Royal Bournemouth Hospital while Poole becoming a centre for planned treatment and operations. According to BBC (2020), currently, the new trust employs approximately 9,000 staff and combined turnover of approximately £630 million.

Personal Factors

Under the social cognitive theory, cognitive structure in relations to formation and delivery of the healthcare services by University Hospitals Dorset NHS Foundation Trust is derived from self-efficacy and outcome expectancies. Bandura defined self-efficacy as a “people’s beliefs about their ability to produce designated levels of performance” that in turn influencing their objectives and aims. In this case, the two hospitals proposal to merger comes in light of advancing quality of care while restructuring due to financial constraints (Bandura, 1986). According to CCG, the changes were necessary in order to tackle the projected shortfall in funding. The dynamic changes in the health care that include evolving healthcare needs (diabetes, obesity, and antibiotic resistance), need for modernisation (telehealth and equipping hospitals for specialised services), growing aging population, and advancement in medical sector are pushing hospitals to restructure their respective operations that include mergers. For these, organisations including those in medical sector are shaped by need to oversee its survival, growth, enhance its performance, and remain profitable. The internal factors captured by organisational culture, business models, organisation aim and objectives, and its staff composition.

Although organisations are subject to several complexities brewing from interaction from different variables, each organisation objectives as well as those of its employees shape the directions it takes and performance. According to Berzonsky (2011), perceived managerial efficacy influence the goal setting, implementation of short and long-terms objectives, and forecasting of the internal changes. As such, grounding on the theory, CCG acknowledges the need to restructure the hospitals in line to financial constraints as well as projected increase in service quality and hospital performances. According to Berzonsky (2004), perceived self-efficacy have positive correlation with one’s performance. But first, in an organisational perspective, it has to identify the variables that in implementing will maximise intervention effect.

Environmental Factors

Building from reciprocal determinism aspect of the theory, moving the A&E services to Royal Bournemouth Hospitals may trigger unforeseen increase in the emergency cases as well as the longer distances the patients will have to travel may have a negative and reciprocal effect on number of patients (Rangel, and Keller, 2011). BBC reported that just before closure and merger of the two hospitals in 2018, Poole’s A&E saw a record number of patients (235 patients in a day) and receiving 77 ambulances. More so, despite the hospital saying the waiting time being around 4-hours, one visitor reported waiting for 14 hours in the department (BBC, 2020). In the larger perspective, one can argue that moving the emergency services to Bournemouth hospital will ultimately have a long-term effect on the wellbeing of the patients in the sense that just the cognitive knowledge of limited or lack of the services offered by Poole hospital will lead to increase of the cases. Nevertheless, the opposite effect can happen where the distance to Bournemouth will result in patients opting not to seeking medical attention for non-life threatening problems. The decision to make Poole Hospital elective in nature (centre for planned treatment and operations) by moving the emergency and maternity services was largely driven by external factors that include financial, perceived consumer base, and long-term organisation financial returns. The critics of the restructuring held that the expected outcomes and intention for moving A&E services was support by hospital management need to improve the performance in terms of return rather than quality of service and in expense of public health.

Behavioural Factors

Although the hospital argued that there was no particular reason for the sharp increase in A&E patients numbers, concern of the public welfare and patient safety were highlighted in the legal challenge launched in the wake of planned move and closure. The campaign against the merger based its argument would affect the patients welfare and safety. Given that lack or limited competition would have on the quality of services and value to the patients and public, the merger induced a concern on incentives driving the hospital to prioritise patients’ treatment and care. The trusts hold that by merging and implementation of proposed changes would result in delivery of personalised services, improving care and treatment received by each patient (Cartlidge, 2020). The changes aimed at involving home access visits in order to improve patients’ safety, integrated single point referral points, and communication-oriented therapy. However, the experience reported by one staff depicts different perspectives. According to the staff, who had to resign because of mismanagement, mistreatment of staff, and poor leadership, the hospital trust has little considerations of the patients welfare rather its focus is reducing cutting cost and increasing it returns. The observations held is that even after merger and transfer of services and functions, the staff who were kept at minimum were bullied by management, ‘extremely poor management’, stressed, and management having unprofessional and unacceptable behaviour. According to the theory, individual’s behaviour, in the case the hospitals, is rooted on experiences, surrounding, culture, and thinking.

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Conclusion

The essay examines the personal, environmental, behavioural factors as outlined by Bandura’s Social Cognitive Theory model in relation to merger of Royal Bournemouth and Poole Hospitals. According to the theory, cognitive structure provides a personal frame of reference in problem solving, making decisions, and interpretations of information. Arguably, identity held by the community is association with the hospitals and access services without having to wait for long hours as well as travel long distances, and moving the services subverts that identity triggering opposition.

References

Bandura, A., 1986. Social foundations of thought and action. Englewood Cliffs, NJ, 1986(23-28).

BBC News, 2018. Record patient numbers at Poole Hospital's closing A&E. [online] BBC News. Available at: [Accessed 17 April 2021].

BBC News, 2020. Bournemouth and Poole hospital trusts merge. [online] BBC News. Available at: [Accessed 18 April 2021].

Berzonsky, M.D., 2004. Identity processing style, self-construction, and personal epistemic assumptions: A social-cognitive perspective. European Journal of Developmental Psychology, 1(4), pp.303-315.

Berzonsky, M.D., 2011. A social-cognitive perspective on identity construction. In Handbook of identity theory and research (pp. 55-76). Springer, New York, NY.

Berzonsky, M.D., 2011. A social-cognitive perspective on identity construction. In Handbook of identity theory and research (pp. 55-76). Springer, New York, NY.

Burke, H. and Mancuso, L., 2012. Social cognitive theory, metacognition, and simulation learning in nursing education. Journal of Nursing Education, 51(10), pp.543-548.

Cartlidge, S., 2020. Today is an important day for our hospitals - here's why and how we got here. [online] Bournemouth Echo. Available at: [Accessed 18 April 2021].

Font, X., Garay, L. and Jones, S., 2016. A social cognitive theory of sustainability empathy. Annals of Tourism Research, 58, pp.65-80.

GOV.UK, 2020. Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust / Poole Hospital NHS Foundation Trust merger inquiry. [online] GOV.UK. Available at: [Accessed 18 April 2021].

Luszczynska, A. and Schwarzer, R., 2005. Social cognitive theory. Predicting health behaviour, 2, pp.127-169.

NHS, 2021. NHS England » University Hospitals Dorset NHS Foundation Trust. [online] England.nhs.uk. Available at: [Accessed 18 April 2021].

Ramirez, E., Kulinna, P.H. and Cothran, D., 2012. Constructs of physical activity behaviour in children: The usefulness of Social Cognitive Theory. Psychology of Sport and Exercise, 13(3), pp.303-310.

Rana, N.P. and Dwivedi, Y.K., 2015. Citizen's adoption of an e-government system: Validating extended social cognitive theory (SCT). Government Information Quarterly, 32(2), pp.172-181.

Rangel, U. and Keller, J., 2011. Essentialism goes social: Belief in social determinism as a component of psychological essentialism. Journal of personality and social psychology, 100(6), p.1056.

Riley, W.T., Martin, C.A., Rivera, D.E., Hekler, E.B., Adams, M.A., Buman, M.P., Pavel, M. and King, A.C., 2016. Development of a dynamic computational model of social cognitive theory. Translational behavioral medicine, 6(4), pp.483-495.

Whitaker, B.G. and Godwin, L.N., 2013. The antecedents of moral imagination in the workplace: A social cognitive theory perspective. Journal of Business Ethics, 114(1), pp.61-73.

Williets, B., 2020. Royal Bournemouth and Christchurch Hospitals merger with Poole cleared for go-ahead. [online] Bournemouth Echo. Available at: [Accessed 18 April 2021].


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