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The professional role at the workplace is to be effectively followed as it helps to accomplish goals and makes the employees develop pride in their work along with show enhanced working performance. In order to make appropriate change in the organisation, the execution of working actions by following professional role is important as it helps to perform activities that ensure enhanced change management. In this report, the professional roles to be played in making change management within the NHS are to be discussed. For this purpose, initially the rationale for the change and the specific change to be made is to be identified and discussed. The importance of listening to patients and measuring quality as professional role in making the change is to be explained. The models and tools to be followed in making the change management within the NHS are to be identified and discussed. The key aspect of change management is to be critically analysed and way of transition towards professional practice is to be discussed.
In general, change within the NHS is needed because of changing needs of the current population who are expressing requirement of urgent care for new complex health issues that were not previously present or identified since a decade (Campbell, 2017). Therefore, change in the NHS is essential as it is going to include new care practices in meeting raised expectations and needs of the service users to provide them enhanced quality care. According to Pascoe (2017), there has been huge change and development in the healthcare field by introduction of new innovative technologies and medications for recovery and treatment such a remdesivir drugs, robotic surgery, artificial intelligence and others. In this respect, change is required in the NHS so that they can adopt the new technologies and medication to be implemented in their practice to deliver better and innovative care to the service users. The NHS are required to create change in their organisational working nature and principles so that they are able to create value for money toward the service users (nhsconfed.org, 2019).
At the current situation in the NHS, I wish they need to create change in reducing waiting time for care towards the service users or patients. This is because since 2015 the percentage of patients receiving care within 18 weeks’ time for non-essential health condition has reduced and it is currently 85% whereas in 2015 it was 92% and it has totally alerted after the Covid-19 pandemic where waiting time has exponentially increased (health.org.uk, 2019). Moreover, in the past 5 years, the target for treatment initiation within 62 days of urgent GP referral for cancer patient has not been met for most of the patients (health.org.uk, 2019). This indicates that instant step of change in the NHS is required so that the waiting time is reduced for the patients as longer waiting time leads patients to remain devoid of care that contributes to their deteriorated health condition.
The listening to the patients is essential because they provide valuable feedback regarding the care provided to highlight hindrance and error being faced in the care. It leads the health professionals and nurses to determine their mistakes and understand the causes behind the complaints made by the patients. This, in turn, orients the health professionals and nurses to adopt changed strategies of care so that the error and mistakes are resolved to deliver better quality and satisfactory care to the patients (Maccoby et al., 2013). As argued by Brooks et al., (2016), failure to listen to the patients in healthcare leads the professionals unable to identify and specify faults and error in care. This orients the health professionals to deliver hindered quality care without their knowledge of the changed essential to be made for better health condition of the patients as per the need of the service users. For example, in Mid Staffordshire NHS Trust, it was seen that failure of the nurses to listen to the patient’s needs and demand lead many to experience unnecessary fall, remain dirty, express deteriorated health care and few faced fatal condition (NHS, 2013).
The barriers experienced in listening to the patients by the health professionals and nurses include increased workload and minimum amount of time available to be spent for each patients in providing them care (Steele et al., 2019). Moreover, due to different language being spoken by the patients other than English leads the health professionals experience challenge to understand their needs and listening to the patients in managing their care with intension of change (Steele et al., 2019). The barriers experienced by patients in reporting their needs and making complaints which led the health professionals and nurses faced hindrance in listening to patients include fear of repercussions in making wrong statement or compliant out of lack of understanding, lack of knowledge in using IT (Information Technology) services to provide feedback, unable to read and write, lack of access to healthcare information and its use out of poor vision and others (Kvrgic et al., 2018). This is because poor vision leads the patients unable to understand in which aspect care is been delivered in wrong way in turn making them face barriers in leading the health professional listen to their feedback.
The mechanism that is effective to be used in gaining feedback from patients and listening to them includes use of patient questionnaires and patient forum groups by the health professionals. This is because forum allows the patients to make direct comment on their care to the health professionals as well as the questionnaires led the health professionals understand their specific mistakes and error in care to be resolved by specifically listening to each patient (Al-Jabr et al., 2018). The Friends and Family Test is to be included in accessing feedback and listening to patient’s needs and complaints (NHS, 2013). This is because the family and friends are close relatives of the patients who support them in their healthcare and can make effective judgemental complaints about the care provided on behalf of the patient to make health professionals and understand the changes to be made in the care (Manacorda et al., 2017).
The response toward feedback from the patients can be made by performing clinical audits in the healthcare environment. This is because clinical audits assist in reviewing any process of care practise against previously set standards to determine the extent to which the quality standards are followed (Payne and Hysong, 2016). Therefore, by performing clinical audits it can be ensured to what extent the complaints made by the patients are true and actions to be taken in resolving them. In order to respond to the patient’s feedback, the current healthcare services and their way of delivery are to be measured by the line manager in the organisation on the basis of national or regional performance standard indicators. This is because it would make the line manager understand the extent of specific error in care mentioned by the patients are affecting care delivery, in turn, making them try to take appropriate actions in resolving them (Hysong et al., 2017). The response towards the patient’s feedback is essential to be provided and action based on the feedback is to be taken because they help the healthcare managers and professionals determine the quality of care and improvement to be made in enhancing the current quality of care which is not at per standards as reported by patients (Gude et al., 2019).
In order to enhance care quality, the guidance from National Institute for Care Excellence (NICE) and local trust policies is to be taken in healthcare. This is because the NICE and local healthcare trusts provide detailed information about the skill and knowledge to be present along the way specific interventions are to be made based on specific health condition in regarding specific people (NICE, 2020). The Care Quality Commission (CQC) has the role to act as independent healthcare regulator for health and social care services delivered in England, UK. They monitor, assess, examine and regulates hospitals and care homes to help them maintain proper care standards in delivering quality support to patents or service users (CQC, 2020). In order to improve care by responding to the feedback of the patients, the healthcare organisations are to arrange monitoring by the CQC and seek guidance from them about the measures to be adopted based on their report to deliver quality care by the organisation (CQC, 2020). The NPSA provides patients safety alerts to the healthcare trust regarding all care services and actions that are considered to be unsafe and must be withdrawn (england.nhs.uk, 2019). In this respect, the information provided by NSPA is to be focussed by healthcare trust to ensure they provide quality and safe care to the service users.
In order to measure quality in the healthcare, statistical methods are to be adopted to rate delivered care services and treatment by the service users and health professionals. This is because it would lead the line managers in the organisation understand the extent to which they have failed in maintaining quality of care and provides them clear information about the measures to be taken in which aspects of care to create quality care environment for patients (Barr and Dowding, 2019). The another way of measuring healthcare quality being delivered to the patients is checking its efficiency in comparison to the healthcare standards and indicators mentioned by the Department of Health in the UK. This is because Department of Health mentions national healthcare standards that are essential to be met to lead the quality care delivery to the patients and avoid legal suits by the healthcare organisation (gov.uk, 2020).
The inter-professional enhance service users safety and healthcare nationally and locally because varied professionals with diver experiences and skills work together in determining care and delivering it to the service users. This leads to avoid skill and knowledge gaps to be faced by professionals while working alone that leads to raise error in care and cause negative impact on the health of the patient to make them experience deteriorated health condition (Hardin et al., 2017). For example, the UK National Chronic Obstructive Pulmonary Disease (COPD) Resource and Outcome project was developed by making inter-professional collaboration between the British Thoracic Society (BTS) and the British Lung Foundation (BLF). The project was developed with the intention to make inter-professional working to determine the changes in existing care regarding COPD to be made within the NHS to ensure better and safe healthcare delivery to the service users which is currently not reached (Roberts et al., 2010).
The inter-professional collaboration enhanced service user’s safety by reducing medical errors and mistakes (Cunningham et al., 2019). For instance, in the NHS, collaboration with the pharmacist and nursing professionals are made in delivering medication to the patients. This because the pharmacist guides the nurses regarding the way they can avoid making unnecessary medication error and ensure safe medication delivery to the patients (Cunningham et al., 2019). The inter-professional collaboration enhances patient’s safety and care by reducing inefficiencies and lack of resources along with reducing healthcare cost. This is because different professionals share care ideas for each patients to develop holistic and safe care plan for the individual (Seston et al., 2019).
The two key tools frequently used for service improvement includes SWOT and process mapping. The pros of using SWOT analysis is that it allows to identify the existing strength and opportunities present in the working environment to overcome the identified threats and weakness identified that are hindering care services and avoiding improvement in care. Moreover, it supports making strategies in improving hindered service qualities (Phillips and Simmonds, 2013). However, the limitation of using SWOT analysis tool is that it leads to create increased number of ideas which altogether cannot be implemented at the same time in making service improvement within the organisation (Phillips and Simmonds, 2013). In contrast, the benefit of process mapping is that it highlights the key causes leading to hinders care and in turn provides clarified and specific ideas to be followed in improving care process and services (Phillips and Simmonds, 2013a). However, the limitation in creating process map is that it requires increased patience and skills which if not present leads to create hindered map that eventually cause inappropriate service improvement (Phillips and Simmonds, 2013a). The process map is to be used because it is simpler tool and present less complicated ideas to be implemented in making service improvement compared to SWOT analysis tool.
The two key models often used for service improvement are Kotter’s Change Management Model and PDSA Cycle. The advantage of using Kotter’s Change Management model is that it provides systematic way of developing plan in making service improvement and put emphasis on the way employees could be included who are key resources in making the service improvement successfully (Vokes et al., 2018). However, the limitation of the model is that it is a step-by-step process and failure to meet one step would result in creating complication in reaching service improvement. Moreover, the implementation of model to reach service improvement is quite time consuming and its top-down approach discourages any alteration or co-creation to be added in the middle (Teixeira et al., 2017). In contrast, the advantage of PDSA cycle is that it supports constant improvement and allows keeping control over ideas towards its effective established through proper analysis in making service improvement (Christoff, 2018). However, the only limitation faced with PDA cycle is that it does not promote proactive steps in making service improvement (Christoff, 2018).
In making the identified service improvement, the PDSA cycle is to be used. The PDA Cycle stands for planning, doing, studying and Acting (Christoff, 2018). In the planning stage, the measures to be taken in making the service improvement are identified (Christoff, 2018). In reducing waiting time for patients to receive care in the NHS, it is planned to reduce any unnecessary and extra appointment by patients with no extra need to care. This is because cutting down unnecessary healthcare appointments would create time and space for existing patients in the line waiting to avail care avoid being delayed in receiving support from the GPs (general practitioners). In the NHS, it is seen that lack of management of proper schedule causes delay in care and increased waiting time for patients. This is because cancelled timings for appointment are seen to be unfulfilled with another patient to be cared or reviewed as well as reappointment for the patients are provided over delayed time, in turn, creating increasing waiting time for patients (Limb, 2019). Therefore, another strategy to be implemented in making the service improvement is making proper schedule of appointment and reappointments. In addition, online opportunity is to be created for patients in accessing virtual care and consultation from GPs who are facing non-essential health complications.
The Acting includes implementation of the planned strategies in making the service improvement (Christoff, 2018). For implementing reduction of any unnecessary and extra appointment by patients to reduce waiting time for major patients, the reason behind each GP appointment is to be thoroughly reviewed and analysed by nurses. In order to implement the strategy of properly scheduling of appointment and reappointments, a chart or timetable is to be properly maintained by the nurses or staffs for the GPs indicating time and date. Moreover, strict rules are to be maintained in making reappointments so that no lengthy waiting is created for other patients who are present in waiting list to receive care from GPs. Moreover, online portal is to be created in making online consultation to be available for patients. The Study includes observation of the implemented strategies in causing service improvement (Christoff, 2018). Thus, effective study is to be made to determine the extent to which the implemented plan is effective to reduce waiting time for patients to visit GPs and avail care from them. For this purpose, patient's feedback and monitoring of GPs care are to be made through use of survey questionnaires and interview. Finally, based on the gathered observation additional changes if required is to be made to effectively continue in reducing waiting time for patients to avail care from GPs in the NHS.
In order to create sustainable and supporting change as mentioned in the NHS, continuous monitoring for 12 to 18 months is to be executed after implementing the change. The monitoring regarding service improvement or change is essential as it allows observing and inspecting the progress of the change over a period of time to ensure that the changed strategies or measures implemented are effectively followed by the employees and staffs (Flodgren et al., 2016). However, failure to monitor change effectively after its implementation leads the leaders unable to determine the extent of success they reached with the change and whether or not the service improvement made is actively followed in creating the change (Grant et al., 2018). Therefore, monitoring would lead to create sustained change of arranging faster healthcare appointments for patients in reducing their overall waiting time for care because it would allow keeping regular surveillance to determine to the extent the rules and measures asked are followed. In case they are not followed, actions can be implemented to ensure the hindered activities that are blocking the sustainability of the change are resolved and successful service improvement is reached.
The sustainability of the mentioned change for NHS that is reduction of waiting time for patients to access care is to be ensured by allowing free flow of required finances needed in making the change. As previously mentioned through process mapping, increased recruitment of staff is required to establish the change. In this regard, to allow the NHS has presence of required finances are to arrange crowdfunding techniques. This is because it is found that NHS already is low in funds and require increased amount of money to arrange existing services and making improvements (Graaf and Snowden, 2019). The crowd funding is regarding as the technique in which funds are received from the public for a genuine cause to be managed effectively (Bassani et al., 2019). Since the change in NHS is for betterment of care quality towards the public, thus crowd funding could be used to gather financial resources in making the change sustainable. The presence of appropriate and qualified healthcare professional along with trained nurses is required in sustaining the change. Therefore, the HR department in the NHS is required to take active approach in recruiting experienced physicians and trained nurses who can help in creating sustainable change.
The barriers to be faced in making the mentioned change or service improvement in the NHS include lack of motivation of the staffs and healthcare professionals in participating in the change. This is because they may think that the reduction in the waiting time for patients is not required as they are already delivering timely care to over 82% of the patients which is quite high. In order to resolve the barrier, the staffs are to be provided evidence regarding increased waiting time for the patients have continuously increased and it has affected in negative manner towards public health. It would create awareness among the staffs in accepting to work effectively to establish the service improvement strategies in making the change. The other barrier to be faced in establishing the change is lack of effective knowledge among the nurses and health professionals along with patients regarding the way to use online consultation for lowering waiting time in receiving care. In this respect, training regarding the way to use and maintain patient online portal for consultation is to be provided to the service users, physicians and nurses.
The other barrier to be faced in establishing the change is lack of effective time management and scheduling of appointment by the nurses to ensure lowering waiting time for care regarding the patient. In this respect, time management and scheduling training are to be provided to the nurses to help them understand the way strategies to be used in scheduling appointments and reappointment so that care can be provided within less amount of time. In order to implement the mentioned care, the transformation leadership style is to be used. This is because transformational leaders are found to be curious to delve deep into the issue in determining the roots of the problem so that innovative solutions for problems can be found to resolve it (Suchman et al., 2011). Since in the PDSA cycle, the key initial part is planning the strategies therefore transformation leader is required as they have the curiosity to under the problem with deep knowledge and plan effective strategies in resolving it.
The transformation leaders are found to be visionary and have keen perception of the actions to be taken so that a better future through any change or service improvement can be created (Suchman et al., 2011). In developing proper plan in the PDSA cycle, the leaders need to have effective vision in determining actions so that the service improvement to be made create better effect in the present as well as in the future. Therefore, the use of transformation leader is effective in making the change. The transformational leaders are found to have effective communication ability and efficiency to create team activity in accomplishing any task (Jambawo, 2018). In respect to PDSA cycle, leaders required to be effectively communicative in mentioning the roles to perform by staffs for establishing strategies for achieving successful change. Moreover, without team attitude and action not change can be effectively established. Therefore, the use of transformational leadership style is effective in making the change through the change model. The transformational leaders are found to have the capability in tolerating risk in making any action or change (Suchman et al., 2011). In the PDSA Cycle, the change cannot be executed proactively and risk are probable to be faced initially to be later resolved. Since PDSA cycle is used as change model in making the change, therefore the leaders require to have the ability in accepting and managing risk due to which transformational leadership is the best and effective style to be implemented in making the change.
In order to reflect regarding personal leadership skills, the Rolfe’s reflective model is to be used. This is because Rolfe’s provides appropriate framework to judge and reflect on personal skill to determine the action to be made in future to resolve the hindered personal capabilities as identified (Skinner and Mitchell, 2016). The steps of Rolfe’s reflective model are as follows: What?, So What? And Now What?.
In the last 2 years, whenever I was asked to be a leader to manage any problems and assist people I always tried to understand the root cause of the problem. I always expressed eagerness to learn different factors that has led to raise the problem. This is because in this way I thought I could understand the nature of unusual actions that led to the rise of the problem in planning effective strategies to resolve it. Moreover, my subordinates mention that I have effective interaction ability in making all understand the key actions to be performed. This is because they express that they always have clarified vision regarding their role to be performed and goals to be achieved whenever they talk with me as the leader. As a leader I often found efficiency in keeping team attitude. This is evident as I feel being a leader though I have the sole responsibility and effective knowledge compared to my subordinates in understanding what steps are to be taken for effective work management and change. However, accessing ideas from the team could lead to create better scope and collaboration in more effectively managing the work.
The self-reflection informs that I have effective curiosity and analysis skill as a leader. This is effective skill needed as leader because curiosity makes the leaders identify different ways to survive from complex problem and develop innovative ways in executing work practises successfully (Leigh et al., 2017). Moreover, it is seen that I have effective communication skill as strength of being a leader. The presence of effective communication skill is important for leaders to properly consult and interact ideas with the subordinates in making them develop clarified vision about the goals and roles at work to be accomplished by them to ensure productivity in the organisation (Myers and Chou, 2016). Moreover, the presence of effective communication skills makes the leaders well-capable of understanding problems on the subordinates and assists them in resolving the issues to ensure positive working environment (Leigh et al., 2017). I also found that I have effective team attitude in working as I feel all individuals are to be included in sharing ideas to determine enhanced plan in reaching the work goals.
At the present, I feel that NHS requires constant change according to the innovation and development happening within the working environment. In this respect, I consider to have the attitude and skill of making continuous professional development as a leader while working in the NHS. This is because it is the only way in which constant change within the NHS can be managed. I also require having effective evidence-based practice skill and researching skill to be a better leader in future. This is because evidence-based practise would help me influence my subordinates in making change and researching skill will help me remain updated about the changes occurring within the healthcare field to be included in the NHS as an effective leader for supporting its enhanced progress in delivering quality care to the service users.
The above discussion mentions that due to advances in medical technology, needs of population and others regarding care, the NHS require to implement service improvement or change in their existing practise. I wish the NHS to create service improvement in reducing waiting time for care regarding patients so that early and timely care is reached to them for keeping them healthy. In this process, the PDSA cycle as change management model and process mapping a change management tool is effective to be used. The transformational leadership style and qualities are to be followed in making the determined change within the NHS.
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