Page 232 - Managing Change in Organizations

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The change equation

CASE
STUDY Health Service Trust (HST)

This case study sets out extracts from documents drawn from an organizational review
of a National Health Service (NHS) Trust in the UK. Since recent reforms, health service
‘providers’ are organized as trusts which are managed by a board but remain part of the
UK NHS.

Brief

1 This diagnostic study was undertaken to provide an input to the trust board. The
objective was to present a summary of views of managers and professional staff about
the effectiveness of the existing corporate structure and management arrangements
of HST. The purpose of the review was to aid the board in ensuring that HST has in
place a structure and management which aid the achievement of the objectives of
the trust. Specifically, the terms of reference were as follows:
(a) Review the management arrangements of HST and make recommendations for
change aimed at increasing the efficiency and effectiveness of HST.
(b) The review should consider and take into account the recommendations and
suggestions made in a number of recent reports, including:
– Hospital Manager–Consultant–Nurse Study Report, June 1992 (completed by
a consultant).
– Audit Commission’s Nurse Management Review, August 1992.
– King’s Fund Organizational Audit Visit, September 1992 (both national
organizations concerned with public service management and health serv-
ice management).
(c) The study will be wide ranging and cover all aspects of HST’s management.
(d) Any recommendations must fully support HST’s philosophy of clinical manage-
ment and devolving authority and responsibility as near to the point of delivery
of care as possible.
(e) The review should aim to streamline channels of authority and accountability at
all levels in the organization.

(f) The review should encompass management support.
(g) The proposed structures must not increase, and preferably should reduce, man-
agement costs of HST.

Approach to the study
2 A working group of managers was established who would work with the consultant
in carrying out this diagnosis. This allowed a large number of interviews to be carried
out quickly and ensured the relevance of the review. The consultant and the working
group designed the interview schedule and identified the target group to be inter-
viewed. A total of 121 interviews were carried out across HST from board level down
to ward sisters. (Three people refused to be interviewed.) The consultant and the
working group have been involved in summarizing the results and in drafting this
report. In addition a number of individuals wrote to the consultant expressing views
relevant to the management review.
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