Page 233 - Managing Change in Organizations

CarnCh12v3.qxd 3/30/07 4:29 PM Page 216

Chapter 12 ■ Diagnosing change

3 The following information is included as appendices:
Appendix 1: the interview schedule.
Appendix 2: a list of specific comments drawn from the interview notes.
(Neither is included here.)

Arrangement review of HST
4 A number of points were held in common by the majority of those interviewed. HST
was seen as a well-regarded organization comprising many capable people. It was
seen as innovative and as having many specialties which were known nationally for
various developments. Almost all respondents thought that the team of which they
were a member was effective, cohesive and friendly. Individuals and teams were seen
to possess the necessary technical, professional and other skills and were seen to
work together well.
5 Communication was seen to need improvement but recent improvements were also
acknowledged. Nevertheless an examination of Appendix 2 will quickly reveal many
expressed concerns in this area. Linked to this, people expressed concern about man-
agement style and change. There has been a lot of change recently. Many feel that
changes have been neither handled sensitively nor communicated effectively. Some sug-
gest that there is too little cooperation and too defensive an approach; others feel that
there are too many committees and working parties and that it is difficult to identify a
decision-making forum. The UMT (Unit Management Team) is seen as too large and too
diverse (regarding the interests represented on it) to be a source of effective decisions.
6 Many of those interviewed put the case for greater devolvement. Some called for
devolvement of finance and for personnel to directorates, some called for greater
devolvement within directorates, some called for devolvement of hotel services, some
called for devolvement of other services. Linked to this, some referred to the impor-
tance of service agreements between directorates and directorates providing services.
7 Many of those interviewed held strong views about the impact of split sites on effec-
tiveness; however, varying views are held. Some felt that certain smaller units are
effective because they can be managed as small cohesive units and would not wish
to lose this advantage; however, most recognized that split-site working brings dupli-
cation, higher costs, frustration and problems of communications, management and

control. The infrastructure generally was seen as a source of constraint and all would
prefer major new capital development while recognizing that this is an issue outside
this management review.
8 There is a widely recognized lack of accountability of a range of issues. Beds are not man-
aged as a whole – some of those interviewed indicated that HST needs to get to grips
with this soon. Linked to this, admissions and discharge policies were seen as ill-defined
by some. Purchasing and stock control were seen as in need of further improvement. The
whole business-getting process was seen as needing organizing. As more and more of
the workload comes from GP fund-holders, people-health purchasing is carried out by
health authorities and GP fund-holders – general practitioners to whom budget has
been devolved are questioning how to find the time to obtain this business, manage the
expectations of fund-holders, engage in service development and relate to other pur-
chasers. The role of clinicians was perceived to be central but no one could see how they
were to find time to play it effectively. Most, if not all, clinicians involved in management

216