Page 234 - Managing Change in Organizations

CarnCh12v3.qxd 3/30/07 4:29 PM Page 217

The change equation

were already devoting all of their available management time. How more was to be
made available was perceived to be an important dilemma.
9 Linked to this, there is a widely held view that while the principle of clinical directorates
and the involvement of clinicians in management is sound, the individual clinician
often finds that the demands of managing the directorate cannot be met within the
existing sessional allowance. Conversely the need to, and their own preference to,
maintain their clinical work makes providing more time not a valid option. This is
clearly recognized as a big dilemma. Many clinicians also felt they had received little or
no relevant training in management – some pointing out, however, that clinical and
other demands had meant that they had been unable to attend what was provided.
10 There is complete agreement that much more needs to be achieved on information
and on budgeting. Too many people either are unclear about budgets, costs and
related matters (e.g. what budget is available, what things cost) or believe the avail-
able information (whether budget reports or other information) is too global, does
not provide the right information, or is wrong. It is widely recognized that much
improvement is already underway but there is a wide measure of cynicism about the
present situation. All recognize this as a key constraint to further devolvement and
to a flatter corporate structure.
11 It is important to recognize the strong feelings expressed regarding the need for a
flatter structure and for a greater clarity of structure, accountability and of roles, job
descriptions and so on. Some say HST is overmanaged. Some say it is impossible to
find out who to go to in the event of problems affecting patient care. Widely held is
the view that people have insufficient resources to deliver patient care. More con-
sultants, more junior doctors and more space were constant comments from many,
but this is not the whole of it. Many wish to see quicker decisions, more decisive
management, more visible management and more access to top management. All
of this is seen as requiring a flatter structure, greater clarity of accountabilities, much
improved budgeting and information, improved communication, job descriptions
and the like. In particular, decision making and professional representation needed
review. The UMT was not an effective decision-making body and other medical con-
sultative arrangements would need to be reconstituted. Many recognized that the
roles of business development managers and nurse managers were not clearly dis-

tinguished in practice, and also varied across the clinical directorates. This created
unnecessary confusion for some and needed to be resolved. Linked to this are a num-
ber of career issues, not least for nursing staff.
12 Turning to corporate structure and management, there was both a measure of
agreement and significant controversy. These varying views are therefore set out
more fully as follows:
(a) Of the 118 people interviewed, 67 made specific comments regarding the cor-
porate structure. Of the 51 who did not so comment, all had indicated that other
changes would lead to improvements at HST, and more than 90 per cent of them
were clear that management changes were needed, most commonly to clarify
roles and accountabilities, to improve communication and to devolve authority
throughout the organization.
(b) Of the 67 who made clear comments on the structure, 45 argued that the num-
ber of clinical directorates should be rationalized, most commonly to between four
➔

217