Page 236 - Managing Change in Organizations

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The change equation

14 Second, it is clear that any changes should deliver both a clearer, simpler and flatter
organizational structure and one which creates career possibilities for employees. In
addition it should engage clinicians in the priority work of management in ways
which are consistent with the limited time they have available and which make the
best use of their management time. The two priorities which this review points to are
the development of service so as to grow the business over time and the achieve-
ment of the business plan in any particular year.
15 There seemed to be a clear view that any changes include attention to arrangements
for professional representation. It is self-evident that not all professionals can be
involved in management and that there are many and often complex professional
issues to be dealt with in HST. Professional representation with inputs at board level
and operational management level were therefore needed.
16 There was clear agreement that quality assurance and effective information provision
were essential whatever changes to management arrangements were to be made.
Much progress has been made and is in hand. Any changes need to be carefully and
thoroughly planned alongside the planning of change in these two key areas.
17 Overall it is recommended that HST consider, in detail, a rationalized clinical direc-
torate structure which does the following:
(a) Organizes clinical care around four clinical areas, each with a clinical chair and an
experienced general manager.
(b) Devolves budget responsibility to specialty level.
(c) It is essential that responsibilities be so organized that clinical chairs along with
specialty managers can devote sufficient time to managing budgets and develop-
ing the business of specialties and the clinical area (requiring attention to clini-
cal/service development and working with clients/potential clients such as GP
fund-holders).
(d) As part of this the positioning of diagnostic services, theatres and ITU should be
considered carefully. Basically these departments provide services to the various
specialties. To manage and resource them properly it is essential that the spe-
cialties be properly charged for the use of these services.
(e) Any proposal for change needs to be integrated with plans to develop quality

assurance and information systems. Responsibilities for operational management
quality assurance, information and business management must be clarified at
board level. In particular there seems to be a powerful case for a well-defined bed
management procedure.
(f) Finally, professional materials management should be considered. Moreover, wage
payment arrangements should be integrated within the personnel department to
avoid duplication of information. The key here from experience elsewhere is to
ensure that the payroll is managed by an experienced and capable payroll manager.
18 The purpose of this report is to present the views of managers and professionals.
These are to be worked up into specific proposals to be presented to the board in a
separate document. This work is now underway by the executive members of the
board supported by the author of this report. The objective is to complete this work
by 3 February for presentation to the trust board on 10 February.
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