Page 237 - Managing Change in Organizations

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Chapter 12 ■ Diagnosing change

Options for change
These options for change were considered by the trust board in the light of the above
and in order to achieve the following:
■ Support a move toward a more devolved patient-focused care organization.
■ Involve clinicians in priority management tasks.
■ Simplify the reporting arrangements and structure.
■ Create effective cost centres.
The five options were as follows:
1 No change.
2 Fine tuning.
3 Create an internal market.
4 Create a facilities directorate.
5 Reduce the functional directorates.
Option 3 was the most radical change involving reducing clinical directorates from eleven
to four and requires the clinical chairs to contract with an operational services directorate
for services (staff, facilities, beds, etc.) allowing them to focus on clinical outputs. However,
this required extensive and sophisticated information systems not yet available and assumed
a degree of attitude change and contracting skills not likely to be widely available.
Under option 4 the clinical chairs retain control over service inputs, except beds
which would be controlled by the director of facilities. Under option 5 functional direc-
torates are reduced by merging operational services under the director of operation
services, clinical directorates are reduced to five, the fifth being clinical support services.
Briefly, a version of option 4 was selected as the basis for change on the grounds that
the capabilities for option 3 were not available and could not readily be obtained,
whereas options 1, 2 and 5 brought insignificant operational benefits and made no
progress toward a more devolved approach to patient-focused care.

Conclusions

There are three main conclusions to draw here:
1 The case deals with changes to a professional service organization in which issues of
professional autonomy, public service and managerial/operational effectiveness must
be balanced.
2 Given that point, the systematic approach to diagnosis created learning because atti-
tudes were clearly changing as a consequence of the impetus created by the review;
thus people who had opposed the streamlining of clinical directorates now came to
accept the arguments for such a change, and the inevitability of it. Conversely the
board was seen as being prepared to listen to contrary views.
3 Risk analysis always represents a key issue in change decisions. The two key issues in
risk analysis are impact and capabilities. What impact will be created where and on
whom (which groups) and how will they respond? What capabilities are required
either immediately or as a consequence of the impact, and can they be acquired? Is
the change feasible, and over what time scale?

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