July 27, 2008

Essay on the Generic Worker Concept: Impact of the Changes at the NHS Trust Hospital

Introduction

Organisational changes occur almost inevitably as part of further development. Undergoing significant changes at various points of organization life is always for a purpose. For instance, when organisation changes its overall strategy perhaps through adding or removing major section or practice and changing the very nature by which it operates are embraced all for the sake of competitive advantage. The latter is very true for the NHS Trust hospital. The organisation considers changing the internal process by means of introducing generic worker concept. The change was perceived to be an important tool in translating flexibility, teamworking and responsiveness into competitiveness of both the people and the organisation.

What the NHS Trust Hospital Did – The Onset of Generic Worker Concept

At NHS, the initiative to implement a generic worker concept drives shared services between the hotel services and nursing departments with the ongoing commitment to maintain the top-to-bottom focus on organisation’s objective which is to provide value for money through quality services. The main purpose of the generic worker strategy is the continuous improvement. The continuous improvement placed its focus on improving customer satisfaction by means of continuous and incremental improvements to processes (Dettmer, 1997, p. 10).

According to the Two Factor Theory by Frederick Herzberg, there are hygiene and motivation factors to organisational changes. Hygiene factors are working conditions, quality of supervision, salary, status, security, company, job, company policies and administration and interpersonal relations while for motivational factors include achievement, recognition, responsibility for task, interest in the job, advancement to higher levels and growth (Ellis, 2004, p. 82). Some of these elements are embedded on the generic worker concept change strategy at NHS hospital. In discussing the strategies the NHS had implemented, this paper will use the eight-stage process by Kotter (1996).

1) Establishing a sense of urgency – to overcome complacency, create a strong reason why change is needed.
Philips and Holton (1997) made mention that for positive organisational change to occur specific factors such as people’s readiness and top management’s commitment are of critical importance (p. 10). The generic worker concept conforms to two basic requirements for a better performing workforce. First is on managerial implications such as simplifying complex compensations scheme and formalisation of control as well as cost savings idea. On the operational part, this change strategy is chosen so as to respond to the burden overworking, reducing redundancy at work and the so-called ‘waiting for action time’.
2) Creating the guiding coalition – build a team with right composition of power, level of trust and shared objective to lead the change.
The importance of building a team is on carrying out effective administration and making informed decisions (Brody, 2004, p. 384). Within the Site Services Directorate, specialised units of implementers are formed. The three service providers group as caterers, porters and domestics are divided into teams and are provided with team leaders and supervisors/managers in addition to ward managers.
3) Developing a vision and strategy – which clarifies direction, motivates people and helps coordination.
Kotter (1996) maintains that gives direction and provides the focus for all activities within the organisation, inspires people throughout the organisation and binds them together. As part of the organisation’s business plan, the proposed concept is one of the seven key changes to enhance efficiency and improve healthcare services for the patients. The generic worker concept aimed at improving efficiency and effectiveness of service provision at ward level. The combined role of porters, domestic and catering staff is an effort to upgrade the skills of these support workers.
4) Communicating the change vision – to make sure everybody understands it.
Communication is an incremental instrument in getting all the employees on board as it can deliver collaborative efforts towards the achievement of common goals (Sisaye, 2001, p. 129). The flow of information regarding the generic worker change follows a top-down, trickle down effect. The concept was born from the Hotel Services Director’s unit down to porter managers, domestics supervisors and ward managers and then transferred to the people involved.
5) Empowering employees for broad based action – to eliminate barriers, time constraints.
Provided that hotel services staff were to be based at ward level, the requirement of supplemental training and education to perform new roles is evident. NHS provided their people with such, in addition to basic pay raise. This figures that the empowerment of employees serve as a powerful tool in overcoming the challenges and risks of organisational changes (Harigopal, 2006, p. 300).
6) Generating short term wins – to stay the on the course as major change will take long time.
Philips and Holton (1997) also assert that creating a win-win environment is essential to the change process (p. 244). As evident, the change process embraces customized action plans with the flexibility to accommodate corrective actions whenever necessary. The concept, as well, was initially administered by proficient small management team with a well-organised reporting schema.
7) Consolidate gains & produce more change – using ‘short term wins’.
The consolidation of gains suggests that resistance to change only happens when people does not realise the overall positive impact of the changes to them (Kotter, 1996, p. 81). The reallocation of duties is one of the major changes that NHS implemented. Such endeavor points on the greater emphasis on the making sense of rotas that delineates line of duties and eventually the ownership of tasks.
8) Anchor the new culture – to innovate & change continuously and to firmly ground the operating style.
As such, what embodies the change to be successful are organisational imperatives that benefits all the organisational members through new values as stated in the objectives (Cameron and Green, 2004, p. 187).Based on the pilot implementation, the generic worker strategy proves to be insufficient and facing a lot of resistance from the operational level. This brings us to discuss the limitations and loopholes of the proposed change.

The theory of mechanistic and organic systems as developed by Burns and Stalker (1994) suggest that the changing conditions of the generic worker concept is an endeavor that falls short of the contributive nature of knowledge and experience. True enough, the Hotel Services staffs are provided with ‘unrealistic’ nature of tasks through the consolidation of cleaning, portering and catering responsibilities. The task scope in addition has a basic shedding of responsibility that is embedded on limited field of rights, obligations and methods that will genuinely empower them despite the provision of training programs.

Limitations and Deficiencies of Generic Worker Concept – What Went Wrong

From its inception, the generic worker concept is inherently problematic and conflict-laden. The specialist nature of the change strategy branched into several quandaries including issues on performance assessment, sense of ownership, lack of consensus, employee resistance, demarcation issues and communication process as well as gender issues and work patterns. Put simply, the chosen strategy is a challenge to status quo and brings about powerlessness on employees’ part.

Goldratt, through his theory of constraints (TOC), explains that the concept of every organisational change is central to cause and effect. Though NHS had already divided the organisation into more controllable, manageable units, there still remains the difficulty in managing the actual, potential and emerging constraints due to the proposition of the change strategy. What the NHS has done otherwise than what is acceptable is the lack of acknowledgement of the degree of inertia regarding the change. Necessarily, NHS would not be able to exploit the constraints to their advantage and then elevate the constraint to maximise the change strategy’s advantages (Dettmer, 1997).

The challenge is basically on the intertwining functions of Hotel Services and the nurses as there are blurring responsibility on a specific task specifically between female and male staff, and also the interface between Hotel Services and ward managers. Given that there are already the concerns of low employee motivation and absenteeism, the proposed concept also contribute to the emergence of more uncertainties at the ward level especially on complying with the duties given on rotas. Realising the matter, the generic worker strategy has no clear performance measures to which pay was to be based. To wit, there are no service-level agreements of performance measure acceptable for all stakeholders involve.

Informal communication processes was the main source of information, which in return affects lower rate of employee buy-in. The managers of change were not able to gather the workforce as a ‘cohesive social unit’ that it should be. Team briefings and staff notice board were understated. Further, the terms of employment and the structure of remuneration are other administrative issues; a condition that calls the attention of the trade union.

According to Kotter and Schlesinger, there are six change approaches that outline the four reasons that certain people are resisting change. These are parochial self-interest, misunderstanding, low tolerance to change and different assessments of the situation. Poignantly, these characterises the change strategy that the Hotel Services Deputy Director proposed. The generic worker concept imposes practical concerns from the people such as enforcement of collaborative working and scheduling dilemmas. There are also communication problems, some people are very keen on organisational support of role changes and the greater disadvantages of the change (Banhegyi and Banhegyi, 2007, p. 103).

The UNISON intervention

The union did not, at not cost, agree with the Trust’s ‘improvement exercise’ of implementing the generic worker concept. The debate led to the voting process of who are in favor and not for the proposed change; a process that voiced out the collective opinion of the NHS hospital’s staff. The extent of resistance to generic worker strategy could be explained by the Theory of Planned Behaviour (TPB). Developed by Ajzen in 1988, this theory asserts that within NHS hospital are behavioural, normative and control behaviours. These are the consequences, expectations and attitude towards any organisational change (Ajzen, 2005). However, for NHS, increasing the knowledge along does not necessarily deliver the right attitude regarding the change. Instead, the change strategy generated ‘unfavorable’ behaviours. But, for their employees, these unfavorable behaviours that are proven by the resistance to generic worker concept means protection of individual interest and elevating the labor bargaining power and consensus-building. The results echoed the desire of the employees – 12 are in favor while 150 are against the change with the rest abstained.

Conclusion

The case of NHS Trust Hospital’s change strategy known as the generic worker concept was promising. Nonetheless, there are so many ambiguities that only resulted in the resistance of the majority of the Hotels Services staff. From its onset, though the strategy was perceived to be a vital tool in promoting competitive advantage, the generic worker concept is rather complex in nature. This paper presents the actions that the hospital undertook and the insufficiency of the proposed concept. Several models and theories such as continuous improvement, six change approaches and organisational visioning as well as two factor theory, theory of mechanistic and organic systems, theory of constraints and theory of planned behaviour are integrated within the text.


References

Ajzen, I 2005, Attitudes, Personality and Behaviour, McGraw-Hill International.

Banhegyi, S G and Banhegyi, E M 2007, The Art and Science of Change, South Africa, STS Trust.

Brody, R 2004, Effectively Managing Human Service Organizations, London, UK, Sage Publications, Inc.

Burns, T and Stalker, G M 1994, The Management of Innovation, New York, Oxford University Press.

Cameron, E and Green, M 2006, Making Sense of Change Management: A Complete Guide to the Models, Tools and Techniques of Organizational Change, London, UK, Kogan Page Publishers.

Dettmer,H W 1997, Goldratt’s Theory of Constraints: A Systems Approach to Continuous Improvement, Milwaukee, WI, US, American Society for Quality.

Ellis, C W 2004, Management Skills for New Managers, US, Division of American Management Association.

Harigopal, K 2006, Management of Organizational Change: Leveraging Transformation, London, UK, Sage Publications, Inc.

Kotter, J 1996, Leading Change, Boston, Mass, USA, Harvard Business Press.

Philips, J J and Holton, E F 1997, Leading Organizational Change, Alexandria, VA, US, American Society for Training and Development Press.

Sisaye, S 2001, Organizational Change in Development in Management Control Systems, Emerald Group Publishing.

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