All types of changes both up to present and planned initiatives involve changing traditional clinical and non clinical practices and behaviours. Requirements of new reporting mechanisms, processes, external scrutiny, and information collection will impose additional pressure for staff that already have hectic working life. We believe this will undermine the performances of staff.
Another reason why we are against change is that there are hardly any publications which consider issues and problems that are particular to change processes within health care organisations.
So all the changes that take place in the NHS are usually first trailed in the NHS. This means there is no room for error. It is common sense that when any change takes place it involves risk taking. Can we in our NHS afford to take unnecessary risks which involve putting patient’s lives at risk, when the main objective of the NHS is caring for people? We can’t afford to play lottery games with people’s lives. It’s alright in a business world to take a chance and lose few pounds, but not in health organisation when a risk involves losing human lives.
We also oppose any unnecessary changes simply due to the fact that there are no models to learn from the experiences of practising health managers. Managers are continually forced to focus on immediate solutions to problems, solutions which are short term. This enables the political party in power to raise its profile in the media. Its makes the party look like its achieving its targets in improving the NHS, when in fact they are really damaging the long term of the NHS. Managers in the NHS have little opportunity for developing longer term organisational change strategies. This is why we oppose these unnecessary short term changes. Another reason why we oppose these unnecessary changes are because if one political party starts a change and then loses power to another party then the party that comes in power has totally different views on how NHS should be running, which leads to more changes being brought about, even though the first set of changes have not yet been completed leaving the organisation in chaos. According to Cummings et al (1985), & Dawson, (1996), organisational change is chaotic, often involving shifting goals, discontinuous activities, surprising events, and unexpected combinations of changes and outcomes. Change is more complex than optimistic governments thinks and believes. It is hard to make changes stick (Kanter, 1989). According to Kanter, change cannot be ordered to happen. Employees are becoming more central, and their legal and operational influence is growing. Kanter et al argues that change is only successful when the entire organisation participates in its effort.
One current example of the change which the government is introducing is the job evaluation scheme. Under the new system, basic pay will be determined on the basis of job weight. Job weight will be assessed using a new NHS job evaluation scheme. According to the government, the agreement is founded on the need to ensure a fairer system of pay for NHS staff that will support modernised working and help deliver modernisation. The reason why we are against this is because this involves grading the staff, each individuals roles are scored and then mapped into one of the eight pay bands, which will then determine their pay. When people are involved in grading, if they are not graded in a way where the individual agrees with the grading, it can cause low self esteem. Individuals feel useless. If the change mechanisms are not beneficial to the NHS staff they may decide to leave, which means there will be even more shortages of NHS workers. Grading causes problems. Last grading is still not adequately solved yet the government has decided on grading again. What the new pay system really means is that staff will be given more tasks and responsibilities and a little increase in pay. So it’s not a really huge increase in pay but rather they are only getting paid extra for doing more. This may affect the NHS staff in the following ways:
- They may not be able to cope with the introduction of new jobs or new skills, which means increase in the number of grievances about grading
- They may not be able to cope with any ‘grade drift’, with lower grades having less to do, while other jobs may have drifted upwards, and
- There may be leap – frogging to catch up with pay rates elsewhere in the organisation.
We don’t believe that this job evaluation scheme will work because the agenda for change overlooks the behaviours and attitudes of the NHS workers. We believe this will prove to be a particular problem since modernisation and reform are often linked to behvioural and attitudinal change. The scoring system is also complex and complicated. Another reason why we are against this change is because this change is not changing behaviour of individuals but rather it is attempting to change their values and attitudes (Plant, R 1987), which we don’t agree with. We also believe this change will not work as NHS workers are unconvinced about the manner of change, and care deeply about the organisation. We also oppose change because change programmes in industry are often highly developed, visible, expensive process yet even they don’t result in successful change. The success rates of major change programmes in fortune 1000 companies are estimated between 20% &50% (Garside, P). So from these statistics we don’t believe the change will be successful one. We can only predict the result of the change from these companies because there’s not a lot of literature on health care organisations change. We don’t believe the change will be successful simply because leaders and employees see the change differently. To the leaders, change is an opportunity, and a survival strategy. To the employees it is disruptive and intrusive. One of the paradoxes of change is that during a time of change trust is the most difficult to establish. If mistrust exists with in an organisation then it is almost imposable to make any changes in that organisation. Staff want to know that a process which is about to begin has a predictable, known route, and that they will be treated fairly. We don’t believe this to be the case when it comes to job evaluation process. We don’t believe the government has guided or have involved the NHS workers in making these changes. We also believe the NHS workers don’t believe that government is capable of delivering what they have promised. Another reason why we don’t believe the change will be successful is because in the widespread reorganisations and reviews of acute health services change in the United Kingdom and abroad, it has been shown on numerous occasions that making changes are difficult to accomplish.
We believe that the change won’t be successful because the NHS workers will be too distant from the source of the change. They won’t have enough knowledge about the change. We believe the NHS workers will resist any changes for number of reasons, for example (Kanter, 1985):
- Loss of control. Too much is done to people, and too little done by them.
- Too much uncertainty. Information about the next steps and likely future actions is not available.
- There are too many things changing simultaneously, interrupting routines and making it hard to know the proper way to get things done.
- Concerns about competence. People wonder about their ability to be effective after the change; will they be able to do what is required?
- More work.
- Historical factors
- Reluctance to change behaviour
- Strong peer group norms
- Custom bound
- No perceived benefits
- Threat to status
Conclusion
We also oppose changes simply because people are no longer prepared to accept being manipulated, influenced, and pressured into accepting changes which people don’t understand, or which they don’t agree with. Countless change programmes have failed despite well argued logic, rationale, and technical argument because people in positions of legitimate power and authority wavered in their support.
According to Garside, P, most people working in NHS do not wish to change their location, style, or mode of working. They not only do not embrace and engage with the plans for change, they actively resist. The culture of the organisation, its norms, values, behaviours and policies as perceived by staff, must change for change to occur, which we don’t believe the government can manage to do. We believe everybody is emotionally attached to the NHS and any attempt to change it will have fatal consequences.
Finally we oppose change because when people can no longer deal successfully with the amount of changes, they begin to display dysfunctional behaviour (Conner, D, 1998).
REFRENCES
Benton, D. (2003), Agenda for Change: job evaluation. Nursing Standard. 17.36, 39 – 42
Conner, DR. (1998), MANAGING AT THE SPEED OF CHANGE. West Sussex. John Wiley & Sons
Garside, P. (1998), Organisational context for quality: lessons from the fields of organisational development and change management London.
Kanter, RM. (1992) THE CHALLENGE OF ORGANISATIONAL CHANGE London. The Free Press.
Plant, R. (1987), Managing Change and Making It Stick. London. Fontana
