Organisational Factors
It could be said that the problems highlighted above are all a result of the organisational structure of the NHS. The of initiatives and targets and the code of conduct as described in the text are indicative of a bureaucratic organisation and provide the rules necessary to ensure efficient operation of the organisation. One drawback of this system however is that it discourages individual creativity within the job roles; the job description acts as an instruction book for the job holder to follow and they will do as instructed or in all likelihood they will be replaced with somebody who will. These strict rules or standard operating procedures as they are called in many organisations are required both in my industry, aviation, and the NHS to ensure that certain standards are upheld for the health and safety of both the staff and customers. It is these targets and initiatives or revisions of them – the product of bureaucracy – which create the apparent sense of instability within the management and affect morale within the workforce. You could argue that while they meet one part of the objective - to reduce costs - it simultaneously and directly contradicts the governments plan to create an NHS which is more caring and people centred. The level of government control over hospital policy at a local level is also a problem caused by the organisations’ structure. The NHS is still largely centrally controlled despite improvements in the area. The most recent attempts to address the issue being the introduction of Strategic Health Authorities and Foundation Trusts aimed at increasing the level of autonomy for individual hospitals and reducing the amount of bureaucracy involved in the delivery of patient care. (http://www.nhs.uk/aboutnhs/howthe-NHSworks/authoritiesandtrusts/Pages/Authoritiesandtrusts.aspx). There is however still the problem of ‘symbolic policy-making’ (Edelman 1971 cited by Ham 1985), particularly in the areas of the NHS which have not immediately benefited from the governments’ attempts at de-centralisation, whereby the policy makers (government) issue an initiative but fail to make available the necessary resources to make its implementation possible.
“…successive attempts to give greater priority to groups such as the mentally ill, mentally handicapped and elderly have not been accompanied by the allocation of significant amounts of additional resources, nor have ways been found of achieving a major shift towards these groups within existing budgets… [and] …act primarily as a way of maintaining political support and stability” (Ham, 1985:112)
These situations will also lead to frustration within the management group trying to implement the new policies as directed but seemingly without the required support from the Department of Health, leading to further de-motivation. Resistance to change is also perceived by management among the clinicians; the main concern for the doctor is to treat the patient, whereas the focus of management is efficiency and implementation of new or revised policy. Riley (1998) clearly demonstrated the differences between the two groups.
(Riley J (1998) Helping doctors who manage. London: King’s Fund, cited by http://www.bma.org.uk/ap.nsf/Content/hpr3~changing?OpenDocument&Highlight=2,management,problems)
Their differences were also highlighted by the Chief Medical Officer when he addressed quality of care and the different views of quality that each had while introducing the concept of Clinical Governance.
“Sir Liam also pointed out that the approaches to quality within the NHS were fragmented and lacked co-ordination. For example, the managerial view of quality was different from the medical view and it was not clear what methods would reliably lead to improvements in quality.
If quality was to be placed at the top of the agenda, and clinical governance to be truly patient-centred, a profound cultural change was required.” (http://www.dh.gov.uk/en/Aboutus/MinistersandDepartmentLeaders/ChiefMedicalOfficer/ProgressOnPolicy/ProgressBrowsableDocument/DH_5049089)
The effect of highly trained and skilled medical professionals who carry high status and are used to working with a high level of professional freedom being ‘managed’ by highly trained and experienced, but, non-medical staff and in particular the differing priorities that they have, has created a culture clash between the two groups of professionals which requires the culture change referred to by Sir Liam. As already highlighted, the standard of management is key to the standard of healthcare delivered however, the relationship between clinical and non-clinical staff is key to the standard of management governing its delivery.
Conclusion
While several factors have been identified which contribute to the problem of management in the NHS, I feel that it has been clearly demonstrated that all of these factors are interrelated and interdependent and ultimately all exist as a result of the structure of the organisation. The financial difficulties faced by NHS managers in running their facilities, be it a GP running a local practice or Chief Executive of a group of hospitals such as Leeds General Infirmary and St. James’ Teaching Hospitals are all the result of the funding model in use by the government. However, in the large part, managers and clinicians alike are still subject to criticism from Government Ministers when it comes down to NHS performance issues and use of resources by way of the annual performance ratings.
Communication problems are an inherent danger of operating large organisations and a certain degree of difficulty can be expected if not excused in the NHS purely as a result of its size – again this could be solved with more government emphasis on foundation trusts. In short the problems faced by management in the NHS are in some form or other all either directly linked to its organisational structure or exacerbated by it and all could contribute to the erosion of staff morale.
Question 2
Do you think that it is possible to successfully control an organisation without managers? Support your answer with examples from organisations with which you are familiar.
“Managers are people who steer an organisation towards meeting its' objectives. Management has been described as: 'the process of planning, organising, leading and controlling the efforts of organisation members and of using all organisational resource to achieve stated organisational goals.' A manager's job is to maintain control over the way an organisation does things, and at the same time to lead, inspire and direct the people under them.” (http://www.thetimes100.co.uk/theory/theory--organisation-management-structures--313.php)
All organisations large or small have goals or objectives, and for those goals or objectives to be achieved someone must take control and direct the collective efforts of the workforce towards them. In a large organisation someone has to lead and be in control of the available resources to ensure that they are used in the most efficient and effective way; these are management functions. In my opinion, no organisation can be run without managers, or, at least not without these certain management functions being performed. My father owned a small delicatessen for a number of years; he had one employee who worked part time during the busy periods at the weekends. He had no manager as such; however he took care of the accounts, ordered stock, arranged advertising, paid his staff and served his customers; as the owner of a small business he had to take on all roles including that of a manager in a larger business, working with food, his business was also subject to government restrictions which he as the owner was responsible for implementing and ensuring that his staff was adhering to. Different types and sizes of organisations suit different management structures and styles, and as important as it is to have management, the correct management structure is equally important to ensure that an organisation runs efficiently.
My current organisation employs over 6200 staff deployed in various different roles across the organisation. The company is a service provider in the aviation industry providing services to customer airlines and serving the general public. There are several areas of expertise in the organisation which require specialist staff in each area, from customer service roles to technical engineering roles. The company is a hybrid of functional, divisional and hierarchical management structures with managers in each operational department organised by related function or business area e.g. passenger services manager which is responsible for passenger check–in, meet and greet services and special services for passengers with special needs; technical services manager which is responsible for the maintenance of the ground support equipment, mechanics, engineers and aircraft cleaners; the operations services manager is responsible for those who coordinate all of the flight handling activities and produce flight documentation for the flight crew etc. It is then also split according to specific functions such as human resources, sales, finance and safety with managers in each area. Each manager reports to another manager who has a slightly broader area of responsibility who then reports to a vice-president with yet more responsibility and so on until after the senior vice-president, divisional senior vice-president, you reach the executive vice-president, president, vice chairman and finally the chairman. This gives the company a tall organisational structure whereby there are many levels of hierarchy from the shop floor up to the ‘board room’.
As I said previously, the key to running a successful organisation is selecting the correct management structure to run it. In my opinion the example given of my own company shows a structure which reduces flexibility and inhibits adaptation, which for an organisation which exists in a fast changing global market poses a real danger to it’s survival as it will struggle to keep ahead of it’s competitors in the market. The advantage of course for my company is that it has a monopoly over the industry in the country that it operates and competitors are simply not granted operating licenses, therefore it has no competitors… for now. In that environment, a large organisation does not necessarily need to be easily adaptable, and can use its bureaucratic processes and its hierarchical management structure to create stability in the organisation, which in the case of my company has lead to a highly profitable group being formed. However should the operating environment change at any point in the future - as is expected to happen within the next five years as the country itself attempts to compete on the global stage - the ability to react and adapt to changes in its operating environment will be crucial to its profitable survival in a competitive environment. It is in competitive situations when organisations have to quickly adapt that the organisations management structure and the functions and roles of its managers will play an important part in its success or failure. Companies such as the one in which I am currently employed which operate in the aviation industry and indeed organisations such as the UK NHS in the health sector operate in highly regulated markets with many legal restrictions placed upon their operations to ensure the safety of the public. Organisations in these industries benefit from a bureaucratic structure because it encourages the strict adherence to rules and regulations. While all managers are responsible for completing the four management functions of planning, organising, leading and controlling within their area of the organisation, managers at different levels contribute to a company in different ways fulfilling different roles. There are ten roles encompassing all management activities, these can be split into three further role categories: informational; interpersonal and decisional (Daft, 2006:19, 20). According to Mintzberg and as cited by Daft, each of these roles represents the activities undertaken by managers to accomplish those four functions of management, although dependant on the position of the manager in the hierarchy of the organisation, the type of organisation itself as well as individual skills and abilities among other things, these roles will be given greater or lesser emphasis. However each of the roles should be fulfilled to some extent for the organisation to meet its objectives.
In my organisation top management focus on planning – enabling the company to be ready for any changes to its environment which may occur, while middle management focus on organising – acquiring and deploying resources according to the budget agreed with top management, junior/front line management focus on the functions of controlling and leading, ensuring that the strict operational rules and procedures are adhered to and taking corrective action when they are not, but also motivating the workforce and leading them through difficult times, be it periods of staff shortage when the workload is much higher, or during summer months when working outside for twelve hours in temperatures in the high forties centigrade and humidity in the high eighties percent can be enough to break the most dedicated and loyal employee. The distribution of roles across the organisation allows individuals to focus on specific tasks, and reflects the importance of the rules and procedures adopted as a result of the regulated environment in which both the health and aviation industries operate.
Conclusion
Put simply large organisations cannot be successfully controlled without managers. As demonstrated, in industries such as my own, managers are required to ensure that the stipulated rules and regulations are adhered to by the general workforce to avoid adverse effects to the organisations operation. Several levels of managers are required to ensure that all other functions required to be completed by management are undertaken to ensure the overall success of the organisation.
Again, in small organisations, whilst managers are not necessarily required, certain management functions are required. Controlling and leading as management functions are required to ensure that externally regulated controls are adhered to, and that any staffs are motivated to perform to the required standard; planning and organising in small organisations however may no be so important depending on their level of development.
In conclusion, to reiterate what was written at the beginning of this paper, yes, an organisation can be controlled without managers however, management functions i.e. planning, organising, leading and controlling along with their associated roles should be carried out to some degree in order for an organisation to prosper. Furthermore, beyond a certain size, managers will need to be employed to allow the different management roles to develop and be distributed across the organisation to allow continued success.
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