Management in Health Care Organisations.

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Management in Health Care Organisations

This assignment will aim to discuss the implementation of a nursing initiative, which could change practice. It will focus upon the process of change in relation to evidence-based practice. Then go on to discuss barriers to change, the role of change agents and how different management and leadership styles influence the change process.

The implementation of research based evidence into nursing practice has long been recognised as an important issue. The aim of evidence based practice (EBP) being to help clinicians base their actions on best current evidence. Newly educated nurses are aware that nursing research is very valuable to nursing because it challenges and tests the effectiveness of the care we give. However much nursing practice still remains rooted in myth (Walsh and Ford, 1989). To overcome this problem nurses must recognise the importance of evidence based care and the improvements to nursing practice (Parahoo, 1997).

The UK National Health Service (NHS) Research and Development strategy launched in (1991) acknowledges the importance of developing a NHS where practice and policy is more evidence based. The strategy is designed to create research-based health services in which scientific information is available to influence the process of health care delivery systems (Sullivan, 1998). Evidence-based practice appears to be largely derived from the concept of Evidence-based Medicine. Furthermore, Sackett et al (1996) states that this development should come as no surprise as nursing has long had an interest in identifying a clear theoretical basis for practice and considerable work has examined the relationship between theory, practice and research.

Despite the advantages to EBP, it is not as widespread as one would expect. In addition to this Cutcliffe (1997) states that there is a regular requirement for those at the centre of NHS self-governing trusts to implement new health care policies. The Department of Health document (DoH, 1993) 'Report of the Taskforce on the Strategy for Research in Nursing, Midwifery and Health Visiting' stresses the need for EBP to become the norm and highlights the benefits in terms of improved quality of care and increased patient satisfaction, that should occur as a result of the implementation of EBP. However the profession still appears at times to struggle to base practice and the development of services on research findings.

In order to facilitate and support health care professionals in having the necessary knowledge and skills to deliver EBP, it is essential that their employing organisation encourage this approach (Haddock and McSherry, 1999). Over the past 15 years, health organisations have become so concerned with ensuring 'financial governance' (balancing the books) that other important organisational issues integral to patient care such as clinical risk, quality, standards and patient outcome have taken second place (DoH, 1997).

Therefore to achieve clinical effectiveness the government has introduced a framework of Clinical Governance and EBP is a critical component within this process (Haddock and McSherry, 1999). Within the Clinical Governance framework, advocated by the White Papers 'The New NHS Modern Dependable' (DoH, 1997) and 'A First Class Service: Quality in the New NHS' (DoH, 1998), there is an emphasis on improving quality of care, treatment and services through employing the principles of clinical governance. Clinical governance gives the NHS as a whole and trusts at local level, responsibility to ensure quality of care: consistent standards of quality and emphasises the importance of routine EBP.

As discussed the introduction of Clinical Governance emphasised the importance of ensuring quality in standards of clinical care. It is acknowledged that research can potentially provide the knowledge base required for the development of nursing care and services. Thus ensuring that not only do clients get the best possible care and treatment, but also, the knowledge acquired through practice and research contributes towards making professional practice more sound (Kay et al, 1995). The UKCC endorses the concept of education and lifelong learning stating "As a registered nurse you are personally accountable for your practice, and in the exercise of your professional accountability, must maintain and improve your professional knowledge and competence" (UKCC, 1996, 9, (3), p9). Therefore the implementation of EBP would enable professionals to enhance their professional knowledge and give them a sound basis to justify their decisions.

Nevertheless, implementation of EBP in mental health nursing and the change in practice it commands, is an idea of enormous merit, but as well known, an ideas merit, does not guarantee acceptance (EBMH Notebook, 1999). This notion therefore leads on to the discussion of change and change theory.

Change is nothing new and indeed has been our only constant, but change today is faster and more complex than it has ever been before (Manion, 1994). Change is a concept currently enjoying much debate and analysis within nursing (Pryjmachuk, 1996) hence one of the purposes for this assignment. Change is an essential part of life, however in essence it is only likely to be welcomed if it is perceived as being necessary, rather than inevitable.

Change theory originated from Kurt Lewin in 1951. His model of change is one of the most widely promoted models. Lewin introduced the concepts of driving and restraining forces that either help or restrain the change process (Lancaster and Lancaster, 1982). He describes driving forces as those that facilitate change, by electing a change agent and moving the group with this agent. Restraining forces are those who slow the change process or stop the change from taking place. Change occurs when one force outweighs the other. Lewin states that it is important to know the driving and restraining forces in order to deal with the restraints.
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There are numerous theories that explain how and why change occurs, but Lewin (1951) identified three phases to change, unfreezing, moving and refreezing. Therefore for change to occur, the current state must be 'unfrozen' by people becoming aware of the problem and the necessity for change. Then the forces holding the change in equilibrium must be worked on by increasing the forces driving the change and minimising those resisting it. Finally everything must be 'refrozen' with the change integrated into the person, the organisation and the culture.

However a number of other models derived from sociological research ...

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