This is a supplementary report, aimed at aiding further explanation of the change that took place at NHS UK. This paper reviews literature on various models and frameworks, provided by many researchers and scholars and links to varied aspects of change that was initiated at NHS. It illustrates how the change has been implemented through proper planning and control, effective people and process management. However NHS did fall short on some aspects of the change plan, which are illustrated in our findings. Further research is recommended in area, as majority of the work available talks about the effective implementation and management of the change plan. Textual analysis is used as the research methodology.

2.1 The National Health Service, UK

Since its launch 60 years ago, the NHS has grown to become the world’s largest publicly funded health service. It is also one of the most efficient, most egalitarian and most comprehensive. The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. At its launch by the then minister of health, Aneurin Bevan, on July 5 1948, it had at its heart three core principles:

  • that it meet the needs of everyone,
  • that it be free at the point of delivery,
  • and that it be based on clinical need, not ability to pay

2.2 The Change Plan

These three principles have guided the development of the NHS over more than half a century and remain. However, in July 2000, a full-scale modernisation programme was launched and new principles added. These require that:

  • The NHS will provide a comprehensive range of services
  • The NHS will shape its services around the needs and preferences of individual patients, their families and their carers
  • The NHS will respond to the different needs of different populations
  • The NHS will work continuously to improve the quality of services and to minimise errors
  • The NHS will support and value its staff
  • Public funds for healthcare will be devoted solely to NHS patients
  • The NHS will work with others to ensure a seamless service for patients
  • The NHS will help to keep people healthy and work to reduce health inequalities
  • The NHS will respect the confidentiality of individual patients and provide open access to information about services, treatment and performance.

2.3 Triggers of Change

Firms operate in a dynamic environment which affects the firm in a great way. The environment offers reasons to firms to change and in order to remain competitive firms need to adapt and alter themselves. If firms do not change, they will cease to exist. In order for firms to understand its environment, PEST analysis and SWOT analysis may be carried out.

The PEST analysis is like a scan of the external macro-environment in which firms operate in ( On the other hand, SWOT analysis by Edmund et al. in 1960s gives a framework for generating strategic option in a given situation. These two analyses will highlight the factors that trigger the firms to modify and change. Below is the PEST and SWOT analysis for the NHS to reach a conclusion on what the triggers were for the NHS to change.

PEST Analysis

The PEST analysis has been adapted for the NHS from ‘Managing Change and Innovation in Public Service Organizations’ by Osborne and Brown (2005).


  • Political factors are very important when scanning the development and future of NHS. Its environment is after all fundamentally political one as it is a public service organization.
  • The government’s rules in terms of public service have gone from a rationing to a user-responsive mode.
  • The New Labor government is more focused upon community governance. This has forced NHS to effective management of public service and to include the community’s ideas and needs for the planning and managing of services provided by NHS.
  • One major element of the new environment of public services that has been embedded in the UK by the New Labour government is the concept of ‘plural state’. A range of partners from the government, private sector and the NGOs have been involved in the planning and management of public services.


  • The way public sector environments have been funded has changed over the last few years. Funding of local government has undergone changes from traditional rates systems to community charges.
  • Public sector organizations have moved towards economic sustainability. A core task for the organizations is to secure ongoing funding from alternative sources to develop its income base.


  • The ageing population in the UK has put more pressure on NHS to meet the needs of this increasingly elderly population.
  • At the 21st century, customer expectations of public services have changed. They are not happy with the ‘given’ quality.
  • Emergence and awareness of health and treatment of new diseases requires health services to adapt to these changes.


  • The improvements in technology have laid pressure on the administration of public services. Also the use of management information systems has an influence on public services.
  • Technology is used in hard systems to change the operation of organizations and soft technology that includes the way services are delivered.

SWOT Analysis

The SWOT analysis has been adapted from the British Medical Association website.


  • Commitment to improve public health within parameters provided by government.
  • Defined competencies of senior staff, relevant to the public health.
  • Secure provision of core public health programs: screening and immunization.
  • Discharge of statutory duties and major role in management of risk.
  • Commitment to development of a multi-disciplinary approach to public health.
  • Flexible approach to duties with strong sense of corporate responsibility, enabling fast NHS response on a wide spectrum of issues.
  • Credibility with partners and public.


  • Public Health in the NHS has been practiced in small units expected to achieve challenging targets – unsustainable.
  • Remote bureaucratic back room services unable to engage with the population.
  • Poor investment by Primary Care Trusts (PCT) and partners in non-financial information systems.
  • Little consideration has been given to the organization of either Public Health or Health Promotion to ensure the success of these functions.


  • Government policy has created a very favorable environment in which to work for Health Improvement.
  • Primary Care is now managed in a way that makes it possible to deliver public health programs across populations.
  • Opportunity to develop models that combine the benefits of centralization and decentralization.


  • Larger PCT’s may rationalize Public Health departments rather than build capacity.
  • Practice Based Commissioning may undermine the population perspective.
  • Absence of effective Public Health at Local Authority level.

After analyzing by these two models, the triggers of change can be seen for NHS and can be presented in Lewin’s Force Field Analysis (1951) as given below.

The change implemented in NHS to achieve the above objectives was an transformational coupled with incremental change.Transformational change is a radical, grounbreaking alterations that show a move from the accepted patters of organizational behaviour and operations.(Kleiner and Corrigan, 1989). Incremental change is a more gradual one ( Patrickson and Bamber, 1995).The firms usually start with a transformational change however research findings indicate that incremnetal change is the usual outcome of change initiatives. (Pettigrew et al, 2001) The change plan was phased over a long time frame, starting from 1997 onwards. We have tried mapping the change plan by adapting from Lewin’s model of change (1951) and Bridge’s model of change (1980).

However we suggest some adjustements to this model in our analysis as It does not allow for reviewing the plan at everys step and excludes an impotant aspect of ‘feed back loops’. NHS being such a huge organisation implementing change across the entire organization simultanously is a herculean task, which needs monitoring and improvemnet at every level. To achieve this feedback loops become imperative. Also the fact that various change plans have been implememted simultanously makes it very difficult to carry the poject to success and sustainibility, hence the suggestion of feedback loops that ensures that improvemnets achieved are constantly innovated and standardised.

Our model

Linking the commitment of the senior leadership to our adaptation of Bridge’s and Lewin’s model we see that, at NHS, the senior management displays very little involvement in the initial stages of the change implementation. Gradually we see that the participation and commitment has increased but it is still not at par with the amount of commitment required. As per the model, at any given point in time there are three dimensions to change. Things are ending, new aspects are emerging and others are in a constant state of change. The changes shaping are divided into three zones. In the first zone, old is ending and phasing out, while in the neutral zone, change is emerging and the last zone marks new beginnings. Managers need to focus differently, depending on in which zone majority of the sub plots of change lie. Example at the point where majority of the change is taking place in ending the old, managers need to focus on driving communication and training and creating a sense of commitment. While when majority of the plots lie in the neutral zone, which is characterized by uncertainty and vulnerability, the management need to put all their energy into managing the emotional contracts of the staff and deciphering the reasons for any resistance. Finally, at a point when the neutral change starts morphing into new beginnings, standardizing and freezing these changes are where all efforts need to be focused on.

As the change at NHS is incremental, things are always changing. Thing are in a constant state of flux which means that there are reduced levels of motivation and commitment from the staff. This also implies that NHS has not reached a stage where they can freeze. They are still in the phase of change, characterized by turbulence. Freezing being the last phase as per Lewin’s model, seems a far fetched dream, as standardizing and freezing things in such a large organization, with the change being such a long term agenda is virtually impossible. Hence we suggest that NHS implements reviewing and monitoring as a vital aspect of its implementation plan, through which they should aim at standardizing small wins and celebrating them to raise the low motivation and commitment levels.

Writing about the strategic change and drawing the strategic plans for managing the change is not so difficult. But on the other hand we should remember that the organizations are subjective realities or social systems. Organizations are nothing but individuals, groups and their relationships and networks. In aspect of strategic planning also it’s possible to say if managers don’t pay attention to the factors of the people within their organization, it means that are forgetting one important part of their strategies. As Johnson & Scholes (2005) are referred to process of enabling success process and the role of the people in this process.

             Enabling Strategic Success (Adapted from Johnson & Scholes 2005)


As Richard Luecke (2003) is defining “The people in these systems (organizations) have identities, relationships, communications, attitudes, emotions and differential powers.” Moreover Barbara Senior (1997) is mentioning to the Organizational iceberg metaphor. And she is defining that each organization is consist of two parts: First formal organization which is out  of the water and it is visible for everyone such as goals, strategies, products and services and second the informal part of the organization which is under the water and invisible such as values, beliefs, organizational culture and norms.

 “A psychological contract represents the mutual beliefs, perceptions, and informal obligations between an employer and an employee. It sets the dynamics for the relationship and defines the detailed practicality of the work to be done. It is distinguishable from the formal written contract of employment which, for the most part, only identifies mutual duties and responsibilities in a generalized form” (Wikipedia, 2008).

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According to Jacqueline (2004), Psychological contracts are individual beliefs in reciprocal obligations between employees and employers. In today’s continually changing business environment organizations have to change strategic direction, structure and staffing levels to stay competitive and gain advantage (Armenakis & Bedeian, 1999). These changes lead to a great deal of uncertainty and stress among employees (Terry & Jimmieson, 2003) which leads to resistance to change in the organizations.

Individuals in organizations resist change for a variety of reasons (Kets de Vries & Balazs 1999), for example, some ideas for change are simply ill conceived, unjustified, or pose ...

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