Case study about Wellton NSH trust hospital

You are required to compile a portfolio
of FIVE short answers on a week by week basis to questions relating to the core
themes from the lectures and seminars applied to an organisational case study,
Wellton NHS Trust (Appendix A).

Apply your knowledge from the module to the case study and
support your answers with reference to relevant literature and research in the
related areas using the Harvard Referencing system.

1. Issued in week 2

What are the principles of scientific management
and how have they been applied in the Medical Records Department at Wellton NHS
Trust? What are the disadvantages of using this approach to organising work and
what other factors should the hospital consider in its approach to managing its
employees?

2. Issued in week 4

How could Wellton Trust assess the personality of
their work force and what might be the advantages and risks of doing so?

Hint: In your answer you should
consider how effectively personality can be tested and what the organisation
might do with the results.

3. Issued in week 6

With reference to relevant behavioural OR social
learning theory, advise the hospital on how it could approach the development
of staff in the new HSDU unit. Discuss the implementation problems and barriers
to learning which the store development team may need to overcome.

4. Issued in week 8

Drawing on your knowledge from weeks 7 (Groups and
Teams) AND 8 (Leadership), what factors have contributed to the effective team
work demonstrated in the Accident and Emergency Department? Advise the manager
of any risks associated with this strong team approach

5. Issued in week 10

How effectively have the changes in the medical
records department been managed? What factors should the hospital consider when
implementing change again in the future to improve their approach?

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Guidelines

All answers must be:

• Between 600 and 800
  words long. (NOTE: 800 words is the MAXIMUM word limit for each answer. There
  is no +10% allowance on these questions.)
• Supported with
  relevant literature using the Harvard Referencing system. This requires
  citations (references to relevant literature) within the answer itself which
  then must also be listed in full in a reference list at the end of your work. Work
  will not be awarded a pass grade at this level of study without a clear
  demonstration of this skill.
• Compiled into a
  SINGLE word document containing ALL answers which is uploaded on a weekly basis
  into the assessment link on blackboard (note the ‘old version’ will be
  overwritten each week as you submit the new updated version of the document).
• For the final
  submission you must:
• Submit all FIVE
  completed questions. Please note: Your grade
  will be penalised if your portfolio is incomplete
• Include a completed
  title sheet (appendix B) at the front of your portfolio clearly indicating the
  FOUR questions you want to be graded. Please note: If you fail to submit this title sheet your tutor
  will automatically grade the first four answers in your portfolio
• Work will be
  assessed using the undergraduate marking scale (Appendix C) and the assessment
  rubric for the module (Appendix D).
• Submission for Anonymous Marking
• You must submit your
  work using your student number to identify yourself, not your name. You must not use your name in
  the text of the work at any point. When you submit your work in Turnitin you
  must submit your student number within the assignment document and in the Submission title field in Turnitin
• Assessment hand in Monday 20th January 2020
• Please note this is a progressive assessment and
  therefore many support plan extensions do NOT apply. Please read the details of
  your plan carefully if you have a support plan in place.

Appendix A: Case Study

Wellton is a medium sized NHS Trust in
the north of England. With an annual turnover of £330 million and around 6,000
clinical and support staff it provides medical services to a population of
450,000 people. The Trust Board is responsible for setting the strategic
direction of the Trust led by the Chief Executive Officer (CEO). Departments
are organised into three clinical directorates, medical, clinical support and
surgery, each lead by a director of services.

Within each directorate there is a
traditional hierarchy of medical and administrative staff, paid according to
the type and level of job on a rigid pay band structure implemented by the
national Agenda for Change project. For example, the organisational structure
for the Medical directorate is illustrated below:

Staff receive 27 days annual leave
(rising to 33 days after 10 years service) and access to the generous NHS
pension scheme. A package of childcare services and vouchers, occupational
health care and counselling services, work related training and development, as
well as a range of discounted products and services for NHS employees are also
available. In addition the Trust presents a range of long service awards to
employees to recognise their commitment to the organisation.

The Trust has recently been through a
major change process following the decision to merge with a smaller Trust. This
has seen expansion of the Royal George hospital site to absorb services from
the closure of two small community hospitals. The strategy was developed to
achieve cost savings and service improvements however the hospital closures
have unsurprisingly caused considerable concern in the local communities they
serve. This has been escalated by media reports of problems in the Royal George
and a rising number of complaints about patient care. The Trust has also
dropped 10 places in the latest national inpatient survey.

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In September a new HR manager joined
The Trust. In their first meeting together the CEO informed the HR manager
about the difficulties they had been experiencing in the last 9 – 12 months. With
growing media interest in NHS failures and continuing financial and political
pressures on the NHS, the CEO knew he could not ignore these problems. He asked
the new HR manager to take some time to observe and research what she thought
was going on. During her first six weeks she spent time talking to and
observing the different departments and made some key discoveries.

The Surgery Directorate:
Theatre Department

Last year the Trust completed a multi
million pound investment and development of the theatre department at the
Prince George hospital as part of its merger strategy. This included the
addition of six new operating theatres, bringing the total to 26, and the
opening of a hospital sterilisation and disinfection unit (HSDU) enabling
theatre equipment to be cleaned on site. This offered a more responsive service
to the operating theatres than contracting the services to a 3rd party, ensuring that sufficient
surgical equipment is available when required. However things do not appear to
be running to plan in the new department. There have been quality issues in the
HSDU with the return of dirty surgical equipment holding up operations. In
addition, inadequate maintenance records, which could possibly put patients at
risk, resulted in five of the older operating theatres being closed down for 2 weeks.
This put a huge pressure on the remaining theatres and resulted in the
cancelation of elective surgery with a critical impact on surgery waiting lists
and an increase in patient complaints.

Despite a well run recruitment campaign
to staff the new unit the department also appeared to be experiencing some
significant staffing problems. To ensure the required levels of clinical cover
to run the department safely the HR manager notices some staff have been
working for 12 days in a row without a break. This might go some way to explain
the low scores in the staff survey regarding the Trusts commitment to helping
staff balance their work and home life. Staffing problems have also been
identified in the theatre department’s team of porters who are responsible for
moving patients around the department and between the theatre and the hospital
wards. Sickness rates in this team are well above the hospital average and the
staff shortages caused by this have had significant impacts on the speed at
which patients move through the department. The late arrival of patients for
their theatre slots has resulted in medical staff standing around waiting for
patients to arrive. As a result the scheduled theatre sessions have regularly
been running late. While many of the theatre nurses have been happy to work
during these over runs for free in the past this has now become so regular that
they are asking for overtime payments to be made and staff have made complaints
to their Trade Union representative.

Clinical Support
Directorate: The Medical Records Department

In the Medical Records Department
changes have been implemented to bring all of the Trusts records and
appointment services into one central department to reduce costs. Staff have
relocated from two community hospital record departments to a new purpose built
administration and records library on the Royal George site which has provided
them with greatly improved working conditions. Jobs within the

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department have been redesigned with
the move. In the community hospitals, records staff covered all jobs in the
department, preparing medical records for clinics, sending out appointments,
setting up new clinics on the computer system, filing and answering telephone
queries from hospital staff and patients. In the new move, these functions have
been separated out so each employee can specialise in one area and build their
expertise. Detailed procedures have been drawn up for each function to help
improve consistency of service, for example when dealing with patient enquiries
staff now follow a script on the computer to ensure they cover all the
necessary information. Staff have been carefully briefed on the procedures
relating to their own jobs and trained on the new computer and telephone
system. The records manager also holds daily team briefing sessions with staff
to cascade information to them about the department’s performance. She appears
to be in firm control of the department giving clear directions about what
needs to be done each day, allocating each task to a member of staff. She has
also completed all the staff appraisals and set every team member the same
performance objectives to meet the departments key performance targets (KPT).

However this department has also
experienced some difficulties. One of the biggest complaints from the clinics
has been the loss of patient records. Clinics have been held up and some
patients have had to have medical tests repeated as a result. This has led to a
lot of ‘in fighting’ in the team, with the old Royal George staff blaming
employees who have transferred from the community hospitals for filing records
incorrectly on the new system. When the records manager investigated some of
the missing records she actually found a number of the missing files had been
withheld by the doctors and consultants themselves, revealing a problem with
the overall process rather than with the ability of any of the team members.
She is working on designing a new process to tackle this but her discovery has
done little to heal the rift in the team. Two of her best staff have left the
hospital to take jobs elsewhere. This has left the department short staffed, a
problem made worse by difficulties persuading the staff who are left to move
their shifts around. The department is regularly short staffed on Friday
afternoons and ‘out of hours’ (evenings and weekends) so staff who do work
those shifts come under considerable pressure to keep up with answering queries
and dealing with problems. The manager tells the HR manager she is concerned
that two further members of staff have told her they are looking for new jobs.
They say they don’t enjoy coming to work anymore. One of the team tells the HR
manager

“I don’t know what this organisations is about
any more. I loved working at Moortown, I hate this new department! No one asked
us what we thought about the change. It was all about saving money. No one
thinks about us. I sometimes think they forget about the patients now as well.”

Staff feel that a threat of job losses
has been hanging over the department since the merger and this is a source of
concern.

“I’d leave if I could but I’ve been here more
than 10 years so I get more holiday then I’d get elsewhere. I help my daughter
out with childcare in the school holidays so we’d be stuck if I lost that. To
be honest that’s the only reason I’m not looking for a job somewhere else right
now!”

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The Medical Directorate:
Accident and Emergency Department (A&E)

The HR manager notices there appear to
be far fewer problems in the Accident and Emergency Department. An increase in
patients attending the Royal George A&E department of 5% compared to last
year has placed considerable pressures on the department to cope with just
short of 100,000 attendances. To cope with this the new Clinical Manager has
spent a lot of time in the department talking to patients and staff and
observing its day to day operations. She set up a number of action teams and
asked them to look at developing and putting in place solutions to a number of
the key problems including speeding up the patient booking in service, the
treatment and discharge of minor injuries and the completion and return of
results from blood and radiological tests. Each team consisted of a mix of
staff including doctors, nurses, administrative staff, and porters and was
asked to spend 15 minutes, twice a week working on their solutions. As a result
of new initiatives implemented by the action teams the department is now
meeting its performance target to see and discharge 95% of patients within 4
hours for the first time. Due to its success, the Clinical Manager has
suggested that the department continues to use the action teams to look for
further ways to improve the service and has asked the staff to make suggestions
about what areas they think the department should look at next. The staff have
decided they think infection control is an important area they want to look at
and have suggested to the Clinical Manager that they would like to look at this
issue in other departments as well to help them identify good practice which
they could implement in A&E and to see if they can also share any of their
own ideas with the rest of the Trust. The manager told the staff she thinks
this is a great idea and has offered to help the team by talking to the other
Clinical Managers to see if they would be willing for their teams to get
involved with the project.

Checking the staff survey results back
in her office, the HR manager notices the A&E department recorded the
highest scores in the Trust. 87% agreed or strongly agreed that they would
‘recommend the Trust as a place to work’ and 73% said they always or often look
forward to going to work.

“I enjoy it. If I didn’t enjoy it I wouldn’t like
coming and I enjoy coming to work…I wouldn’t change jobs unless I really,
really needed to” (Nurse – A&E)