Essay on the Management Theory


Introduction

National Service Frameworks are the most important guidelines of the National Health Service which determine standards and rules obligatory for all medical establishments. National Health Service sets specific quality requirements and strategies for Clinical Practice in order to meet the highest standards in medical services. The field of clinical practice involves coronary heart disease, cancer, mental health and diabetes. Also, it relates to medical services provided for older people and children. In order that healthcare agencies achieve their goals and objectives the work of individual members must be linked into coherent patterns of activities and relationships. This is achieved through the structure of the organization and the nature of relations.

The NHS Framework for Quality

Help with Essay on the Management Theory
Help with Essay on the Management Theory

In clinical practice, the NHS Framework for Quality, Department of Health emphasizes the importance of creating an environment in which “excellence” can flourish. It places clear responsibilities on chief executives, trust boards, and individuals to base practice on sound research evidence and to monitor the outcomes of care through audit activity. Central to quality strategy is the Clinical Governance Framework, which incorporates clinical risk management, accountability of the organization and individuals, and performance management. It stresses the need to examine processes to assure quality and value for money. Guidance produced by the NHS Executive accentuates the need for a human resources strategy focusing on developing leadership, people management, resource sharing, and partnership working, and stresses the quality of service delivery. This, together with the focus upon the “patient journey” or process of care deliver clearly illustrates the overall focus of the areas of excellence identified within the EFQM Excellence Model. This approach clearly identifies that improved business “results” are achieved through successful management and improvement of “enablers.” The plan builds upon earlier policy documents stressing that service must satisfy its customers with ever-improving standards of care and must offer its staff a positive work experience (Sims, 2003).

Macro Level
Administrative level
One of the main levels in national service framework is the administrative level. In clinical practice, it is concerned with the co-ordination and integration of work at the technical (technological) level. Decisions at the administrative level relate to the resources necessary for performance of the technical function, and to the beneficiaries of the products or services provided. In clinical practice, administrative level is concerned with those activities involved in recruiting of professional staff, training, and development within the organization and infrastructure, namely the systems of technology planning, finance, quality control, etc. which are crucially important to an organization’s strategic capability in all primary activities. Decisions is concerned with mediating between the organization and its external environment, such as the users of the medical services, and the procurement of resources; and  the ‘administration’ of the internal affairs of the organization including the control of the operations of the technical function. According to theoretical concepts (Sullivan, Decker 2005) the administrative level in clinical practice unable to plan and supervise the execution of work of the technical function without the knowledge, expertise, practical know-how and enthusiasm of people who are closest to the actual tasks to be undertaken. For this reason, people operating at the technical level make known to higher levels the practical difficulties and operational problems concerning their work (Amey 1986).

Institutional Level
On the institutional level, national service framework is concerned with broad objectives and the work of clinical practice as a whole. Decisions at this level is concerned with the selection of operations, and the development of clinical practice in relation to external agencies and the wider social environment. It provides a mediating link between the administrative level and technological level. It should be mentioned that in clinical practice there is not a clear division between determination of policy and decision making, co-ordination of activities and the actual execution of work. Most decisions are taken with reference to the execution of wider decisions, and most execution of work involves decision. Decisions taken at the institutional level determine objectives for the managerial level.

Technology
It is very evident that HIS (hospitals information systems) changes the manner in which doctors, nurses, and other professionals in the hospital work, and this is exactly the problem. In general, the actors interviewed felt that there is a lack of organization within the hospitals and a lack of coordination among the various service units. Another common barrier to the future development of EPR perceived by most of those addressed in this study was the lack of training of healthcare professionals in informatics and their resistance to changing their work practices (this ties directly to pressures that come from labor unions, which are quite strong in this sector).

The development of quality has been divided into different spheres of responsibility. The top hierarchy consists of the Director and Council. Next is the Chief Surgeon (the manager of quality management) who is in charge of quality development. The next layer contains the quality coordinator who plans and organizes the implementation of the whole development of quality. In each profit center, organizations have their own quality manager and, in each sphere of responsibilities, a position in charge of quality. People in charge of quality are key in the quality development and continuously communicate (Ginter, Swayne, Duncan, 1997).

Regulation and Data Protection
Regulation and data protection of patient data are controlled by the Data Protection Agency and administrative departments within the Ministry of Health, such as the Sub-Directorate General for Information Technology Systems. In addition, INSALUD has an Organization and Planning Department, which coordinates and manages issues related to the application of new technologies. These administrative bodies play an important role in the adoption and implementation of EPR systems and, when interviewed, were very optimistic about the development of these systems in hospitals. These standards allow management to have an outline of appropriate options of financing by the regional Health Service and of the efficiency and effectiveness of the system. These pre-filtered options redefine managerial decision making that has to assess the coherence and both the economic-financial and the strategic organizational feasibility. Many health care agencies today realize the key to cost containment is better management of the patient. Better management not only improves the patient’s well being, it reduces the number of encounters that the patient has with emergency departments, hospital admissions, and possibly visits to the physician’s office (UK HealthCare Quality Initiatives, 2007).

Micro Level
Micro level is closely connected with organizational and employees relations within the framework. The functions of the formal structure and the activities and defined rela-tionships within it, exist independently of the members of the organization who carry out the work. However, personalities are an important part of the working of the organization. In practice, the actual operation in clinical practice and success in meeting its objectives depends upon the behavior of people who work within the structure and who give shape and personality to the framework.

Personal Level
The distribution of tasks, the definition of authority and responsibility, and the relationship between members of the organizations can be established on a personal and informal basis. But with increasing size there is greater need for a carefully designed and purposeful form of organization. There is need for a formal structure. There is also need for a continual review of structure to ensure that it is the most appropriate form for the particular organization, and in keeping with its growth and development. Within the formal structure of an organization work is divided among its members and different jobs related to each other. The division of work and the grouping together of people should, wherever possible, be organized by reference to some common characteristic which forms a logical link between the activities involved (Hansten, 2003).


Group Work

The division of work among members of the organization and the coordination of their activities is at the essence of structure. According to Sullivan, Decker (2005) it is possible to single out the following layers of structure which serve as coordinating mechanisms for the work of the organization mutual adjustment; direct supervision; standardization of work processes and output; and standardization of worker skills.

In clinical practice, intergroup splitting and polarization occurs and drives a wedge between them. Primitive fight and flight unconscious actions surface as a manifestation of regressive psychodynamics produced by collective anxieties. With respect to innovation management, many critics analyzed the organizational level (within the organizations or groups). At this level, researchers look at those techniques, skills, and capacities related to managing innovation. In large hospitals and medical centers, innovation management included market and prospective studies which, in many cases, would come directly from headquarters outside of UK. Public actors used strategic plans to define priorities for periods of time (either one- or four-year plans) and to coordinate their activities. Research groups managed innovation by exploiting their capacities and also by exploring new ideas, although these were often restricted to the available public funding where priority setting in R&D depends more on this funding than the priorities defined by the funding agencies. Hospitals, in many cases, needed to establish formalized practices for innovation management, especially with regard to future development for information systems. In the development and definition process involved in creating the new hospitals, groups of individuals representing public officials, firms, and medical professionals were brought together to define the future hospital and to align their preferences and expectations.

Following National Service Framework guidelines, clinical practice needs consultants who can direct a planned change effort based on genuine participation of managers and staff. This effort must be driven by valid information (interviews, observations, policies, and facts) gathered from a process of organizational assessment, diagnosis, and feedback sessions designed to confirm or reject findings. In other words, the strategy for intervention must be consistent with the findings of an unbiased organizational assessment that would be intended to identify barriers to change. In this case, barriers to change mean any impediments to developing a more resilient organization that is capable of responding effectively to managed care. Hence, if the employees of hospitals understand the demands for change triggered by healthcare reforms, then the best response to such conditions-one that will ensure the continued integrity of the institution-must be the result of a collaborative strategy owned by hospital management and staff. Finally, this effort must be directed by independent designed to confirm or reject findings. In other words, the strategy for intervention must be over-identify with any one individual (executive) or group (of executives) and lose perspective and focus on the total system change (National Service Framework, 2007).

Staff Relations
Staff relationships has a great influence on the decision making process. Persons in a staff position have no direct authority in their own right but act as an extension of their superior and exercise only ‘representative’ authority. In clinical practice, staff relationship between the personal assistant and other staff except where delegated authority and responsibility has been given for some specific activity. This may be partially because of the close relationship between the personal assistant and the superior, and partially dependent upon the knowledge and experience of the assistant, and the strength of the assistant’s own personality.

In clinical practice, staff relationships arise from the appointment of personal assistants to senior members of medical staff. Persons in a staff position have no direct authority in their own right In practice, nursing staff often do have some influence over other staff, especially those in the same departments or grouping. This may be partially because of the close relationship between nursing staff and doctors, and partially dependent upon the knowledge and experience of the nursing staff, and the strength of the nurse’s own personality. Psychoanalysis assumes that people have both conscious and unconscious intentions, that the latter frequently conflict with the former, and that conscious aims are often frustrated by divergent unconscious goals (Moran 1999).

As with other aspects of the personnel function it is important that line managers are involved, at least to some extent, with employee relations. But there must be good communications and close consultation with the personnel department. There must be teamwork and a concerted organizational approach to the management of employee relations. This is made easier when top management, who retain ultimate responsibility for the personnel function, take an active part in fostering goodwill and co-operation between departments and with official union representatives. Top management should agree clear terms of reference for both the personnel manager and line managers within the framework of sound personnel policies.

Lateral Relationships
Lateral relationships exist between individuals in different healthcare departments or sections, especially staff on the same level. These lateral relationships are based on contact and consultation and are necessary to maintain coordination and effective performance. Lateral relationships may be specified formally but in practice they depend upon the co-operation of staff and in effect are a type of informal relationship. The determination of policy and decision-making, the execution of work, and the exercise of authority and responsibility are carried out by different people at varying levels of seniority throughout the organization structure. It is possible to look at clinical practice in terms of interrelated levels in the hierarchical structure (Moran 1999). At the departmental and unit level the medical staff might assume a prominent role for day-to-day personnel matters, with the personnel manager as adviser, and if necessary as arbitrator. They would be more concerned, at least in the first instance, with the operational aspects of personnel activities within their own departments.

Discussion Section
Today, clinical practice is undergoing profound changes. In order to survive, hospitals downsizing and cutting costs. Directed by a national consulting firm, the employees of the hospitals and medical centers are faced with a three-phase approach to change: First, cut costs by downsizing; second, flatten the administrative hierarchy of clinical practice (hospitals and medical centers) and reduce the number of departments; and third, locate avenues to improve operational efficiency and cost effectiveness. Despite the consultants’ efforts to structure the downsizing phase in a manner that required management to carry out the percentage of agreed upon cuts in their units, the hospital employees were not sufficiently involved in the process. In fact, the executive- and consultant-driven process for downsizing-that included two noteworthy meetings discussed in my response to the earlier set of interviews-depersonalized human relations by structuring a “clean way” to eliminate people’s jobs (UK HealthCare Quality Initiatives, 2007; Moran, 1999).

Patients have become more aware of quality care and are more capable of articulating their hopes and needs. Hamel and Prahalad present a simple two-by-two matrix where one axis represents needs-those that customers are capable of articulating and those that they can’t yet articulate. The other axis represents classes of customer-patients those classes that the organization currently serves and those that it does not. However well an organization meets the articulated needs of current customers, it runs a great risk if it doesn’t have a view of the needs customers can’t yet articulate, but would love to have satisfied (Hamel and Prahalad, 1994).

Medical technology can generally reap the benefits of economies of scale. Products or services that attract well-funded users beyond the limits of a particular culture result in production volumes that quickly bring the costs down, thus extending the health benefits to far more people while generating larger cash flows to fund more interesting research. If your competitor outreaches you, it is hard to stay in existence. Thus, family type relationships not only exist at the micro-level between the employees and the company but also at the macro- level in the interlinking relationships between individual companies and groups of companies (Itemfield and Healthcare, 2006; National Service Frameworks, 2007).

The facts mentioned above show that it is necessary to maintain a balance between an emphasis on subject matter or function at higher levels of the organization, and specialization and concern for staff at the operational level. Work can be divided, and activities linked  together, in a variety of different ways. While this process may be less painful for the executives and consultants, it may have serious and far-reaching consequences for hospital morale and membership. Nevertheless, in the case of clinical practice, everyone seems to appreciate the need for change in an environment of managed care and decreasing census. However, the hospital executives and consultants have not taken advantage of that fact. There is no evidence that they acknowledge this fundamental agreement with their employees. More important, downsizing is a top-down, unilateral process at hospitals that is rendering hospital employees powerless and depressed (Health Care: Consumers and Patients, 2003).

Management theory shows that it is made easier when top management, who retain ultimate responsibility for the personnel function, take an active part in fostering goodwill and harmonious working relationships among departments. Top management should agree clear terms of reference for individuals within a framework of sound personnel policies. Within this framework the personnel function can be seen as operating at two levels: the organizational level and the departmental level. In clinical practice, separate units of different size, location and mix of skills, means of necessity the personnel function is decentralized and prime responsibility has to be with management. An understanding of the capabilities of individuals and groups terms of attitudes, abilities and skills, as well as an understanding how individuals relate one to another, is an important part of the preparation and development of National Service strategy.


Conclusion

The success or failure of a current strategy employed by National Service Framework depend not only on decisions made in the past but also on how those decisions are being implemented now by people employed by the organization. The allocation of duties and responsibilities is according to medical experience, or where a particular technical skill or special qualification is required the correct design of structure which is of most significance in determining organizational performance. Good structure of the medical units does not by itself produce good performance. Particular attention should be focused on a phase in market evolution when managed clinical practice sector move from including cost-ineffective healthcare providers that promote market penetration to deleting them after establishing themselves in the market. Decision about the future strategy of the clinical practice is made by National Health Service and strategies are implemented by medical staff, so it is important to take into account the nature of relations within clinical practice framework.

References
1.    Amey, L.R. A Conceptual Approach to Management. Durham, NC: Praeger Publishers, 1986.
2.    Ginter P.M., L.M. Swayne, and J.W. Duncan. Strategic Management of Healthcare Organizations Cambridge: Blackwell Publishers, 1997.
3.    Hamel, G., and C. Prahalad, Competing for the Future. Boston: The Harvard Business School Press, 1994.
4.    Hansten, R. ‘Streamline change-of-shift report’. Nursing Management. 2003. Aug; 34(8), pp. 58-9,.
5.    Health Care: Consumers and Patients. 2007. http://www.ahrq.gov/consumer/
6.    Itemfield and Healthcare. 2006. http://www.itemfield.com/solutions/healthcare.aspx
7.    National Service Frameworks. 2007. http://www.nelh.nhs.uk/nsf/
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10.    Regulation work program. 2007. http://www.kingsfund.org.uk/health_topics/regulation_work.html
11.    Mason, C. Guide to practice or ‘load of rubbish': The influence of care plans on nursing practice in five clinical areas in Northern Ireland’, Journal of Advanced Nursing, 1999. 29, 2. 1081-1090.
12.    Moran, M. Governing the Health Care State: A Comparative Study of the United Kingdom, the United States and Germany.  Manchester: Manchester UP, 1999.
13.    Sims, Caroline E. Increasing Clinical, Satisfaction, and Financial Performance Through Nurse-driven Process Improvement. Journal of Nursing Administration. 2003, 33(2):68-75.
14.    Sullivan, E.J., Decker, Ph. J. Effective leadership & Management in Nursing 6th ed. Pearson Hall, 2005.
15.    UK HealthCare Quality Initiatives. 2007. http://www.ukhealthcare.uky.edu/quality/index.htm

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