Structural Change Process: The NHS

The case study report below is complete dissection of the undertaken structural change process by the Rossett NHS Hospital Trust to achieve its business objectives. Rossett NHS Hospital Trust attempted to introduce generic worker concept involving about 250 employees from its huge employee base of 2800. This change was part of a wider, strategic transformation in the NHS hospital with its focus on human resources issues, and in compliance with government initiatives, in the process realise continual improvement in quality of services rendered to patients and improve value for money.

The nature of and rationale for the attempt of introduction of the generic worker concept was to achieve significant reduction in waiting times, improve flexibility, responsiveness to the patient needs by combining the roles right to the ward level and creating a central pool. This would enhance multiskilled work force who are eligible enough to conduct other full range of domestic and portering roles and other services including serving patient, clearing, and portering.

The management through this structural change i.e. adapting to generic worker concept wanted to improve the working atmosphere of its employees by improving the flexibility in task allocation and rendering by its employee base and motivation of impacted employee base which in-turn reduce the absenteeism, which, is currently among the highest, when compared to the industry average. The finance department claimed that successful implementation would help to provide good value for money and make cost savings and proposed single grade and pay spine to the impacted employees and performance bonuses on attendance. From the operations perspective, this would bring about enormous benefits of flexibility and would simply and improve efficiency by avoiding waiting for action time and wasted journey and other duplication of efforts. The report below tries to analyze in depth about.

Literature review

Team Management

Team Constitution:

When two or more people interact among each other to accomplish a goal then it is called group. A group of people who work intensively with each other to achieve a set goal is called a TEAM. Team members should always be driving by the goal rather than individual results. The success of a team depends on the accomplishment of set objective or the drive to excel the same. Team functionality impacts the organizations effectiveness and performance. The contributing factors from the both the individual and organization context which are the driving factors for team existence and performance:


Contributing factors for team cohesiveness and performance

There are different types of teams which include functional or departmental, cross-functional, and self-managing. Each of these types of teams have certain characteristic features which differentiate their functioning style and objectives set to achieve. There are four essential elements that make the team successful or adventurous; goals/objectives, interdependence, commitment, and accountability.

There are basically three different formats of team functionalities which explain how each team exhibits their cohesiveness and working style, as explained below.

  • Basic functional team structure
  • Team should be encouraged to develop:
  • Positive Interdependence
  • Face-to-Face promotive Interaction
  • Individual Accountability/Personal Responsibility:
  • Teamwork Skills
  • Reduce social loafing as it is human tendency to put forth less effort in team than individually.
  • Conflict management among the team members.

Team Development and Management:

Team development is a process which needs to be carried along cautiously and in controlled manner. Team management is set of processes and/or procedures carried out along to achieve the teams’ set objectives or goals. As Bruce Tuckman (65) explained the process is formed of five major steps as forming, storming, norming, performing, and adjourning. Following these steps in true intentions would only build the team to be together, build constructive consensus of ideas/thoughts, and explore newer avenues leading to effective result oriented team.

Bruce Tuckman’s five stage team development


The processes that account for an individual’s intensity, direction, and persistence of effort toward attaining goal is called motivation. Motivation is said to be intrinsic, that drives from within or from intangible benefits or extrinsic, that drives from outside facilitators or from the tangible benefits.

The term motivation can be described in many different formats and views, as of author mentions, Dr Stephen P. Robbins, this is the process that account for an individual’s intensity, direction and persistence of effort toward attaining a goal (S. P. Robbins).

In general there are broadly two types of motivation;

1. Process theory

2. Content theory

A process theory defines motivation as a rational cognitive process occurring within the individual as explained through Adams’ Equity theory. While on the other hand, a content theory defines motivation in terms of need satisfaction as explained through the Maslow’s Hierarchy of needs theory. Hence, the above two theories defer in many ways because each recognize motivation and its application due to the circumstances.

Motivation Factors that will motivate if they are present are the claim of achievement, advancement, recognition, and responsibility. Dissatisfaction is not normally blamed on Motivation Factors, but they are cited as the cause of job satisfaction.

Herzberg believed that organizations should motivate employees by adopting a democratic approach to management and by improving the nature and content of the actual job through certain methods. Some of the methods managers could use to achieve this are:

1. Job enlargement – workers being given a greater variety of tasks to perform which should make the work more interesting.

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2. Job enrichment – workers being given a wider range of more complex, interesting, and challenging tasks. This should give a greater sense of achievement.

3. Empowerment – delegating more power to employees to make their own decisions over areas of their working life.

Hygiene Factors that de-motivate (in absence)

Such as supervision, interpersonal relations, physical working conditions, and salary. Hygiene Factors affect the level of dissatisfaction, but are rarely quoted as creators of job satisfaction.


Herzberg’s Two-factor Theory

In the case study provided, the two main types of motivational theories which through me reading are most adaptable are the Porter and Lawyer’s theory which is a Process theory, its features and how it adapts to the workplace. And on the content theory side I find the Herzberg’s Motivation-Hygiene Theory, its features and how it adapts to the workplace to be most suitable.

Porter and Lawler (1968) explained that modulating the work atmosphere so that effective performance would lead to both intrinsic and extrinsic rewards, which would implicate to increase in complete job satisfaction. Understandably in this model is the assumption that intrinsic and extrinsic rewards are additive and correlated, yielding complete job satisfaction.

According to Porter Lawler Theory, any premises that felt needs cause human behavior and that the effort expended to accomplish a task is determined by the perceived value of rewards will result from finishing the task and the probability that those rewards will materialize (GAGNE and DECI, 2005)

Porter and Lawler (1968) expanded Vroom’s initial work to recognize the role of individual differences (e.g., employee abilities and skills) and role clarity in linking job effort to actual job performance. This is one of most comprehensive motivational structure based on the expectation theory which elaborates on all the factors which can influence each individual’s motivation. Porter and Lawler incorporated a feedback loop to recognize learning by employees about past relationships.

Porter’s and Lawler Theory


Leader is one who can impress upon a group to behave or act according to his/her objectives. The leader’s ability in doing so depends on the ability in process application of both knowledge and skills. According to Northouse’s (2007) definition – Leadership is a process whereby an individual influences a group of individuals to achieve a common goal. The ability of process application of a leader can be explained through the process leadership explanation. (Jago 1982). But, in general there are traits which influences our action, this can be explained through the Trait Leadership (Jago 1982).

Jago’s Leadership theories

This explains that the leadership is learned, leader’s ability of application of process of skills and knowledge depends on the traits or attributes he posses or believes in.

Today, leadership is increasingly associated not with command and control but with the concept of inspiration, of getting along with other people and creating a vision with which others can identify. For example, Adair sees leadership as a combination of example, persuasion and compulsion that results in making people do things they might not otherwise have done.

According to Levine, leaders need to concentrate upon moving people and organisations forward by increasing the competency of staff and the co-operation of teams in order to improve the organisation. A leader’s job is to constantly challenge the bureaucracy that smothers individual enthusiasm and the desire to contribute to an organization.

Leadership and management

Management is more usually viewed as getting things done through other people in order to achieve stated organisational objectives. The manager may react to specific situations and be more concerned with solving short-term problems. Management is regarded as relating to people working within a structured organisation and with prescribed roles.

Management may arguably be viewed more in terms of planning, organizing, directing and controlling the activities of subordinate staff.

Leadership, however, is concerned more with attention to communicating with, motivating, encouraging and involving people. The emphasis of leadership is on interpersonal behaviour in a broader context. It is often associated with the willing and enthusiastic behaviour of followers.

There are other differences between leadership and management. For example, Zaleznik explores difference in attitudes towards goals, conceptions of work, relations with others, self-perception and development.

• Managers tend to adopt impersonal or passive attitudes towards goals. Leaders adopt a more personal and active attitude towards goals.

• In order to get people to accept solutions, the manager needs continually to co-ordinate and balance in order to compromise conflicting values. The leader creates excitement in work and develops choices that give substance to images that excite people.

• In their relationships with other people, managers maintain a low level of emotional involvement. Leaders have empathy with other people and give attention to what events and actions mean.

• Managers see themselves more as conservators and regulators of the existing order of affairs with which they identify, and from which they gain rewards. Leaders work in, but do not belong to, the organisation. Their sense of identity does not depend upon membership or work roles and they search out opportunities for change.

Transactional and Transformational

There are two fundamental forms of leaderships – Transactional and Transformational

Transactional leadership is based on legitimate authority within the bureaucratic structure of the organisation. The emphasis is on the clarification of goals and objectives, work task and outcomes, and organisational rewards and punishments. Transactional leadership appeals to the self-interest of followers. It is based on a relationship of mutual dependence and an exchange process of: ‘I will give you this, if you do that’.

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Transformational leadership, by contrast, is a process of generating higher levels of motivation and commitment among followers. The emphasis is on generating a vision for the organisation and the leader’s ability to appeal to higher ideals and values of followers, and creating a feeling of justice, loyalty and trust. In the organisational sense, transformational leadership is about transforming the performance or fortunes of a business. This type of leadership is best suited during the structural change circumstances.

Critical Analysis

Proposed change

The management of the Rossett NHS Hospital Trust hospital envisioned to revamp the organizational structure through seven key changes in their business plan for the yea. Of them the reports elaborates on the attempt to introduce multiskilled, ward based teams of support workers. This transformation would impact around 250 employees. The objective of the changes was to achieve competitive advantage over other hospitals and earn greater customer satisfaction. The proposed change is an attempt to introduce the generic worker concept to significantly reduce the waiting time and improve the compliance with government initiatives and introduction of major information systems. The Site service Directorate was responsible for this implementation. It was broadly constituted of Hotel Services (domestic and portering staff), which was managed by Deputy Director of Site Services, but the actual ownership of the change was owned by Director (Anita Patel). The changed comprised all the porter and domestic staff. The staff was divided into three groups under three managers while some of the staff were stationed at specific departments but majority were placed in the central pool to attend to various duties including serving food and assisting nurse ancillary staff. These staffs were to report to the managers at Site Services Directorate (which was a conflict reason in practice). This change required additional training to get acquaintance with new jobs they would have to perform. The staff had to embrace to work flexibility and teamwork and some needed to face change in shifts. This change is structure came out with great news with structured payment system and pay rise along with performance bonuses aimed at improving the employee motivation and job satisfaction.

Actual change

The vision of management was taken bitter tone when it came out open and functional though they envisioned greater and positive response from all involved including middle managers and the actual employees impacted but the story in practice was completely different which lead to failure in implementation to achieve the objectives.

The actual impacted staff showed little or no interest in the change as thought it to be invasive into their working schedule and their interest of work. Though certain women staff were happy to see the men staff doing the cleaning and others and but the nurse felt they were neglected and their duties were invaded by the lower ranked staff. Majority of staff had no clear idea has what kind of activities they would be involved which lead to reduced job identification and satisfaction.

These changes brought out major conflicts among the middle managers and actual working staff as there were not clear demarcation of duties or jobs and who would be involved where and when would be the staff put at work, all this created lots of confusion and job dissatisfaction and conflicts among the actual working staff and also between the department involved. The managers (middle) were not able to clearly identify the conflicts which lead to ineffective actions to tap these differences. The managers were not able to distinguish out the problems and gel the differences due to loss of ownership of job. As one of porter staff mentioned the change as “fire-fighting”- there is no service level agreement in place against which to measure performance.

The other area where conflict and confusion rose was with the rota preparation as manager were having hard time to track who can do what and where to place and when to place them since they to pick from the general pool of employees. The manager were facing difficulty in tracking and employees felt bias treatment bestowed upon few employees and that rota system preparation was not in-line with conditions laid down for change. The other major problem was the gender issue which came out in open when most of men openly showed their dissatisfaction to working as cleaners. This issue was completely neglected, as no manager looked into it right from the planning stage to the implementation stage. From the manager’s point of view they seemed to be completely powerless as no clear demarcation of rules and regulations, which lead to ineffective control by them on the change and could not initiate any mending ways or improvise the circumstances.

To add to the present situation even the union (UNISON) was against the change implementation saying it would radically change employee benefit agreements and that this is just a cost improvement exercise without considering the employee and their concerns and advocated employees to vote against the change. So, to conclude this whole generic working concept was utter failure, though there was last ditch effort to save the change by the management but could not succeed in their effort.

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Recommendations and conclusions

On careful dissection of the whole of the happenings during the trial period of the change envisioned by the Rossett NHS Hospital Trust I deem the following recommendations and conclusions as the most suitable and adaptable the trust should have taken to the successful accomplishment of their business vision.

Of note, there were certain positive points to the envisioned generic worker concept, these were (to mention a few);

  • Simplified pay structure.
  • Performance bounces linked to attendance.
  • Option of shift changes.
  • Job profile enhancement and new job cultivation.
  • Opportunity of greater team building avenues.
  • Greater customer satisfaction feasibility.
  • Improvement to the financial health of the trust.

But these good points were not communicated down to the employees in practical.

On the leadership front, the management though had these benefits on the paper and on the discussion table with the down line managers but did not clear demarcate roles and regulations for the immediate line managers to exhibit and propagate these benefits and also let them exploit their leadership skills in handling the circumstances in day-to-day running during the trial period. The immediate line or reporting managers were left stranded having nothing to do to with various grievances of the actual and effected work force under them. These restrictions and inability led the team manager and members to have job dissatisfaction and lack of motivation to pursue the management vision. There was need for a transformational leader who took up the responsibility and courage to stand up to the occasion driven the team to envision the same vision as seen by the management.

The moral of the image above, when during any change the leader’s transformational ability comes handy as he has to tackle and win over the employee resistance, depending on the complexity of the task, and also the magnitude of change envisioned by the management. But none these ever exhibited by any of line and immediate managers of Trust Hospital.

On the motivational front, after careful literature review the basics of the Porter’s and Lawler Theory which was based on the expectancy theory was completely neglected by all levels of management in the Trust Hospital. The line managers did nothing to motivate the employee effected, or should say, had no say in taking control of the situation, this lead the team to be completely de-motivated and resultant being them to be less inclined to pursue management vision of structural change though it benefited them greatly.

Motivational level at the line manager was equally demoralized as the top management did not let them express themselves during any of the meetings and only positive points were discussed rather taking the holistic view of the structural change into consideration. Both the intrinsic and extrinsic rewards though were present in the structural change present but were not explained to the team effectively which lead to demotivation of the work force.

On the team management front, members were not cohesive with each other and always in their old stigma of work culture and they were confronted upon before going ahead with the changes which lead to the feeling of neglect growing in them. The basic contributing factor of team cohesiveness were not put to practice, when the members felt that their rota was prepared as the change structure specification there was no one to provide them with consolidating reasons showing single lane attitude from the management.

The trial team formed (reciprocal task based team) where exposed and were happy with the structural change (voted in favor of vote) but management could not duplicate their satisfaction and motivation to the rest of the actual work force impacted by the proposed structural change envisioned. Team members were not introduced to the new change and their conflicts and concerns never made to the change meetings between the line managers and top management. The delicate gender issues were also equally neglected. This clearly shows the areas where the management completely failed and needs to improve if they ever needed to achieve their objective in the future.

To conclude for the failure of the envisioned structural change proposed by the management cannot be restricted to one area or department but a complete collapse of non-adherence to basics of structural management theories to mention a few team building and management, motivation, and leadership as discussed in the report above. Had the top management been able to clearly embark the capacity and specified roles along with rules and regulations to the line managers and taken into consideration the concerns of the actual work force to be effected by the generic workers concept the results would have been in favor of the structural change. To sum up, there was utter chaos and neglect to stick to the basic structural change management theories which lead to negate the structural change to generic worker concept by the actual work force to be impacted though there were numerous benefits to the Trust hospital and employees to be impacted.

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