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, “Multi-skilling at Rossett NHS Trust”. The case is about the introduction of multi-skilled, ward-based teams of support workers in Rossett NHS Trust hospital, a medium-sized hospital in the UK. NHS Trust provides a complete range of midwifery and acute services and employs over 2800 staff, of which about 1650 work full-time and almost 80% of its employees are female. The staff turnover rate is quite low and appears to be declining. Absenteeism due to sickness is also low except for ancillary staff for which it appears to be double the hospital average. The proposed change to introduce multi-skilling within NHS Trust would‟ve largely affected about 250 people mostly including ancillary staff. The idea behind the introduction of generic working was to improve efficiency and provide job enrichment for its workers and to combine the roles of porters and domestic staff in order to improve responsiveness and flexibility to patients‟ needs. The change mainly represented wide part of strategic transformation in the NHS with main attention on improvement in service quality and value and human resource issues. Though this organisational change was of a great benefit to the patients, however, it did give rise to certain issues. In this assignment we‟ll apply Management and leadership theories such as Blake and Mounton‟s Managerial Grid, Transactional/ Transformational leadership and Adair‟s Action-Centred Leadership. For motivation, Herzberg‟s two-factor theory, Maslow‟s Heirarchy of Needs, Equity Theory and for Groups and teams, Mayo‟s Human Relation Approach, Tuckman‟s Stages of Group Development and Belbin‟s nine team roles. MANAGEMENT AND LEADERSHIP: Using Blake and Mouton‟s Managerial grid (1964), the management of NHS trust can be said to be 9.1 managers, sometimes referred to as “autocratic task managers”. These are only concerned with the task and have little or no concern for people, and have an autocratic style of leadership. The main problem with the generic working concept within the NHS Trust was that it was not based on what was beneficial for the employees but was all about organisation making more money. This is why the managers only stressed on its positive features, as Selwyn Fisher, the finance director, said that its successful implementation will help to provide good value for money and will make cost savings. There was also a focus on achieving competitive advantage with commercial players. Though, this is a positive factor for managers and negative for employees as managers will be using their power and control over them so as to ensure that the implementation is successful. For instance, during the pilot scheme some of the domestic staff was required to change their work patterns and work extra 35,000 hours a year.
Transactional/Transformational Leader: Where organisational change is required, this calls for a transformational leader. „A transformational leader is the one who has a vision to make changes so as to cope with situation and the ability to communicate and inpire followers so that they change their way of doing things (Bass, 1985). In the given scenario, Anita Patel, the director of Hotel Services, actually „owned‟ the change and could‟ve been an effective transformational leader as she proposed to introduce generic-working concept so as to improve flexibility and responsiveness to patient needs, however, she didn‟t have the charisma to inspire people.
individual and task needs. 2005). and then come safety needs. Maslow‟s theory is best demonstrated as a pyramid. but instead they focused on the implementing generic-working successfully.In transactional leadership the exchange between leader and subordinate depends highly on a stable situation and leader identifies the needs and expectations of subordinates and structures the context accordingly (Bass. Managers should‟ve maintained a balance between the three elements. On the first level are the basic psychological needs. esteem needs and finally self-actualisation needs. Adair also recognised that too much attention paid by the leader to any one specific area can lead to ineffectiveness in the group.managing individuals needs. Adair suggested that it is important for a good manager and leader to have a complete command over the three main interconnected areas of this model: . The emphasis in the case study is clearly on the task need: operational benefits and improved patients needs. The basic idea was that people are always wanting for more and that depends upon what they already have. junior manager and head of domestic staff.e. This causes de-motivation amongst porters who openly expressed their unwillingness to undertake cleaning duties and thought that to be women‟s work. selfactualisation. improving quality and developing teams and productivity. Maslow suggested that human needs are arranged in a series of levels. 1985). The behaviour of employees at NHS can be determined by what motivates them and the rewards and fulfilment they derive from it. Denis Lipton. MOTIVATION: Motivation is another aspect of this case study. by doing so it would have helped them in achieving results. with the staff outcomes are only assumed by the management instead of effectively meeting the individual and team maintenance needs. Adair‟s Action-Centred Leadership: Recognising the importance of the team. Maslow‟s Hierarchy of Needs: Applying Maslow‟s Hierarchy of Needs (1943) at NHS. Looking at the NHS trust. managers didn‟t considered what gender issue porters had regarding undertaking cleaning duties and what would make them comfortable at job.achieving the task needs .managing the team or group needs . According to Maslow all these needs are particularly important and each one must be satisfied before moving on to the next level. building morale. . only then a person can move to the top level of the pyramid i. John Adair‟s Action Centred Leadership Theory can be applied to NHS. there appears to be a clear evidence of „lack of need satisfaction‟. It is defined as „degree to which an individual wants and chooses to engage in certain specified behaviour” (Mullins. social needs. could‟ve been a transactional leader as she was responsible for day-to-day implementation of generic-working concept and would‟ve altered the concept a bit according to the needs of staff so as to make it work but the only problem was the lack of authority.
would improve motivation as porters will feel part of the team and will be recognised at ward level which appears to be in line with Mayo‟s human relations approach (1945). security. Equity Theory: The equity theory of motivation (Adams. GROUPS AND TEAMS: Group and team-working has been an aspect of organizational life for a long time. 2) Motivator factors such as growth. pay. This according to Patrick Davenport. Management promotes the benefits of group working and stresses on the common interests of individual workers. „tension‟ helps to motivate the individual to eliminate the unfairness and this appears to be case at NHS. working conditions. etc are also important Although managers tried to adopt Hertzberg‟s motivation and hygiene factors through the use of performance related pay (PRP) so as to link pay with achievement. The same philosophy was the basis for management‟s decision of generic working at NHS. and the goals of the organization as a whole. Mayo‟s Human Relations Approach: For generic working concept to take place. 2004b). who proposed that factors which lead to job satisfaction are different from factors leading to job dissatisfaction and named this “Two-Factor theory of motivation”. who believed that by being part of a team work satisfaction can be achieved. etc. where one part states that „unfairness‟ may lead to tension within an organisation (Buchanan & Huczynski. that is.e. The other part of equity theory i. recognition. for example. 2004a). Also with regards to porters. This is a process theory which is based on our perceptions of fair treatment. it can be related to salary issues as they were only given a pay rise of 2% as compared to domestic staff who were given a pay rise of 8%. 1963) applies the same principle. This is evident at NHS by the group of ward hostesses who enjoyed privileged position among their colleagues whose work focused mostly on cleaning and hardly had contact with patients or clinical personnel. Job enrichment concept was firstly brought forward by Frederick Herzberg. Two factors are: 1) Hygiene factors: features of the work environment rather than the work itself. entire domestic and portering staff was required to be based at ward level instead of in a central pool. status. responsibility. of senior management (Buchanan & Huczynski. . organized by management into teams.- Herzberg‟s Two-Factor Theory: One of the assumptions underlying the generic working concept was that staff will benefit from job enrichment. Staffs do have support of the union who were able to influence management‟s decision to implement generic-working within NHS and managed to bring it to an end. it didn‟t actually satisfy any further factors. HRM director.
as one manager said „it is about boundaries between groups‟. At NHS Trust this will be the formation of 12 domestic and portering staff in a group for the pilot scheme which ran for a year. Another issue was of „ownership‟ of tasks. doctors. we have: Forming is the initial formation of the group and bringing together a number of individuals. specialist and implementer. . the lack of a team leader caused a lot of problem with performing the tasks. all these different groups and it was almost impossible to make them all work in teams. Many porters openly expressed their unwillingness to undertake cleaning duties.‟ Adjourning: Group disperse in this final stage. 2010a). co-ordinator. so that their positive attributes complement each other. which gave rise to tension between Hotel Services and nursing as some of the duties from nursing staff was reallocated to domestic staff.. One major issue raised during the pilot scheme was the gender issue. Belbin (1993) identified nine key roles that are present in an effective group. One of the problems with team-working concept was informal groups. 2010b). Perfoming: At this stage the group starts concentrating on the achievement of its purpose. At NHS. completer. UNISON strongly opposed generic working and advised its members not to facilitate its implementation. shaper. Norming is the one in which close relationships are developed and group demonstrates cohesiveness. Informal group exist because of unavoidable interactions of individuals in the group as they associate with one another (Ackroyd and Thompson. as one manager said that staff believe „the rotas are so difficult to follow that went up on the board it was “where‟s my job? I haven‟t got a job”. physiotherapists. Within NHS Trust. which lacks at NHS. there are nurses. Bruce Tuckman (1977) suggested that generally groups pass through five clearly defined stages of development. A team role is described as characteristic of the way in which one team member interacts with another whose performance serves to facilitate the progress of the team as a whole (Mullins & Christy. A system of management allocating the tasks was adopted. These are plant. 1961). resource investigator. He argued that an effective team often consists of people who are although of the same type. This gave rise to communication problem since those responsible for managing the change didn‟t gather all the staff to discuss the changes and relied too much on informal communication. Apart from the problems mentioned above the generic working concept also failed because staffs were greatly influenced by The Trade Union (UNISON). 2004c). but need a balanced mix of individual characteristics.. monitor-evaluator. 1999). Applying this to Rossett NHS Trust. All of these roles have different characteristics. Staff notice board were use to display work rotas which caused a lot of disturbance. Conflicts arise within the group. either cause of the achievement of task or due to members leaving the group (Buchanan & Huczynski. Storming: Members of the group get to know each other better and put forward their views more openly and forcefully (Mullins & Christy.- Stages of Group Development: The task of management at NHS was to create effective work group by developing supportive relationships (Likert. teamworker. Belbin‟s Nine Team Roles: Another very popular framework which is widely used to understand the roles within a group or team is Belbin‟s Team Role Theory.
2004d). Another drawback of the team was the lack of Belbin‟s team roles. if Mayo‟s human relations approach along with contingency theories was adopted. there is no member from administrator so as to play a role of monitor-evaluator for instance. waiting for action time and duplication of effort as Rensis Likert (1961) said that group forces are important to influence the behaviour of individual work groups with regard to productivity and waste. motivation and team-work. If only management would‟ve identified all these issues at the beginning it might have resulted in a successful implementation of generic-working. Keeping this in mind. management should‟ve involved UNISON especially in the small domestic team which was step-up to implement generic-working concept. etc. management believed that generic-working will even-out the workload for porters and will improve efficiency by avoiding wasted journeys. The idea of multi-skilling appears to be beneficial for employees both in short and long term. it would‟ve increased their motivation and consequently service level efficiency and resultant employee‟s satisfaction. However. CONCLUSION: The above assignment analysed the implementation of generic-working concept within NHS trust from three major aspects: management and leadership. At NHS. which was formed within NHS Trust for the pilot scheme. and had given the power to ward managers so as to make their own guidelines based upon what satisfies the employees. Management need to change the way they interact with the employees. which has also been encouraged by research. participative management would‟ve been effective. delegation of tasks and job-security for nurses were identified. NHS being a highly centralised structure with little delegation causes de-motivation amongst junior staff. communication. . Currently. In order to provide a balance of roles within a team. However. Though this strategy transformation at NHS was to incorporate continuous improvement in service-quality. When it comes to team-work.For the team. the overall organisational effectiveness can be improved (Buchanan & Huczynski. it‟s introduced within NHS made staff feel that it is only a cost improvement exercise. gender. UNISON speaks for the staff and this would‟ve helped the management to understand employees‟ point-of-view and make amendments accordingly. however. where management considers employee‟s opinions and alters its approach according. the team went through different stages and problems like porters‟ gender issue. it did give rise to issues like control. it was important to have a balance of each of Belbin‟s nine team role to be an effective team. plus also to affect the performance of the entire organisation. Using Tuckman‟s stage development theory. members can double up and play several roles. this theory might not be as effective in this scenario as managers didn‟t pay much attention to these roles when forming the team. For example. which was beneficial for both management and the employees. By involving the people with knowledge and experience in the decisionmaking process. power. All the members are doing the same job. management are classified as autocratic task managers since they only focus on the implementing generic-working concept successfully because of financial benefits.
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