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Change remains inevitable in the running and operations of health facilities across the United Kingdom (UK).  Embracing change allows fusion and introduction of new ideas and ways of doing things that improves overall performance.  For majority of healthcare facilities, change is a continuous process, both in terms of leadership and in the operational spectrums.  This paper incorporates Ashford and St. Peter’s Hospitals National Health Service (NHS) Foundation Trust in discussing on the aspects of leadership and change management.  The paper briefly describes the organization and the type of changes that has occurred, drawing on Lewin’s Force Field Analysis to model and evaluate forces driving change and those acting as barriers to change.

Overview of Ashford and St. Peter’s Hospitals NHS Foundation Trust

The Ashford and St Peter’s Hospitals NHS Foundation Trustis the largest in terms of provision of acute hospital services in Surrey with the capability to serve a population of approximately 410,000 people across parts of Hounslow and North West Surrey. The two main hospital sites include St. Peter’s Hospital in Chertsey and Ashford Hospital located in Middlesex (Ashford and St Peter’s Hospitals NHS Foundation Trust 2018). They offer services at Working Community Hospital, Royal Surrey County Hospital and Milford Hospital.  The Trust has a board that comprises the chairperson, seven non-executive directors and seven executive directors that have the mandate to spearhead the management and operations of the hospital.

Some of the specialist services offered by the Trust include cardiology, orthopedics, vascular services, neo-natal intensive care and bariatric surgery. The Trust is committed to ensuring that they render high quality healthcare services to their customer. Care Quality Commission has ranked the Trust Services as “Good’ indicating its commitment and drive to render the best services to its clients. Additionally, the Trust has been nominated amongst 40 top hospitals by Comparative Health Knowledge System (CHKS), a national provider of healthcare intelligence based on a number of indicators for quality and safety for a number of years it has been in operation (St. Peter’s Hospitals NHS Foundation Trust Annual Review 2017).  Over the five years, the Trust has undergone/made various changes to improve service delivery and general performance. The Trust has defined its values that guide and ignite passion in its staffs as they commit to offer their services to their clients.  The values include putting patients first, embracing personal responsibility, passion for excellence and pride in working as a team.

Change Management at Ashford and St. Peter’s Hospitals NHS Foundation Trust

The organization has had organizational structural changes in terms of administrative procedures and management systems to aid in meeting the customers’ needs more effectively.  In September 2017, the Trust made changes in its top management /leadership. The Trust was delighted to receive a new chairperson, Andy Field, to head the board.  The change was necessary to allow continued delivery of services at the Trust. The Trust has an obligation to elect new chairperson to ensure that its operations continue smoothly. Therefore, the appointment of the new chair was part of the changes that the Trust has always been practicing in accordance with its bylaws. Such changes allow new ideas and approaches of doing things because leaders possess different skills and would have different perspectives and approaches to various situations or problems.

There have been many other changes in the Trust’s board leadership, Terry Price, one of the directors who had served as non-executive director for nine years steeped down (St. Peter’s Hospitals NHS Foundation Trust Annual Review 2017). This position was taken over by Marcine Waterman who joined the Trust on 1 April 2018 in the same capacity. Furthermore, Sue Tranka also joined the Trust as the new Chief Nurse after Heather Caudle departed (St. Peter’s Hospitals NHS Foundation Trust Annual Review 2017). 

Ashford and St. Peter’s Hospitals NHS Foundation Trust has also experienced people-centered changes which began in 2017.  The aim of this change was to alter the behaviors, attitudes, skills and performance of the employees at the Trust. This has been achieved through rolling up of training programs and promoting effective communication through leadership, motivation and interaction with various groups, the aim was to change the way to solve problems, the way employees learn new skills and how they should perceive themselves, their jobs and the organization. The program at the Trust further aimed at developing skilled and motivated staffs. 

The leadership and talent management strategy program was approved in 2016 with the intention to offer a range of interventions for managers, leaders and staff for their own development (St. Peter’s Hospitals NHS Foundation Trust Annual Review 2017). The program has helped build collective and compassionate leadership, promoting engagement and contributing to creation of organizational culture that has and continues to sustain quality improvement. The program has played a major role in helping or promoting good relationship among the leaders, managers and staffs as well as promoting effective problem solving because of the skills and knowledge that it provided to the participants. Similarly, executive walkabouts have allowed senior leaders to positively engage with teams and staffs on the front-line leading to high standards of patient care and at the same time building strong relationship. Challenges at the organizations are discussed using Manager’s Team Brief and Chief Executive Sounding Board.

Additionally, the Trust has introduced wellbeing and resilience group which developed new six ways to wellness plan that has helped the staffs members to reflect upon their work, especially during difficult situations, hence enabling them sustain their productivity. The six ways to wellness include being able to take notice, be active, keep learning, give, connect and care (St. Peter’s Hospitals NHS Foundation Trust Annual Review 2017)

The Trust has also undergone technology changes in terms of digital improvements in the neo-natal intensive care services. The organization introduced a tailored digital system known as BadgerNet, replacing the traditional folder of handheld notes. The new technology allows accessibility of care during the antenatal period and labor, but the healthcare professionals and women through mobile app and computers. This change has helped to improve service delivery and enhance customer relationships. The organization is further developing electronic ordering diagnostic tests such as x-rays and blood tests in partnership with other trusts to enhance service delivery. This is a demonstration of open-mindedness and readiness to work with other focused minded partners to achieve the goals and visions of the Trust (St. Peter’s Hospitals NHS Foundation Trust Annual Review 2017). 

Analysis Incorporating Lewin’s Force Field to Evaluate the Forces Driving Change 

The change process at Ashford and St. Peter’s Hospitals NHS Foundation Trust can be analyzed and understood with the aid of Lewin’s Force Field Analysis model which ensures that a business responds to the environment within which it operates (Burnes and Cooke 2013). For any change to take place, there are the driving forces and the restraining forces that act as barriers to the change which underpins this model. At the Trust, change management as well goes through various processes and at many times, there is competing forces in action. 

 In most cases, necessity for changes comes from dissatisfaction with the present strategies (failures, performance to meet the set objectives, higher score rates just to mention) (Wong-MingJi Diana 2013). For this change to take place, there is need to develop a vision to achieve better alternatives (Cassell and Johnson 2006). Development of strategies come in to institute the change despite the resistance, which is always inevitable to overcome to achieve the ultimate desired results.

According to Lewin’s Forces of Analysis, the forces driving changes and forces resisting changes are in confrontation with each other (Burnes 2009; Northouse 2015).However, at the Trust, the driving forces have exceeded the restraining force leading to changes. At the Trust, the internal forces for change emanating from within the organization have played major role in the changes so far experienced. Changes in technology and people oriented changes emanate from the urge of the organization to move forward, achieve its goals, and ultimately, vision. One of the reasons was the feeling that the organization could do better than it was. The management at the neonatal services thought it wise to digitalize records for its patients to improve in the quality of services that they provide to women.  Furthermore, introducing digital platforms was a good move in terms of improving the rating and the image of the Trust in terms of providing better quality health services to the clients.

 The move to change or accept changes was equally driven by the desire to increase profitability and other performance measures. Health organizations, even though focuses on providing care, have recurrent expenditures and areas of spending including paying staffs, hence the need to remain afloat to continue offering better services. Therefore, the drive to embrace these changes would increase profit margins because of attractiveness to clients based on the quality services that the Trust would be offering (Schein 2004).

 It is also important to consider the concept of PESTEL in appreciating the driving force that pushed the Trust to embrace these changes. Political, economic, social cultural, technology, environmental and legal factors play a role in the changes. These have played a role in various ways evident; Political process in the country has defined policies and procedures for operation of the heath facilities. The stability in the political process has contributed to the efficient delivery of services by the Trust. Economic situation through taxes, gross domestic products, income index also contribute to the operation of the Trust. The financial challenge the Trust faces has contributed to its slow development in terms of expansion plans.  On socio cultural front, the Trust understands the culture, values and beliefs of the clients hence, have endeavored to align their services to meet these expectations. Advancement of technology has also affected the Trust operation exhibited by increased plan to adopt new technologies to keep up with the changing trends. The hospital has also embraced the concept of sustainable environmental initiatives through guided and secure disposal of the chemicals and used products. On legal front, the law requires that the Trust operates and sets its standards to comply with the National Heath act.  The hospital has set rules and standards guiding principles that ensure compliance with the law.

 The concept of SWOT analysis is also essential in understanding the motivation for embracing change. The organization, when embracing change, has to evaluate its strengths, weakness, opportunities and threats. Strengths at the Trust are found in its professional and experienced directors and managers that understand the systems and the operations of a hospital. Furthermore, the staffs are respective to change and innovative.  Embracing these changes would also provide some opportunities such as increased number of clients and improved ratings. The level of satisfactions amongst its customers would also rise positively impacting on its level of performance and image.

The need to reorganize to increase competitiveness and efficiency is one of the motivation and driving force for the adoption of the changes at the Trust. Increasing efficiency is attainable through proper installation of digital platforms. Technology has proven to enhance service delivery and efficiency. For instance, the rolling out of digital platform and the ongoing efforts to work closely with other partners to implement technology in the operation of the organization indicates the quest to improve performance. Furthermore, the increased attention to quality is also a driving force for the hospital to upgrade its services to attract more clients. Many health facilities and hospitals exist in the UK offering similar services and, therefore, clients have the choice of where to seek their medication. It is, therefore, important that the Trust endeavor to offer high quality and competitive services to continue earning the trust and confidence of potential clients. Another internal driver of change is the ageing and decline in a business products or equipment. At the Trust, the manual system has been overtaken by time, hence the need to go digital to remain relevant and to move in concurrent with the rest of the organization and the world.

 It is also important to embrace change to cement positive and cordial working relationship among various employees and management (Huczynski and Buchanan 2009). Conflicts between staffs and management and between departments can only be resolved through programs such as training and wellness and resilient programs deployed at the Trust to help build unity and positive relationship. Such avenues/initiatives promote effective communication and act as an avenue to motivate the staffs and teams to work together to achieve the common objective in the organization.

There is also need for greater flexibility in organizations structures to pave way for the smooth operation and changes (Banfield and Kay 2012; Carberry and Cross 2015). At the Trust, the organizational structure is very flexible in the sense that it provides opportunity for director and senior managers to step done and pave way for others. Such systems have seen new changes being done in the structure and leadership of the Trust, hence promoting continuity and success of the organization. The level of conflicts and disagreements tend to be low and this opportunity as well allows new members with new sets of skills and knowledge to join the management to spearhead changes. This demonstrates the transformative leadership spirit to bring positive changes to achieve ultimate goals (Cronshaw and McCulloch 2008: Mello 2015).

Concerns about effective communication and de-motivated employees as well as poor relationship are yet another driving force that has contributed to changes at St. Peter’s Hospitals NHS Foundation Trust.  The wellness program that the Trust introduced gave opportunity for the staffs to reflect and to cooperate and work in unison as a team for the wellbeing and good of the organization. At the Trust, the external forces have also played a role in the changes experienced in the last five years. Increased demands for higher quality and improved level of customer services exerted pressure on the Trust to improve in its services to meet these demands. In a business circle, the customer is always the boss, therefore, it is important to understand exactly the kind of services that please and attracts customers to offer such services (Mankin 2009). Customers’ wishes require fulfillment for them to remain loyal, believe, and even trust the hospital.

Increased level of competition is another external factor or driving forces that has contributed to improvement and changes at the trust. Currently, there are quite a number of health facilities that have enough, sophisticated equipment, experienced professionals, and facilities that offer various services to clients. To remain afloat and leave a mark, it is important that the Trust continuously embrace change in its structures, leadership, and processes to meet these demands. These changes including, technological and people oriented changes are, therefore, coming amidst intensified competition from similar agencies that offer similar kind of services to the populace.

Other reasons for the changes include globalization, ethics and social values, changing nature and composition of the workforce among many others (Handy 1999).  For instance, the nature of workforce is changing and the organization has to offer these workers the requisite skills and knowledge through training for them to be competiveness and motivated to work. Therefore, it is in good faith and standing for the Trust to provide training opportunity that gives them an opportunity to build relationship and exercise effective communication skills. 

 Even with the Trust having managed to embrace change, there are quite a number of restraining forces that make change harder, a clear depiction that change will also be resisted regardless of it being good.  The reason for this resistance is the perception that changes may lead to disruptions from the norms and be stressful (Hayes 2014). Other reasons that make people to resist change include; parochial self-interest, habit, misunderstanding of the purpose or need of change, low tolerance of chance/sense of security, different assessment of the situation, economic implications and  fear of the unknown (Kotter 2012). Similarly, overall organizational barriers such as existing power structures, failure of previous change initiatives, structural inertia, and resistance from the work groups make people to resist change (Jabri 2017).  At the Trust, the probable cause or barrier for change is the economic implications for instituting the changes. However, this barrier was managed through options of selling part of the land and donations from volunteers. Furthermore, the management undertook noble steps to manage the change through explaining the need for change, providing adequate information to the stakeholders, consulting, negotiating, and offering support and training, involving people in the process, building trust and sense of security and in building employee relationships 

Summary on Driving Force and Barrier to Change

In summary, leadership theories and management models remain critical in spearheading changes and reforms. Leaders have to set visions and understand what they want. Transformational theory provides an avenue for leaders to be open minded and embrace changes that positively build an organization to realign their goals (Warrilow 2018).  The Lewin’s Force Analysis model of change management has also expanded the understanding of the change process at St. Peter’s Hospitals NHS Foundation Trust, expanding the scope of understanding on the driving forces and restraining forces when organizations are instituting changes.  In this case,   the single biggest drive force for change at St. Peter’s Hospitals NHS Foundation Trust is to provide quality services to clients to retain them and ensure that the hospital remains afloat (St. Peter’s Hospitals NHS Foundation Trust Annual Review 2017).  On the other hand, the single biggest barrier to change is the economic restrains that have impacted on its potential to institute changes. Regardless, the organization is on the right footing as it has demonstrated resilient and commitment to embrace many other changes provided they work for the better of the organization, staffs and the clients.

 Conclusively, St. Peter’s Hospitals NHS Foundation Trust is one of the UK’s NHS trust Hospital that clearly epitomize and demonstrate the inevitable nature of changes.  Organizations are always in a state of inertia and must always remain ready to embrace changes. In this day and age, the world is moving at a very great speed because of various internal and environmental factors that affect the operations of organizations. Internal and external changes including political economic, social cultural, technological, legal and environmental factors are affecting the way the health sector is running. It is, therefore, important that the leadership/management understand and appreciates these changes to be in a position to provide better leadership and quality services to the clients and stakeholders.  Lewin’s Field Analysis is one of the models that better explains the change management at the St. Peter’s Hospitals NHS Foundation Trust and which other organizations can adapt to be able to undertake the change process in an effective manner. The management and leadership of St. Peter’s Hospitals NHS Foundation Trust have done the most important thing to lead and to share the vision and the purpose of the changes, which has facilitated the change process. Leaders, therefore, must understand that change is a process that requires people to work together to communicate and to share in the successes together. 

Reference List

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