In April 2002, three hospitals combined to establish the King Edgar Hospitals NHS Trust with the objective of enhancing the services and decreasing duplication. The Trust was under a tremendous pressure to reduce waiting lists and sorting out of other managerial issues such as delays in discharges, inaccurate admissions of patients to wards, poor relationships with social services, high number of patient complaints. In response to this situation, the Executive Director of Nursing, Tracey Burns, was appointed to take the lead .
Burns in concert with three assistant Directors of Nursing formed four groups that targeted a varied aspect of the discharge process. One group suggested a toned down form of the ‘Point Prevalence” method, which involved monthly monitoring of performance and enumerating the appropriate performance indicators. The other groups proposed incorporation of nurses’ roles and responsibilities into the performance assessments, better educational programs to aid nursing staff in understanding and executing effective and timely planning of discharge. Another group emphasized on the role of nurse-led-discharge (NLD) and the need to focus on defined discharge criteria for each ward .
Burns teamed up with the Director of Information Management and Technology to establish necessary information systems. The Assistant director of Practice Development presented the baseline data to them to track the progress in terms of readmission frequencies, length of stay of patients etc.
Sue Green played an important role by engaging and helping the front-line nurses. She ensured efficient tracking of health status of patients, mediated through regular presentations to the nurses’ groups.
Who creates resistance and Why?
The trust was given negative response and media coverage regarding the waiting list issues and suffered a financial penalty of 30 million pounds.
The political pressure within NHS trust to satisfy the waiting list targets generated undesirable impact. For instance, in many circumstances, waiting list numbers were incorrectly reported the hospital management was questionable. Some hospitals were roping in additional staff nurses and physicians in A & E department to increase their ratings .
How is resistance manifested?
Resistance is manifested in the form of reluctance from some physicians and nurses towards cooperation with the changes in discharge planning and NLD .
What types of resistances were faced by the leader?
Burns and her associates had to face many tapes of resistances ranging from opposition from the physicians and nurses to hurdles associated with the lack of communication and efficiency.
What were the reasons and sources for resistance?
Inept and disorganized practices and lack of communication was impeding the release of patients. For instance, certain patients were only waiting for test reports or prescriptions or did not entail a bed in the hospital. Abrupt and random declaration of patients as fit to go home and sudden commencement of discharge procedures, was one of the reasons obstructing the discharge process. Inappropriate communication with Social services and lack of information regarding the updated care schemes further exacerbated the matters .
Despite Green’s initiatives, active involvement from nurses was challenging. Some
nurses were hesitant to spend additional time at workplace since it involved extra training
and decreased the availability of time for other conventional roles and counselling of
Yet another blow to the NLD process was opposition from physicians in participation into this approach. To resolve this matter, matron Nikki Thorton sought help from two physicians who backed up the program by justifying their support towards the workshop. They endorsed that it aided in reducing the work load for junior staff and enhanced patient turnover. One more round of resistance came from nurses towards the practice of nurse led discharge process and showed lack of confidence in the Trust, fearing that may not receive support in case of readmissions. To this, Thorton responded by reassuring them of complete support .
How did the leaders address these issues?
With the support of the higher authorities, Burns developed a workshop on enhancing the discharge procedures. She worked in close association with her colleague, Green and involved her entire group of matrons. With the help of Green, Burns employed the ‘Point Prevalence’ technique that recruited a team of a sister, physical therapist, occupational therapist and a social worker to visit and monitor the stability of patients on every ward. The preliminary results demonstrated that over 17 % of the patients did not require acute care hospital bed and could do with basic care in a different department .
6. Were the techniques successful?
The positive impact of the workshop led by Dr. Burns and the NLD was evident from the observed changes in work attitudes and the consequent energetic and active discharge planning and the nurses are abreast of the status of patients. The planning of their care was monitored on a regular basis .
Impact of Organization Change
Barsoux, Jean-Louis and Gilmartin, M. Leading Organizational Change: Improving Hospital Performance. 2007. 1 February 2016.