NHS Trust hospital case Aya, Aleksandra, Sandip

Profile NHS Trust provides a full range of acute and midwifery service to a population of about a quarter of a million people. NHS Trust provides a full range of acute and midwifery service to a population of about a quarter of a million people. Organization employs 2800 staff; change involves only 250 people. Organization employs 2800 staff; change involves only 250 people. Organisational change: an attempt to introduce multiskilled, ward-based teams of support workers in a medium-sized NHS Trust hospital in the UK. Organisational change: an attempt to introduce multiskilled, ward-based teams of support workers in a medium-sized NHS Trust hospital in the UK. All staff would be multiskilled and able to do a full range of roles: cleaning, transporting patients, serving food, etc. All staff would be multiskilled and able to do a full range of roles: cleaning, transporting patients, serving food, etc.

Motivation Herzberg’s two-factor theory helps to reorganize and improve the design of jobs Herzberg’s two-factor theory helps to reorganize and improve the design of jobs Extrinsic factors: Extrinsic factors: Working conditions would improve as workload would be distributed equally, there would be no ‘waiting for action time’, ‘wasted journeys’... Working conditions would improve as workload would be distributed equally, there would be no ‘waiting for action time’, ‘wasted journeys’... Salary/status: All existing formal status and pay differences (except management) would be removed. However, as a result of generic working, all staff would be upgraded and receive a pay rise. Performance pay would be based upon attendance. Salary/status: All existing formal status and pay differences (except management) would be removed. However, as a result of generic working, all staff would be upgraded and receive a pay rise. Performance pay would be based upon attendance. Relationship with peers: it would be a team work, would feel like part of the process Relationship with peers: it would be a team work, would feel like part of the process Intrinsic factors: Intrinsic factors: Advancement: Additional training (food serving, cleaning, portering) Advancement: Additional training (food serving, cleaning, portering) Responsibility, sense of achievement, recognition: Undertake a wider range of tasks, work in team, see the result of work, closer relations with patients. Responsibility, sense of achievement, recognition: Undertake a wider range of tasks, work in team, see the result of work, closer relations with patients.

Motivation Motivation is improved by job rotation, job enlargement and job enrichment Motivation is improved by job rotation, job enlargement and job enrichment Give employees opportunity to increase their responsibility and involvement, therefore, opportunity for advancement, achievement and recognition. Give employees opportunity to increase their responsibility and involvement, therefore, opportunity for advancement, achievement and recognition. Employees benefit from the resultant job enrichment and cooperative teamwork Employees benefit from the resultant job enrichment and cooperative teamwork However, not everyone was satisfied: However, not everyone was satisfied: Porters thought of a cleaning as a women’s job and didn’t want to do it. Porters thought of a cleaning as a women’s job and didn’t want to do it. Porters are undestaffed and suffering from a low morale with a poor sickness record Porters are undestaffed and suffering from a low morale with a poor sickness record ”fire-fighting” ”fire-fighting” Only 12 people votes in favour, against, the rest declined to vote. Only 12 people votes in favour, against, the rest declined to vote.

Team work Advantages (in theory): Advantages (in theory): people perform a range of tasks and don’t get bored with the routine work; people perform a range of tasks and don’t get bored with the routine work; No status and payment difference No status and payment difference the patient cares would improve; the patient cares would improve; everyone would be included in the social life of the hospital, everyone would feel more responsibility. everyone would be included in the social life of the hospital, everyone would feel more responsibility. Drawbacks (in reality): Drawbacks (in reality): one manager: ”It’s about boundaries between groups. […] … and making them work in teams is impossible”. one manager: ”It’s about boundaries between groups. […] … and making them work in teams is impossible”. Not satisfied with work rotation Not satisfied with work rotation Was not team work in many cases, some people refused to perform particular tasks Was not team work in many cases, some people refused to perform particular tasks

Structure The structure would The structure would be team-based consist of employees consist of employees from various functional departments. Interdisciplinary approach Interdisciplinary approach to management. Permanent team solve ongoing Permanent team solve ongoingproblems. They tried to radically reengineer job design They tried to radically reengineer job design to improve quality, service, speed and cut costs. According to modern thinking such approach should have worked. However, in reality it failed to motivate a majority of workers, brought more uncertainty and decreased efficiency. According to modern thinking such approach should have worked. However, in reality it failed to motivate a majority of workers, brought more uncertainty and decreased efficiency.