Aim:Study of a completed project. Learning StylesExperimental Conceptual Modeller(Trial and Error) (Theory) (Copy)High Risk Moderate Risk Low RiskPreferred Path: Modeller Conceptual Experimental
National Health Service (NHS) UK. Started in 1948, 60 years old. Covers 60 million people. Treats 1 million patients / 36 hours or 8/second. Employs 1.5 million staff. Budget of £90 billion for 2007/2008 (60% staff pay, 20% for drugs and supplies, 20% building, equipment, training, catering and cleaning). 80% of total budget with local NHS Trusts. Income from Taxation and N.I.(approx £1500/a/person).Source: www.nhs.uk/aboutnhs/pages/about.aspx
NHS RotherhamSir Gerry thinks doctors need closer managingwww.news.bbc.co.uk/1/hi/health/6234919.stm
Author, has observed the programme (Can Gerry Robinson Fix the NHS?)on BBC 2 at 2100GMT on Mon 8, Tue 9 and Wed 10 January, 2007. The chief executive of Rotherham General Hospital, Mr. Brian James admitted: “If 5% of our patients choose to have operations elsewhere, we could be in trouble. It is a question of survival”. “(BBC 2007, OU 2007)”, Sir Gerry is a Management Consultant who consults NHS Rotherham management in diagnosing the problem.
Objectives: Reducing waiting lists of patients. Explore ways to improve efficiency of staff. Improve patient services. Maintain a consistent and upward growth in Trust funding.
Tasks Duration inActivity Description Dependency weeks A Improve communication between the hierarchy. --- 2 B Maximum utilisation of consultant schedule. A 2 C Consultants see more patients. B 1 D Maximum utilisation of Surgeon schedule. C 2 E Surgeons perform more surgeries. D 1 F Replacing general anaesthesia with local anaesthesia. --- 4 G Space allocation for Splitting up O/T into 2 divisions. A 2 H Approval from Ministry of Health. G 2 I Approval from Infection control department. H 2 J Fund allocation from NHS Trust for the division. I 4 K Planning and Execution of Operation theatre division. G 1 L Surgery staff schedule for simultaneous operations. K 1 M Staff feedback system to improve patient services. A 1 Monthly schedule system regarding meetings between management and floor staff to resolve issues and improve N efficiency. A 1
Spare Time ES EF LS LF LS-ES On Critical path A 0 2 0 2 0 Yes B 0 2 3 5 3 No C 2 3 5 6 3 No D 3 5 6 8 3 No E 5 6 8 9 3 No F 6 10 9 13 3 No G 2 4 2 4 0 Yes H 4 6 4 6 0 Yes I 6 8 6 8 0 Yes J 8 12 8 12 0 Yes K 12 13 12 13 0 Yes L 10 11 13 11 0 Yes M 11 12 11 12 0 Yes N 11 12 11 12 0 Yes
Gantt Chart 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15WeekActivity A B C D E F G H I J K L M N
Risk Assessment High Low Risk Managed Reducing High Carefully waiting list HI/LRImportanc e ofproject toorganizati on Reject Routine Low
Cost Benefit Analysis (CBA) Balances between costs involved and benefits offered. Positive if benefits higher than costs and vice versa. Boardman A E (2004) NHS benefits are higher than costs as survival is challenged with no other option remaining rather than invest in efforts towards reducing waiting lists. Beta Probability.(a = 12 weeks/Earliest, b = 15 weeks/Latest, c = 26 weeks/Actual). Expected weeks = 16 weeks.
Group DevelopmentForming: Norming: Uncertainty about group Members Closed relations formed. more assertive. Structure emerges. Output low. Self conscious. Performing:Storming: Fully operational. Solidarity. Members more assertive. Aggressive/personal attack. Adjourning: Leadership change. Membership turnover. Over. Consultant has utilized group development tools to extract work from NHS staff & mgmt.
Group Think Concerns. Diagnosis. • Over confidence in terms of • Calculated risks with pros uncalculated risks. and cons. • Ethics are compromised in • Ethical concerns are decision making. addressed and taken into • Self Censorship or reserve consideration. rights to discuss different • Leader encourages criticism, aspects and directions. 2 groups with optimistic • Majority rules with no space critical analysis. for objections. • Devil’s advocate and • Negative and closed vision adjudicator process. about competitors • Broad minded study about competitors activities, Source: e.g..SWOT analysis.http://www.cedu.niu.edu/~fulmer/groupthink.htm
Individuals at work Time Innovation NHS Chief Executive Patient services NHS floor Admin staff Skills Technical HRD
LeadershipManager is aGood Employee( GE ).Consultant is aGreat SolutionProvider ( GSP ).Leader is a GreatActor ( GA) . Source: www.NHSLeadershipQualities.nhs.uk
CultureRole Culture (NHS Bureaucracy)Senior ManagementPillars (Surgeons & Consultants)Operative (Floor staff)Transformation of NHS Culture from Role to Power.Power Culture (Centralised Power, Rapid decision making) Spider and the Web.
Conclusion:• Study of symptom as well as the core problem.Symptom is high waiting list, problem is ineffective chief executive.• Application of tools like Task building, Spare time and Gantt chart to draw a road map for implementation, execution and control. (26 weeks : 15-12 weeks).• Risk assessment, CBA and Beta probabilities for better financial management (Calculated Risk Management).
•Important Management issues like Groupdevelopment, Group think concerns, Individuals atwork, Leadership and culture change in relativity tothe subject of presentation.•Improving patient services by max.utilization ofoperational time, resources and staff motivation,ensures consistent/upward growth in local NHSTrust funding.