This essay considers leadership and management in the context of a problematic merger of services from two hospitals onto one site. The essay focuses on the change management process within one department to highlight key leadership, team, and cultural issues that negatively affected the newly merged department. The microcosm of the department mirrors similar occurrences across the two merged hospitals. The essay concludes with a comment on the organisational consequences if a macro intervention is not implemented.Model of Leadership And Leadership Style in Nursing Essay
Confidentiality has been preserved by anonymising the identity of the hospitals and departments concerned.
BACKGROUND
This essay explores a recent change process involving the creation of a psychiatric liaison team based in a NHS hospital Accident and Emergency Department. (A & E) in January 2004.
The change occurred because of the merger of two hospitals that resulted in a number of structural changes, including the amalgamation of a traditionally split emergency service into a one site A & E department. The liaison team replaced the existing deliberate self-harm service which had operated in the one hospital for two decades.Model of Leadership And Leadership Style in Nursing Essay
The new liaison team consisted of eight newly appointed G-grade mental health nurses, a team leader, and a consultant psychiatrist who had both previously worked in the deliberate self-harm service. The hours of operation initially were 08:00 to 22:00 and there were two nurses on duty on early and late shifts.
During a four week induction period, the team participated in team building and training exercises and developed into a cohesive, effective group. The team created clear key performance indicators specific to the psychiatric liaison team, established an action plan to achieve the set objectives, and planned to carry out six-monthly reviews. The team developed a shared vision to provide high quality, person centred care to the A & E department without breaching government’s four hour targets (DOH, 2001). The team leader’s leadership style was democratic, and she fostered collaboration and involvement within the team (Walton, 1999). The team members considered her an expert in the field, and respected her for it.Model of Leadership And Leadership Style in Nursing Essay
In July 2004, the service manager attended a monthly team meeting. At the meeting she was informed that a major change was expected to the hours of operation. The service would be extended to a 24-hour service starting in September 2004. In order for the liaison team to cover a 24-hour roster there was initially be a reduction in the number of nurses on duty, however, more staff would be recruited if necessary after a six month service review. An exact date for the review was not given. The change had not been communicated as part of the strategy for the greater merger.Model of Leadership And Leadership Style in Nursing Essay
The Department of Health (DOH) modernisation agenda for the NHS, (DOH, 2002) sets out to modernise services in the NHS, and introduced a three star rating scale against which each NHS Trust’s performance is compared against benchmark standards. Funding in turn is dependant on the star rating achieved. One such standard relates to delays in A & E departments, and stipulates that mental health patients should have 24 hour access to services, and that patients should be assessed and treated within four hours of arrival. (DOH, 2001) The underlying rationale for the change was therefore that the psychiatric liaison service had to provide a 24-hour service in order for the hospital to comply with the benchmark. Management of the merged hospitals did not consider staff shortages or how the four hour target might affect the quality of service provision, particularly when staff are under constant pressure to discharge patients before they exceed the benchmark standard. (RCP, 2004) In the service described above, reaching the necessary 98 % four hour target proved impossible, because the staff numbers did not match the requirements of the service.Model of Leadership And Leadership Style in Nursing Essay
The service was therefore to be expanded without additional staff, implying not only changes in hours and shifts, but also changes in work patterns. The team members reacted negatively to how the change process was introduced. Concerns were expressed about the reduction in staff numbers and questions were raised as to how the staff would be able to cope. The sense of security and continuity were put at risk. (Walton, 1999) The service manager was not available to address the concerns due to an increased scope of responsibility because of the merger that was beyond her normal remit. Lack of two way communication between the manager and the employees meant tha
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