NHS Trust NHS Trust hospital casehospital case

Aya, Aleksandra, SandipAya, Aleksandra, Sandip

ProfileProfile

NHS Trust provides a full range of acute and NHS Trust provides a full range of acute and midwifery service to a population of about a midwifery service to a population of about a quarter of a million people.quarter of a million people.

Organization employs 2800 staff; change Organization employs 2800 staff; change involves only 250 people.involves only 250 people.

Organisational change: an attempt to introduce Organisational change: an attempt to introduce multiskilled, ward-based teams of support multiskilled, ward-based teams of support workers in a medium-sized NHS Trust hospital workers in a medium-sized NHS Trust hospital in the UK.in the UK. All staff would be multiskilled and able to do a full All staff would be multiskilled and able to do a full

range of roles: cleaning, transporting patients, range of roles: cleaning, transporting patients, serving food, etc.serving food, etc.

MotivationMotivation Herzberg’s two-factor theoryHerzberg’s two-factor theory helps to reorganize helps to reorganize

and improve the design of jobsand improve the design of jobs Extrinsic factors:Extrinsic factors:

Working conditions would improve as workload would be Working conditions would improve as workload would be distributed equally, there would be no ‘waiting for action distributed equally, there would be no ‘waiting for action time’, ‘wasted journeys’...time’, ‘wasted journeys’...

Salary/status: All existing formal status and pay differences Salary/status: All existing formal status and pay differences (except management) would be removed. However, as a (except management) would be removed. However, as a result of generic working, all staff would be upgraded and result of generic working, all staff would be upgraded and receive a pay rise. Performance pay would be based upon receive a pay rise. Performance pay would be based upon attendance.attendance.

Relationship with peers: it would be a team work, would feel Relationship with peers: it would be a team work, would feel like part of the processlike part of the process

Intrinsic factors:Intrinsic factors: Advancement: Additional training (food serving, cleaning, Advancement: Additional training (food serving, cleaning,

portering)portering) Responsibility, sense of achievement, recognition: Responsibility, sense of achievement, recognition:

Undertake a wider range of tasks, work in team, see the Undertake a wider range of tasks, work in team, see the result of work, closer relations with patients.result of work, closer relations with patients.

MotivationMotivation Motivation is improved by job rotation, job Motivation is improved by job rotation, job

enlargement and job enrichmentenlargement and job enrichment Give employees opportunity to increase their Give employees opportunity to increase their

responsibility and involvement, therefore, opportunity responsibility and involvement, therefore, opportunity for advancement, achievement and recognition. for advancement, achievement and recognition.

Employees benefit from the resultant job Employees benefit from the resultant job enrichment and cooperative teamworkenrichment and cooperative teamwork

However, not everyone was satisfied:However, not everyone was satisfied: Porters thought of a cleaning as a women’s job and Porters thought of a cleaning as a women’s job and

didn’t want to do it.didn’t want to do it. Porters are undestaffed and suffering from a low morale Porters are undestaffed and suffering from a low morale

with a poor sickness recordwith a poor sickness record ””fire-fighting”fire-fighting”

Only 12 people votes in favour, 150 - against, the Only 12 people votes in favour, 150 - against, the rest declined to vote.rest declined to vote.

Team workTeam work Advantages (in theory): Advantages (in theory):

people perform a range of tasks and don’t get bored people perform a range of tasks and don’t get bored with the routine work; with the routine work;

No status and payment differenceNo status and payment difference the patient cares would improve; the patient cares would improve; everyone would be included in the social life of the everyone would be included in the social life of the

hospital, everyone would feel more responsibility.hospital, everyone would feel more responsibility. Drawbacks (in reality): Drawbacks (in reality):

one manager: ”It’s about boundaries between groups. one manager: ”It’s about boundaries between groups. […] … and making them work in teams is impossible”.[…] … and making them work in teams is impossible”.

Not satisfied with work rotationNot satisfied with work rotation Was not team work in many cases, some people refused Was not team work in many cases, some people refused

to perform particular tasksto perform particular tasks

StructureStructure The structure would The structure would be team-basedbe team-based

consist of employees consist of employees from various functional from various functional departments.departments. Interdisciplinary Interdisciplinary approach approach to management.to management. Permanent teamPermanent team solve ongoing solve ongoing problems.problems. They tried to radically reengineer job They tried to radically reengineer job design design to improve quality, service, speed and cut costs.to improve quality, service, speed and cut costs.

According to modern thinking such approach According to modern thinking such approach should have worked. However, in reality it failed should have worked. However, in reality it failed to motivate a majority of workers, brought more to motivate a majority of workers, brought more uncertainty and decreased efficiency.uncertainty and decreased efficiency.