INTRODUCTION:

This assignment will be focusing at the leadership and organisational behaviour issues revealed in the case study, “Multi-skilling at Rossett NHS Trust”. The case is about the introduction of multi-skilled, ward-based teams of support workers in Rossett NHS Trust hospital, a medium-sized hospital in the UK. NHS Trust provides a complete range of midwifery and acute services and employs over 2800 staff, of which about 1650 work full-time and almost 80% of its employees are female. The staff turnover rate is quite low and appears to be declining. Absenteeism due to sickness is also low except for ancillary staff for which it appears to be double the hospital average.

The proposed change to introduce multi-skilling within NHS Trust would’ve largely affected about 250 people mostly including ancillary staff. The idea behind the introduction of generic working was to improve efficiency and provide job enrichment for its workers and to combine the roles of porters and domestic staff in order to improve responsiveness and flexibility to patients’ needs. The change mainly represented wide part of strategic transformation in the NHS with main attention on improvement in service quality and value and human resource issues.

Though this organisational change was of a great benefit to the patients, however, it did give rise to certain issues. In this assignment we’ll apply Management and leadership theories such as Blake and Mounton’s Managerial Grid, Transactional/ Transformational leadership and Adair’s Action-Centred Leadership. For motivation, Herzberg’s two-factor theory, Maslow’s Heirarchy of Needs, Equity Theory and for Groups and teams, Mayo’s Human Relation Approach, Tuckman’s Stages of Group Development and Belbin’s nine team roles.

MANAGEMENT AND LEADERSHIP:

Using Blake and Mouton’s Managerial grid (1964), the management of NHS trust can be said to be 9.1 managers, sometimes referred to as “autocratic task managers”. These are only concerned with the task and have little or no concern for people, and have an autocratic style of leadership. The main problem with the generic working concept within the NHS Trust was that it was not based on what was beneficial for the employees but was all about organisation making more money. This is why the managers only stressed on its positive features, as Selwyn Fisher, the finance director, said that its successful implementation will help to provide good value for money and will make cost savings. There was also a focus on achieving competitive advantage with commercial players. Though, this is a positive factor for managers and negative for employees as managers will be using their power and control over them so as to ensure that the implementation is successful. For instance, during the pilot scheme some of the domestic staff was required to change their work patterns and work extra 35,000 hours a year.

Transactional/Transformational Leader:

Where organisational change is required, this calls for a transformational leader. ‘A transformational leader is the one who has a vision to make changes so as to cope with situation and the ability to communicate and inpire followers so that they change their way of doing things (Bass, 1985). In the given scenario, Anita Patel, the director of Hotel Services, actually ‘owned’ the change and could’ve been an effective transformational leader as she proposed to introduce generic-working concept so as to improve flexibility and responsiveness to patient needs, however, she didn’t have the charisma to inspire people.

In transactional leadership the exchange between leader and subordinate depends highly on a stable situation and leader identifies the needs and expectations of subordinates and structures the context accordingly (Bass, 1985). Denis Lipton, junior manager and head of domestic staff, could’ve been a transactional leader as she was responsible for day-to-day implementation of generic-working concept and would’ve altered the concept a bit according to the needs of staff so as to make it work but the only problem was the lack of authority.

Adair’s Action-Centred Leadership:

Recognising the importance of the team, individual and task needs, John Adair’s Action Centred Leadership Theory can be applied to NHS. Adair suggested that it is important for a good manager and leader to have a complete command over the three main interconnected areas of this model:

- achieving the task needs

- managing the team or group needs

- managing individuals needs.

Adair also recognised that too much attention paid by the leader to any one specific area can lead to ineffectiveness in the group. The emphasis in the case study is clearly on the task need: operational benefits and improved patients needs, with the staff outcomes are only assumed by the management instead of effectively meeting the individual and team maintenance needs. Managers should’ve maintained a balance between the three elements, by doing so it would have helped them in achieving results, building morale, improving quality and developing teams and productivity.

MOTIVATION:

Motivation is another aspect of this case study. It is defined as ‘degree to which an individual wants and chooses to engage in certain specified behaviour” (Mullins, 2005). The behaviour of employees at NHS can be determined by what motivates them and the rewards and fulfilment they derive from it.

- Maslow’s Hierarchy of Needs:

Applying Maslow’s Hierarchy of Needs (1943) at NHS, there appears to be a clear evidence of ‘lack of need satisfaction’. Maslow suggested that human needs are arranged in a series of levels. The basic idea was that people are always wanting for more and that depends upon what they already have. Maslow’s theory is best demonstrated as a pyramid. On the first level are the basic psychological needs, and then come safety needs, social needs, esteem needs and finally self-actualisation needs. According to Maslow all these needs are particularly important and each one must be satisfied before moving on to the next level, only then a person can move to the top level of the pyramid i.e. self-actualisation.

Looking at the NHS trust, managers didn’t considered what gender issue porters had regarding undertaking cleaning duties and what would make them comfortable at job, but instead they focused on the implementing generic-working successfully. This causes de-motivation amongst porters who openly expressed their unwillingness to undertake cleaning duties and thought that to be women’s work.

- Herzberg’s Two-Factor Theory:

One of the assumptions underlying the generic working concept was that staff will benefit from job enrichment. Job enrichment concept was firstly brought forward by Frederick Herzberg, who proposed that factors which lead to job satisfaction are different from factors leading to job dissatisfaction and named this “Two-Factor theory of motivation”. Two factors are:

1) Hygiene factors: features of the work environment rather than the work itself, for example, pay, status, security, working conditions, etc.

2) Motivator factors such as growth, recognition, responsibility, etc are also important

Although managers tried to adopt Hertzberg’s motivation and hygiene factors through the use of performance related pay (PRP) so as to link pay with achievement, it didn’t actually satisfy any further factors.

- Equity Theory:

The equity theory of motivation (Adams, 1963) applies the same principle. This is a process theory which is based on our perceptions of fair treatment, where one part states that ‘unfairness’ may lead to tension within an organisation (Buchanan & Huczynski, 2004a). This is evident at NHS by the group of ward hostesses who enjoyed privileged position among their colleagues whose work focused mostly on cleaning and hardly had contact with patients or clinical personnel. Also with regards to porters, it can be related to salary issues as they were only given a pay rise of 2% as compared to domestic staff who were given a pay rise of 8%.

The other part of equity theory i.e. ‘tension’ helps to motivate the individual to eliminate the unfairness and this appears to be case at NHS. Staffs do have support of the union who were able to influence management’s decision to implement generic-working within NHS and managed to bring it to an end.

GROUPS AND TEAMS:

Group and team-working has been an aspect of organizational life for a long time. Management promotes the benefits of group working and stresses on the common interests of individual workers, organized by management into teams, and the goals of the organization as a whole, that is, of senior management (Buchanan & Huczynski, 2004b). The same philosophy was the basis for management’s decision of generic working at NHS.

- Mayo’s Human Relations Approach:

For generic working concept to take place, entire domestic and portering staff was required to be based at ward level instead of in a central pool. This according to Patrick Davenport, HRM director, would improve motivation as porters will feel part of the team and will be recognised at ward level which appears to be in line with Mayo’s human relations approach (1945), who believed that by being part of a team work satisfaction can be achieved.

- Stages of Group Development:

The task of management at NHS was to create effective work group by developing supportive relationships (Likert, 1961). Bruce Tuckman (1977) suggested that generally groups pass through five clearly defined stages of development. Applying this to Rossett NHS Trust, we have:

Forming is the initial formation of the group and bringing together a number of individuals. At NHS Trust this will be the formation of 12 domestic and portering staff in a group for the pilot scheme which ran for a year.

Storming: Members of the group get to know each other better and put forward their views more openly and forcefully (Mullins & Christy, 2010a). Conflicts arise within the group. One major issue raised during the pilot scheme was the gender issue. Many porters openly expressed their unwillingness to undertake cleaning duties. Another issue was of ‘ownership’ of tasks, which gave rise to tension between Hotel Services and nursing as some of the duties from nursing staff was reallocated to domestic staff.

Norming is the one in which close relationships are developed and group demonstrates cohesiveness, which lacks at NHS. One of the problems with team-working concept was informal groups, as one manager said ‘it is about boundaries between groups’. Informal group exist because of unavoidable interactions of individuals in the group as they associate with one another (Ackroyd and Thompson, 1999). Within NHS Trust, there are nurses, physiotherapists, doctors, all these different groups and it was almost impossible to make them all work in teams.

Perfoming: At this stage the group starts concentrating on the achievement of its purpose. At NHS, the lack of a team leader caused a lot of problem with performing the tasks. A system of management allocating the tasks was adopted. This gave rise to communication problem since those responsible for managing the change didn’t gather all the staff to discuss the changes and relied too much on informal communication. Staff notice board were use to display work rotas which caused a lot of disturbance, as one manager said that staff believe ‘the rotas are so difficult to follow that went up on the board it was “where’s my job? I haven’t got a job”...’

Adjourning: Group disperse in this final stage, either cause of the achievement of task or due to members leaving the group (Buchanan & Huczynski, 2004c). Apart from the problems mentioned above the generic working concept also failed because staffs were greatly influenced by The Trade Union (UNISON). UNISON strongly opposed generic working and advised its members not to facilitate its implementation.

- Belbin’s Nine Team Roles:

Another very popular framework which is widely used to understand the roles within a group or team is Belbin’s Team Role Theory. A team role is described as characteristic of the way in which one team member interacts with another whose performance serves to facilitate the progress of the team as a whole (Mullins & Christy, 2010b). Belbin (1993) identified nine key roles that are present in an effective group. These are plant, co-ordinator, monitor-evaluator, resource investigator, shaper, team-worker, completer, specialist and implementer. All of these roles have different characteristics. He argued that an effective team often consists of people who are although of the same type, but need a balanced mix of individual characteristics, so that their positive attributes complement each other.

For the team, which was formed within NHS Trust for the pilot scheme, it was important to have a balance of each of Belbin’s nine team role to be an effective team. In order to provide a balance of roles within a team, members can double up and play several roles. However, this theory might not be as effective in this scenario as managers didn’t pay much attention to these roles when forming the team. All the members are doing the same job. For example, there is no member from administrator so as to play a role of monitor-evaluator for instance.

CONCLUSION:

The above assignment analysed the implementation of generic-working concept within NHS trust from three major aspects: management and leadership, motivation and team-work. Though this strategy transformation at NHS was to incorporate continuous improvement in service-quality, it did give rise to issues like control, power, gender, communication, etc. Currently, management are classified as autocratic task managers since they only focus on the implementing generic-working concept successfully because of financial benefits. Management need to change the way they interact with the employees. At NHS, participative management would’ve been effective, which has also been encouraged by research. By involving the people with knowledge and experience in the decision-making process, the overall organisational effectiveness can be improved (Buchanan & Huczynski, 2004d). Keeping this in mind, management should’ve involved UNISON especially in the small domestic team which was step-up to implement generic-working concept. UNISON speaks for the staff and this would’ve helped the management to understand employees’ point-of-view and make amendments accordingly.

The idea of multi-skilling appears to be beneficial for employees both in short and long term, however, it’s introduced within NHS made staff feel that it is only a cost improvement exercise. NHS being a highly centralised structure with little delegation causes de-motivation amongst junior staff. However, if Mayo’s human relations approach along with contingency theories was adopted, where management considers employee’s opinions and alters its approach according, and had given the power to ward managers so as to make their own guidelines based upon what satisfies the employees, it would’ve increased their motivation and consequently service level efficiency and resultant employee’s satisfaction.

When it comes to team-work, management believed that generic-working will even-out the workload for porters and will improve efficiency by avoiding wasted journeys, waiting for action time and duplication of effort as Rensis Likert (1961) said that group forces are important to influence the behaviour of individual work groups with regard to productivity and waste, plus also to affect the performance of the entire organisation. Using Tuckman’s stage development theory, the team went through different stages and problems like porters’ gender issue, delegation of tasks and job-security for nurses were identified. Another drawback of the team was the lack of Belbin’s team roles. If only management would’ve identified all these issues at the beginning it might have resulted in a successful implementation of generic-working, which was beneficial for both management and the employees.

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