J udge Business SchoolJ udge Business School

Frameworks for change in health & sickness organisations

Sandra DawsonCambridge International Health Leaders

Programme2006

Context is always important!

And health systems are some of the most complex at every level

-policy

-managerial

-professional

-individual

Cost, complexity

and the need for effective change

management

infinite supply

infinite demand political involvement

political sphere

state funding, regulation, party

politics

scientific sphere

knowledge & applications

professional sphere

diversity & dominance

industrial sphere

global investment

public sphere

public expectations of life

and death

Increasing therapeutic potential

Informed and assertive patients

Drive for public and preventive health measures across the population

Universal coverage

Health workforce under pressure

Increasing co modification and individualisation of health issues, and targeting of policy

Consumer choice

Tensions in Health Policy

Complex scientific and technological processes

concentration of specialists

Societal factors affecting health

Demand for assurances on public safety issues, and for more provision

accessible diagnosis & treatment inter-sectoral approaches in health

Behavioural factors affecting health

Tensions in Health Policy

Managerial context

What are the managerial imperatives (core purposes)?– Cost, value for money, quality of public health, quality

of sickness service (clinical and non-clinical) political support, achieving targets, keeping the organisation going and the people employed…

How do you secure your resources?

What specialist skills do you have?

How is the shape of your organisation created?

Administration, management, leadership

A Implementing policies and decisions,following rules

M Securing, committing, controlling resources (financial and human),

solving problems, making rules

L Encouraging, motivating, inspiring

Conditions for Behaviour ChangeKnowledgeKnowledge

CapacityCapacity MotivationMotivation

dawson1992

Change Processes in Organisations

Precipitating factors

Members’ felt need for change

Decisions/plans for instituting change

Implementation

Outcomes

Feedback (including evaluation)

Chance

Serendipity

Creativity

Learning

Intuition

Creating a realistic sense of what may be possible, why it is important

and how it may be achieved

Iteration between policy and practices

FinancialPressures

CutStaff

Staffingcosts

LOSCosts

Earlier releaseof patients

Patients movemore slowly

Re-admitsincrease

unintendedconsequences

Systems Thinking

Innovation associates (1996)

Why change?What are the imperatives?Threats and opportunities?

Appraise and evaluateWhat are the alternatives?And the consequences?

Always communicate!!