INS317: Organisational Change Management - INSEAD - Nursing Case Study

INTERNAL-CODE: MAS5616

Leading Organisational Change

The Trust board discussed a wide range of problems at its monthly meeting in March 2003, including increased trolley waits for patients in the accident and emergency (A&E) department, bottlenecks in the medical admissions ward, high admission rates, patients placed on the wrong wards, increased lengths of stay, delays in discharges, poor relationships with social services, and increased patient complaints. (For the standard patient flow, see Appendix 2). As the 11-member board debated these topics, it became clear that many issues pertained to the inefficient processing of patients, which inhibited the hospitals’ capability to reduce their waiting lists. Given government scrutiny of long waiting lists—and the resultant autonomy repercussions for the Trust—sorting out these capacity and throughput problems was deemed a priority. As part of the broader turnaround strategy, someone needed to drive and accept accountability to improve the performance of the admission-to-discharge chain. Rodger Andrews, the Chief Executive, asked Tracey Burns, the Executive Director of Nursing, if she Would take the lead. As a former matron, Burns was acutely aware of these problems. Although her responsibilities Were entirely managerial, she was no stranger to hands-on nursing, and she knew that hospital beds were often blocked by patients who were medically stable but had nowhere else to go(e.g., a nursing home). A study conducted in her hospital in March 2000 indicated that as many as 30% of patients were medically fit. She also knew that the necessary changes in systems, performance measures and procedures would amount to something of a culture shock, liable to elicit resistance from both specialist physicians and nurses. However, Burns welcomed the opportunity for two primary reasons. First, there was the professional caregiver’s gut reaction to an unacceptable situation: “I was trying to put myself in the patient’s position, having to spend up to 12 hours on a trolley in an A&E department when you’ve had nothing to eat or drink and you’ve probably got a sore bottom because you're laid on a tiny little thin mattress, with no dignity. For me, it was about saying ‘We can make a change to that now by just moving some of the systems’.”