This report explains how you would lead the

Leadership and Change in Healthcare Management – Management Proposal for a Change in Practice

Executive Summary

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This study explains the fashioning, and execution, of the alteration to a new electronic booking/appointment system for the General Practice in Muddleton. The figure of patients that are seen in general pattern each hebdomad is a consequence of a complex interaction between the demand for assignments from patients and the figure and type of assignments that are offered by the pattern ( Walleret al. ,2001 ) . There is no research that can foretell how many assignments, of what type, a pattern demands, harmonizing to their figure of patients, and so each pattern needs to find this themselves ( Kendrick and Kerry, 1999 ) : as will be shown for the instance of Muddleton, this can be a hard undertaking, particularly when the demographics of the country alterations quickly, as in this instance.

As Walleret Al.( 2001 ) identify, there are many sorts of assignment system ( Warren and Evans, 2008 ) , from ‘drop-in’ as is presently used in Muddleton, to computerized systems running on an ‘embargo’ rule, leting for same-day exigency assignments to be fitted in ( Pascoeet al. ,2004 ) , to full telephone triage offered by GP’s ( Jiwa, 2002 ) or nurses ( Richards, 2002 ) . Richards ( 2004 ) calls in to oppugn the effectivity of telephone triage and so it is decided, for Muddleton, that an electronic booking/appointment system will be implemented to replace the old ‘drop-in’ system of assignments.

The study discusses, in item, the planning for this alteration, in footings of how the alteration will be implemented, and managed, and the timeframe for the execution of the alteration. The study discusses the most appropriate leading and team-working theoretical accounts for the most efficient direction of this alteration, given the current construction, and future way, of general patterns, discoursing several theoretical accounts that would be most appropriate given the state of affairs in Muddleton. A democratic leading manner is deemed most appropriate, following Lewin’s ( 1951 ) theoretical account for alteration direction. The study concludes with a timetabled lineation of how the alteration would be implemented, demoing a clear passage from the planning to the execution phases, and leting adequate clip for all necessary safeguards to be put in topographic point, and preparation to be conducted, to let a smooth passage from the current system to the electronic engagement of assignments.


This subdivision will present the current state of affairs in Muddleton, in footings of what the demands are and what alterations are necessary. The relevant authorities directives associated with general pattern and service demands will besides be discussed. This subdivision besides introduces the theoretical account of alteration that will be used and will warrant the logical thinking behind the demand for doing the suggested alterations.

Muddleton is presently served by one wellness Centre, based on a five spouse pattern, two of whom are parttime. The wellness Centre presently offers assignments on a ‘drop-in and wait’ footing, offering surgeries from 9.00am to 11.00am and from 3.30pm to 5.30pm, Monday to Friday and from 9.00am to 11.00 am on Saturdays. From Monday to Friday, two GP’s work in the forenoon surgery, whilst two other GP’s attend to place visits and one GP covers the eventide surgery ; on Saturdays, one GP is responsible for the exigency surgery. This system worked good for Muddleton for many old ages, but the altering demographics of the country have meant that the assignment system is under terrible strain, with many patients – particularly commuters and parents with ill kids – kicking about the assignment system and their inability to see a GP within an acceptable timeframe ( see Campbell, 1994 ) .

It is clear, based on the ailments from the patients, and the strain being put on the five GP’s and their associated squad, that the assignment system needs passing. The demands are therefore clear: to supply a revised engagement system in order to better the bringing, and quality, of patient attention. There are many necessary alterations that will necessitate to be made, including a alteration of the existent engagement system used and a alteration of the surgery hours and the on the job hours of the five GP’s and their associated squad. There are many alternate systems that could be considered, although for assorted grounds, as will be explained in subsequent subdivisions, it has been decided that an electronic booking/appointment system will be utilized.

In footings of the justification for the demand to do the suggested alterations, the current assignment system in topographic point in Muddleton is non working, in that it is non able to supply the degree of service required for its users. Many patients have been kicking about the waiting times and the GP’s, and associated staff, at the wellness Centre have besides been coming under force per unit area to go to patients in inauspicious conditions. The purposes of the alteration to a different assignment system are to cut down the length of clip patients would wait to see their preferable GP and to better, overall, the service provided to the patients, through alleviating the force per unit area on GP’s, and their associated staff, by supplying a more organized system for seeing patients. In the yesteryear, under the old system, for illustration, assignments could over-run, as they were non allotted a set continuance, intending that fewer patients were seen, per surgery, than really possible ; it is hoped that, aside from supplying better patient entree, patient assignment times would besides be better controlled under the new system.

It is of import to observe here that non merely does the assignment system need to be revised for the interest of the patientsper Sebut that NHS reforms, guided by policies such as Practice-Based Commissioning and Payment by Results, mean that general patterns need to be more efficient and to present higher criterions of attention to patients, under the new GP contract and the Quality and Outcomes Framework ( RCGP,2007 ) . The new federated theoretical account of general pattern foresees cardinal and wide-ranging alterations to the ways in which general patterns will work ( Checkland, 2004 ; Checkland, 2007 ) and Muddleton wellness Centre needs to center itself to suit these alterations.

Analysis for alteration

This subdivision will supply an analysis of the job in order to place the method of alteration that will be most appropriate in this state of affairs. Theories of leading, alteration, communicating, squad working and organizational behavior, along with direction and organisational research, will be utilized in order to supply a thorough analysis of the state of affairs and to place the most appropriate theoretical account of alteration for this state of affairs.

In footings of the existent alteration to the ‘drop in’ system presently in topographic point, the leaders of the alteration would research possible options and so make up one’s mind on a most ‘workable’ solution for them ( Elwynet al. ,2002 ) . It is suggested that it would be best for the electronic system will work on the footing of apportioning several types of assignment ( McKistryet al. ,2002 ) : clean slots, that can be used for any patient ; named physician assignments, that can merely be used for the usual patients of that Doctor ; same-day assignments, that can merely be allocated on that twenty-four hours ; responsibility physician assignments, covering assignments for exigencies that will be covered by the physician on responsibility that twenty-four hours ; and exigency surgery assignments, that are intended to be booked by the responsibility physician for jobs presented at the responsibility physician assignments, that need to be dealt with the same twenty-four hours. This system will let for patients to be allocated to assignments in the appropriate mode by the receptionists and will let for all patients, showing with any type of demand, to be seen in a timely mode ( Meade and Brown, 2006 ) .

The new system will let a greater efficiency in covering with patients, intending that, overall, merely minor alterations will necessitate to be made to the working hours, and format, of the wellness Centre staff, in footings of the surgery hours. Patients have few ailments about the wellness Centre, other than the trouble in obtaining an assignment, and so it is non viewed as necessary to greatly change other constructions already in topographic point. It is suggested that the entire figure of surgery hours remain about the same, but that the surgery be offered from 8.00am to 10.00am and from 4.00pm until 6.00pm, Monday to Friday, and from 9.00am until 12.00pm on Sabbatums. Appointments would be set at 10 proceedingss. This alteration in the surgery times would add one excess hr each hebdomad to the surgeries, but the displacement in surgery gap hours would let for the high figure of commuters, and households with immature kids, to obtain an assignment at a clip more convenient for them, without holding to upset their on the job twenty-four hours, or their school twenty-four hours, for illustration. Under this new system, patients would cognize when their assignment with their GP is, and would besides cognize that they are non traveling to be kept waiting to see the GP, as they would hold an allocated assignment clip.

In footings of how to implement this alteration, a figure of factors need to be considered ( Lukaset al. ,2007 ; Weber and Joshi, 2000 ) . Due to the many force per unit areas on GP’s, it is going progressively common for GP’s to depute work and duties to other members of an spread outing primary attention squad ( Lakhaniet Al., 2007 ) , with a move off from personalized attention towards a squad attack ( Walleret Al., 2001 ) . The acceptance of the electronic booking/appointment system therefore needs to be undertaken from the position of a multiple-professional attack to team-working ; there are, after all, a scope of professionals, with a battalion of accomplishments, supplying attention as a squad, within Muddleton wellness Centre ( for illustration, the GP’s, the pattern nurse, the territory nurse etc. ) ( Walleret al. ,2001 ; Forthmanet al. ,2003 ) . It is besides of import to acknowledge that the receptionists act as a point of contact for the whole squad and with the patients, as the receptionists are the people who will book the assignments and who will give patients information about accessing the services on offer ( Walleret al. ,2001 ) .

It is non the instance, hence, that the Muddleton GP’s can move in isolation, with respects to the execution of this alteration, as they are dependent on members of their squad for this alteration to work. In add-on to this mutuality of the members of the wellness Centre, it is of import to acknowledge that many members of the squad may be wary of the alteration. Given this, Lewin’s ( 1951 ) theoretical account of alteration is most appropriate, which suggests that alteration is most successful if it occurs in three phases: foremost, to dissolve the position quo, secondly to make motion in order to switch the mark to a new equilibrium degree, and in conclusion, to refreeze the equilibrium, in order that the alteration be sustained over clip. All three stairss are cardinal in footings of guaranting the long-run success of the alteration. Expanding on Lewin ( 1951 ) , Lippittet Al.( 1958 ) suggested that the functions and duties of the alteration agent are as of import, if non more of import, than the alteration itself. Lippittet Al.( 1958 ) showed that how the alteration is diagnosed and assessed, and the progressive stairss taken to obtain and to keep the alteration, along with the necessity for clear functions for each alteration agent are all cardinal in guaranting the long-run success of the alteration ( Hayes, 2006 ; Grol and Grimshaw, 2003 ) .

Given these theoretical accounts of alteration, it is suggested that the alteration needs to be implemented in gradual phases, from clearly defined aims and in clearly defined phases, supported at all phases by clear support from the alteration agents ( i.e. , the leaders of the alteration ) ( McPhee, 2007 ) . The alteration will therefore come from suggestions made by the GP’s and the pattern director, as these are the ‘heads’ of the multi-disciplinary squad, but all members of the squad will be involved in guaranting the success of the alteration, through the execution of Lewin’s ( 1951 ) and Lippittet Al.’s ( 1958 ) theoretical account. The fact that the wellness Centre is run as a squad besides means that squad working theoretical accounts and communicating will besides necessitate to be considered as portion of the successful execution of the alteration. It is hence suggested that Tuckman’s ( 1965 ) four-stage theoretical account of squad development be utilized at Muddleton, in order to beef up the squad at the vulnerable clip from when the alteration will be suggested through to its execution, and beyond, in order to guarantee its continued success. The four phases of Tuckman’s ( 1965 ) theoretical account, i.e. , organizing, ramping, norming and acting, would let the squad to face the alteration and to cover with it, as a squad, guaranting its long-run success.

In order for this to work, nevertheless, and even though the modern general patterns should be based on teamwork ( Lakhaniet al. ,2007 ) , there needs to be leading from above, in order for the squad to be directed from the early, immature, phases, to the ulterior, self-managing phases, i.e. , to direct the squad through Tuckman’s ( 1965 ) four phases, and, through Lewin’s ( 1951 ) forcefield analysis, to battle any restraining forces that might deter the successful acceptance of the alteration, leting end congruity to be achieved. The duty of the leader ( director ) would be to fix for the alteration, through a general ( SWOT ) analysis of the necessary alterations, and to pull off the alteration through pull offing the critical elements of the alteration ( i.e. , those identified by Lewin, 1951 ) . In this instance, the ‘leader’ would be the five GP’s, in concurrence with the pattern director. The other people ( stakeholders ) involved in the alteration would be the other staff in the pattern ( i.e. , the receptionists, the pattern nurse, the territory nurses etc. ) and the patients. As the whole pattern demands to work as a squad to guarantee the success of this alteration, and as the pattern is presently run as a squad, the leading manner can non be autocratic ; nor can it be delegative or free reign. The leading manner for the alteration direction will hence be participative ( i.e. , democratic ) , which will let for each squad member to take part in the procedure of implementing the alteration, through leting each squad member to input their feelings about, and suggestions for betterments in, the alteration, in the format of regular audiences with the leaders of the alteration.

In drumhead, hence, the most appropriate theoretical account of alteration in this state of affairs is for Muddleton’s five GP’s and pattern director to work in coaction, as leaders of the alteration procedure, in order to implement the necessary alterations to the booking/appointment system, under a democratic leading manner, through a gradual procedure of execution, leting for Lewin’s ( 1951 ) suggested theoretical account for alteration direction. Whilst merely the leaders would be responsible for inventing the program for alteration, and the existent alterations to be implemented, all members of the general practice’s squad would be involved in implementing the alteration, in a audience format which would let suggestions from all squad members, leting for the potency for betterments to the suggested alteration ( Callaly and Arya, 2005 ) . In add-on, all stakeholders ( i.e. , patients and other professionals connected with the pattern ) would be involved in the procedure from the beginning, in footings of being informed of the alterations, from their origin, therefore increasing the opportunities of a successful passage period for the new system.

Plan of action

This subdivision will utilize the analysis presented in the old subdivision to place how the proposed alteration will be implemented. A specific and timetabled action program will be presented, including how patients and staff of the alteration would be informed of the alteration, how the staff would be trained and how the system would be implemented, amongst other factors. The preparation of the program of action, what the program of action is and how it will be implemented will all be discussed.

It is suggested that, although all members of the squad are cognizant of their functions and duties, a procedure map would be a utile tool in footings of guaranting that all members of the squad understand their new functions and duties ; this would non merely assist in reenforcing the new equilibrium ( Lewin, 1951 ) but in footings of guaranting the initial success of the launch of the new booking/appointment system. It is suggested that duty charting would be utile in footings of identifying, and deciding, ambiguities in the apprehension of the execution of the new system. The following lineations how the execution of the alteration is envisioned.

It is expected that the leaders of the alteration would run into at foremost, to discourse the possible options for different electronic booking/appointment systems. Once one system has been decided upon, farther meetings would be planned to invent a program for the execution of the alteration. In footings of guaranting the success of the alteration, good communicating is critical between all squad members. For this ground, at the appropriate phase, when the program for implementing the alteration has been finalised, the leaders would run into with the other members of the squad, in order to explicate the alteration, to sketch the timeline for the execution of the alteration and to sketch everyone’s functions and duties under the new system, through duty charting. Further meetings would happen, as necessary, between the pattern director, the other staff ( i.e. , receptionists ) and other professionals, in order ‘iron out’ any confusion or jobs that might hold arisen.

When all members of the squad feel comfy that the alteration can be managed, the preparation should get down: most significantly, the preparation of the receptionists, in the running of the system, as they will be responsible for pull offing the efficient cross-over to this new system. At this point, besides, the patients should be notified of the alteration, through postings in the wellness Centre, for illustration, with the purpose of increasing consciousness of the alteration, and by receptionists reding people of the alterations when they attend for assignments. It is anticipated that the latter phases of the execution of the alteration, from developing until it’s execution, would necessitate two months. Two months is more than long adequate for patients to be informed of, and to go accustomed to the thought of, the alteration.


This study has outlined how the execution of a new electronic system for pull offing bookings/appointments could be managed. The study has suggested a best manner frontward, in footings of taking the alteration ( based on current, and hereafter, waies of general pattern ) , working in a squad to guarantee the successful execution of the alteration and in footings of the existent planning of the timing of the execution of the alteration ( Scott, 2003 ; Silversin, 2003 ) . It is to be hoped that the suggested alteration would increase efficiency at Muddleton and, through this, lead to an addition patient satisfaction ( Hubyet al. ,2008 ; Salisbury, 2007 ) . It is expected, nevertheless, that the increased efficiency in seeing patients would take to increased workplace efficiency for all members of the squad and to less stress being placed on all the members of the squad ( Ahluwalia and Offredy, 2005 ) .

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By whom

Resource required


Research on possible new systems

Practice director

Time to carry on research and discuss findings


Meet to see, and discuss, possible new system

Leaderships ( GP’s and pattern director )

Meeting room


Meet to hold on new system

Leaderships ( GP’s and pattern director )

Meeting room


Meet to hold how the alteration will be implemented

Leaderships ( GP’s and pattern director )

Meeting room


Meet with all members of the squad to discourse the alteration

All members of the squad

Meeting room


Consultation to discourse the alteration

Practice director and all members of the squad

Meeting room


Consultation to discourse concerns of squad members

Practice director and GP’s

Meeting room


Meeting to sketch timetable for the execution of the alteration

All members of the squad

Meeting room


Execution begins – professionals in to put in package. Meetings to discourse concerns.

Practice director and members of the squad straight involved ( i.e. , receptionists )

Fundss for execution


Meeting to discourse the timetable for traveling forwards

All members of the squad

Meeting room


Training Begins

All members of the squad

Time for preparation


Ad of the new system to patients –via postings in the wellness centre/personal presentments by receptionists

All stakeholders

Cost of postings. Time to explicate the new system when patients ask.



Suggestions box available in the response for patients to voice their concerns about the new system/any other suggestions they have about the wellness Centre

Patients – so affecting all stakeholders

Cost of suggestion box. Time to reexamine, discuss and perchance implement, the suggestions received.


Roll-out of the new system

All stakeholders

Time to set to the new system

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