Impact of the National Health Services Direc

Impact of the National hygienicness work DirecEvaluate the Impact of the National Health dishs cypher,Its Success Rate and the Changes it hasMade in UK Health C ar Practices and ProceduresAnne CookAbstractNHS ship was set up to as part of the NHS modernization blueprint launched in 1998 the objective of NHS straight was to offer 24-hour medical information to the general public. This was done through the substance abuse of a telephone in value, a meshsite on the Internet, interactive touch screen kiosks and interactive digital television. NHS withdraw operates across the whole of England and its digital television and vanesite are available across a wider area.Growth and diversity run through been ongoing, with the mental home of providing services to other departments within the NHS framework and ongoing expansion. In the main, the general public is satisfied with NHS Direct services. They pee formed partnerships with other NHS departments to reduce the workload i n areas such as Accident and Emergency these initiatives use up had a mixed triumph ratio.The Business Plan for 2006 onwards was focused on further expansion and result of NHS Direct. However, on April 3rd, 2006, the Ministry of Health announced that the NHS overall had a budget deficit of 50 cardinal pounds and made public that NHS Direct would be forced to reduce their workforce by one third. Overall NHS Direct had met their derrieres, all be it at a high cost due to the requirement for advanced technology to entertain and run the systems needed.The focus of NHS Direct Management ordain at one time be on restructuring and downsizing with a reduced workforce. The supply turnover has always been high at 30% and the staff morale in difficult times depart be a problem that needs addressing in order to retain experienced staff.The overall conclusion is that the NHS as a whole will have to reconsider its ability to volunteer free medical to all based on certain funding. The funding to NHS has join ond over the last decade.Regardless of the increase in funding, the system was non monitored in a way that identified an emergence deficit, now resulting in NHS Direct and other departments having to downsize, in this case not due to their own inefficiency but the overall financial crisis in the whole NHS system. By using change agents the process of going from being a growth division to one that is reducing needs to be well managed to focus on the positive contributions they can make to the wellness of the general public and by closing or re directing the services that they are not handling competently and/or cost efficiently.1. Table of ContentAbstract1. Table of Content2. entre3. Literature ReviewBrief Introduction to Change ManagementNHS DIRECT4. Research Objectives5. Research Methodology6. Research FindingsSWOT AnalysisTable 1 SWOT AnalysisForce Field Analysis NHS, Direct, April 2006Table 2 Force Field Analysis2. IntroductionThe National Health S ervice (NHS) is the largest employer in the UK and has a diverse workforce with many different professional groups (Smith, 2000). The researcher believes that t here is accelerating pace of change within the NHS, as they need to keep a step up and embrace further growth in the public sector. In recent journals there are many problems related to the NHS Direct, which the researcher feels an probe should be undertaken to identify the problems. A political editor saidThe subject field doubted whether the target of 90 per cent of callers speaking to a nurse within quintette minutes would be met. It said NHS Direct was changing the target waiting time to 20 minutes (Waugh, 2002).NHS Direct is the National Health Services 24-hour information, advice and guidance service available by telephone, the Internet, interactive touch screen kiosks and interactive digital television. NHS Direct operates across the whole of England and its digital television and website are available across a wid er area.NHS Direct is a Special Health Authority and employs approximately 4000 staff and handles around 600,000 telephone calls and one million visits to the website distributively month.The NHS Direct website gives unhurrieds the alike(p) information as their doctors, in clear and jargon-free language, which patrons them to make informed choices nigh their health wish well.At the time the HNS Direct website was set up the indeed Health Minister, Rose Winterton, stated We are working to provide a modern, flexible NHS that fits around patients needs and meets their expectations. We know that patients would like more information to support them in making decisions almost their healthcare. This is an important step in providing patients with the resources they need to make informed choicesThe NHS is implementing a 10 year modernization program the NHS modernization Board is advising the Secretary of State on implementing the plan.Due to the vast nature of the NHS, this study will specifically look at NHS Direct and analyze the changes that have occurred, and the affect on stakeholders, both within the NHS and their external customers.3. Literature ReviewBrief Introduction to Change ManagementOver the last 20 years the electrical shock of change has been greater than ever before, as the pace of change is now so fast that, for organizations to sustain business growth and operate successfully they must be able to change with the frequent changes in markets and competition. Therefore businesses must respond very quickly if they are to survive. Clarke, (1994) Today, change is not the riddance but a steady ongoing process that organisation strive on to keep a crucial part of competitive edge.1Burns (2000, p148) statesWhat worked in the ultimo will not work in the future, and organizations, like society at large, will have to change in unprecedented ways if they are to survive.Managing change is a broad area to concentrate on, as change affects organizat ions in general and people in many different ways. The NHS has made changes to their provision of health care, which gave rise to the NHS Direct in the first place however, the current financial crisis shows that initiatives in health care to date have not been adequate or appropriate. The one area that has not changed is the demand and scope of the services to be provided they are providing medical for all, regardless of the persons ability to pay. Certain members of the public have opted for buck private health care insurance but this is not the norm. In addition, the population is aging and increasingly more elderberry bushs need long tern, high care that pieces public press on available resources.It is easy to change the things that nobody cares ab reveal. It becomes difficult when you start to change the things that people do care aboutor when they start to care about the things that you are changing. 2(Lorenzi and Riley 1994)The NHS is important to the vast majority of th e population it is considered a right to have medical care available to all, regardless of their financial contributions. closely people do not carry private health care insurance. The Ministry of Health has repeatedly changed the NHS to maintain this service, with differing levels of success in recent years. The current land site shows serious financial deficits, a shortage of qualified staff and dissatisfaction with the service.We live at a time when organizations are continually changing and success is now determined by how well the changes are implemented and whether the desired gains can be achieved. (Collins, 1998)The rate of change is increasing in almost all organizations. The pull is intense as the world focuses the time and attention on understanding the forces driving the changing environment and expands or applies the information systems needed to support the changed environment.The develop change management in reference to the comments of 3Peter Drucker is as to whe ther one can manage change at all or merely lead or facilitate its occurrence within an organisation.Change management is the process by which an organisation gets to its future state, however creating change starts with creating a vision and therefore empowering individuals to act as change agents to attain that vision.In todays rapidly changing, competitive environment, the ability to change efficiently, can distinguish the winners from the losers. Many health-related organizations find themselves unable to adapt due to the independence of technologic change.NHS Direct has been in a period of change due to their growth since inception. In 1998, the change was positive, bringing on and implementing late technology, growing call centres and providing an expanding service to the general public as well as reducing the workload in some other sectors within the NHS. However, this additional service within the NHS has involved high costs for technological infrastructure, software and i mplementation, as well as on going maintenance and extended the service without colossal reductions to the demands on other sectors of health care.NHS DIRECTPurpose of the NHS DirectThe NHS is a 24-hour health help line that handles around 100,000 calls every week across its 22 sites. Since the launch of the first wave of NHS Direct sites in March 1998, the service has expanded to cover the whole of England. In addition, it has developed a range of multi-channel services, including NHS Direct Online, Information Points using touch screen kiosks, NHS Direct in Vision (new digital TV pilot projects) and the Self-Help Guide (formerly the NHS Direct Healthcare Guide).NHS Direct has alike expanded, working with frontline staff and managers to devise new with out-of-hours services to succeed in their aims and objectives providing consistent gravel to high quality, integrated care.Ref 4http//www.nhsdirect.nhs.uk/ a new ingress to healthcareThe NHS Plan A Plan for Investment, a Plan f or Reform, July 20004. Research ObjectivesIntroduction of the NHS direct has made a big departure to the existing practise and presents a major challenge in the management of change in the public sector.The aim of this report is to analyze the role of the NHS Direct through the use of the Internet and the impact on the Medical services. The following areas will be evaluatedInvestigate the purpose of NHS Direct.Research the NHS Direct history and its operations.Identify the NHS Direct objectives and the success to dateInvestigate the Impact on all stakeholders, including Medical Services and the general publicEvaluate the role of NHS Direct Website in helping NHS Direct meet its objectives.The challenges the change has imposed on NHS Managers and the affect on their change management approach5. Research MethodologyA literary review will be undertaken to study the NHS Direct and the elements listed in the research objectives.A range of sources will be utilised including e-journals an d journals, newspapers, books and the Internet.The success of the change management will be measured by the success of NHS Direct and its ability to meet predefined goals and objectives, referred to as Key exertion Indicators. The KPIs include the changes being introduced and new services that have heavy(p) since inception of the service.The NHS Direct website will be evaluated as to how user friendly it is, what content it provides, and its acceptability from the user community.6. Research FindingsInvestigate the purpose of NHS Direct.NHS Direct is a response to the desire for increase patient empowerment. It is alsorecognition that the NHS is a complex, multi-layered system that can be confusing for the non-health professional. NHS Direct enables people to make decisions about their own or their familys health by providing expert advice and up to the minute information. The service can also act as a 24-hour signpost, directing people to the most appropriate level of care.NHS Dir ect was launched in 1998, initially at three pilot sites, to provide easier and faster advice and information for people about health, illness and the NHS so they are better able to care for themselves and their families.The success of NHS Direct in achieving this aim rests largely on the premise that it should be getatable to all sectors of the population regardless of race, age, gender, preferred language choice, income, sensory impairment, disability, social positioning or cultural background/preference. Ref NHS Direct website, a new gateway to healthcare http//www.nhsdirect.nhs.uk/Objectives of NHS Direct Specific objectives set for the service includedTo provide for the public a confidential, reliable and consistent source of professional advice on healthcare 24 hours a day so that they can manage many of their problems at home or know where to turn to for appropriate care.To provide simple and speedy ingress to a comprehensive and up to date range of health and health relat ed information.To make better quality, increase cost-effectiveness and reduce supererogatory demand on other NHS services by providing more appropriate response to the needs of the public.To allow professionals to develop their role in enabling patients to be partners in self-care, and help them focus on those patients for whom their skills are most needed.The Ministry of Healths mission to modernize the NHS is not confined to hospitals. The roll-out of NHS Direct, a nurse-led telephone help line, and the introduction of walk-in primary care centres indicate that the same philosophy is being applied to GP services. The common theme in these initiatives is the desire to improve access and convenience within the NHS, a theme that is emerging as the defining element of New Labours approach to health policy.The modernization of the NHS, which included the introduction of NHS Direct was a major change designed to streamline the interface between the general public and the NHS. As the N HS Direct service grew, it came under criticized for rupture the personal link between patients and their GP. Some patients preferred the face-to-face interaction with their doctor when a health problem arose, even though the situation did not require medical procedure or physical intervention and was competently handled by a call to NHS Direct.Ref Coulson Thomas, C and Coe, T (1991), The Flat organisation. British Institute of Management London. They stated that Change is an ever-present feature of organizational life, though many would argue that the pace and magnitude of change have increased significantly in recent years. The Institute of Management, formerly the British Institute of Management, which regularly carries out surveys of its members, has certainly found this to be true. In 1991, the institute inform that 90 per cent of organizations in its survey were becoming slimmer and flatter.Such change will bring exemption there are 4 bases for resistance to change, identif ied as follows by Leigh, A (1988) Effective Change. IPMCultural When change seems at odds with accepted values and norms the way we do things around here.Social When change threatens to disrupt relationships or break up valued groups.Organizational When change affects formal, hierarchical status and threatens the individuals power and influence. mental When change is seen to be counter to the individuals vested interest, when loss outweighs gain.NHS Direct could have created resistance in all the above areas.Cultural for many senior citizens, for example, prefer to talk face to face with their medical personnel and those less computer literate people would not be inclined to use the web site as a source of information. There is a trust relationship between many doctors and patients who have worked together on the individuals health needs for many years.Social NHS Direct has been criticized for severing the ties between doctor and patient and recommending patient care options t hat differ to those normally followed by the patient under his/her GP.Organizational an article on the BBC, 30 August 2001 ref http//news.bbc.co.uk/1/hi/health/1516701.stm shows a concern regarding the changes to the organizational structure. NHS Direct blame for rise in 999 callsThere has been a 30% rise in 999 calls since last year. The introduction of the NHS Direct help line has been blamed for a start in the number of 999 calls made to an ambulance service.The Isle of Wight Healthcare NHS Trust is failing to meet government-set response targets of answering 75% of life-threatening calls within eightsome minutes.The trust says its efforts are being hampered by a 30% rise in call-outs since NHS Direct was made available to islanders.NHS Direct denies it is advising people to call out ambulances without good reason. The facts are denied by the manager of NHS Direct, he believes the increase in calls were correctly recommended by NHS Direct and that hey are being used as a scap egoat for the inability of the ambulance services to meet their target for responding to calls.The Times on line, quotes the NHS chief, Dec 08, 2005, in the article titled, Turbulence is the Price of a Better Service When you are introducing change you will inevitably have some degree of turbulence,Psychological The Emergency Medical Journal, C J Morrell, et al wrote a report entitled The Impact of NHS Direct on Other Services The Characteristics and Origins of Its Nurses. It states the introduction of any new health service can clearly have an impact on other services in two distinct ways firstly, by altering the pattern of patient demand for existing services and secondly, if it competes for the same resources, by affecting the ability of existing services to supply care.This was commissioned in response to increasing criticism that the service was fetching qualified nurses away(p) from the profession. The article went on to point out that a number of the nursing staff working for NHS Direct actually have disabilities or personal reasons for not being able or willing to do active nursing duties and have been encouraged back into the work force by NHS Direct they would differently have remained outside of their profession al together.Research the NHS Direct history and its operations.NHS Direct was one of the new services that were introduced in 1999/2000 to improve and reform the NHS healthcare making it a modern, efficient and patient led health service giving patients more choice and better access to their own healthcare.The service provides access to confidential health advice and information, 24 hours a day, in a range of easy and convenient ways the NHS Direct telephone service, NHS Direct Online website and the NHS Direct synergetic service on digital satellite TV service. As well as helping patients improve their health and looking after themselves, NHS Direct helps patients access the right health care service for their needs.The value of the use of technology was reported by 5Carr (1996) who agrees that, when properly used, information technology is a powerful bastard for increasing speed, quality, and flexibility, and for creating new, different, and effective process operations. It enables businesses to maximize their return on investment and deliver breakthroughs in competitive advantage. But in practice, many organizations have been displace millions of dollars down the drain by applying sophisticated information technology to automatic existing processes. The consequences? Making the same mistakes faster.The costs and changing structure of the NHS Direct in the past and concerns regarding the accounting were tabled by the National Audit Office in Feb 2006 ref http//www.nao.org.uk/pn/05-06/0506484.htmEstablished in 1999, until April 2004 NHS Direct was centrally managed by the Department of Health but the service was delivered at a local level by 22 NHS Trusts. When NHS Direct became a Special Health Authority in April 2004, it had to put in place new accounting systems and procedures. While these systems were being established the host Trusts which had previously funded and managed the service continued to be responsible for providing accounting and payroll services under service level agreements. Since NHS Direct had not implemented a centralized ledger or payroll system and the payroll providers and records were dot across the country, there was an absence of central management control over the processing of payroll.Work by NHS Direct and the NAO has indicated that in the region of 1.6m of payroll use of goods and services in 2004-05 may be inaccurate.According to todays report, NHS Direct has also been unable to provide evidenced comparative income and expenditure figures for previous years. NHS Direct has estimated total income and expenditure of 121 million for the previous year based on returns provided by the host Trusts to the Department of Health together with an estimate of cen tral departmental costs, but has been unable to provide sufficient evidence to support these figures.Identify the NHS Direct objectives and the success to dateObjectives are stated as Key cognitive operation Indicators (KPIs) and divided into sections Patient, Staff and Organisation, Stakeholders Financial. The table below summarizes the KPIs for the sections, as stated in the Executive Report for July 2005, tabled in Sept 2005. This provides a recent snapshot of NHS Directs adhesion to KPIs and provides actuals for previous month and year allowing comparisons for improvement over the period. As the department is in a growth phase, these KPIs include measurements of change management as well as maintenance and adherence to standards and processes and procedures.The section for Financial KPIs does not include any metrics, therefore it is assumed they were not discussed or agreed prior to the tabling of the report.The following table has been extracted from the Executive Scorecard , a method used to measure adherence to targets.Patients KPIsOverall, patients reported being satisfied with the service received, however, the department did not achieve its objectives against the majority of KPIsThe number of complaints were up from 2004, although lower than reported in JuneNumber of complaints responded to within 20 days was 39% below target and 37% worse than in JuneSerious adverse incidents exceeded the target and has shown an improvement over prior year and month figuresThe number of web visits and calls answered were lower. This is likely to be due to the fact that this was summertime and not due to any shortcoming on the service.The number of abandoned calls is above target, although improved over the periodThe judging of calls, all types, have met target and are significantly improved over the period.The National Audit Office paper NHS Direct in England, published in 2002 stated NHS Directs project team has balanced the need to publicize the service and it s capacity to meet demand. It has already met its target for 60% of the population to be aware of NHS Direct by March 2002. Public satisfaction with NHS Direct is consistently very high at over 90%. Very few callers received the pursue signal when telephoning, but in Sept 2001 only 64% of callers were able to speak to a nurse adviser within 5 minutes compared with the current target of 90%. Staff Organisation KPIsSchedule adherence appears to be a problem, with the target not being met by 2 key staff members by 9 18%.The cause for concern is within the rolling year turnover rate for staff. This is exceptionally high at 39% and this should be further investigated to find out the root cause.The BBC article Call Centres An Ideal Calling an NHS Direct employee commented However, with a staff turnover of some 30%, it looks as though the call handlers are not enjoying the fruits of this telecommunications boom.Jonathan, who works at a major call centre in northern England, has seen thi s staggering turnover at first hand. Two-thirds of the people who join us dont make it past their second month. Most of the others leave within a year, he says.Companies have been accused of taking a cavalier attitude to happiness of their staff, preferring to hire agency workers rather than investing time and money in a full-time workforce.Stakeholder KPIsThe departments reached the majority of stakeholder KPIs stakeholders are other departments within the NHS and therefore this indicates that the NHS Direct should have a successful relationship within the NHS as a whole.July 2005 Executive ScorecardPatient KPIs (Key Performance Indicators)ActualActualActualRatingJun-05TargetPrev mthLast YearG% Patients satisfied with service99%95%98%99%RNumber of complaints (per 10,000 calls)0.840.51.010.49RNumber of complaints responded to within 20 days56%95%93%GSerious adverse incidents (per 10,000 calls)0.160.240.340.25ANumber of web visits963.3k1040.9k1013.0k662.6kANumber of calls answered57 0.01k591.3k553.5k526.3kAAbandonment rate7%5%10%13%A% calls answered within 60 seconds76%95%71%57%G% urgent calls commencing clinical assessment in 20 minutes97%95%97%50%A% non-urgent calls commencing clinical assessment in 60 minutes97%95%97%50%G% of HI calls assessed within 3 hours91%90%91%90%Staff OrganisationGOverall ICT availability99.97%99.00%99.99%99.99%RSchedule Adherence Nurse Advisor61%80%61%57%ASchedule Adherence Health Advisor72%80%70%66%ACalls per available hour7.78.88.77.5GShort term indisposition6%6%5%5%RRolling year turnover rate for staff39%25%39%30%A% of funded staff in establishment90%100%91%93%Stakeholders KPI