According to Sines & Saunders (2009), change is something that is different from present condition or appearance. There are different types of changes and every change has it’s own impact. The grounds for proposed change can be skill mix, relocation of services, access and entitlement, referral systems, working condition, staffing levels, resource allocation, management, professional roles, responsibilities and accountabilities, reviewing and monitoring systems throughout the organizations. Wallace & Webber (2006) have stated that, the main purpose of relocation of service is to improve the existing services. For example, the Department of Health has recently improved the service for the veterans and severely injured service personnel. Some of the rationales for proposed changes are described below:
A new service along with an existing one may need to be introduced. For instant, mix of skills or new allocation of service may be necessary with an organization.
Development in technology and other progress put pressure automatically to form changes throughout the organizations. So, organizations have to undergo through a change process to cope with the new situation. A new form of services come may be introduced as a result of changes. For example, the entire NHS structure is going to be digitized because of the technological improvement in the UK.
Organizations often conduct performance appraisal to monitor and control the quality of service to find out the faults. If there is any, they try to solve that which can result change in service delivery.
Etto (2009) has stated that the customers and consumers have an ever changing mentality. So, service providers have to introduce new products or services or improve the existing one to compete with other organizations and the global market. For example, people may tend to get services from other countries or private hospitals if the services of NHS are kept unchanged where customers or patients expect more from them.
Competition with other service providers helps to introduce changes and it results satisfaction of the service users. Sometimes dramatic changes in the organizations attract non-potential customers as well.
Demographic changes like increase the number of aging people, increase of child birth or increase of critical disease will require special care which will lead health care system to change.
Satisfaction level can lead organization to change if the level is low.
Community action groups which may be regarded as pressure groups are instrumental to bring change. It is noticeable (particularly in local elections) that a local representative may be elected based on support for a community project, i.e. the building of a health clinic with the improved of plans to relocate services.
New legislations, acts, policies and requirements of these may affect the existing services which can lead changes. For example, according to the Protection of vulnerable adults (POVA) or care standard act 2000 requires criminal record bureau (CRB) check before starting their employment with vulnerable adults, children and families.
1.2 Assess potential benefits to staff, service users and communities of proposed changes.
According to Senior & Swailes (2010), change is a word which is essential in every sphere of life especially throughout the organizations because usually it brings efficiency, staff and customer satisfaction. It also cuts extra costs of the organizations, response times so that service users can get service quickly. The department of health, NHS and some other organizations are bringing changes in their organizations. Among them, the Department of Health has already laid down some targets, policy initiatives and organizational changes (both management and structural changes) which have developed the quality of care received by the patients. As a result, communities as well as all the staff and service users are being benefited from proposed changes.
Without this, Tanner & Harris (2008) have noted that, the department of health works in partnership with everyone who are directly and indirectly involved with health and social care services. This organization has focused on some important issues to improve the health care services throughout the nation and these are:
A better partnership relationship among the carers, doctors, social workers, GPs and patients. All the health care professionals can now share information among one another regarding any patients. As a result, misunderstanding, confidentiality and patients’ welfare etc. are now easy to achieve.
An improved process of commissioning. The department of health has guided to follow the commissioning process strictly so that no life of any children becomes unsafe. So, the whole community is being benefited.
Inter-professional and inter-agency collaboration and teamwork. It is very unusual that a professional must be expert of everything. But if professionals from different background work together, can solve any problem discussing with them. So, service users, service providers as well as the community are being benefited from this change.
According to Care Services Improvement Partnership (2008) and NHS (n.d.), some of the key benefits are given below:
Improved health and emotional wellbeing
controlled and improved quality of life
Lead to develop skills
Greater confidence for the individuals
Make a positive contribution
Choice, control and services which are built around the individual.
Freedom from discrimination
Economic wellbeing for the service users
Early intervention and personal dignity
1.3 Identify challenges and suggest strategies for reducing undesirable impacts.
According to Pasmore (2010), there are many challenges to take into account while making any changes in an organization. He stated that changes and new things are not always welcomed. For example, an agile and lean ideas and practices are introduced (or proposed) in established an organization, the unfamiliar ideas meet with resistance. Organizations may need to provide some extra time for employee engagement.
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Research carried out by Fullan & Ballew (2004) has found that the first challenge of change is basically a high degree to resist something new. According to them, people resist change because of fear of the unknown and may not understand what is happening or coming next or because of disrupted habits which leads them to feel upset to see the end of the old ways. In addition, people may suffer from loss of confidence or control because of change. They may think, they are incapable of performing well under the new ways and things will be being done “to” you rather than “by” or “with” you basis.
Employees may think their current timetable needs to be changed and have to work extra in terms of physically and psychologically. They may think that they will be humiliated because of changes. Also, staff may have lack of purpose not seeing a reason for the change and/or not understanding its benefits. All the things need to be considered before making any change and avoid any undesirable impact. But still people may resist the changes. There are many strategies to reduce undesirable impacts but the most suitable strategy should be applied to certain problem. According to Sengupta et al (2006), strategies to reduce undesirable impacts can be normative re-educative strategy, power-coercive strategy, Rational-empirical strategy, power- adaptive strategy.
Normative re-educative strategy: Sengupta et al (2006) have defined this strategy as a strategy that believes “the norms of the organization’s interaction-influence system (attitudes, beliefs, and values–in other words, culture) can be deliberately shifted to more productive norms by collaborative action of the people. It focuses on norms, change attitudes, and values of the organization’s members. But if attitude is changed, values and norms may behave differently. One can see this in cultural change programs that organizations introduce and in this type of change individuals participate in their own re-education.
Rational-empirical strategy: Sengupta et al (2006) have stated that, this strategy begins from the assumptions that individuals are rational and will follow their own self interests when it is revealed to them. Change is based on the communication of information and the proffering of incentives. Therefore changes achieved by highlighting to individuals affected by the change that is consistent with their own self interest to except the change. In other words individual go along-with the change because they can see that it is in their own interests to do so.
Power-coercive strategy: It is based on the application of power, whereby the process of influence is compliance (Sengupta et al 2006).This involves getting individuals with less power to comply with the plans and the directions of those with the greater power.
Environmental-Adaptive: According to Sengupta et al (2006), people argue disruption and loss but they readily settle in to new conditions. Change is usually based on building a new organization and gradually transferring people from the old one to the new one. They suggested some key checkpoints to reduce unexpected impacts for successful changes which are given below:
Benefit: it makes sure people involved see a clear advantage in the change.
Compatibility: it keeps the change as close as possible to existing values and experiences.
Simplicity: it makes the change as easy as possible to understand and use.
Triability: it allows people to try the change step-by-step, making adjustments as they go.
Making change inevitable: it creates a felt need and urgency for change.
A diagram to minimize the resistance of change is given below:
Minimizing resistance to change
Diagram: Minimizing resistance of change
2.1 Devise strategies and criteria for reviewing changes.
According to Estrella (2000), evaluating research survey, weightening up the evidence and comparing changes with one another can be very effective way to devise strategy and criteria for reviewing change. There are many types of changes such as subsystem change, transformational changes, incremental changes, remedial changes, developmental changes, planned changes, emergent changes, episodic changes, continuous changes etc. These changes can be reviewed on the basis of evaluation of research survey. The basics of research survey can be descriptive research, survey, successful samples, questionnaires, prediction, casual explanation, panel study, single sample, evaluation etc. Different types of data can be collected from these approaches such as attitudes, opinions, beliefs, preferences, behaviours etc.
Attitude: it means what people say they want
Opinions: it reveals what people think might be true
Beliefs: it means the things people know as truth
Behaviour: this is what people actually do
Demographic characteristics: it represents what people are
Preferences: it is that people might choose
Koontz & Weihrich (1990) have stated that, there are few basic questions which are asked to the people and these are usually linked to open response, partially open response, closed response, semantic differential scales, agreement and rating scales, ranking scales, checklists etc. Rewards, costs and trust of people must be taken into account while reviewing change by surveys. More people will help to review the impact of changes if there are more reward options. Also assessing reliability and validity are very important for reviewing change. There are many types of validity like face validity, content validity, concurrent validity, discriminated validity, predictive validity, construct validity. Reliability can be test-retest reliability, internal consistency and sstability. Sampling theory is another strategy to review change. This strategy helps to review change by providing a sample statistic or sample or census, identifying the target population, obtaining a manageable collection of objects to study and pproviding a qualitative representation of population characteristics. It can also provide a sample statistic to identify the target population. Data should be analyzed and coded at the end for a successful review of change. Thus change can be reviewed.
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2.2 Measure impact against agreed criteria
According to Lock (2007) and Koontz & Weihrich (1990), the Impacts within any organization against agreed criteria are very important in terms of Staff satisfaction and Customer Satisfaction. Their satisfaction level can be measured by surveying, interviewing based on different issues e.g. what is their expectancy from the organization, what needs to be improved, what should come to light for their satisfaction etc.
Staff satisfaction: Huber (2006) has explained staff satisfaction or employee satisfaction as a measurement of happiness of employees’ in terms of working environment and job roles. Staff satisfaction is very important to a successful organization as happy employees produce more outcomes and create more satisfied customers. Organizations often need to change their policy and structures to be successful and to achieve organizational goals and conflicts and staff dissatisfaction may arise from here. As new things are not often welcome, so they may resist the changes as well. But good employers know how to satisfy their employees and cope with this situation.
Organisational changes such as skill mix, working condition, management, relocation of services, etc can lead to considerable changes in traditional roles and responsibilities (Holzemer, 2009). It has psychosocial challenges for the employees in the shape of job uncertainty, the feeling that one is not mastering the new work situation or lacks the competence to do so and consequently difficulties in implementing change processes and using new work processes. In these cases, efficient employers show direct and indirect benefits to their employees to avoid resistance e.g. cost effectiveness, reduced job stress, quick response time, and effective allocation of service.
Customer satisfaction: The impact of proposed change on customer satisfaction is an unintended consequence or outcome of an intended strategy or action. Research from Cochran (2003) has found that customer satisfaction is the most important criteria for an organization to be successful. Department of health, NHS and some private hospital have made some significant changes to their organizational structure and in terms of service delivery. So, customers are being served quickly and they can access to the service in a short period of time. Customers are now getting improved health and emotional wellbeing, improved quality of life, Choice, control and freedom from discrimination, economic wellbeing, personal dignity etc.
2.3 Evaluate overall impact of changes.
Pasmore et al eds. (2009) and Cummings & Worley (2008) have noted that every change should have positive outcome through the organizations. The overall impact of changes in an organization can be the efficiency of the employees, cost-benefit, case completion, referral rates, waiting and response times etc.
Efficiency of an organization: Efficiency of an organization means how effective an organization is to achieve its goals (Daft, 2009). Every organization should be more effective after making any changes whatever it structural change, change in referral system or relocation of services. Organisational efficiency mainly relates to the use of resources to achieve best possible outcome which refers to the amount of resources an organization uses in order to produce a unit of output. An organisation that maximises its resources in production without waste is an efficient organization. For example, NHS and GP surgeries are now becoming more efficient in terms of service delivery. Now if a patient changes their appointment time more frequently, their registration may be cancelled. They need to pay for re-registration. As a result, both clients and service providers are keen to maintain their schedule strictly. So, the NHS authority may not have to pay extra to the GPs and doctors for their unproductive works. As a result, NHS ranked first place among the countries in terms of service delivery to the patients.
Cost-benefit: according to Dompere (2004), this is an idea that tries to fix if a project worthwhile economically. The overall benefits should be greater than the costs. NHS as an example is concerned about the patients in terms of how they can be treated and the success rate of surgeries can be hundred percent. The NHS authority is also concerned about the hospital and surgery procedures, how doctors, surgeons, nurses and other clinicians perform with the skills and abilities. It is a government organization. So, profit does not take into account but it needs to take into account that how many and what kinds of patients they have served and what is the outcome based on the cost. Though the intension of NHS is not to make profit but they should balance the cost with service outcome to be a cost effective organization.
Referral rates: Baker et al (2006) have stated that, referral system in health care means having a relationship between a primary health care provider and a higher-level hospital during the transfer and discharge of a patient. In the UK, General Practioners (GPs) are responsible to see and for the primary diagnose of disease of a patient. If they fail to diagnose or give a solution to the patient, then the patients are sent to higher level hospital where they are treated by the specialist doctors. The effectiveness of a GP can be measured by the referral rates, well-being of the patients, number of cured patients etc. Once it was a time, the referral rates of the GPs were very high as sometimes they did not try their level best to serve a patient. In that time the GPs had no rewards in terms of service delivery. But now NHS has been re-structured and GPs who have high referral rates are marked as non-effective. So, they have to take compulsory training to increase their service outcome. Now, the overall referral rates are falling gradually and patients are getting good service because of these changes.
Waiting and response time: Anon (n.d.) has shown that waiting and response time of the patient is still significantly high though the department of health has been re-structured. But the overall waiting and response time is falling day by day as the NHS is trying to digitalize the whole organization. Also, they have planned to work along with the private hospitals to give the fastest and best possible care to the patients.
3.1 key demographic and social trends in the Scotland.
Demographic and social trends in Scotland:
According to Paterson et al (2004), the population in Scotland has been declined slightly during the last twenty years. Around 117000 people have been declined over the two decades. In addition, the fertility rate is the lowest in Scotland compared to the countries in United Kingdom. The key demographic trends are given below:
Population trends: According to General Register Office for Scotland (2001) and Paterson (2004), the population in Scotland has fallen in the year to 30 June 2002 to 5,054,800 which is 0.2 per cent less from the mid-2001 where there was a level in the first half of the 20th century. A natural decrease has been experienced from the year of 1997. The mortality rate among the older people was significantly high compared to last four decades. The natural decrease (6,065 in 2001-02) was a bigger reason for population decline. In addition, Scotland’s population is getting older which is projected to continue ageing. About fifty percent of the people are now over 39, which are four years older compared to the year of 1991.
Anon (n.d.) & the census 2001 has shown that the total residents of Scotland were 5,062,011 until 29 April 2001 of which 48% were male (2,432,494) and 52% were female (26,29,517). Children aged fifteen and under (about one million) accounted were 19% of the population. The population in Scotland was considerably low compared to England.
Fertility rates: Research carried out by Coyle et al (2005) has found that the fertility rates are in same condition with the population trend. It is the lowest among the Scottish people and every woman has 1.48 children in average. In 2002, the entire number of births (51,270) registered was the lowest ever recorded. It is the 6th repeated year where the number has fallen with record. It shows the fact that adult women are giving birth of fewer children and having them not at early age. As a result, average completed family size fell less than two and was expected to drop further for younger women after 1953. Fertility rates in their 20s are little bit more than half the rate forty years ago when rates for women aged over 30 have gradually increased. Scholars are unable to fully understand the reason of low Scottish fertility rate. Data suggests that it may be the reflection of life choices among the couples as house prices and the price of daily chores are increasing day by day. In addition, dual earning couples, delay motherhood, low income, breakdown of relationship, religion difference etc. also may be responsible for low fertility rates.
Migration: According to Murphy (2004), historically, Scotland is a country for the immigrant people. But it is noticeable that, migration rate in Scotland has been fallen sharply during the last few decades. Data has shown that net emigration from Scotland is much lower than forty years ago. Scotland experienced around 3,000 migrants loss in 1998 to rest of the UK. Figure shows that most of the people (15-34) are immigrating to England compared with Scotland. Population projections by the General Register Office for Scotland (GRO) based on a new baseline, assume a net out-migration from Scotland of 1,000 a year.
Social trends: Research from to Paterson et al (2004) has shown that, social trend in Scotland is considerably noticeable from the last two decades. The birth rate is being controlled very strictly by the Scottish couples. Once there was a trend to give birth at early age among the women which is considerably low now. The household are breaking into smaller sizes at recent years. The average household size in Scotland was 2.31 people per household compared with 3.2 people per household in 1970s. Households are tended to spend more on services than goods. Household spending on services was more than 50% of net domestic household expenditure. They are now spending more money for travel and tourism compared to past years.
Education rate from primary level to higher level has been increased during the recent years (Gibson, 2008). More than three-fifths of three and four-year-olds are in early year’s education now. The proportion of three and four year olds enrolled in all schools in Scotland was 63 percent triple the rate in 1970s. Scotland experienced a higher unemployment rate though the education rate is growing high. Unemployment rates for men and women are 8.1% in Scotland which is 1% higher than England.
According to The Scottish government (2004), Scotland has recorded the lowest number of crime in 2001 which breaks the records of last 25 years. Totally 385,509 crimes were reported over that year for the first time when the figure has dropped below 400,000.
3.2 Potential impacts of key demographic and social trends on health and social care service delivery and provision in the Scotland.
According to Paterson et al (2004), there are some significant impacts on health and social care service delivery because of the demographic and social trends in Scotland. If current trends continue, the population will be reduced from five million in Scotland by the end of the decade. It is an issue that reduces the reserved and devolved matters. In addition, it has some particular effects for the requirement and supply of public services. On the other hand, they are becoming positive in terms of social life in some cases. Some of the examples of these are detailed below:
Transport systems will need to become accustomed for the changing demand due to East-West migration.
Supply of school buildings and teachers or lecturers will have to adapt to falling numbers of young people in some areas. For example, the number of students in publicly funded primary schools may fall by 19% over the next decade.
Scotland has not only a declining but also an ‘ageing population’ which may lead to a fall in working-aged people. So, they need to be paid higher for and to provide services. For instant, an ageing population may put extra pressures on National Health Service and they need pay extra cost for free personal care of the aging people.
The number of crimes has been fallen significantly in Scotland. So, people are now more secured and government can cut down some extra cost while budgeting. It is notified that many people become injured by the criminal. So, the healthcare services need to pay them but now this cases are lower than before which reduces health care cost slightly.
The government may need to allocate their resource newly because of population change.
Some health care service may not be available locally and service users may need to struggle and face difficulty to get service. For example, major operations may not be performed locally.
Relationship breakdown can a common issue because of late motherhood which will create extra pressure to social care services. But social services may not be available everywhere because of the small population in a particular area.
A smaller supply of key workers might guide to increase vacancies in some occupations and inflationary pressures on their salaries.
3.3 Appropriate service responses to likely changes.
Anon (2003) & Bloch (n.d.) have identified some areas which need to be considered to protect the negative changes in Scotland. Some of these are given below:
Scotland has got lots of talents and their education rate is satisfied and even better than some other parts in the UK but their employment rate is higher than other parts in the UK. Many graduates and fresh talents are tended to move from Scotland because of this reason. So, employment facility should be widened throughout the country. In addition, new industries, offices etc. can be developed to attract the people with no job. Minimum wages more than other parts of the UK can also be positive.
Unemployment rate among the older people is high and they are tended to leave their jobs early which can cause further depression in life. They may not be able to pass their lazy time by doing nothing at home which may lead them to illness. As a result, government will have to pay for their healthcare cost and that is extra burden to National Health Services as most of the people depend on it. Research from Heponiemi et al. (2007) & Bernklev et al. (2006) have shown that unemployed older people are at higher risk to become sick than the employed. Attractive salary, good and friendly working environment, available support during work time, better pension scheme can increase the employability rate among the older people.
According to O’Neill (2010), debit and credit card fraud was at record high in Scotland. About one out of nine was the victim of card fraud. So, residents had lack of financial security which leaded them to move somewhere else. So, adequate protection must be facilitated throughout the country to reduce this trend.
Motherhood is being delayed across the country. The reason for this is to take fewer children than before as price of daily living things are rising day by day. Also, dual earning families are growing. Mothers may need to away from work for long time because of motherhood which can create barrier in her career. So, safe maternity should be ensured to reduce this trend. Also, adult early birth can be encouraged by socially and benefit can be considered for this.
Tax incentives can be implemented widely to encourage having more children among the couples. Facilitating combining parenthood and full-time employment can be an advantage as well.
Migration rules can be loosening to enter in Scotland for the legal people for cultural and religion mix. People are tended to live in multi-cultural countries more than single cultural and religion countries. Without this, legal migrated people can contribute to improve local economy which can help to cut down the unemployment rate.
Religion balance, improved healthcare facility, social and political stability, improved security in social and financial life will also be a significant impact to stop the negative changes in Scotland.
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