Category: NHS

Introduction

The main objective of the NHS is to ensure that all residents of the UK are able to access medical services irrespective of their demographic, social, cultural or economic background (NHS 2014). One of the major advantages of the NHS is that it enables the residents of the UK to receive healthcare free of charge. In addition, it provides a variety of services to all patients. This has resulted into improved health outcomes in the country.

However, the NHS has faced serious challenges in the last few years. These include limited funding from the government and inadequate capacity to handle rising demand for medical services (Schmid et al. 2010, pp. 455-486). In addition, patients have complained about declining service quality standards, whereas physicians are concerned about deteriorating terms of service.

This has forced the government to intervene by implementing new policies and strategies to improve the performance of the NHS. This report will provide a detailed analysis of the NHS, with the aim of proposing recommendations to the government to improve its performance. The report will begin by highlighting the current state of the UKs healthcare system. This will be followed by analysis using various tools and models.

Problems

First, secondary care institutions are facing sustainability challenges. This is illustrated by the fact that nearly 15% of the countrys hospitals that provide specialized care have been declared unsustainable in the recent past.

As more institutions become clinically and economically unsustainable, access to high quality healthcare will reduce significantly (Rothgang et al. 2008, pp. 132-146). Second, the government believes that it should reduce its expenditure on healthcare by 20%. This need arose as a result of the countrys poor economic performance in the last five years.

Third, there is no effective integration between hospitals and community services. Some of the factors that hinder integration include poor communication, conflicting objectives among care institutions, and competition among care providers (Williams 2011, pp. 100-113). Fourth, the public has lost trust in general practitioners (GPs). The GPs have focused on pursuing their interests at the expense of providing improved and accessible services to the public.

Aims and Objectives of the Healthcare System in the UK

First, the government intends to cut its expenditure on healthcare without compromising quality and access. This objective is meant to improve efficiency in the healthcare system. Second, the NHS intends to distribute the existing workload between primary and secondary care institutions.

A fair distribution of the workload will enhance capacity optimization in existing care institutions, thereby improving access. Third, the integration between care institutions is to be improved. This objective will facilitate effective and efficient cooperation among care providers (Williams 2011, pp. 100-113).

Fourth, the NHS intends to increase the range of local services that are provided by the GPs. This will restore public confidence and trust in GPs (Costigliola 2012, p. 42). In addition, the demand for secondary care will reduce if improved services are provided at the local level. Finally, the process of commissioning healthcare is to be improved by increasing the representation of clinicians in the CCGs. Improved participation of clinicians will ensure that quality medical services are available in every region in the UK (Costigliola 2012, p. 52).

Stakeholders

The stakeholders include the Care Quality Commission (CQC), National Health Service (NHS) England, Clinical Commissioning Groups (CCG), Health and Wellbeing Board, the government, the National Treasury, and Monitor (NHS 2014). The CQC monitors the health sector by ensuring that care institutions are providing safe, effective, and high quality medical services. NHS England facilitates access to healthcare by providing adequate care facilities, medical supplies, and qualified physicians.

The main role of CCGs is to plan and design the process of providing medical services at the local level (NHS 2014). This involves purchasing medical services such as planned hospital care and rehabilitation care. The Health and Wellbeing Board collaborates with the commissioners and the community members to facilitate equitable access to healthcare at the local level. Monitor regulators the health sector by ensuring that the services provided meet the varied needs of the citizens (Monitor 2014).

Analysis of Major Provider Sectors

The government of the UK provides healthcare at different levels. These include primary care, secondary care, community care, and social care. Primary care is mainly provided by general practitioners and nurses as a first response to various health conditions. Primary care provides universal and comprehensive access to all citizens (Greener 2009, p. 76).

The services include diagnosing diseases, prevention of diseases, and encouraging healthy behaviors (NHS 2014). The main strengths of the countrys primary care system include high access rate and effective coordination of services. However, the system is underfunded and the demand for services keeps rising (Appleby et al. 2014).

Secondary care in the UK is provided by consultants who are hired by the NHS. The consultants are doctors and health professionals who specialize in specific areas such as cardiology and physiotherapy. Generally, the consultants provide their services in hospitals that are owned by the government (NHS 2014).

The main strength of the UKs secondary care system is that it provides high quality medical services. In addition, it is less expensive than those of most developed countries. However, access to secondary care in the UK has reduced tremendously in the last decade due to limited capacity. Patients have to wait for a long time to be attended to by specialists such as neurologists. In addition, poor coordination between primary and secondary care institutions limits access.

Community care is mainly provided at the local level to specific groups of people such as the disabled and the elderly. The aim of community care is to enable beneficiaries to receive care while maintaining their independence in their residential homes or care homes (NHS 2014). The services provided by the community care system include meals, helping with domestic chores such as cleaning, personal tasks such as bathing, and recreational activities.

Community care enables the government to reduce the strain on health facilities since the services are provided in the patients home or in a care home (Appleby et al. 2014).

The main weakness of the community care system is that the criteria for selecting the beneficiaries is often complicated and time consuming. Social care is also provided at the local level to help citizens and their families to cope with the life challenges that are attributed to disability and illnesses. Social care is also negatively affected by the complexities associated with selecting the beneficiaries.

Analysis of the NHS

SWOT Analysis

SWOT analysis highlights the strengths and weaknesses of the NHS. It also identifies the opportunities that are available to the NHS and the threats in the health sector (Gerlinger 2009, pp. 145-175). Table 1 summarizes the strengths, weaknesses, opportunities, and threats.

Table 1: SWOT.

The main strength of the NHS is its ability to provide medical services on a large-scale to the residents of the UK. Moreover, it has an extensive infrastructure and well trained medical personnel. The threats facing the NHS include limited funding and the increase in the number of patients with chronic conditions. The opportunities that are available to the NHS include using NHS 111 call service to enable more patients to access healthcare. Moreover, the NHS can address its capacity constraints by collaborating with private providers to deliver healthcare.

PESTEL Analysis

The PESTEL analysis highlights the external factors that are likely to influence the performance of the NHS in future. These include political, economic, social, technological, environmental, and legal factors (Greener 2009, p. 213). The influence of these factors is summarized in table 2.

Table 2: External Factors.

The main external factors that pose significant threats to the NHS include increase in the prevalence of long-term conditions and rapid aging of the population, as well as, reduced funding. These factors will lead to resource limitations, thereby causing failure. However, improvements in e-learning and digital inclusion provide opportunities for cost reduction through technologies such as telehealth.

Competition: Porters Five Forces Analysis

Porters five forces analysis highlights the nature of competition in UKs health sector (Costigliola 2012, p. 115). Table 3 summarizes the main forces in the competitive environment that are likely to influence the competiveness of the NHS.

Table 3: Market Forces.

Table 3 shows that the NHS is able to overcome competition in the market. This is explained by the fact that the NHS is the largest provider of healthcare and its services perform better than those of the competitors in terms of accessibility and costs. However, the NHS should improve the quality of its services to overcome the threat attributed to alternative services such as medical tourism.

7S Analysis

The 7S analysis is a strategic management model that states that an organization must align and reinforce its soft and hard elements to achieve success (Sadler 2003, p. 56). The soft elements include staff, skills, shared values, and style. The hard elements include structure, strategy, and system (Sadler 2003, p. 56). These elements are summarized in table 4.

Table 4: The Soft and Hard Elements of the NHS.

The organizational values that have been adopted by the NHS include compassion, improving lives, commitment to quality, and working together for patients. Compassion and commitment to quality will enable the employees of the NHS to provide the best healthcare, thereby improving patients health.

In addition, teamwork will facilitate effective coordination of healthcare services. Professional development will improve the employees skills. As a result, they will be able to satisfy patients health needs. The NHS delivers healthcare through several organizations, which include CCGs, and NHS foundation trusts. The organizational structures of these organizations should be streamlined to improve efficiency in healthcare delivery.

Stakeholder Analysis

Stakeholder analysis identifies the individuals and organizations that are likely to influence the activities of the NHS. Generally, stakeholders with high interest and power/ influence on delivery of healthcare are likely to have a great impact on the strategy and activities of the NHS and vice versa (Sadler 2003, p. 73). Table 5 sheds light on the stakeholders.

Table 5: Key Stakeholders.

Stakeholders with high interest in healthcare are the main consumers of medical services. Thus, the NHS must align its strategy to the needs of stakeholders with high interest (patients) to achieve success. Non-medical personnel have low interest because they are not directly involved in the provision of healthcare. Thus, they are not likely to have a significant impact on the strategy of the NHS.

The union leaders and the government have high influence on healthcare provision. Thus, the NHS must satisfy their needs, which include cost reduction and maintaining acceptable quality standards. Medical staff, Monitor, and CQC have high interest and influence. Thus, the NHS must actively manage them to ensure long-term cooperation. The patients and Public Health have high interest and low influence. Thus, the NHS should keep them informed about its activities to facilitate access to care.

Recommendations

The government should adopt the following recommendations to reform the NHS. The main objective of the recommendations is to address the weaknesses of the NHS so that it can overcome external threats and take advantage of existing opportunities. The recommendations will also meet the objectives of the healthcare system in the UK.

Reduce Spending by 25%

Reducing expenditure is the major strategy that the NHS needs to reduce its budget deficits. Expenditure should be reduced by adopting the following strategies. First, the organizational framework of the CCGs should be decentralized. One of the major weaknesses of the NHS is high operating costs, which are partly attributed to centralization of CCGs organizational framework.

Significant cost reductions can be achieved by decentralizing CCGs. This will involve increasing the participation of the local communities in commissioning healthcare. The local communities will have high involvement in the ownership and management of healthcare facilities. This will promote cost reduction at the local level.

Second, specialized services should be merged. Services such as treatment of chronic diseases should be centralized or merged to reduce costs. This strategy is justified by the fact that specialized services are very expensive to provide. Centralizing the services will lead to cost savings through sharing of scarce resources (Wilstow 2012, pp. 5-13). For example, accessing specialists such as cardiologists who are in short supply will be easy and cost-effective if their services are centralized.

Reorganization of the Workforce

Reorganization of the workforce through professional development is required to improve the quality of healthcare. In this regard, the NHS should adopt the following strategies. First, the NHS should train more specialized medical personnel. The NHS has a long patient waiting list because of the limited availability of specialized medical personnel. Thus, it is important to train more specialized personnel to improve service provision (Charlesworth, Smith & Thorlby 2014).

Second, the NHS should focus on on-the-job training of non-specialized medical personnel (Hall, Miller & Millar 2012, pp. 49-62). Improved skills will enable the personnel to provide high quality services, thereby restoring public confidence in GPs.

Third, the NHS should deploy personnel to underserved areas. Increased influence of politicians in commissioning healthcare in the country has led to unbalanced access to care. To address this situation, medical personal should be redeployed from overstaffed to understaffed hospitals and clinics to improve health outcomes (Hall, Miller & Millar 2012, pp. 49-62).

Disease Prevention

The NHS should focus on disease prevention to reduce demand for healthcare, thereby reducing its capacity constraints. Thus, staff and patient education programs should be introduced to increase the information that is in the public domain about disease prevention. If the information is utilized appropriately, infection rates will reduce (Lombardo & Buckeridge 2012, pp. 7-20). This will reduce expenditure on healthcare and improve the health of the citizens.

Regular screening of members of the public should be conducted to facilitate early detection of various illnesses. As a result, it will be possible to provide timely interventions to prevent premature deaths (Gerlinger 2009, pp. 145-175). Moreover, chronic diseases such as cancer can be treated at a low cost if they are detected early.

Quality of Healthcare

Improving the quality of healthcare is the major strategy that the NHS should adopt to improve patient outcomes and to win the trust of the public. The NHS should introduce effective care pathways to improve the quality and safety of healthcare. Care pathways will use evidence-based clinical interventions, thereby reducing chances of medical errors. The resulting improvements in health outcomes will reduce readmission rates and strain on healthcare resources (Gerlinger 2009, pp. 145-175).

Monitor and CQC should provide guidelines and technical assistance to improve compliance. Moreover, Monitor should improve supervision of healthcare providers. This will ensure that only accredited institutions are providing medical services, thereby improving quality.

Use of Technology

Use of advanced information and communication technologies is one of the main strategies that the NHS should adopt to improve access to healthcare. The NHS should focus on using telehealth, websites, and mobile phone applications. Since majority of the population already has access to the internet and mobile phones, telehealth and websites will be convenient and cost-effective channels for delivering healthcare (Ramena & Staggers 2013, p. 14).

Furthermore, care providers should use text reminders to encourage patients to attend medical appointments. Empirical studies indicate that SMS text reminders motivate patients to attend all clinical appointments, thereby improving their health (Mitchell & Selmes 2007, pp. 423-434).

Participation of the Private Sector in Service Provision

The participation of the private sector is required to increase the capacity to provide healthcare to all citizens. The government should provide incentives to private insurers to provide affordable health insurance. As the cost of health insurance premiums reduce, more citizens are likely to pay for their healthcare. As a result, the budget deficits that the NHS is grappling with will reduce.

The government should also deregulate establishment of private hospitals and clinics. By eliminating regulations that prevent entry, the participation of the private sector will increase, thereby enhancing access and quality.

Capacity Change

The capacity of the healthcare system should be increased to meet future increase in demand for healthcare. The NHS should establish additional hospitals, care homes, and clinics to address the expected increase in demand for care. Moreover, the NHS should improve availability and functionality of medical equipment. One out of five public hospitals is not sustainable partly because of inadequate equipment (Appleby et al. 2014). Thus, the existing medical equipment should be improved to enhance clinical sustainability.

Integrated Care

The NHS should focus on providing integrated care to eliminate fragmentation of medical services, which often leads to poor patient outcomes. There should be improved collaboration among commissioners to facilitate pooling of resources at the local level to provide more services to citizens (Currie, Finn & Peters 2007, pp. 406-417).

Additionally, healthcare for the elderly and patients with long-term conditions should be centralized. Evidence from the Veterans Health Administration in the US shows that patient outcomes often improve if the services needed by specific groups such as the elderly are centralized.

Conclusion

The NHS is the leading provider of healthcare in the UK. Its main strengths include access to an extensive infrastructure and well trained personnel. Furthermore, it is capable of developing and implementing improved healthcare solutions. However, its effectiveness is threatened by several factors. These include rising demand for healthcare, reduced funding from the government, and declining quality of healthcare.

Despite its weaknesses, the NHS can still be reformed by taking advantage of the opportunities in the healthcare sector. These include the use of telehealth and partnering with private care providers. Moreover, the NHS must improve its internal efficiency to reduce operating costs. This calls for centralizing specialized services and decentralizing the organizational framework of CCGs. Furthermore, the NHS must improve the quality of its healthcare services in order to regain the trust of the public.

References

Appleby, J, Humphries, R, Thompsons, J & Jabbal, J 2014, How is the health and social care system performing. Web.

Charlesworth, A, Smith J & Thorlby, R 2014, The coalition governments health and social care reforms. Web.

Costigliola, V 2012, Healthcare overview: new perspectives, Oxford University Press, London.

Currie, G, Finn, R & Peters, M 2007, Spanning boundaries in pursuit of effective knowledge sharing within networks in the NHS, Journal of the Health Organization and Management, vol. 21. no. 4, pp. 406-417.

Farnsworth, A 2012, Unintended consequences: the impact of NHS reforms upon Torbay Care Trust, Journal of Integrated Care, vol. 20. no. 3, pp. 146-151.

Gerlinger, T 2009, Competitive transformation and state regulation in health insurance countries, Edward Elgar Limited, Cheltenham.

Gilardi, F, Fluglister, K & Luyet, S 2009, Learning from others: the diffusion of hospital financing reforms in OECD countries, Comparative Political Students, vol. 42. no. 1, pp. 549-573.

Greener, I 2009, Healthcare in the UK: understanding continuity and change, Sage, London.

Hall, K, Miller, R & Millar, R 2012, Jumped or pushed: what motivates NHS staff to setup a social enterprise, Social Enterprise Journal, vol. 8. no. 1, pp. 49-62.

House of Commons 2011, Achievement of foundation trust status by NHS hospital trusts, Stationary Office, London.

Lombardo, J & Buckeridge, D 2012, Disease surveillance: a public health informatics approach, Palgrave, London.

Mitchell, A & Selmes, T 2007, Why dont patients attend their appointments: maintaining engagement with psychiatric services, Advances in Psychiatric Treatment, vol. 13. no. 1, pp. 423-434.

Monitor 2014, What we do. Web.

NHS 2014, About us. Web.

Ramena, N & Staggers, N 2013, Health informatics: an inter-professional approach, John Wiley and Sons, New York.

Rothgang, H, Cacace, M, Frisina, L & Schmid, A 2008, The changing public-private-mix in OECD healthcare systems, Palgrave Macmillan, London.

Schmid, A, Cacace, M, Gotze, R & Rothgang, H 2010, Explaining health care system change: problem pressure and the emergency of hybrid health care systems, Journal of Health Politics, Policy and Law, vol. 35. no. 3, pp. 455-486.

Schmid, A & Gotze, R 2009, Policy learning in health care system reform: the case of diagnosing related groups, International Social Security Review, vol. 62. no. 1, pp. 21-40.

Williams, S 2011, Safeguarding adults at risk in the NHS through inter-agency working, Journal of Adult Protection, vol. 13. no. 2, pp. 100-113.

Wilstow, G 2011, Integration and the NHS reforms, Journal of Integrated Care, vol. 19. no. 4, pp. 5-13.

Introduction

The findings published by the Health Commission, the UK National Health Service (NHS) on the March 2009 Francis Report into Mid-Staffordshire NHS Foundation Trust Failures inpatient care, received a lot of publicity. While the report is important because it illuminates the failures, it is more significant to focus predominantly on what should have been done and what should be done in the near future. This calls for a review of the recommendations that have been tabled by this report as a chat on the way forward (Francis, 2010a).

Review of the Recommendations

For purposes of clarity, this paper will review some of the recommendations so adduced in the report one by one, by first highlighting them and secondly by justifications based on the report, as well the common knowledge that accrues from documented best business practices.

Recommendation 1: The Trust must make its visible first priority the delivery of a high-class standard of care to all its patients by putting their needs first. It should not provide a service in areas where it cannot achieve such a standard.

Joss et al (2002) reckon that, as a principle, it is usually the client who is best situated/placed to echo expectations of a service or a product. This, therefore, affirms the old adage that any establishment must always be cognizant of the fact that everything begins with the client as the middle staff as well as the end consumer. In the case of NHS, the management seemed not very sure of the ongoings because they perhaps did not establish a tool of evaluation that centered on the customers opinion (Care Quality Commission, 2009).

The beauty of a client-centered approach in business, according to Joss et al (2002) is that it is a precursor for the management to foresee and create changes emanating from clients/clientele suggestions as well as demands, and therefore ordinarily shifting clients information (Joss et al, 2002).

Recommendation 2: The Secretary of state of Health should consider whether he ought to request that Monitor-Under the provisions of the Health Act 2009-exercise its power of de-authorization over the Mid Staffordshire NHS Foundation Trust. In the event of his deciding that continuation of foundation trust is appropriate, the Secretary of State should keep that decision under review.

This recommendation would entail a number of advantages. First, in the event that the hospital is still authorized, then staff and management are likely to institute measures to ensure quality delivery of services since they will be acutely aware that they are under scrutiny. Because of this, the management is likely to re-examine its earlier approach with a view to retooling the strategies. They will therefore consider a SWOT analysis methodology in configuring their plan of action. SWOT has been defined by Joss et al (2002) as a useful technique used to comprehend an organizations strengths and weaknesses, as well as for identifying opportunities obtainable and the threats that the organization faces. In the report, there seems to indication that the health facility reviewed its strategies with these facts in mind.

Recommendation 3: The Trust, together with the primary Care Trust, should promote the development of links with other NHS trusts and foundation trusts to enhance its ability to deliver up-to-date and high-class standards of service provision and professional leadership

This recommendation borders predominantly on consultancy and inter-aliases. Inter-disciplinary and consortia networks are important in management and service delivery. Joss et al (2002) observe that such measures provide alternative views that are often times influential in improving services delivery when incorporated. It involves the acquisition of Industry best practices (Francis, 2010b).

Recommendation 4: The trust, in conjunction with the Royal Colleges, the Deanery and the nursing school at Staffordshire University, should review its training programs for all staff to ensure that high-quality professional training and development are provided at all levels and that high-quality service is recognized.

Going by the finding that the clients were largely dissatisfied, the review of training and research should mainly focus on impact evaluation. Joss et al (2002) profoundly assert that impact evaluation is the methodological identification of the impacts and results caused by a program, policy or project including its strategy. These effects, accordingly, could be intended or not; however, the central thrust of impact evaluation is that it aids in an improved understanding of the degree to which programs reach the target group as well as illuminating their effects. Evidently, this seems not to have been taken at the training level, or if it was, then it was not implemented (Francis, 2010b).

Recommendation 5: The Board should institute a program of improving the arrangements for audits in all clinical departments and make participation in audit processes in accordance with contemporary standards of practice a requirement for all the relevant staff. The board should review audit processes and outcomes on a regular basis

Administration of drugs seemed to have been a bottleneck in the report; this was compounded by a lack of follow-up strategies employed by the health facility nurses and the hospital administration at large. One sure way of adopting this recommendation would be to take in the Rapid Appraisal Method, which, according to World Bank (2004), is a faster, reasonably cheaper way of collecting and collating views from the target group as well as other beneficiaries including the stakeholders in response to managements need for valuable data. This way the management of the hospital would be able to adjust and retool their approach to treatment administration follow-ups by patients as well as nurses, and those that oversee this (World Bank, 2004).

Recommendation 6: The Board should review the Trusts arrangements for the management of complaints and incident reporting in the light of the findings of this report and ensure that it:

The report seems to contend that there is general complacency on the part of the staff. This could be because of a deep-seated culture where everybody covers each others back. Therefore, whistle-blowers are seen as betrayers. To correct this, the management should adopt policies, which take into consideration methods that assure confidentiality and deal with blackmail possibilities so that those that would want to volunteer information can do so willingly without fear of intimidation.

Recommendation 7: Trust policies, procedures, and practices regarding professional oversight and discipline should be reviewed in the light of the principles described in this Report.

Disciplinary actions are very important in any organization. It would be important for each of the Trust employees to be compelled to re-read and understand his/her job description. This would keep them on their toes and weed out those that are not performers.

Recommendation 8: The trust and the Primary Care Trust should consider steps to enhance the rebuilding of public confidence in the trust

From the publicity of their failure, public confidence seems to have been lost on the Trust. A good starting point would be to carry out a survey that focuses on the level of public confidence in it. With this, the trust would then institute measures that would win their trust.

Recommendation 9: All NHS trusts and foundation trusts responsible for the provision of hospital services should review their standards, governance, and performance in the light of this report.

A benchmark for delivery will be important in ensuring and defining the course of the hospital operations.

Those responsible for the Hospital failures

These should include almost everybody; the department of health, the patients themselves, the staff, the Board of Directors and Management (Francis, 2010a).

Way by which the management could have better organized their many performance measurements

The management ought to have better organized their many performance measurements in a number of ways: These include.

Use of Performance Indicators

Simply defined, performance indicators refer to dimensions that appraise inputs, outputs, processes, as well as the results for projects or strategies. These indicators usually enable managers to trail progress, reveal results, and take remedial exploits to improve service delivery. For instance, the contribution of key stakeholders in defining indicators is important because they are then more likely to appreciate and use indicators for management decision-making (World Bank, 2004).

The reasons for using them vary, but mainly they are meant to help in the location of performance targets and evaluation of their attainability. In addition, they are important for pointing out problems through an early caveat system to allow corrective action to be undertaken, and more so indicating whether an in-depth assessment or analysis could be required (Greasley, 2009).

The Logical Framework Approach

LogFrame has been defined as that which helps to clarify the goals/objectives of a project, policy and program. It helps in the identification of inputs, processes, outputs outcomes, and impacts. Ideally, it leads to the identification of performance indicators at each stage in this chain, as well as risks, which might impede the attainment of the objectives (World Bank, 2004). Moreover, it is a mode of engaging partners in illustrating objectives and crafting activities. During implementation, the Log frame serves as a useful tool to review progress and take corrective action (World Bank, 2004).

Rapid Appraisal Methods

These are seen as a quick, low-cost way to gather the views and feedback of beneficiaries and other stakeholders, in order to respond to decision-makers needs for information (World Bank, 2004). It has several strong points including the provision of quicker data for decision making which is effective and efficient.

Key Stakeholder Groups

These include the government (particularly, the Department of Health), the Trustees of the Foundation, the patients/clientele group, the organizations staff/employees, the Health Facility Board of Directors, the donors and the United Kingdom Health Commission (Francis, 2010a).

Lessons for the management and Government

From the above recommendations, the management and government can derive valuable lessons. First, there is a need for continuous assessment of health facilities to ensure that they are working all the time and are efficient. Secondly, they need to review patient satisfaction, especially by carrying out impact assessments from time to time. Thirdly, the management and government should review policy interventions in favor of standardized policies in service delivery. Fourth, there is a need for stringent adherence to strict Monitoring and evaluation methodologies. Lastly, there is a need for stringent inspections and evaluation of health facilities before the issuance or renewal of operating licenses.

Reference List

Care Quality Commission. 2009. Care Quality Commission publishes progress reports on Mid Staffordshire NHS Foundation Trust. Web.

Francis, R., 2010a. The House of Commons Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust, Volume.1. HMSO: Her Majestys Stationary Office. Web.

Francis, R., 2010b. Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust Report, Volume.2. HMSO: Her Majestys Stationary Office.

Greasley, A., 2009. Operations Management. Second edition. Chichester: John Wiley & Sons.

Joss, S. et al. 2002. Clients First: A rapid Market Appraisal Tool Kit: Experience and Learning in International Corporation. Helvetas Publications No. 3. Web.

World Bank. 2004. Monitoring and Evaluation: Some Tools and Approaches. Washington D.C: World Bank. Web.

The article by Colin-Thome (2013) addresses the UKs clinical governance through the perspective of the newly reformed National Health Service (NHS) commissioning. The author provides a detailed description of the history of clinical governance that prioritized different aspects of healthcare at different times. As the researcher proceeds to discuss the contemporary issues related to commissioning and clinical governance in the context of the NHS reforming, he identifies inaccuracies, obstructing factors, and other problematic issues.

The author of the article sets a well-articulated context for the problem discussed in the publication. Indeed, the understanding of the developmental path of the UKs NHS allows for a more informed analysis of the currently applied improvements. Overall, clinical governance as a concept is aimed at the improvement of the overall healthcare system by providing the conditions for high-quality patient care through physicians professional advancement (Colin-Thome, 2013). While commissioning plays a significant role in the implementation of the core principles of clinical governance, the author reports on multiple drawbacks in the practical side of the process. However, although the article presents multiple accusations of ineffective implementation of clinical governance, it fails to provide recommendations for improvement or any guidance on drawbacks elimination. The researcher mentions more successful European and American systems that function more efficiently, but he does not explicitly explain how that experience might be introduced to the UK context.

Overall, the article is an analysis-based review of the observed process of the implementation of clinical governance practices in the UK. It accumulates critically important information on the importance of aligning commissioning practices with the ideas of clinical governance aimed at improved patient care, as outlined in the reform. Most importantly, the author concludes that a self-monitoring culture within the healthcare system should remerge in order to ensure the functionality of commissioning and proper clinical governance. However, the author is very implicit concerning the solution to the problem. Also, the article lacks factual, evidence-based support emphasizing the problems to which the author refers.

The article by Spigelman and Rendalls (2015) presents the results of a non-systematic literature review of the publications related to clinical governance in Australia. The authors integrate the findings from various literature sources to enlist all the issues and characteristic features related to the current state of clinical governance in the country. Thus, the article is aimed at generalizing the scope of issues characterizing Australian clinical governance to ensure informed decisions for further development by means of eliminating the difficulties.

The authors present a broad overview of the manifestations of clinical governance across different territories and types of care. A particular strength of the conducted research is the inclusion of the interviews with key stakeholders who provide accurate first-hand information on the real problems. Given the complexity of the healthcare jurisdiction system and the complexity of Australian demographics and geography, the implementation of clinical governance is challenging. Such an imbalance in jurisdictions responsibilities and distribution of responsibilities for care provision induces financial imbalance and higher cost of health care services (Spigelman & Rendalls, 2015). The array of identified problematic issues includes demographic and geographic variations that cause fragmentation in healthcare delivery, as well as management and the overall quality of care.

In summation, the article is strong research that provides a validated and well-articulated list of current issues that Australian clinical governance faces. However, despite the overview of the problematic issues, the guidance for improvement is very theoretical. Indeed, the suggestion for improvement of the functionality of clinical governance is articulated in the form of recommendations for the direction of improvement without practical solutions. Nonetheless, the work done by the researchers is a valuable basis for further search for the solution and development of practical steps toward the improvement of clinical governance.

References

ColinThome, D. (2013). Development opportunities in the new NHS for personal, population and system care. Clinical Governance: An International Journal, 18(2), 617.

Spigelman, A. D., & Rendalls, S. (2015). Clinical governance in Australia. Clinical Governance: An International Journal, 20(2), 5673.

Introduction

Leadership can either make or break the success of an organisation. Priorities that leaders have towards the achievement of organisational goals influence both the followers and the organisation’s reputation. Companies have adopted various theories of leadership such as contingency hypothesis, transformational theory, situational theory, and path-goal theory. Working from a particular theory dictates the principles and values that the leadership upholds. This paper seeks to analyse the issues at Mid Staffs (Trust). The aim is to give an insight on principles and theories of leadership that the institution applies. The analysis further recommends the best practice theory and principles that can help the organisation out of the problem.

The History of Governance Crises at Mid Staffs

The history of the governance crises at Mid Staffs can be traced back to 2004 when the Trust lost the star rating (Duffin 2010). The commission for health Improvement (CHI) reported a drop in rating standards of the Trust. According to Carter (2013), the 2004 report indicated that the Trust had dropped from the three-star status to the zero status. Dean (2011a) points to the fact that the drop in rating was attributed to the Trust’s failure in meeting the set targets in elective surgery, waiting time for cancer, poor financial performance, and the time that patients took while waiting. Triggle (2014) observes that since the Staffordshire Health Authority (SHA) depended on the star rating in measuring its service quality, the Trust set up a plan to recover the star rating. However, officials in the plan were not concerned. They assumed that the drop in rating was attributed to bad record keeping. Officials then relied on a balanced scorecard foregoing the star rating. This ought to have raised an alarm. Secondly, Duffin (2010) observes that in 2005 and 2006 peer reviews highlighted several intriguing concerns that indicated that there was a problem with the ability of the Trust in service delivery.

The reviews also indicated that the management of the Trust was incompetent. Thirdly, Carter (2013) observes that HCC national review indicated that the Trust failed to meet patient and Trust expectations in 2006. In an effort to compromise this situation, the Trust claimed that inability to meet public and patients expectations was caused by non-submitted data. Fourthly, according to Dean (2014), auditor reports indicated major shortcomings in risk management by the Trust. The report indicated that the accuracy and dependability of Trust’s assurance were questionable. The implication of this situation was incompetence of the management. Fifthly, Iven (2010) affirms that surveys by Picker Institute in 2007 confirmed that the Trust was among the 20% worst performing category in the country. Sixthly, in 2007, a whistle blowing report by the staff nurses on leadership was made. However, the Trust management did not resolve the issue at hand. The Royal College of Nursing (RCN) failed to inform the management of the Trust officially. In addition, Dean (2014) reveals how a 2007 report by Royal College of Surgeons (RCS) termed the surgical department of the Trust as dysfunctional.

However, this claim did not awaken the action of regulators. Moreover, the Trust had started a staff cut. Authorities did not question the impact of such a move on service quality. Ignorance of actions that were being undertaken by the Trust resulted in escalation of the problem. Application for Foundation Trust (FT) by the Trust focused on financial status rather than quality. This plan formed another loophole for identification of the escalating quality standards in the Trust. The officials of SHA that was promoting the status of the Trust were aware of the problem of quality and poor management. However, they ignored the case. According to Iven (2010), the pursuit of the promotion of the Trust was therefore made based on finance but not on complete analysis of status. This observation meant that quality and leadership problems in the Trust would not be addressed. Finally, according to Bruce (2013), the background of the problem of Staffordshire Trust is also attributed to the HCC investigation report. This report was accused of being selective. It only addressed the most serious issues in the Trust. This caused laxity in other organs in the Trust that relaxed waiting for the investigator to point at issues that were more important relative to others and/or issues that warranted action. This move resulted in confusion and further escalation of the problems that the Trust was facing.

Kaufman and McCaughan (2013) assert that the impact of all actions was the development of negative culture in the Trust. Since the management did not act swiftly on the arising problems, employees developed laxity. They did not care reporting the problems or raising alarm. For example, according to Hamilton (2013), leaders of Stafford Trust did not appreciate the problems that the Trust was facing, thus resulting in more escalation. Professional disengagement also resulted from failure of the board and the leadership to pursue change. For example, clinicians in the Trust approached the problems they faced with little efforts. Gilam (2013) confirms that employees and management worked from different approaches, a move that attracted conflict and lack of teamwork. The Trust also began facing complaints from customers. Patients complained that leaders and clinicians did not listen to them. Gilam (2013) says that the Trust did not put mechanisms to resolve customer complaints.

Disconnection between the board and clinicians denied the management understanding of what was happening to patients. This scenario worsened the situation. Moreover, poor governance also resulted from the gap between the management and clinicians. According to Bassett (2012), the Trust board failed to account and/or govern the structure of the organisation during the founding years of the problem between 2004 and 2005. Dean (2011b) observes that the board and clinicians delayed in assessing and acting on major risks, for example in addressing the problem of inadequate skilled nurses. Finally, the outcome of shortcomings in the Trust also compromised the standards of nursing and performance of health workers. Poor recruitment, training, and equipping of nurses were evident in the Trust. The situation resulted in poor service delivery.

Analysis of Governance and Leadership Issues

Governance and leadership issues are at the heart of the failure of the Staffordshire Trust. One of the governance issues that come out clearly is development of a negative culture in the organisation. According to Triggle (2013a), the leadership of this Trust had access to various warning signs concerning failure of the Trust to meet quality standards and/or to meet patients’ complaints. However, the leadership department decided not to act on the problems or underrate their significance by concentrating on other issues such as finance. Kaufman and McCaughan (2013) affirm that leadership has a role in cultivating and developing the culture of an organisation. The leaders should have cultivated a culture of openness and sensitivity to issues of quality. The principle of quick response to issues would have ensured no piling up of problems to the extent of shocking the government and public.

Another leadership issue that comes out clearly in this report is the failure of the leaders and board to listen to patients’ issues. Dean (2009) asserts that it is evident that leaders of this Trust had a poor culture of ignoring the views and complaints of their clients. In fact, the management never established structures of dealing with patients’ complaints. Triggle (2014) confirms that several surveys were conducted on patients and employees of the Trust. The results showed that patients were dissatisfied with the management of the Trust. However, in spite of having access to such reports, the management did not act. Clients of any organisation make the organisation remain in business. Paying less attention to their views portrays a culture of ignorance and inverted priorities in the Trust. The Trust’s leadership ought to have had a strong customer affairs department or structures that would have addressed the issues. As a principle, leaders should listen to their followers and/or act on the problems with diligence.

The issue of leadership disconnection is also demonstrated by the poor way in which the board of management governed the Trust. As Bassett (2012) observes, the report indicates that the board was not accountable to actions that took place in the organisation between 2004 and 2005. For example, the leadership resisted clinical governance that was targeted at improving the Trust’s efficiency by 2009. This move resulted in fear and reluctance by clinicians to report problems to the management. As a result, the leadership did not have access to adequate information about the issues of concern in the organisation (Dean 2009). Leaders should cultivate a culture of openness that allows access to information. They should deploy a two-way communication policy that permeates the leadership structure, thus acting as an antenna to sense information. As a principle, a good leader should be an effective communicator.

Fariha (2013) observes that poor governance was evident in terms of lack of focus on the standards of service delivery in the organisation. The management of the Trust mainly focused on financial gains, thereby ignoring the quality of standards. Greed for monetary gains by the management resulted in poor sensitivity to risky issues of standards. Quality of service delivery appeals directly to the clients. Hence, the management should have prioritised it. In addition, Parish (2013) affirms that although the management concentrated its efforts on finances, the Trust was one of the worst financial performers in the country. This observation is an indication of the inability of the board to govern in the leadership. The board also imposed certain economies to the organisation that failed to flourish. The governance principle of foresight was evidently absent in the board.

According to Triggle (2013b), the management also failed to maintain good nursing standards and performance. Poor management of staff policies in the Trust resulted in poor nursing services in the wards. Triggle (2013b) reveals that nurses were inadequate to attend to patients. Besides, they were poorly trained on handling of patients. Therefore, they made the whole system seem to have failed. Leadership is in charge of recruiting the most qualified and equipped employees. It is also the responsibility of the management to ensure employee growth through training and workshops. However, the board of management at Staffordshire failed. Dean (2011b) observes that although nurses reported the problems they faced in the wards, the leadership did nothing to salvage the situation. This case resulted in unmotivated nurses as indicated by the findings of several surveys in the report. Finally, Dynil (2013) observes that the leadership completely failed in goal setting. Prioritising of issues seemed to defeat its competence. For example, the board prioritised financial stability and/or gaining of a foundation status whilst ignoring the most important issues such as quality of service and patients. This observation was a complete lack of foresight in the leadership. Gormley (2010) asserts that governance principles of charisma and involvement of followers were less observed by the management. Hence, the disconnection between them and the nurses resulted in failure of the whole system.

Theories of Leadership

Various leadership theories can be associated with the leadership in Staffordshire Trust. One of such theories is the contingency theory of leadership. According to the theory, there is no one best way to lead an organisation, to organise it, or even to make decisions since decisions are made according to the state of affairs (Tyssen, Wald, & Spieth 2013). In contingency leadership, actions that the leadership takes are fully dependent on the available internal and external environment (Wooton 1977). In the Staffordshire Trust, the board of management seems to be operating based on this theory. For example, Latham (2014) observes that the management appreciates the need for the Trust to acquire the foundation’s status. The appreciation makes the institution fully focused on factors that will enable it succeed at the expense of all other affairs of the organisation. The management department ensured that financial positions would enable it to get this position. It even took action to cut staff nurses, thus leaving inadequate staff members to attend to patients in the ward. The board of management also paid lip service to clients and employees that it would manage the situation but immediately focus attention on finances. According to Malik (2012), this contingent approach followed the wrong priorities. The management also failed to make decisions early enough concerning how to solve its problems. For example, it was not able to predict the consequences of failing to act on patients and employee complaints. According to a survey by McClesky (2014), it was indecisive in terms of acting as evidenced by the low employee morale.

This situation was attributed to the assumption in the contingent theory that no best way could be adopted to make decisions since such decisions had to be made according to the environment or issue at hand. Triggle (2013c) affirms that the management of the Trust handled decisions wrongs. Failure of the applicability of this theory in leadership could be attributed to the poor relationship that existed between the leaders and members (Malik 2012). For example, poor relations between the board of management and the clinicians resulted in poor information flow. Sprinks (2010) asserts that the relationship between the leaders and the nurses was also a cause of failure. Success of the contingency theory also depends on how well the task is structured. In this case, the work of the nurses and clinicians was well established. However, the leadership failed in facilitating them. As a result, the Trust suffered poor communication. Wooton (1977) also confirms another determinant of success in the contingency model of leadership, namely leaders’ position power. In this case, leaders of the Staffordshire Trust were well empowered by the Trust’s policies. However, their pursuit for finances and foundation status made them fail to lead the institution towards success.

Another leadership theory that is applicable in this situation is the path-goal theory that was developed by Robert House (1971). According to the theory, followers will only be satisfied with a leader when they feel that his or her behaviour will lead them to their contentment. In this theory, satisfaction of the subordinates is only achieved if they feel that their leader supports them in their efforts to achieve individual and organisational goals. According to Tyssen, Wald, and Spieth (2013), the path-goal theory further affirms that if goals are understandable, there will be less need for guidance from the leader. In the case of the Staffordshire Trust, the subordinate staff members were not satisfied with the behaviour of the leadership. For example, Gormley (2010) observes how clinicians complained about poor working conditions to the management. Besides, little was done to solve their complaints. In the same case, nurses reported their dissatisfaction with the management of the Trust in different survey reports, although the management did not act on their complaints. Dean (2010) mentions that although the goals of the nurses and that of clinicians may have been clearly set in their job structures, the leadership failed to enable their accomplishment. Sprinks (2010) reveals how the board of management did not support the subordinates in achieving their set goals. The behaviour of the board resulted in a culture of employee disengagement. Employees did not bother to report any incident to the leadership since they believed that they would not act. According to Parish (2013), the existence of a divide between leadership and employees resulted in patients’ complaints on service delivery.

Recommendations for the Development of Governance and Leadership in Mid Staffs

Caillier (2014) asserts that transformational leadership theory that was developed by James Macgregor Burns can be used to salvage the situation at Mid Staffs. According to this theory, followers’ morale and motivation can be enhanced in order to instil a sense of responsibility, teamwork, and organisational identity. The leadership acts as role model in the work setting. Followers are motivated through rewards and recognition. Their empowerment is done through allocation of more responsibilities and higher job involvement. Besides, tasks are aligned with their qualifications. Followers are also occasionally trained and refreshed to fit well in their jobs. McClesky (2014) affirms that leadership and governance in Mid Staff can be developed to achieve the goals of the Trust and/or meet employee and patients’ needs. Firstly, the various principles of leadership that the management failed to engage have to be revamped (Kendall 2010). For example, proper communication lines and structures need to be established in the Trust. Communication is at the heart of good governance.

Access to information through open door policy and proper listening ensures that communication between the leadership and employees is successful. The management should not impose its rules and policies on followers. Instead, it should seek their input and act on them. According to Kendall (2010), the problem of employee disengagement can be resolved through the establishment of functional communication in the organisation. The contingency theory that was applied by the management of the trust should therefore be abandoned. Communication between the management and patients also need to be reorganised. In several reports, clients complained of poor governance and services in the Trust. However, the board failed to act on complaints. Successful communication is a two-way process. Hence, feedback is important. Action-oriented leaders will identify themselves with the followers’ needs. The management of Mid Staff failed to connect with its employees and customers. Communication can solve this problem. Dean (2010) asserts that governance principle of valuing the customer should also be prioritised in the organisation. The management of Mid Staff failed to listen to customers, a situation that resulted in a wider cause of alarm in the country. Customers make an organisations remain in business.

The management should therefore be trained on the value of the customer and the importance of listening to them. According to Latham (2014), assessment of risk factors should also be done in advance to prevent loss of money and/or soiling of the institution’s reputation. For example, before staff reduction or enlargement, the board should engage experts on human resource issues. Well-trained and qualified nurses should also be hired to guarantee high standard services. Nurses and clinicians should also be occasionally trained and refreshed in workshops. The standards of service should not be compromised with pursuit of profit. In a health institution, standards are a priority that should be withheld. The Trust should therefore reorganise its priorities. For example, human life is more important than money and status. Transformational leadership will therefore be witnessed if the board of management in the Trust motivates nurses and clinicians. All stakeholders need to work together as a team. This work plan will result in better standards of service delivery and patient satisfaction.

References

Bassett, S 2012, ‘Accountability in the NHS. Accountability in the NHS. Nursing Management, vol. 19 no. 8, pp. 24-26.

Bruce, J 2013, ‘Learning from Tragedy. (cover story)’, Board Leadership, vol. 2013 no.129, pp.1-6.

Caillier, G 2014, ‘Toward a Better Understanding of the Relationship Between Transformational Leadership, Public Service Motivation, Mission Valence, and Employee Performance: A Preliminary Study’, Public Personnel Management, vol. 43 no. 2, pp. 218-239.

Carter, E 2013, ‘An inquiry that’s hard to ignore’, Lawyer, vol. 27 no.11, p. 9.

Dean, E 2009, ‘Mid Staffs nurses asked to give evidence at independent inquiry’, Nursing Standard, vol. 24 no. 3, p.10.

Dean, E 2010, ‘Mid Staffs nurses will have their identities protected by inquiry’, Nursing Standard, vol. 25 no. 13, p. 7.

Dean, E 2011a, ‘Nurses and patients play a part in new start for troubled trust’, Nursing Standard, vol. 25 no. 32, pp.12-13.

Dean, E 2011b, ‘I am deeply sorry, former SHA chief tells Mid Staffs inquiry’, Nursing Standard, vol. 25 no.34, p. 9.

Dean, E 2014, ‘In the wake of the Francis shock wave’, Nursing Standard, vol. 28 no.30, pp.22-25.

Duffin, C 2010, ‘Mid Staffordshire failed to provide children’s basic care’, Paediatric Nursing, vol. 22 no. 3, p. 4.

Dynil, R 2013, ‘The Francis report on the Mid-Staffordshire NHS Foundation Trust: putting patients first’, Transfusion Medicine, vol. 23 no. 2, pp. 73-76.

Fariha, K 2013, ‘Police Examine New Mid Staffs evidence’, New York Times, 8 June, p. 8.

Gilam, S 2013, ‘Guest editorial. The Francis inquiry: a lost opportunity?’, Quality in Primary Care, vol. 21 no. 4, pp. 205-206.

Gormley, L 2010, ‘Webwise’, Nursing Standard, vol. 25 no. 7, p. 30.

Hamilton, J 2013, ‘Clear intent’, Lawyer, vol. 27 no. 10, pp.40-41.

Iven, F 2010, ‘Lawyer of the week’, New York Times, 14 May, p.69.

Kaufman, G & McCaughan, D 2013, ‘The effect of organisational culture on patient safety’, Nursing Standard, vol. 27 no. 43, pp. 50-56.

Kendall, P 2010, ‘Mid Staffs public inquiry invites evidence from health regulators’, Nursing Standard, vol. 24 no. 46, p.11.

Latham, J 2014, ‘Leadership for Quality and Innovation: Challenges, Theories, and a Framework for Future Research’, Quality Management Journal, vol. 21 no.1, pp.11-15.

Malik, S 2012, ‘A Study of Relationship between Leader Behaviours and Subordinate Job Expectancies: A Path-Goal Approach’, Pakistan Journal of Commerce & Social Sciences, vol. 6 no. 2, pp. 357-371.

McClesky, J 2014, ‘Situational, Transformational, and Transactional Leadership and Leadership Development’, Journal of Business Studies Quarterly, vol. 5 no. 4, pp.117-130.

Parish, C 2013, ‘How about valuing people now?’, Learning Disability Practice, vol. 16 no. 2, p. 3.

Sprinks, J 2010, ‘Mid Staffs prepares for media onslaught on eve of next inquiry’, Nursing Standard, vol. 25 no. 8, p. 11.

Sprinks, J 2011, ‘Many of the failings at MidStaffs are evident in the NHS, says CNO’, Nursing Standard, vol. 26 no. 2, p. 7.

Triggle, N 2013a, ‘Warning signs were ignored,’ says Francis’, Nursing Management, vol. 19 no.10, p.4.

Triggle, N 2013b, ‘Francis report blames NHS for putting costs before patient care’, Nursing Children & Young People, vol. 25 no. 2, p. 7.

Triggle, N 2013c, ‘Francis report recommends creation of registered role’, Nursing Older People, vol. 25 no. 2, p. 5.

Triggle, N 2014, ‘Staff survey: encouraging, but still areas of concern’, Nursing Management, vol. 21 no. 1, pp.10-11.

Tyssen, A, Wald, A & Spieth, P 2013, ‘Leadership in Temporary Organisations: A Review of Leadership Theories and a Research Agenda’, Project Management Journal, vol. 44 no. 6, pp. 52-67.

Wooton, L 1977, ‘The Mixed Blessings of Contingency Management’, Academy of Management Review, vol. 2 no. 3, pp. 431-441.

Introduction

In England, the National Health Service (NHS) is in charge of offering high quality free medical care and regulating most of the facilities for health care provision. There are thousands of people working in the organisation. They are the core resources that enable NHS to achieve its objectives. In addition, the quality of service delivery by any particular unit of NHS or the entire national organisation depends on the delivery care to patients (The NHS Confederation 2008). Thus, when patients complain of poor services in hospitals, they directly imply that NHS is not performing its duties as prescribed in its mandate and organisational objectives (Silvester et al. 2004).

It is hard to benchmark quality delivery and stakeholder satisfaction in health care delivery. One reason for this is that health care is a continuous service and cannot stop for the sake of making a review and a report. Secondly, there are different aspects of health care interaction with different stakeholders. These aspects occur simultaneously, such that it is possible to highlight a line of service delivery, but impossible to isolate it from influences of other lines of service delivery (Silvester et al. 2004).

This paper provides a history of governance crises at Mid Staffordshire, UK, also referred herein as Mid Staffs. The case is about health care governance failures measured by minimum patient safety and quality standards. The paper also reviews the principles of governance and theories of leadership in discussing the case and recommending a governance solution.

History of governance crises at Mid Staffs

Parliamentary reports of the health conditions between 2005 and 2008 for Mid Staffs hospital services were negative. They highlighted the governance problems of the board in charge of the service delivery. As a remedy, changes happened to replace the board with the Mid Staffordshire General Hospital NHS Trust. Before the appointment, the Trust went through necessary scrutiny by the Department of Health and the local Strategic Health Authority. Other public committees were also involved in the vetting process. They rated its risk management abilities and checked for any systematic failures of the trust. There were none identified. The Trust’s conduct and capabilities were above board, based on the common review standards (UK Parliament 2013).

It was in the Trust’s management and leadership that troubling evidence was found. High mortality rates highlighted by a group of patients indicated that hospitals were not taking care of patients as they were supposed to. The blame lay with the Trust’s management (UK Parliament 2013).

After a parliamentary inquiry, there was evidence to show that the external organisations that were in charge of overseeing the operations of the Trust did not detect anything wrong, when clearly there was something wrong happening. There was a systemic failure promoted by the blinded review and oversight given by organisations, such as the Healthcare Commission. The failure was at the national and the local oversight levels (UK Parliament 2013).

From conventional practices of health care, which are in line with best practices of quality management, multiple oversight opportunities are supposed to ensure that there is enough information collected about the quality of service delivery. The information should then be the basis for future regulatory decisions and policies to increase benefits to patients and other stakeholders throughout the country (UK Parliament 2013; Genovese 2014).

The following were the recommendations adopted to improve the delivery of health care as a public service after a parliamentary inquiry into appalling health care status at Mid Staffordshire. First, there would be an examination of what commissioners, supervisors, and regulatory bodies did or failed to do to perpetuate the failure of quality service delivery (UK Parliament 2013). Secondly, there would be an identification of recent changes to improve the situation, which would include the agreement between the Monitor and the Care Quality Commission so that the processes of identifying hospitals became open. There would also be a review of the necessary improvements needed in the scrutiny mechanism and the availing of resources to support governors in charge of the Foundation Trust (Silvester et al. 2004).

The disaster happened in an NHS acute hospital provider trust. This is one of the trusts that are supposed to have a very high level of quality threshold, in both health care and governance standards (UK Parliament 2013). It is also worthy to note that the regulator of health providers in primary care is the same for both public and independently funded care providers. Thus, the policies implemented by the regulator are aimed at providing a common working regime for both kinds of providers (WHO 2014).

In the Mid Staffordshire hospital, patients and their families felt excluded from the process of care delivery. They could not take part in the patient’s care, even though they were the most likely to suffer from the loss of patients’ lives (UK Parliament 2013). The Community Health Councils (CHCs) worked well, but their replacements after reorganisations in the health care industry became ineffective. Unlike the CHCs, which were professional bodies, their replacements were individual volunteer groups that lacked a formal channel of collection and expression of views to implement regulations and enact policy changes (UK Parliament 2013).

There were multiple routes for patients to feed comments into health services and seek accountability, but the routes were ineffective in the Mid Staffordshire case (UK Parliament 2013). In addition, most of the feedback to the health care service organisations or the relevant public management watchdogs like parliament went unheeded, partly due to the lack of expertise and partly due to the lack of a defined issue resolution framework that would be effective for the case (Chau & Kao 2009).

Analysis of Issues around Governance and Leadership

Key principles of governance and their relation to the case

Governance relates to the way individuals or a group works collectively with the goal of ensuring that an organisation remains legally and morally upright. Usually, the group is legally constituted as a board or a trust to perform the governance tasks. Therefore, the board in such as health care organisation would be accountable to the constituents for the fulfilment of the organisation’s mission (Calder 2008; Nwagbara 2010).

The governing board is different from the managing group because of two major issues. First, the governance team establishes policies for its operations, such as rules for board meetings. Secondly, it focuses on strategic issues of running the organisation effectively, rather than concentrating on routine matters. In comparison with the case, it implies that the Trust put in charge of handling the hospitals in Mid Staffordshire was in charge of coming up with appropriate ways of handling its affairs in ensuring its success. Secondly, it was to concentrate on serving the strategic interest of health care facilities under its regulatory authority. Thus, it should have been keen on checking for the effect of policy and general conduct of hospitals. In the case of health care, the most basic result is the patient outcome after hospitalisation (The NHS Confederation 2008).

The effectiveness of the board or the Trust lays in the skills and experiences of its constituent members and any available oversight. Given that the board has self-governance privileges, it has to embrace regular monitoring and evaluation of its own performance and evaluate the individual contribution of all of its members (Scouller 2011).

When board members have extensive experience, they can make decisions concerning the strategic directions of their organisations (Strang 2005). However, extensive experience also fixes the particular member to the intricate details of day-to-day management of the organisation and can be a cause of extensive interference with management activities (Calder 2008). Corporate governance code advises boards to remain independent of management duties. At the same time, it is important for boards to have a long-term view of the organisation. It is not appropriate to rely on short-term goals, as they can fool the board into thinking that it is heading the organisation in the right direction, when it is not (Health Resources and Services Administration 2010).

In the case of Mid Staffordshire, the governance Trust was keen on meeting the necessary benchmarks for quality management, as set by its oversight authority. However, the results of its governance show that it must have neglected the need to look beyond results and considered their organisational implications in the end (Bamford & Chatziaslan 2009). If the Trust had this strategic concern, it would realise that missing some key indicators of quality performance would eventually hurt the organisation’s mandate of delivering quality service, measured in terms of patient outcomes from hospitals (Bernad 2014).

Boards or governing trusts need diversity in their membership to prevent the effects of groupthink (Chahal et al. 2008). Principles of good governance call for leadership, which implies the provision of direction, mentorship, oversight, advice, and analysis (Chahal & Eldabi 2011). The governance team must also have the capacity to meet its obligations, which entail the right mix of skills, experiences, and independence to avoid problems highlighted above and those witnessed in the Mid Stffordshire case (Bean 2009; Wildes 2008).

Above all else, accountability is important, not just for the sake of filling out reviews that are long forgotten after the process. Accountability in this case is about meeting the needs of stakeholders in a regular interval, based on a fair, balanced, and understandable assessment (Martin et al. 2013; Ogbonna & Harris 2011). In comparison to the case, the Trust at Mid Stffordshire hospital case was accountable. It answered to several local scrutiny bodies and was subject to reporting to the NHS. However, the accountability was not reflective of the Trust’s comprehensive purpose, which was to ensure that patients received high quality medical care (UK Parliament 2013).

Another principle of good governance is sustainability. The governing team needs to create value and allocate the value fairly and in ways that service both short-term and long-term needs. It has to reinvest and distribute gains to all stakeholders. The Mid Stffordshire Trust needed to look at the patients’ welfare, their families, the workers at the hospitals, the community interest groups concerned with health care, and any other group qualifying as a stakeholder. Ignoring the families of patients was not a sustainable way to run the Trust’s affairs.

Lastly, integrity as a principle calls for fairness and transparency, as it is the basis of having oversight authority. As much as the Mid Stffordshire Trust answered to its appointing authorities about its work, it failed in the integrity test because it did not answer to all the stakeholder groups. It did not learn about the interests of the stakeholders and come up with feedback reports to show what it was doing to address their concerns. This explains why, despite reporting to the NHS as standard practice, appalling health care results persisted in acute level hospitals under the regulation of NHS in Mid Stffordshire.

Theories of leadership and their relation to the case

Governance requires leadership, thus it is important to review the theories of leadership to build an understanding of a governance case and to come up with best practice recommendations effectively. Leadership theories fall into four main groups, namely trait theories, behavioural theories, contingency theories, and power and influence theories. The first one looks at the characteristics of a person, which make him or her good leader. Given that they are based on personalities, the theories would be most applicable when reviewing the conduct of individual Trust members independently and assessing their contribution to the overall achievement of the trust. At the same time, it can be useful for looking at the Trust as a unit with human characteristics, such as discipline and empathy, to review its performance.

Behavioural theories are concerned about the actions of leaders and can be broken down into autocratic leadership behaviours, democratic leadership behaviours, or laissez-faire leadership behaviours. The background discussion of the Mid Staffordshire case shows that the Trust’s leadership style was autocratic. The Trust made decisions, but it did not rely on input from other stakeholders. This method of leadership was good because it would allow the Trust to avoid associated bureaucracies of dealing with different stakeholders when coming up with policy changes at its level of jurisdiction over hospitals.

Although a particular style of leadership is ideal for particular situations, not all styles would be appropriate when used exclusively. Thus, a combination of different styles is important with regard to both personality traits theories and behavioural theories of leadership. A salient issue with the application of leadership is that there should be adequate knowledge of situational parameters and the application of the correct style to achieve a given outcome. Review and feedback help to keep the leadership grounded on the right strategy at all times.

In light of the above consideration about the absence of good leadership traits or behaviour, the contingency theories step in to resolve the impasse and provide an applicable solution. The theories first assert the unavailability of a correct leader. Therefore, instead of explaining the right leader, the theories provide guidelines for leadership qualities that are appropriate for a given situation (Harris 2009).

Stakeholder interests and knowledge, as well as available information inform the analysis of the right leadership style. A given style would suit quick decision making, while another would remain appropriate for lengthy deliberations and the need to find common grounds. Examples under the contingency theories’ category are the Hersey-Blanchard situational leadership theory and the path-goal theories (Lussier & Achu 2010). As the names suggest, each tries to find an accommodative solution for leadership to suit the capabilities of leaders and the interests of the organisation, as prescribed by stakeholders (Fyke & Buzzanell 2013).

The path-goal theory identifies many potential ways to a goal, but it realises that only one will suit the stakeholders’ interest. Therefore, after acknowledging an interest, leadership has to invest in the identification and pursuit of the right path to the intended goal. From the Mid Staffordshire case, it is apparent that the Trust was pursuing a different path to the goal of quality health care delivery (Harris 2009). It failed to clear away obstacles to improve performance. As discussed earlier in the paper, the biggest obstacle for the Trust was the disregard for information from the patients and their families as the key stakeholders (Lussier & Achu 2010).

Leaders may need to use power and influence to enforce changes (Natale, Sora & Kavalipurapu 2004). Boards of governance have the necessary power to show the direction of their organisations. That is why they are held responsible for the achievement of the organisational goals (Duff 2013). Based on the power and influence theories, appropriate leaders use the power created by legitimacy, reward, or coercion, in addition to the power created by expertise and referrals. As the mandated authority for delivering health care in Mid Stffordshire, the Trust had to become transformative, instead of just complying with routine steps of a governing board (Daft 2011; Deering, Dilts & Russel 2003).

A fundamental failure in the leadership team at the trust was the failure to consider the motivations for different routines and to evaluate their relationship with the delivery of stakeholder interests (Eisenbeiss 2012). It should have realized that routine reporting and scrutiny were meant to limit the repeat of known governance problems (Beerel 2009). However, the Trust did not pre-empt future problems that were unique to the present knowledge. It should have, instead, focused more on collecting feedback and increasing its knowledge of the organisation under it to not only serve as the leading authority in the health care quality delivery matter, but to also inform its strategies to make better improvement decisions (Buschman 2013). According to the case, the local general practitioners only expressed substantive concern when there was external scrutiny, yet this should have been a normal behaviour had the Trust criticized its own leadership (Martin et al. 2013).

Recommendations for the development of governance and leadership in Mid Staffs

Every leadership theory when applied in isolation will seem to fit the Mid Stffordshire case. However, after looking at the case parameters, the following is the approved leadership proposal that should ensure a high and appropriate governance system is in place. It is appropriate to look at situation-independent qualities of leadership as fundamental causes of the problem, given that there were adequate checks and balances in place and still the deficiencies of the health care system at Mid Stffordshire became known. It is also important to look beyond personalities, as the Trust and the overseeing authorities provide leadership based on systems and consist of diversified membership backgrounds (Bertocci 2009).

The eligibility criteria for the Trust were loosened, which made it possible for a relatively less competent team to take over governance of the Mid Stffordshire hospitals. Had there been a thorough scrutiny of the minimum patient safety and quality standards, there would be enough evidence to deny the Trust the governance mandate over hospitals. The above gaps point towards an institutional leadership failure caused by insufficient criticism. A reactive leadership approach would, therefore, suffice to remedy the situation.

The path goal theory recommends supporting leadership, where the creation and improvement of relationship between leaders, followers, and stakeholders is the main goal. However, for unstructured projects, such as the one of leading hospitals in care delivery as a mandate of the Trust in the Mid Stffordshire case, directive leadership would be appropriate because it communicates goals and expectations.

Judging from the notes about the formation of the Trust, it is apparent that the team had adequate experience in health care matters for it to pass the vetting process for appointment. A participative leadership form would ensure that the Trust works closely with the workers in hospitals to identify problems that would be overlooked by the systemic criteria of evaluating work performance in the hospitals. It would work closely with the management to understand arising problems they face that would be unique to Mid Stffordshire or a particular hospital.

Therefore, this paper recommends a governance system that follows the path-goal theory of leadership, as it will remain responsive to arising problems and provide room for internal scrutiny about the mechanisms currently in use.

Conclusion

The basis of this paper was to discuss the Mid Stffordshire hospital health care delivery failure case and then use that as a basis for coming up with an appropriate advice on appropriate ways of reforming governance. To achieve the objective, the case reviewed the principle of good governance and literature on leadership theories. As it did so, it maintained a relationship with the case by linking theoretical underpinnings with the observable characteristics from the case. Lastly, the paper recommended the path-goal leadership system as the best for governance for its responsiveness and situation independence, which make it applicable to the governance of institutions with varied functions like the NHS.

Reference List

Bamford, D & Chatziaslan, E 2009, ‘Healthcare capacity measurement’, International Journal of Productivity and Performance Management, vol 58, no. 8, pp. 748-766.

Bean, J 2009, Lessons in leadership, Linus Publications, New York, NY.

Beerel, A 2009, Leadership and change management, Sage Publishing Ltd, London.

Bernad, E 2014, The politics of Canada’s health care system, Harvard Trade Union Program, Cambridge, MA.

Bertocci, DI 2009, Leadership in organizations: There is a difference between leaders and managers, University Press of America, Lanham.

Buschman, J 2013, ‘Organizational culture, political fallout’, The Journal of Academic Leadership, vol 39, pp. 357-359.

Calder, A 2008, Corporate governance: A practical guide to the legal frameworks and international codes of practice, Kogan Page, London, UK.

Chahal, K & Eldabi, T 2011, ‘Hybrid simulation and modes of governance in UK healthcare’, Transforming Government: People, Process and Policy, vol 5, no. 2, pp. 143-154.

Chahal, K, Eldabi, TJT, Fowler, JW & Ingalls, RG 2008, ‘Applicability of hybrid simulation to different modes of governance in UK healthcare’, Winter Simulation: Proceedings of the 40th Conference, (WSC ’08), pp. 1469-1477.

Chau, VS & Kao, Y-Y 2009, ‘Bridge over troubled water or long and winding road?’, Managing Service Quality, vol 19, no. 1, pp. 106-143.

Daft, RL 2011, Leadership, 5th edn, South-Western Cengage Learning, Mason, OH.

Deering, A, Dilts, R & Russel, J 2003, ‘Leadership cults and cultures’, Leader to Leader, vol 28, pp. 36-43.

Duff, AJ 2013, ‘Performance management coaching: Servant leadership and gender implications’, Leaddership & Organiziation Development Journal, vol 34, no. 3, pp. 204-221.

Eisenbeiss, SA 2012, ‘Re-thinking ethical leadership: An interdisciplinary integrative approach’, The Leadership Quaterly, vol 23, pp. 791-808.

Fyke, JP & Buzzanell, PM 2013, ‘The ethics of conscious capitalism: Wicked problems in leading change and changing leaders’, Human Relations, vol 66, no. 12, pp. 1619-1643.

Genovese, MA 2014, Building tommorows leaders today, Routledge, New York, NY.

Harris, A (ed.) 2009, Distributed leadership: Different perspectives, Springer, London.

Health Resources and Services Administration 2010, The registered nurse population: Findings from the 2008 national sample survey of registered nurses, U.S. Department of Health and Human Services, Washington, DC.

Lussier, RN & Achu, CF 2010, Leadership: Theory, application & skill develoment, South-Western Cengage Learning, Mason, OH.

Martin, GP, Leslie, M, Minion, J, Willars, J & Dixon-Woods, M 2013, ‘Between surveillance and subjectification: Professionals and the governance of quality and patient safety in English hospitals’, Social Science & Medicine, vol 99, pp. 80-88.

Natale, SM, Sora, S & Kavalipurapu, S 2004, ‘Leadership in teams: managerial responses’, Team Performance Management, vol 10, no. 3/4, pp. 45-52.

Nwagbara, U 2010, ‘Managing organizational change: Leadership, Tesco, and Leahy’s resignation’, E-Journal of Organizational Learning and Leadership, vol 9, no. 1, pp. 56-79.

Ogbonna, E & Harris, LC 2011, ‘Leadership style, organizational culture and performance: empirical evidence from UK companies’, The International Journal of Human Resource Management, vol 11, no. 4, pp. 766-788.

Scouller, J 2011, The three levels of leadership: How to develop your leadership presence, knowhow and skill, Management Books 2000, Cirencester.

Silvester, K, Lendon, R, Bevan, H, Steyn, R & Walley, P 2004, ‘Reducing waiting times in the NHS: Is lack of capacity the problem?’, Clinician in Management, vol 12, pp. 105-111.

Strang, KD 2005, ‘Examining effective and ineffective transformational project leadership’, Team Performance Management, vol 11, no. 3/4, pp. 68-103.

The NHS Confederation 2008, The NHS handbook 2008/2009, The NHS Confederation, London.

UK Parliament 2013, Report of the Mid Staffordshire NHS Foundation Trust public inquiry, The Stationery Office, London.

WHO 2014, Public health and environmental health topics, Web.

Wildes, VJ 2008, ‘How can organizational leaders really lead and serve at the same time?’, International Journal of Contemporary Hospitality Management, vol 20, no. 1, pp. 67-78.

Introduction

The National Programme for IT was launched in 2002 by the National Health Service to reform how NHS used information (Burr 2008, p. 2). According to Nieuwenhuizen and Erasmus (2007, p. 45), information is very critical at institutions of health. Cases where doctors repeat medications that a patient has already received are common when the concerned doctors are not able to share data. It is also common to find cases where attending to a patient’s need takes long because or re-diagnosis. The National Health Service realised that a lot of effort was going into waste because of the poor information management system at most of the public health institution. As Levine (2002, p. 74) notes, in most of the cases, patients were forced to register afresh every time they visited public hospitals. This was not only a waste of time for both the patient and the concerned health officers but also a waste of resources. Successful referrals were also hindered because of the poor information management system that largely depended on handwritten records. When handing over a patient from one health officer to another, patient data must be part of the handover process. However, this was not the cases. This meant that the receiving doctor had to start the process anew, a fact that was reducing efficiency in delivering quality services to the clients.

It is upon this background that the NHS realised that a time had come to revolutionise its information management system at all public healthcare facilities. In 2002, it developed this programme to help integrate its communication system to increase coordination between offices and medical officers in all public health facilities. The introduction of the electronic care records was meant to ensure that patient’s data was always available and easily accessible within the database at all the healthcare centres within the country. In this report, the researcher will critically review this program using relevant methodologies and concepts to determine if the best possible results were achieved from it.

Analysis of the Project Using Relevant Methodologies and Tools

The National Programme for IT was a major project for NHS that was meant to transform the communication system at the firm. To analyse this project, it will be important to start by using some of the project management theories to determine if the right procedures were followed by people concerned. According to Kendrick (2011, p. 28), Four Stages Theory of project management is one of the simplest and most commonly used theories of project management. This theory simply outlines the four main stages in a project and defining what should be done at each stage for it to be considered a success. According to this theory, the first stage is the start-up. This is the most important stage in project management. This is because it involves the identification of needs. It is the justification for why the project is necessary. This was done in 2001 by NHS officials in the public healthcare facilities in England. Their review revealed that it was necessary to have an integrated communication system that will enhance communication among departments within a hospital and different hospitals within the country.

It was established that this could only be achieved by establishing electronic health records within all public healthcare facilities. This stage was conducted successfully. The second stage is the planning of the project. Once a problem has been identified and a decision made to address it through a given project, the next important stage in the planning process. According to Levy (2009, p. 78), to achieve success, it is necessary to have a comprehensive plan that details what should be done at various stages, the stakeholders involved in the execution, the time needed for the execution, and the resources. This can properly be done by using a Gantt chart. The report does not have a record of the events that took place other than a rough explanation of when major events took place. This can be summarised in the Gantt chart below.

Completion and Review

Although not presented in the report, the Gantt chart is one of the main tools used in the planning process. When using this tool, the planners will need to break down the entire project into individual tasks. It enables the planners to determine the timeline when various activities within the project should be completed. This way, it will be easy to determine if the project is progressing as per the plans. Another important tool that is used in project planning is the Project Control System which helps in defining project controls. According to Heldman (2011, p. 72), defining project control for this project is very important in enhancing the success of this project. The figure below shows the specific activities that should be addressed in the project control system when using this project management tool.

Source (Kerzner 2010, p. 39)The project control system defines the estimates, budgeting, contract management, cost control, scheduling, and management of finance. These activities have been defined in the sections above. The top management of the National Health Service should be responsible for the controls in this project. When this has been done successfully, the next important stage in project management as per this theory is the execution.

In this stage, the project members will be putting into practice what has been planned and approved by the relevant authority. This process is very critical because it involves bringing to a reality what has been visualised at previous stages. This will need the application of the right technologies and the use of the right workforce. The implementation of the National Programme for IT in the NHS was expected to take eight years, from 2002 to 2010. The specific activities in this project were broken down into for phases. The first phase was scheduled for completion in 2006, the second phase in 2007, the third phase in 2008, while the last phase was scheduled for 2010 (Burr 2008, p. 28). The management enrolled a detailed plan to change the data management records. In the first phase, the NHS replaced manual care records with electronic care records. This was to reduce work when recording the details of the patients. The system made it possible for the officers involved to take all the details of the patients and put it into a departmental database where all the relevant authorities within the department could access it. This meant that at every stage of medication, the relevant officer would only need the identification of the patient to access all the historical health records of the patient.

In the second phase, the system was advance to make it possible for the relevant departments to share a patient’s health records. The interdepartmental transfers of health records were considered appropriate because it allowed medical officers in one department can access the details of a patient in a comprehensive manner (Davida 2008, p. 51). This is very important when dealing with a patient suffering from more than one health problems that need the attention of health officers in different departments (Chin 2004, p. 45). For instance, a pregnant mother who is visiting a health facility because of a wound that needs treatment cannot be given specific types of medicine. This is so because some medicines have a serious negative effect on features. In many cases, a doctor may make prescription without inquiring if the patient is expectant. If the patient receives the wrong medication, then a more serious health problem may arise.

To avoid such unfortunate scenarios, the new system was meant to provide the doctor or nurse with a full description of the health status of a patient before the process of treatment can begin. This made it necessary to have interdepartmental data transfers. The fourth stage went a step higher. The National Programme for IT was meant to go beyond institutions to a regional setting. The authority developed regions within the country that would share their data. This move was informed by the fact that sometimes a patient may visit a different healthcare centre when seeking medication. Through this integrated communication system, it became possible for different centres within a given region to share their patient’s data for efficiency in delivering quality care. The last phase that was scheduled for 2010 would see NHS integrate the communication system for all the public healthcare centres in this country. The patients would be able to access medical data at any part of the country as long as they were attended to in a public hospital in the country.

With a large online database that was shared by various hospitals, a patient in London would have no problems accessing the historical data that was collected in a hospital in Manchester because they will be available in a common database that can be accessed online. The report by NHS dated May 2008 indicates that the first three phases of this project have been completed (Burr 2008, p. 31). The information in this report does not indicate the level of success of the last phase of the project because as the time of its publication, there were two more years to the date scheduled for project completion.

The last stage of a project as defined by this model is the evaluation and closure. As Schmidt (2009, p. 47) says, this involves reviewing what has been achieved and comparing it with the objectives. The aim will be to determine if the intended objectives have been realised by the time the project is brought into completion. If it is determined that some areas need to be addressed, then the project manager will need to lead the project members in addressing the identified gap. If it is proven that the system effectively meets the set objectives, then the system will be put into use, and the project declared completed.

Program Evaluation and Review Technique (PERT)

According to Berkun (2005, p. 54), one of the common concepts in critical review of major projects is PERT. This tool is specifically important in planning and coordination of megaproject such as the National Programme for IT that was initiated by NHS. When using this method, the first stage is always to identify all the elements are identified, and their interrelationship determined. As Carroll (2008, p. 131) observes, this means identifying these elements and establishing how one element would lead to the other or affect others. For instance, in the NHS project, it will start by identifying the elements of the integrated communication system. Once this is identified, the next step will be to establish how each of the elements will be responsible for the construction of the entire system. As Pandey (2009, p. 71) notes, it is like building a roadmap using individual components of the entire structure. To achieve success in the planning process, a network diagram is always necessary. This diagram offers a visual representation of the events and activities involved in the process of completing the project. As Kousholt (2007, p. 118) notes, when using this tool, it is necessary to use arrows to demonstrate the path that will be taken towards achieving the intended goal. The NHS project is an ambitious mega project that involves various components which include hardware, software, people, and equipment to bring it to successful completion.

This network diagram identifies the major elements in this project. The first element is the hardware. To develop the new integrated data recording and sharing system, the NHS had to purchase the necessary hardware. At the individual offices, the health workers needed personal computers as their workstation. These computers will enable the officers to enter and retrieve data whenever it is necessary. To support all the data within a given centre, it will be necessary to have minicomputers, also known as mid-range computers. They can sustain data within a centre (Coulter 2009, p. 137). In large centres, it may be necessary to have mainframe computers. At the regional and level, NHS will need supercomputers to manage the large data at the required speed. Other components of the hardware include the cables, wireless connection device, a router, among others.

The software also forms a major component in this diagram. As Murch (2004, p. 12) notes, a communication system may use software depending on the needs of the system. At the workstation, the health officers will need various forms of software in their computers to enable them to perform their duties efficiently. The database will also need software to make communication between departments possible. It will also need a firewall to protect it from intrusion and viruses. The labour used in the development of the system is another component. The process will need skilled labour to handle various tasks in putting up the system. Semi-skilled labour may also be necessary when addressing physical tasks such as transportation within the centres. The last component, as identified in the diagram above, is the equipment needed to develop the system. These are the tools and machines needed to put various components of software together to form the system (Brigham & Ehrhardt 2013, p. 70). All these elements are needed to complete the system. The report was given by NHS demonstrates the importance of various elements discussed above in coming up with this new system. It is also important to note that each of these elements come at a cost. National Health Services had to purchase the software and hardware needed for the system. The fee charged by the consulting firm that was responsible for the new system included labour and equipment costs.

Conclusion

The National Programme for IT was an ambitious project that was initiated by the National Health Service to help improve patients’ data management at all the public health facilities in England. Launched in 2002, the project was meant to create a new system that will eliminate the manual system that was in use at most of the public healthcare facilities. The project had four phases, with each phase having specific activities to be addressed. The critical review of this project demonstrates that NHS followed fundamental processes in this project that led to the success witnessed in the first three phases of the project. The methodologies and concepts used to identify specific elements of the project that worked together to help achieve success. The report was drawn in 2008, two years before the scheduled date of completion. However, the project was a great success because of the planning and execution strategies that were used.

List of References

Berkun, S 2005, The art of project management, OŔ eilly, Beijing.

Brigham, E & Ehrhardt, M 2013, Financial management: Theory and practice, South- Western, Mason.

Burr, T 2008, The National Programme for IT in the NHS: Progress Since 2006, The National Audit Office, vol. 484. no. I, pp. 1-54.

Carroll, N 2008, Project management: A decision-making approach, Lippincott Williams & Wilkins, Baltimore.

Chin, G 2004, Agile project management: How to succeed in the face of changing project requirements, AMACOM, New York.

Coulter, M 2009, Strategic Management in Action, Pearson Higher Education, New York.

Davida, F 2008, Strategic Management: Concepts, Pearson Higher Education, New York.

Heldman, K 2011, Project management jumpstart, Wiley, Hoboken.

Kendrick, T 2011, 101 project management problems and how to solve them: Practical advice for handling real-world project challenges, American Management Association, New York.

Kerzner, H 2010, Project Management Case Studies, John Wiley & Sons, Chichester. Kousholt, B 2007, Project management: Theory and practice, Nyt Teknisk Forlag, New York.

Levine, H 2002, Practical Project Management: Tips, Tactics, and Tools, John Wiley & Sons, Hoboken.

Critical Review of the National Programme for IT in the NHS 14

Levy, S 2009, Legal project management: Control, costs, meet schedules, manage risks, and maintain sanity, DayPack Books, Seattle.

Murch, R 2004, Project management: Best practices for IT professionals, Prentice Hall PTR, Upper Saddle River.

Nieuwenhuizen, C & Erasmus, B 2007, Business management for entrepreneurs, Juta, Cape Town.

Pandey, I 2009, Project management, Vikas Publishing House, Delhi.

Schmidt, T 2009, Strategic project management made simple: Practical tools for leaders and teams, John Wiley & Sons, Hoboken.

Introduction

The findings published by the Health Commission, the UK National Health Service (NHS) on the March 2009 Francis Report into Mid-Staffordshire NHS Foundation Trust Failures inpatient care, received a lot of publicity. While the report is important because it illuminates the failures, it is more significant to focus predominantly on what should have been done and what should be done in the near future. This calls for a review of the recommendations that have been tabled by this report as a chat on the way forward (Francis, 2010a).

Review of the Recommendations

For purposes of clarity, this paper will review some of the recommendations so adduced in the report one by one, by first highlighting them and secondly by justifications based on the report, as well the common knowledge that accrues from documented best business practices.

Recommendation 1: The Trust must make its visible first priority the delivery of a high-class standard of care to all its patients by putting their needs first. It should not provide a service in areas where it cannot achieve such a standard.

Joss et al (2002) reckon that, as a principle, it is usually the client who is best situated/placed to echo expectations of a service or a product. This, therefore, affirms the old adage that any establishment must always be cognizant of the fact that everything begins with the client as the middle staff as well as the end consumer. In the case of NHS, the management seemed not very sure of the ongoings because they perhaps did not establish a tool of evaluation that centered on the customer’s opinion (Care Quality Commission, 2009).

The beauty of a client-centered approach in business, according to Joss et al (2002) is that it is a precursor for the management to foresee and create changes emanating from clients/clientele suggestions as well as demands, and therefore ordinarily shifting client’s information (Joss et al, 2002).

Recommendation 2: The Secretary of state of Health should consider whether he ought to request that Monitor-Under the provisions of the Health Act 2009-exercise its power of de-authorization over the Mid Staffordshire NHS Foundation Trust. In the event of his deciding that continuation of foundation trust is appropriate, the Secretary of State should keep that decision under review.

This recommendation would entail a number of advantages. First, in the event that the hospital is still authorized, then staff and management are likely to institute measures to ensure quality delivery of services since they will be acutely aware that they are under scrutiny. Because of this, the management is likely to re-examine its earlier approach with a view to retooling the strategies. They will therefore consider a SWOT analysis methodology in configuring their plan of action. SWOT has been defined by Joss et al (2002) as a useful technique used to comprehend an organization’s strengths and weaknesses, as well as for identifying opportunities obtainable and the threats that the organization faces. In the report, there seems to indication that the health facility reviewed its strategies with these facts in mind.

Recommendation 3: The Trust, together with the primary Care Trust, should promote the development of links with other NHS trusts and foundation trusts to enhance its ability to deliver up-to-date and high-class standards of service provision and professional leadership

This recommendation borders predominantly on consultancy and inter-aliases. Inter-disciplinary and consortia networks are important in management and service delivery. Joss et al (2002) observe that such measures provide alternative views that are often times influential in improving services delivery when incorporated. It involves the acquisition of Industry best practices (Francis, 2010b).

Recommendation 4: The trust, in conjunction with the Royal Colleges, the Deanery and the nursing school at Staffordshire University, should review its training programs for all staff to ensure that high-quality professional training and development are provided at all levels and that high-quality service is recognized.

Going by the finding that the clients were largely dissatisfied, the review of training and research should mainly focus on impact evaluation. Joss et al (2002) profoundly assert that impact evaluation is the methodological identification of the impacts and results caused by a program, policy or project including its strategy. These effects, accordingly, could be intended or not; however, the central thrust of impact evaluation is that it aids in an improved understanding of the degree to which programs reach the target group as well as illuminating their effects. Evidently, this seems not to have been taken at the training level, or if it was, then it was not implemented (Francis, 2010b).

Recommendation 5: The Board should institute a program of improving the arrangements for audits in all clinical departments and make participation in audit processes in accordance with contemporary standards of practice a requirement for all the relevant staff. The board should review audit processes and outcomes on a regular basis

Administration of drugs seemed to have been a bottleneck in the report; this was compounded by a lack of follow-up strategies employed by the health facility nurses and the hospital administration at large. One sure way of adopting this recommendation would be to take in the Rapid Appraisal Method, which, according to World Bank (2004), is a faster, reasonably cheaper way of collecting and collating views from the target group as well as other beneficiaries including the stakeholders in response to management’s need for valuable data. This way the management of the hospital would be able to adjust and retool their approach to treatment administration follow-ups by patients as well as nurses, and those that oversee this (World Bank, 2004).

Recommendation 6: The Board should review the Trust’s arrangements for the management of complaints and incident reporting in the light of the findings of this report and ensure that it:

The report seems to contend that there is general complacency on the part of the staff. This could be because of a deep-seated culture where everybody covers each other’s back. Therefore, whistle-blowers are seen as betrayers. To correct this, the management should adopt policies, which take into consideration methods that assure confidentiality and deal with blackmail possibilities so that those that would want to volunteer information can do so willingly without fear of intimidation.

Recommendation 7: Trust policies, procedures, and practices regarding professional oversight and discipline should be reviewed in the light of the principles described in this Report.

Disciplinary actions are very important in any organization. It would be important for each of the Trust employees to be compelled to re-read and understand his/her job description. This would keep them on their toes and weed out those that are not performers.

Recommendation 8: The trust and the Primary Care Trust should consider steps to enhance the rebuilding of public confidence in the trust

From the publicity of their failure, public confidence seems to have been lost on the Trust. A good starting point would be to carry out a survey that focuses on the level of public confidence in it. With this, the trust would then institute measures that would win their trust.

Recommendation 9: All NHS trusts and foundation trusts responsible for the provision of hospital services should review their standards, governance, and performance in the light of this report.

A benchmark for delivery will be important in ensuring and defining the course of the hospital operations.

Those responsible for the Hospital failures

These should include almost everybody; the department of health, the patients themselves, the staff, the Board of Directors and Management (Francis, 2010a).

Way by which the management could have better organized their many performance measurements

The management ought to have better organized their many performance measurements in a number of ways: These include.

Use of Performance Indicators

Simply defined, performance indicators refer to dimensions that appraise inputs, outputs, processes, as well as the results for projects or strategies. These indicators usually enable managers to trail progress, reveal results, and take remedial exploits to improve service delivery. For instance, the contribution of “key stakeholders in defining indicators is important because they are then more likely to appreciate and use indicators for management decision-making” (World Bank, 2004).

The reasons for using them vary, but mainly they are meant to help in the location of performance targets and evaluation of their attainability. In addition, they are important for pointing out problems through an early caveat system to allow corrective action to be undertaken, and more so indicating whether an in-depth assessment or analysis could be required (Greasley, 2009).

The Logical Framework Approach

LogFrame has been defined as that which helps to clarify the goals/objectives of a project, policy and program. It helps in the identification of inputs, processes, outputs outcomes, and impacts. Ideally, it leads to the “identification of performance indicators at each stage in this chain, as well as risks, which might impede the attainment of the objectives” (World Bank, 2004). Moreover, it is a mode of engaging partners in illustrating objectives and crafting activities. During implementation, the Log frame serves as a useful tool to review progress and take corrective action (World Bank, 2004).

Rapid Appraisal Methods

These are seen as a “quick, low-cost way to gather the views and feedback of beneficiaries and other stakeholders, in order to respond to decision-makers” needs for information” (World Bank, 2004). It has several strong points including the provision of quicker data for decision making which is effective and efficient.

Key Stakeholder Groups

These include the government (particularly, the Department of Health), the Trustees of the Foundation, the patients/clientele group, the organization’s staff/employees, the Health Facility Board of Directors, the donors and the United Kingdom Health Commission (Francis, 2010a).

Lessons for the management and Government

From the above recommendations, the management and government can derive valuable lessons. First, there is a need for continuous assessment of health facilities to ensure that they are working all the time and are efficient. Secondly, they need to review patient satisfaction, especially by carrying out impact assessments from time to time. Thirdly, the management and government should review policy interventions in favor of standardized policies in service delivery. Fourth, there is a need for stringent adherence to strict Monitoring and evaluation methodologies. Lastly, there is a need for stringent inspections and evaluation of health facilities before the issuance or renewal of operating licenses.

Reference List

Care Quality Commission. 2009. Care Quality Commission publishes progress reports on Mid Staffordshire NHS Foundation Trust. Web.

Francis, R., 2010a. The House of Commons Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust, Volume.1. HMSO: Her Majesty’s Stationary Office. Web.

Francis, R., 2010b. Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust Report, Volume.2. HMSO: Her Majesty’s Stationary Office.

Greasley, A., 2009. Operations Management. Second edition. Chichester: John Wiley & Sons.

Joss, S. et al. 2002. Clients First: A rapid Market Appraisal Tool Kit: Experience and Learning in International Corporation. Helvetas Publications No. 3. Web.

World Bank. 2004. Monitoring and Evaluation: Some Tools and Approaches. Washington D.C: World Bank. Web.

The article by Colin-Thome (2013) addresses the UK’s clinical governance through the perspective of the newly reformed National Health Service (NHS) commissioning. The author provides a detailed description of the history of clinical governance that prioritized different aspects of healthcare at different times. As the researcher proceeds to discuss the contemporary issues related to commissioning and clinical governance in the context of the NHS reforming, he identifies inaccuracies, obstructing factors, and other problematic issues.

The author of the article sets a well-articulated context for the problem discussed in the publication. Indeed, the understanding of the developmental path of the UK’s NHS allows for a more informed analysis of the currently applied improvements. Overall, clinical governance as a concept is aimed at the improvement of the overall healthcare system by providing the conditions for high-quality patient care through physicians’ professional advancement (Colin-Thome, 2013). While commissioning plays a significant role in the implementation of the core principles of clinical governance, the author reports on multiple drawbacks in the practical side of the process. However, although the article presents multiple accusations of ineffective implementation of clinical governance, it fails to provide recommendations for improvement or any guidance on drawbacks elimination. The researcher mentions more successful European and American systems that function more efficiently, but he does not explicitly explain how that experience might be introduced to the UK context.

Overall, the article is an analysis-based review of the observed process of the implementation of clinical governance practices in the UK. It accumulates critically important information on the importance of aligning commissioning practices with the ideas of clinical governance aimed at improved patient care, as outlined in the reform. Most importantly, the author concludes that a self-monitoring culture within the healthcare system should remerge in order to ensure the functionality of commissioning and proper clinical governance. However, the author is very implicit concerning the solution to the problem. Also, the article lacks factual, evidence-based support emphasizing the problems to which the author refers.

The article by Spigelman and Rendalls (2015) presents the results of a non-systematic literature review of the publications related to clinical governance in Australia. The authors integrate the findings from various literature sources to enlist all the issues and characteristic features related to the current state of clinical governance in the country. Thus, the article is aimed at generalizing the scope of issues characterizing Australian clinical governance to ensure informed decisions for further development by means of eliminating the difficulties.

The authors present a broad overview of the manifestations of clinical governance across different territories and types of care. A particular strength of the conducted research is the inclusion of the interviews with key stakeholders who provide accurate first-hand information on the real problems. Given the complexity of the healthcare jurisdiction system and the complexity of Australian demographics and geography, the implementation of clinical governance is challenging. Such an imbalance in jurisdictions’ responsibilities and distribution of responsibilities for care provision induces financial imbalance and higher cost of health care services (Spigelman & Rendalls, 2015). The array of identified problematic issues includes demographic and geographic variations that cause fragmentation in healthcare delivery, as well as management and the overall quality of care.

In summation, the article is strong research that provides a validated and well-articulated list of current issues that Australian clinical governance faces. However, despite the overview of the problematic issues, the guidance for improvement is very theoretical. Indeed, the suggestion for improvement of the functionality of clinical governance is articulated in the form of recommendations for the direction of improvement without practical solutions. Nonetheless, the work done by the researchers is a valuable basis for further search for the solution and development of practical steps toward the improvement of clinical governance.

References

Colin‐Thome, D. (2013). Development opportunities in the “new” NHS for personal, population and system care. Clinical Governance: An International Journal, 18(2), 6–17.

Spigelman, A. D., & Rendalls, S. (2015). Clinical governance in Australia. Clinical Governance: An International Journal, 20(2), 56–73.

Executive Summary

The National Programme for Information Technology (NPfIT) was planned to deliver better services to the patients and the health institutes. But unfortunately, the programme failed to deliver and had to be stalled due to various reasons that were beyond control. The programme was planned for a period of 10 years (starting from 2002) but it had to be shelved abruptly in 2009. It is understood that the project was able to complete some of the features but the most significant, the Summary Care Records (SCR), could not be completed. The result was very horrifying. Several patients died due to lack of proper care.

The contract for the implementation of the programme was given to CSC but the company was unable to honour its commitment of providing the requisite programme (SCR) to 220 health trusts throughout the United Kingdom. But CSC alone cannot be blamed for the lacuna. Even the NHS failed to provide the required 160 trusts where the SCRs were to be delivered. There has been a lot of rage among the people and the industry about the inefficiency and negligence of the government. Billions of dollars of people’s hard earned money has been thrown down the drain with no clear explanation.

The Leeds Teaching Hospital which is the major health trust of the United Kingdom also faced several difficulties in adhering to the new guidelines and the programme. But due to its sincere efforts, the hospital has been able to cope up with the previous problems and has developed its own networking in order to serve its patients.

Introduction

The National Programme for Information Technology (NPfIT) in NHS was commenced in 2002 and was designed to revolutionize the use of information (pertaining to patients) by the NHS. The programme was expected to be one of the largest IT projects in the global healthcare sector (Coiera 2007) and was scheduled for a ten years’ period. The NPfIT programme’s ultimate motive was to improve the provisions, features, and quality of patient care (Randell 2007). The programme was supposed to furnish various important aspects (such as hypersensitivity and the medication being provided) in the treatment (and follow up) of patients (Hughes 2010). Though some parts of the programme were completed successfully, the others stumbled upon various hurdles that ultimately contributed to the failure of the programme. One of the most significant parts of the programme that failed to deliver was the Summary Care Records (SCR) system (MPs publish report on the dismantled National Programme for IT in the NHS 2013). The SCR system was planned for the benefit of the staff and the patients (Connecting For Health n.d.).

The contract for the NPfIT was awarded to CSC and the initial contract value was £3.1 billion. The contractor was required to handover SCRs to 220 trusts throughout the country. Due to the contractor’s inefficiency and non-compliance of the delivery terms, fresh negotiations were made with CSC. It is noteworthy that even the Department was unable to fulfil its obligation of providing 160 trusts for implementing the CRS (Committee of Public Accounts 2014).

Unfortunately, the SCR programme had to be scaled down in 2009 due to its involved costs and underperformance. It is noteworthy that the government had already spent a whopping amount of £12 billion by the time the programme was scaled down (Charette 2009). The NPfIT was also shelved in the year 2011 (Department of Health 2011). The programme’s failure was not the first of its kind in the United Kingdom (UK); there have been instances where large IT programmes have failed due to heavy costs and not being able to maintain the programme schedule. The failure had great negative repercussions; hospitals were unable to keep track of their patients, especially those who needed immediate medical attention (Doward 2008).

Literature Review

Considering the problems and delays being faced by the patients, the UK government decided to upgrade the existing technology within the healthcare sector. The improved technology was aimed at providing better services to the patients and also to expedite the work of the NHS staff (NHS Trust n.d.).

During the progress of the programme, there were several attempts by the computer scientists involved in the programme to call for an evaluation of the programme’s progress. Unfortunately, the Health Committee, on behalf of the government, rubbished the attempts as being pointless (Ritter 2007a). Several prominent academicians also requested the government to hold an inquiry into the feasibility of the programme (Ritter 2006a). Even the participants of the NHS Confederation research programme were not happy with the government’s decision to appoint negligible number of contractors for the project (Bruce 2011).

By the year 2010 (March), almost 1.25 million records had been updated and it was expected that by the end of 2014, a total of 50 million records would be updated (BBC 2010). The doctors supported the endeavour but were pessimistic about the department’s competence in achieving the target (Computer Weekly 2008). Commenting on the pace of including the data in the database, the British Medical Association commented that the pace was very fast. Moreover, some people were even not aware of such developments and those who were aware, did not have the requisite knowledge of the procedure to be followed (BBC 2010). So, ultimately, the Summary Care Records (SCR) was shelved due to the growing unrest among the sector (Brittain 2010). The politicians are passing on the blame to each other and the public rage doesn’t seem to calm down; this has resulted in the government being in the headlines for the wrong reason (Masters 2014).

Likewise other major organizations, NHS also has a risk management programme but the problem arises when the implicated risks are miscalculated (Jeffcott & Johnson n.d.). There is no specific definition for the breakdown of information technology projects. Breakdowns can take place at any phase of the implementation of the project (Brotherton, Fried & Norman 2008).

The failure of the NPfIT by NHS was a massive one that involved huge amounts that are expected to reach £10 billion. The Public Accounts Committee considered the attempt of NHS, to revolutionize the communication system within the health sector, as the worst disaster (Walker 2013). But is should be understood that such costs don’t include the potential costs that might have to be incurred due to cancellation of Fujitsu’s contract (BBC 2013).

Since the programme was expected to expedite the day-to-day jobs, the trusts planned job-cuttings in advance (in order to save money). But this step of the trusts backfired as the programme failed to deliver and there were chaos in the various trusts. Several deaths occurred and the investigations revealed that the major cause was inadequate staff at the respective trusts (Donnelly 2013). According to the Royal College of Nursing, there was a shortage of about 20,000 nurses (Gregory 2014).

Scores of patients suffered due to the negligence of hospitals and hundreds even died as a result of shortage of staff and poor facilities. While wrong medication was administered to some of the patients, some of them were totally neglected (Telegraph 2013). The government, in a bid to save its face, took severe action against eleven hospital trusts that were among those responsible for the deaths of patients (Triggle 2013).

The scandal was revealed when an inquiry was initiated to ascertain the reasons for the death of hundreds of people at Stafford hospital. It is reported that 400 to 1200 patients (mostly aged patients) died at the hospital due to inhuman practices being followed by the staff (Campbell & Meikle 2013). The overall death figure is more appalling; 14 NHS trusts have been held responsible for the deaths of 13,000 patients (Donnelly & Sawer 2013). These 14 trusts have been advised to adhere to the suggestions of the concerned officials (Sky News 2013).

The dilemma met by the Nuffield Orthopaedic Centre should have been an eye opener for the government and the various NHS trusts. But the Department of Health was optimistic and claimed that such problems would not persist. But unfortunately, the experiences of Buckinghamshire Hospitals NHS Trust convey a different story; they were facing great difficulties in the reporting system (Ritter 2007b).

Methodology

This report discusses the reasons for the failure of the NPfIT in NHS (UK) and also the views of various scholars on the implications of the failure. Most of the references have been taken from online articles, news reports and statistics. Considering the significance of the problem, the researcher has referred only authentic websites. The ethical aspect has been considered and no bias has been encouraged in the discussions. In order to explain the implications of the failure of the NPfIT on health institutions, the case of Leeds Teaching Hospital has been discussed. Leeds Teaching Hospital is considered to be the major NHS trust in the country.

Findings/Results

Angel Eagle, Member of Parliament, had informed the parliament that thousands of NHS staff and millions of patients used the NPfIT service. This claim requires a deep thought because the actual number of patients and NHS staff are far more than the numbers she stated. Like for example, it was reported that 87% of the general practitioners were online with the system. But it is also reported that only 22% of the general practitioners were actually using the service (Ritter 2007c). Probably, the MP might have meant 87% of the 22% general practitioners who were using the service. There were political ambitions and reasons behind launching the programme. The intentions were appreciable but the execution was a total disappointment (Maughan n.d.). The government has been receiving criticism for the expensive failure. £2.7 billion of public money has been thrown down the drain and the government has no explanation (Poole 2011).

The case of Martin Ryan is an eye opener for us to understand the severity of the damage that has been done. Ryan was left without food; he could not swallow and the feeding tube was not inserted. The negligence was a result of a communication gap between the staff responsible for the treatment (NHS ‘Failures’: Man starved in hospital care 2009).

At the time when the programme was suspended, the expected cost was £6.4 billion but by the year-end 2013, the cost had risen to £10 billion (Syal 2013). Some analysts estimate the cost to be much higher than this and believe that such amount would have been enough to pay the wages of 60,000 nurses for 10 years (Martin 2011). The suspension of the programme will bring severe monetary problems for the trusts. They will now have to trust their own resources to develop a dependable records system (Hall 2011). It is noteworthy that during the initial stages of the programme implementation, the National Audit Office had suggested that the benefits of the programme could not be judged and it needed time to assess the actual monetary benefits (Bourn 2006).

The NPfIT programme was supposed to be the world’s biggest healthcare IT project but it ended up as being the biggest IT project failure (Flinders 2011a). According to Finkelstein, IT projects fail due to several factors like insufficient users, ambiguous business aims, sub-standard software architecture, undependable statistics, and haphazard implementation (as cited by Flinders 2011b). Yann L’Huillier believes that in order to get approval from the concerned authorities, big IT projects perform well during the initial stages but once they get the requisite approval, the problems start creeping in. Also, there are several unexpected situations that arise during the progress of the project. Such situations have a great impact on the project’s performance (as cited by Flinders 2011c). On the same line, James Martin is of the opinion that IT projects fail due to inadequate requirement of a massive project. Improbable project costs and time-frame also lead to the unsuccessful completion of the project (as cited by Flinders 2011d). According to the NHS, ePrescribing can have repercussions on the lives of the healthcare staff (NHS n.d.).

Case study: Leeds Teaching Hospital NHS Trust

Leeds Teaching Hospital is the major NHS trust of the United Kingdom. The hospital has a teaching faculty that is considered to be the largest in Europe (Leeds Teaching Hospitals NHS Trust 2013). The hospital has a well organized IT department that tries to fulfil the requirements of the NPfIT. The hospital has been able to successfully implement some of the features of the programme such as the online availability of prescriptions and appointment booking. But there are other features that are yet to be fulfilled such as the online availability of patient records (Ritter 2006b).

The increased costs of the project implementation by Leeds Teaching Hospital (and others as well) has had an impact on the services being provided. Leeds Teaching Hospital had to redesign its management system and the process. The staff had to be given ample training for being acclimatized to the new system. Even the existing data had to be changed. All such tasks involved great expenditure. Moreover, the absence of Patient Administrative System was a big hurdle for Leeds Teaching Hospital in meeting the booking objectives (Ritter 2006b).

In spite of all such impediments, the Leeds Teaching Hospital is trying to prove itself. The hospital has been able to facilitate access to the SCR by the pharmacists (Barr 2012). The hospital is all set to compete in the new NHS scenario and aims at delivering best services to its patients. The hospital has plans to improve its information system and communicate better with the general practitioners and the patients (Thorne 2012). The hospital has recommenced its ‘digital dictation and speech recognition project’ (Evenstad 2013a). The hospital is now at the final stages of its contract with the NPfIT and has entered into a fresh contract with Accenture. The new contract will be for the hospital’s communications system (Evenstad 2013b). Recently, Leeds Teaching Hospital has been able to abolish the use of paper work and uses Emis Web (Evenstad 2014).

Discussion

Previous examples show that the success rate of IT projects is negligible as compared to the cost (Ambler 2010). The NPfIT of the NHS also got affected by the numerous problems pertaining to large IT projects. Probably, an absence of a transparent link between the priorities of the project and the actual project implementation was one of the main factors that lead to the programme being stalled. There was no proper leadership and guidance for the executing body. Another problem was the inefficiency of the involved people in maintaining the time-frame. The future risks were not considered and as such the programme came under the impact of such risks. The future rise in price (of various commodities and services) was also not considered that resulted in a finance crunch. A crucial factor was that the government funds were not enough for the trusts to carry on with the programme (Hendy et al. 2005).

Recommendations

The earlier framework of the programme had only a few contractors, who had the monopoly. If more small and medium enterprises are involved in the programme, the results could be encouraging. It would have been effective if the stakeholders would have been involved rather than the bureaucrats who were not concerned with the services. Instead of launching such a massive programme, the government should have made it mandatory for hospitals to develop their own record systems that were compatible with the set guidelines. The record systems of various hospitals could then be centralized for use by the general practitioners and the people.

References

Ambler, S W 2010, IT project success rates by team size and paradigm: Results from the July 2010 State of the IT Union Survey, Web.

Barr, F 2012, Leeds hospital pharmacists access SCR, Web.

BBC 2010, Q&A: Electronic medical records, Web.

BBC 2013, NHS IT system one of ‘worst fiascos ever’ say MPs, Web.

Bourn, J 2006, Department of Health: The National Programme for IT in the NHS, Web.

Brittain, N 2010, NPfIT’s Summary Care Records system suspended, Web.

Brotherton, S, Fried, R & Norman, E 2008, Applying the work breakdown structure to the project, Web.

Bruce, S 2011, NPfIT failures have left NHS IT “stuck”, Web.

Campbell, D & Meikle, J 2013 Failing hospitals to be named and shamed in NHS care overhaul, Web.

Charette R N 2005, Why software fails, Web.

Coiera, E W 2007, ‘Lessons from the NHS National Programme for IT’, The Medical Journal of Australia, vol. 186. no. 11, pp. 1-2.

Committee of Public Accounts 2014, The dismantled National Programme for IT in the NHS, Web.

Computer Weekly 2008, Evidence mounts for NPfIT review, Web.

Connecting For Health n.d., Summary Care Records deliver improved performance and time savings in Leeds, Web.

Department of Health 2011, Dismantling the NHS National Programme for IT, Web.

Donnelly, L 2013, Shortage of 20,000 nurses in NHS, report warns, Web.

Donnelly, L & Sawer, P 2013, 13,000 died needlessly at 14 worst NHS trusts, Web.

Doward, J 2008, Chaos as £13bn NHS computer system falters, Web.

Evenstad, L 2013a, Leeds resumes digital dictation, Web.

Evenstad, L 2013b, Leeds takes Agfa PACS, Web.

Evenstad, L 2014, Leeds uses web for staff records, Web.

Flinders, K 2011a, The world’s biggest civilian IT project finally looks to have failed but is the NHS IT failure a surprise?, Web.

Flinders, K 2011b, The NHS IT project is dead, but why do large IT projects so often fail? Part 2, Web.

Flinders, K 2011c, NHS IT project is dead, but why do large IT projects fail? Part 3, Web.

Flinders, K 2011d, NHS project is dead, but why do large IT projects fail? Part 4, Web.

Gregory, A 2014, Patients more likely to die in hospital because of savage nursing cuts making wards less safe, Web.

Hall, K 2011, Burying the NHS National Programme for IT, Web.

Hendy, J, Reeves, B, Fulop, N, Hutchings, A & Masseria, C 2005, Challenges to implementing the national programme for information technology (NPfIT): a qualitative study, Web.

Hughes, J 2010, Upload of NHS care records suspended, Web.

Jeffcott, M & Johnson, C n.d., The use of a formalised risk model in NHS information system development, Web.

Leeds Teaching Hospitals NHS Trust 2013, Overview, Web.

Martin, D 2011, £12bn NHS computer system is scrapped…and it’s all YOUR money that Labour poured down the drain, Web.

Masters, A 2014, Sharp end 10^th March 2014, Web.

Maughan, A n.d., Six reasons why NHS National Programme for IT failed, Web.

MPs publish report on the dismantled National Programme for IT in the NHS 2013, Web.

NHS n.d., Challenges and lessons learnt, Web.

NHS ‘Failures’: Man starved in hospital care 2009, Web.

NHS Trust n.d., The National Project for Information Technology NPfIT, Web.

Poole, R 2011, ‘System failure’ – £11 billion NHS IT system finally abandoned, but not before slamming a high bill on taxpayers, Web.

Randell, B 2007, A computer scientist’s reactions to NPfIT, Web.

Ritter, T 2006a, How the Health Committee took decision to hold NHS NPfIT inquiry, Web.

Ritter, T 2006b, Confidential NHS paper on the health of the National Programme for IT, Web.

Ritter, T 2007a, Health Committee MP criticises report on NPfIT electronic patient record, Web.

Ritter, T 2007b, Whitehall officials pledge not to repeat troubles of Care Records Service go-live at Nuffield hospital – but similar problems have already occurred at another hospital, Web.

Ritter, T 2007c, Statistics and the NPfIT “success”, Web.

Sky News 2013, NHS report: Teams sent in to 11 failing trusts, Web.

Syal, R 2013, Abandoned NHS IT system has cost £10bn so far, Web.

Telegraph 2013, Mid Staffordshire Trust inquiry: how the care scandal unfolded, Web.

Thorne, C 2012, Leeds changes directory in IT refresh, Web.

Triggle, N 2013, Hospital trusts rapped over major failures, Web.

Walker, C 2013, Costs of failed NHS IT project continue to rise, Web.