Transforming the South Devon Health Community

Posted: January 4th, 2023

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Transforming the South Devon Health Community

Part I – Individual Report

The Shortcomings of the Existing Model

The unit handling stroke patients at the South Devon Health Community was until 2003 handled at the Torbay General Hospital within the Elisabeth ward that only had the capacity for 18 beds yet it received more than 600 admissions each year. The unit was later shifted to the George Earle ward, and the bed capacity at this time grew to 24 beds. Many feel the new station is efficient because of the larger bed capacity, but the station offers both acute care and rehabilitation services. Offering both services within the same station creates a situation the beds are inadequate to admit all the stroke patients because most of the beds serve patients in the post-acute stage still undergoing rehabilitation, while other wait to be put under nursing or long-term residential care.

The Torbay acute center was the only committed station for stroke patients in the South Devon health community. Only ten beds are issued to care for elderly stroke patients at one of the local health facilities at Newton Abbot that stroke patients could use. The patients requiring social services in a nursing or residential home fill most of the beds while some of the beds have patients with other health issues than stroke. The number of patients starts to surge in 2003 but the issue of bed capacity continues to be a major challenge forcing some stroke patients to stay in non-stroke wards where it is difficult to access specialized care. The increase in patients forces some to be admitted to the maternity wards. The other factor that contributes towards the delay, and which derails the freeing of beds is the fact that only the consultant has the mandate to discharge patients. Nonetheless, if a person is lucky enough to get a bed in the stroke unit, he or she has to stay for as long as three weeks to complete the rehabilitation process. Also challenging, is that other than the beds being filled up by patients undergoing the rehabilitation process, the stroke section serves as the only available inpatient station for other patients suffering from neurological-related issues, thereby filling the beds with non-stroke patients. The situation implies that often patients in need if specialist care would have to get the services from home, to one of the local health facilities, or a nursing center within South Devon, which deny them appropriate care. It is also clear that the primary care trusts within the area working with the stroke unit are not aware of the type of care that is available for stroke patients throughout the whole community.

The social services are in charge for improving the care of patients after the complete rehabilitation or leave hospital. The workers served with care homes to put individuals needing long-term attention, and who cannot get the right care at home. The apparent challenge is the lack of adequate space at care homes to take care of the patients. Also, patients make the decision of whether they need home care based on their financial capacity, which creates a situation where the beds remain occupied while the patients wait for a place to be set up at home. The situation creates some constraints on the social services and care for acute patients. Another concern is the emergence of two departments within the South Devon community focusing on social services, but adhering to dissimilar referral structures and systems, hence further making things more difficult.

The description of the challenges at the stroke unit provides valuable insight into the nature of an effective chronic care system. It shows that a chronic care system should have adequate beds to accommodate as many patients as possible to ensure that every person gets the right attention. Enough beds make it possible to attend to each patient on individual basis until the right time arrives to release them for home care. Also, the analysis shows how an effective chronic care system should be one that has adequate number of caregivers to ensure that each patient receives the necessary attention they deserve. The caregivers should be competent enough, and should understand what it takes to offer the best care to the patients. The description of the challenges facing South Devon health community illustrates the importance of making continuous transformations within the facility to address emerging issues such as the increase in patients and their changing demands. Failing to make adjustments on regular basis could create a situation where the care system is not able to handle the influx or the changes thereby creating considerable inconveniencies.

Handling Issues relating to Organisational and Professional Power and Politics

Jenkins handles the issues relating to organisational and professional power and politics in steering the change by trying to overcome the possible barriers. Jenkins seems to know that convincing all stakeholders to accept the new changes would be a difficult task. She knows that getting the stakeholders together and getting their suggestions and input would be a difficult task but is committed to bring everybody along. She knows that fostering coordination between the general practitioners, the general hospital, the community hospitals, and the social services would be hard, but she goes ahead with the campaign knowing that working as a team would make everyone feel that they contribute to the initiatives. Jenkins believes that if the facility is to improve the care it gives to stroke patients it would be necessary to integrate social services into the pathway, which could be hard as they are not part of the same organisation. Another barrier for Jenkins would be to develop and widen the rehabilitation facility at the Torbay general Hospital because she fears that with the current capacity the unit would not be able to handle the more than 625 stroke patients the facility receives annually, even with additional beds.

Jenkins has to deal with the barriers that catch her off guard if she wants to achieve the expected results. For example, convincing all stakeholders that maintaining the acute center in Torbay General Hospital and create a specialist rehabilitation facility with the Primary Care Trusts (PCTs) proves to be quite difficult. Peter Sleight is one of those who feel the plan might not deliver expected results. Sleight counters the plan by Jenkins saying that much transformation must take place at Newton Abbot Hospital; otherwise patients will not be happy when they have to move from the highly developed Torbay Hospital to Abbot. Other members of staff also oppose the plan by Jenkins to improve the functions of Abbot fearing that they would have to alter their functions. Jenkins deals with the unexpected issue where some workers from Torbay feel unhappy for having to shift from Abbot to Torbay as the Newton Abbot lacks some of the equipment and technology that make work efficient. Some social workers also oppose the idea that they may not oversee the rehabilitation process, an opposition Jenkins did not see coming.

Jenkins uses her professional and expert power to get buy-in for the service transformation, and also uses other sources of power and influence to promote her agenda. She uses her skills and competence to encourage the team members to accept the changes by constantly explaining and reminding the workers why things must change to achieve impressive results. For example, she encourages the team members to accept the changes arguing that the transformation from treating diseases to preventing ailments would result in reduced emergencies. She adds that the capacity to share clinical data such as test outcomes, medical imaging and patient history would give all health-care providers such as general practitioners and hospital, and community based services with a common structure. Jenkins uses her professional and expert power to pass her agenda in the way she does not appear to be shaken by the opposition from some members of staff. She proceeds with all her plans, and faces the opposition boldly. Nonetheless, she receives support from some individuals which offers her the courage and the power to proceed with the transformation.

Jenkins’ Vision and Communication Strategies

Jenkins’ handling of the change process sells her as a visionary leader who has effective communication skills. Jenkins emerge as a visionary leader who values communication in the way she forms a steering committee with participants from all sectors of the health community to help her develop and execute a suitable plan. She brings along various stakeholders, including the Stroke Association regional coordinator, social service representatives, nurses, and patients among others to facilitate the development of the new plan. Her inclusion of other parties suggests that Jenkins is a visionary leader who understands how difficult it would be without incorporating other parties into the exercise. Jenkins seem to understand that constant communication with members of the steering committee will offer a good chance to develop new ideas, and will make it possible to deliver results that are diversified and flexible in their nature. Also, Jenkins displays the quality of a visionary leader in the way he identifies the need for change at the facility holding that the transformation is the only way the station will be able to offer care to as many stroke patients as possible while maintaining quality care. It would be hard for Jenkins to roll out her agenda if it is not for the visionary and communication strategies she deploys.

Several things work well for Jenkins, but it is apparent she has to improve on some areas to achieve better results. She manages to inform the stakeholders about the plan, and she even forms a committee to help her implement the framework. However, Jenkins must improve how she sensitises the team members about the planned changes to overcome the opposition arising from some members. Also, she should improve on how she brings in more stakeholders, including officials from the government to record better results in the implementation process.

I would characterise Jenkins as an effective change leader who uses relevant skills and competence to achieve the desired outcome. She decides to proceed with making changes despite the hurdles she could experience at the workplace, and she appears to be optimistic in the way she handles the entire process. She knows that although the initiative would take a lot of time it would provide the most suitable strategies, particularly for the staff in the acute unit, as they could now realise the intricacy of the entire process.  Jenkins is a suitable change leader because prior to executing the plan she takes time to sensitise the others why things must take a new turn, including taking a team of social workers with her for a trip that would inform them how an excellent center operates. She hires a mini bus that take every person for a six-hour journey to the center of excellence for caring for stroke patients where most of the workers have the chance to know each other. Jenkins qualifies to be an effective change leader because she spends her time assessing how the transformation would compare with some of the effective structures globally. For example, she compare the stroke services in the UK with the other healthcare structures, including the American Kaiser Permanente structure, which links payment, long-term attention, pharmacies, physicians, and hospitals under one corporate model. The comparisons Jenkins make shows that she is committed to get the best results from the change process, and therefore, an effective change leader.

Measures used to assess the Success of the Change Project 

Jenkins and her team use various approaches to assess whether the change project is successful or not. Comparison with other health facilities that handle stroke patients effectively may help to determine whether the group is in the right path or not. Another factor that would measure the success of the change project is whether the stroke patients get quality services without competing for bed space, which is currently the biggest hurdle. Another measure for success would be to get all workers contributing towards the initiative without displaying any form of dissatisfaction. 

Part II – Reflection on Potential Lessons

Fiona Jenkins, who heads the Physiotherapy for the NHS South Devon Health Services, must make tough decisions that would restructure the stroke unit. She knows it would be difficult to convince the stakeholders about the need to reduce the amount a patient spends in the acute section to create space for more patients and, at the same maintain efficiency. Jenkins’s primary objective in embarking on the venture is to maintain NHS’s plan of offering better reach to primary care and advance medication and treatment for patients living with long-term chronic ailments (INSEAD, 2008). The case presents valuable lessons that could benefit practitioners in the health and non-health sectors, which makes it necessary for the relevant groups to pay attention to its content.

The case shows the importance of embracing change when operations do not give the expected results, or when circumstances change. Jenkins saw the need to restructure the stroke unit soon after getting the mandate to steer the institution, which illustrates how she appreciates change. She employs suitable change management techniques, making it easier for her to review and redesign the South Devon stroke services with ease. Jenkins acknowledges the need for change and goes ahead to notify all stakeholders how the institution must alter how it attends to stroke patients to handle the increasing numbers. 

The case illustrates the importance of working as a team while developing a project that would have a significant impact on people. Working as a team creates the chance to gain more information from others, and makes the work easier. Teamwork creates confidence among the team members because each person feels like part of the end product. Jenkins shows that she appreciates teamwork when she sets up a steering committee with members from all sectors of the health community that offered care to stroke patients (INSEAD, 2008). She takes time to develop a capable team comprising of specialists to facilitate the redesigning process. The case shows how working as a team increases the chances of convincing more stakeholders. The study shows that Jenkins puts the steering committee close to her to make it easier to know the suggestions of all stakeholders and receive their valued support. The team is a vital requirement when working on a project, and bringing everyone on board increases the chances of being successful. 

The case shows the importance of increasing quality because it increases the likelihood of customer satisfaction. The case informs how Jenkins’s overall goal in reviewing the stroke services at South Devon is to advance the quality of care for stroke patients (INSEAD, 2008). Planners and executers learn the importance of creating an action plan that would lead them towards quality production. For example, Jenkins follows four main objectives while redesigning the services; she seeks to increase the number of patients admitted to acute units, elevate rehabilitation at the community level, establish cooperation among stakeholders, and transform discharge procedures. Setting a plan to increase quality satisfies all parties and creates a good impression for the planner or leader. 

Works Cited

INSEAD. (2008). Service redesign at South Devon NHS Trust (A). INSEAD.