Assignment exploring the issues related to the management of change within clinical practice
In this essay I aim firstly to attempt to identify a change in practise I would wish to make and secondly, link this to the theory of change management and leadership management. The vision I would like to implement would be for the Worcester Royal Hospital psychiatric wards to have access to on site gym facilities, and for the psychiatrists to prescribe exercise to all inpatients. Currently exercise is not used widely as an intervention in psychiatric nursing. The Labour government acknowledged that the physical health needs of people with mental health problems had been neglected and that this group need support to access appropriate healthcare and health promotion services (Department of Health, 2009). Over the last ten years there has been progress made regarding the use of exercise in mental health services. In 2004 a research team asked GPs if they would consider prescribing exercise instead of antidepressants for low mood. Only 5% said they would. In a recent follow-up survey in June 2011, the proportion of those willing to prescribe it had risen to 22 %, reflecting a clear shift in attitudes and beliefs (Baker 2001) . However, I personally do not feel this is a large enough rise. From my experience in working in psychiatric wards at this hospital I have observed that exercise is much underused. For example there are no gym facilities and no exercise groups at all. I propose that all psychiatric inpatients should have access to and encouragement to attend physical exercise facilities. This is despite a large body of evidenced based research that has proven exercise can be an intervention to prevent and alleviate mental illnesses. For example, one study of the effects of physical exercise on depression concluded that after sixteen weeks exercise was just as effective as SSRI’s but without any of the side effects. Physical exercise also had the benefit of improving physical health and improving self-esteem through socialising (Craft et al 1997). In order to do this I will need to use change management theory and leadership theory. Change management is a structured approach to shifting or transitioning individuals, teams, and organizations from a current state to a desired future state. It is an organizational process aimed at helping employees to accept and embrace changes in their current business environment In order to implement my change there would be a number of things I would need to consider. Firstly, I would need to consider how my change will be implemented. Ackerman (1997) has distinguished between three types of change: developmental, transitional and transformational. I would need to decide which strategy of change would best suit my vision. I feel it would be best to attempt to carry out a planned transitional change. This is an implementation of a known new state; involving the management of the interim transition state over a controlled period of time. My interim transition stage would be the process of building gym and exercise facilities while training staff capable to work in both psychiatric and exercise fields. This stage would also involve negotiating and finding a way around the administrative, health and safety and policy barriers which I estimate would be the biggest difficulty. My known new state would be encouraging psychiatrists to prescribe exercise and encouraging the service users to make use of the exercise facilities during their time as inpatients. I would define my change as episodic rather than continuous. Episodic can be defined as ‘infrequent, discontinuous and intentional’ (Weick and Quinn 1999). Sometimes termed ‘radical’ or ‘second order’ change, episodic change often involves replacement of one strategy or programme with another. However, once my intervention of exercise has been established I plan to make continuous change to it so as to make incremental improvements to ensure it...
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