The implementation of the care of the dying policy at the writer’s area of practice involved the process of change. This involved the use of both leadership and management theories which are essential to increased effectiveness as supported by Moiden (2002). The change was a political one due to the government initiatives to improve end of life care (Department of Health 2008). Antrobus (2003) states that political leaders aim to deliver improved health care outcomes for patients. The essay will critically analyze both leadership and management theories from the top of the organization to the bottom. These theories were used to implement this change to enhance quality care in this clinical area. The essay will also critically analyze and evaluate the nurses’ self management skills in fulfilling their role as clinical managers within interdisciplinary and the changing context of the healthcare.
Similarly, the essay will discuss the implications upon quality assurance and resource allocation for service delivery within the health care sector. These will be related to current government strategies. The effects of government strategies in involving the user and carer or significant others in decision making process within current clinical and legal frameworks (Department of Health 2000b) will also be debated. Similar debate will also be on the nurses’ involvement in policy making (Antrobus 2003). Further discussion on government strategies will be discussed on the introduction of clinical governance and essence of care. Braine (2006) states that the purpose of implementing change is to improve effectiveness and quality. The whole process of change was based on the introduction of the care of the dying booklet which meant that all healthcare professional documented their notes in the same booklet.
The change took place in a large hospital to implement a new policy which was politically driven by the government to improve quality of care. Like most hospital organizations, the hospital traditionally uses a bureaucratic management approach (Marquis and Huston 2006) reinforced with authoritarian leadership to facilitate efficiency and cost effective care. This is done through planning, coordination, control of services, putting appropriate structures and systems in place and monitoring progress towards performance activities (Finkelman 2006 and Faugier and Woolnough 2002). According to Marquis and Huston (2006) bureaucracy was introduced after Max Weber’s work to legalize and make rules and regulations for personnel to increase efficiency.
The ward manager as a change agent had to design and plan the process of change. Designing change involved understanding the purpose of change and gathering data as supported by Glower (2002). Planning included identifying driving forces and ways to reduce restraining forces (Glower 2002). Unlike the top management who used bureaucratic management theory, the ward manager applied the human relations management theory (Marquis and Huston 2006) at ward level. This management theory is designed to motivate employees to achieve excellence.
The human relations theory was introduced in attempt to correct what was believed to be the shortcoming of bureaucratic theory which failed to include the human aspects (Marquis and Huston 2006). Often referred to as motivational theory, Lezon (2002) agrees that this theory views the employee in a different way and helps to understand people better compared to the autocratic management theories of the past. It is based on theory Y of Douglas McGregor’s (1960) X and Y theories cited in (Lezon 2002). Theory Y assumes that people want to work, are responsible and self motivated, they want to succeed and they understand their position in the organization. Perhaps the appropriateness of this theory can be linked to the implementation of clinical governance which emphasizes that it is the responsibility of health care professionals to ensure effectiveness,...
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