The impact of Organisational Change on the wellbeing of staff in NHS England.

The impact of Organisational Change on the wellbeing of staff in NHS England. 

CONTENTS

CHAPTER ONE

• INTRODUCTION

• BACKGROUND TO THE PROBLEM
• STATEMENT OF RESEARCH PROBLEM
• RESEARCH OBJECTIVES
• RESEARCH QUESTIONS
• SIGNIFICANCE OF STUDY
• RESEARCH STANCE
• PURPOSE OF STUDY

CHAPTER TWO

• THE CONCEPT OF ORGANISATIONAL CHANGE
• CAUSES OF ORGANISATIONAL CHANGE
• HEALTH AND SOCIAL CARE ACT 2012
• IMPLICATIONS OF NHS REFORMS FOR NHS STAFF
• ORGANISATIONAL CHANGE AND MORALE IN THE NHS
• STAFF BURNOUT
• POSSIBLE DETERMINANTS OF BURNOUT
• UNDERSTANDING STAFF MORALE
• CHANGE MANAGEMENT

CHAPTER THREE

• CHANGE MANAGEMENT
• ORGANISATIONAL CHANGE AND STRESS
• STRESS IN THE NHS
• NHS STAFF SURVEY

CHAPTER FOUR

• RESEARCH METHODOLOGY
• RESEARCH DESIGN
• EXPLORATORY
• QUALITATIVE
• PHENOMENOLOGICAL
• RESEARCH METHODS
• POPULATION AND SAMPLE
• POPULATION
• SAMPLE SIZE

CHAPTER FIVE

• PRESENTATION AND ANALYSIS OF DATA

CHAPTER SIX

• SUMMARY OF FINDINGS
• RECOMMENDATION
• CONCLUSION

BIBLIOGRAPHY

LEARNING STATEMENT

APPENDIX ONE: QUESTIONNAIRE

APPENDIX TWO: ETHICS APPLICATION

APPENDIX THREE:  SUPERVISION RECORD

APPENDIX FOUR: DISSERTATION PROPOSAL

ACKNOWLEDGEMENT

CHAPTER ONE

The National Health Service (NHS) is the publicly funded national healthcare system in England. It is also the largest single-payer health care system in the world primarily funded through the general taxation system and overseen by the Department of Health, NHS England provides healthcare to all legal English residents, with most services free at the point of use. Some services, such as emergency treatment and treatment of infectious diseases are free for everyone, including visitors.

The NHS was established through differing legislations; which resulted into four health services in the United Kingdom; NHS England, the NHS Scotland, HSC Northern Ireland and NHS Wales. The respective UK government ministries for each home nation had its own control before falling under the control of devolved governments in 1999. In 2009, NHS England agreed a formal NHS constitution, which set out the legal rights and responsibilities of the NHS, its staff, and users of the service. The establishment of the Health and Social Care Act 2012, came into effect in April 2013 and GP-led groups were given responsibility for commissioning most local NHS services.

Under the new system, a new NHS Commissioning Board, called NHS England, oversees the NHS from the Department of Health. The Act has also become associated with several reforms that have taken place in the NHS in recent times, coupled with the perception of increased private provision of NHS Services. This development has inevitably led to concerns that the new role of the healthcare regulator (‘Monitor’) could lead to increased use of private sector competition, balancing care options between private companies, charities and NHS organisations.

This study focuses on NHS England. Its activities and reforms and how they affect NHS staff particularly their morale, psychology and overall wellbeing. It  will also examine the impact of organisational change on the human resource aspect of the organisation and whether they are being considered or overlooked in the decision making process. Finally, the conclusion and recommendations will be reflective of the overall view of the research counterpoints of arguments and debate.

BACKGROUND

The concept of organisational change comes from the nature and environment of organisations. Organisations must change and adapt regularly to maintain pace with competitors in a rapidly changing business environment. Change means a series of events, which support the process of development in organisations (Kassim, Tahajudin et al, 2010). Change can also occur because of a variety of internal and external factors, over which organisational leaders sometimes have very little or no control.

Organisational change generally means right sizing, new developments and change in technologies, re-scheduling operations and major partnerships (MCNamara, 2011). Also, organisational change includes mission changes, strategic changes, operational changes (including structural change), technological changes and changing the attitudes and behaviours of employees to align with the strategic direction of the organisations.

Organisational change is about the process of changing an organisation’s strategies, processes, procedures, technologies, and culture, as well as the effect of such changes on the organisation.

Change is a fact of working life. A static environment can quickly antiquate an organisation, hence change is a constant and necessary requirement for organisations to perpetually evolve, stay competitive and survive in this volatile global economy.

NHS (England) in particular, has been undergoing rapid change with the introduction of patient choice, the transition to a system of payment by results and the move towards practice-based commissioning among recent developments.

Organisational change can help streamline business processes and eliminate redundant systems or groups. However, it can also have negative consequences. It is a fact of working life that the way staff feel about their workplace has an impact on the quality of patient-care, as well as on the efficiency and financial performance of an organisation. This is driven home by the Boorman review on the importance of health and wellbeing in the NHS. The Research demonstrates the link between staff satisfaction and mortality rates. It suggests that higher staff satisfaction is linked to higher patient satisfaction and that staff experience shapes patience experience, rather than the other way round.

To minimise the negative impacts of change in organisations like NHS England, strategic change in an organisation should always seek to achieve advancement in both business and employee performance. The overall change process should reflect a ‘win-win’ situation for both the organisation and its employees. Much of the literature on organisational change admits that change tends to cost more, takes longer, and results in fewer benefits than originally anticipated. Thus, successful (and positive) organisational change depends on inter-facing and properly engaging with all the people involved.

Health sector reform(s) has generally focused on changes in financing or organisational structure, often to the neglect of the key resource-the staff. A primary reliance on achieving reform through organisational restructuring can be self-limiting in this labour-intensive sector. Form should follow function, and function is the delivery of health care, which depends on having the right mix of motivated staff in place. Staffing is a key input, but it is also the main cost in most health systems. Without effective staffing and committed staff, it is unlikely that health sector reform will be successful.

STATEMENT OF RESEARCH PROBLEM

The Care Quality Commission (CQC) reported that 17 NHS hospitals were failing to operate within safe staffing levels. This is yet more clear evidence of the impact of constant reforms (organisational change) on staff of NHS England.

The problems with NHS staffing are long standing and started in the Thatcher era, when the NHS budget was severely squeezed for many years. Though the previous labour government addressed the problem when it significantly increased NHS funding to match EU average  spending, however, all the good work was undone when the labour government brought in their damaging £20 billion “efficiency savings” plans in 2009 (“the Nicholson challenge”), which are now financially crippling many NHS foundation trusts up and down the Country. Since 65% of the NHS budget is spent on staffing, it was inevitable that these unprecedented levels of “efficiency savings” would result in staff cuts. Moreover, it was not just the problem of cuts in the absolute numbers of staff; but equally about the cuts in the levels of the most qualified staff. To save money, cheaper, less qualified staffs were replacing staffs deemed to cost more. This will clearly had implications for the quality of care delivered.

Another problem was the multibillion-pound top-down reorganisation of the NHS. Professor Patrick Dunleavey from the LSE (London School of Economic Science) has estimated that the coalition reforms will cost upward of £4 billion and he went on to label them as “policy fiasco”. In addition, the reforms would introduce more competition and choice into the NHS with much more private sector provision. This requires excess capacity in the service, which not only wastes resources, but will also take NHS staff out of NHS hospitals and into the private sector to duplicate services. This is clearly an inefficient use of money and will have detrimental effects on NHS England staffing levels.

The growing privatisation of the NHS England means more NHS England staff migrating to the private sector, often with poorer terms and conditions. Those who remain employed by NHS England may have to reapply for their jobs on several occasions, and/or face wage cuts, if not downgrading. Consequently, there has been a freeze on pay in NHS England. Along with other public sector workers, pay rises were capped until 2020. Not surprisingly, morale in many NHS organisations became low. At the same time, wide scale reorganisation and fragmentation of the NHS made it difficult to ensure sound work force planning.

Another problem was in the area of employment. For instance in the nursing sector. In 2013, a report by the Royal College of Nursing (Running the red light) estimated that the NHS was on the verge of a work force crisis with, for example, there was an estimated 20,000 unfilled vacancies across England. Barts Health NHS Trust was coping with the largest private finance initiative debt in the Country, and this provides one snapshot of what this means. Following a nursing skill mix review in October 2013, the trust announced that 161 whole time equivalent posts nursing posts were to be cut, and a further 472 posts for nursing and healthcare assistants were being down-banded (i.e. put on a pay grade lower than the one already identified as appropriate for the role they are undertaking).

The effects of downgrading are pretty obvious-loss of staff morale, eventual loss of pay once an initial period of pay protection has expired, heavier workloads, increased stress, burn-out and reduced quality of care provision. These effects were experienced along with long-term anxieties about redundancy and career path. Worker’s unions also pointed out that if nurses were down-banded, they were no longer obliged to undertake the duties associated with their previous grade; hence nurses in this position were often pushed into ‘choosing’ between becoming de-skilled or deploying their skills without getting their due recognition (either financially or professionally).

RESEARCH OBJECTIVES

The main objectives of this study were based on organisational change in the NHS England and how it affects staff of NHS. They are as follows:

• The study sought to unravel the intricacies of organisational change in the NHS and how they influence workforce planning in the organisation.
• Explore the experiences of governance and incentives during organisational change for managers and clinical staff.
• Establish a link between organisational change and organisational problems like stress, burn-out and low productivity
• Find solutions to workforce crisis necessitated by organisational change by analysing strategic management, human resource management and strategic decisions that enhance organisational goals in the NHS.

RESEARCH QUESTIONS

The following research questions were generated to guide the study:

• What is the impact of organisational change in NHS England?
• What is the impact of organisational change on staff in NHS England?
• Can organisational change lead to stress, burnout and other crisis in NHS England?
• What should be done to promote staff-friendly organisational change in NHS, are there any possible solutions?

SIGNIFICANCE OF STUDY

The significance of this study was to assist and serve as a guide to public and private health institutions, corporate organisations, consultants, managers, and administrators when formulating policies or engaging with the performance management system. Furthermore, it could enable the NHS England, related agencies and similar organisations across the world to enhance their understanding and attitudes towards organisational change, human resource management and performance management system.

Ultimately, it helps to shape the thinking of policy makers by hinging their ideas on the issues raised in this study.

RESEARCH STANCE

The study used interpretivism as its research philosophy. Interpretivism is the necessary research philosophy for this study because it allowed the researcher to understand the details of the situation, to understand the reality or perhaps a reality working behind them

PURPOSE OF STUDY

The purpose of the study is to define and study the concept of organisational change in NHS England, explore the relationship between the concept of organisational change and organisational performance and  analyse the effect of organisational change on staff wellbeing in the organisation. The study will make recommendations that would proffer solutions to the identified problems.

FORMAT OF STUDY

Chapter 1 gives a brief insight on what the study would entail; from the background through to the format of the study. The subsequent chapters of this study will shed more light on the impact of organisational change on the staff of NHS England.

Chapter 2 investigates the literature, which will be based on theories and relevant approaches to management quality. The theories will be derived from academic reviews, journals, articles, past research and published texts.

Chapter 3 discusses the research methodology. It presents the type of research and its design. The research instrument is also presented which in this case is the questionnaire. It further explains the method of data analysis while also detailing the issue of the limitations of the study, validity and reliability.

Chapter 4 presents the findings of the test questions and also analyzed the data collected.

Chapter 5 shows conclusions drawn from the analysis of the results and suggests recommendations that could be employed to deal with the problems observed. It also suggests area of future research.

CHAPTER TWO

THE CONCEPT OF ORGANISATIONAL CHANGE

This chapter presents recent studies carried out on organisational change and NHS England, which are relevant to the research study. In this chapter, a closer look is taken at organisational change, NHS England, management approaches, human resources and their impact on organisational performance and the overall wellbeing of NHS Staff. Furthermore, it dissects a variety of ideas (related to the research topic) as contained in books, Articles, Journals, Conference papers, Newspaper publications and the internet; with a view to validating the research and giving it an objective basis.

Grimsley (2018) defines organisational change as both the process in which an organisation changes its structure, strategies, operational methods, technologies, or organisational culture to affect change within the organisation and the effects of these changes on the organisation. He added that organisational change could be continuous or occur for distinct periods. All organisations undergo ongoing change, and studying the ways organisations change provides perspective on the process.

Organisational change also refers to any alteration that occurs in total work environment, including alteration of structural relationships and roles of the people in the organisation. It is an important characteristic of most organisations. An organisation must develop adaptability to change otherwise it will either be left behind or swept away by the forces of change; hence organisational change is inevitable in a progressive culture. Every modern organisation is expected to be highly dynamic, versatile and adaptive to multiplicity of change.

Organisational change is largely structural in nature. An enterprise can be changed in several ways. Its structure, its technology, its staff and other elements can be changed. Organisation change also calls for a change in the individual behavior of employees. Organisations survive; grow, decay depending upon the changing behavior of the employees. Most change disturbs the equilibrium of situation and environment in which the individuals or groups exist. If a change is perceived to be detrimental to the interest of the individuals or groups, there is always a tendency that they will resist the change.

CAUSES OF ORGANISATIONAL CHANGE

1. External pressure:
2. Change in technology and equipment: advancement in technology is the major cause (i.e. external pressure) of change. Each technological alternative results in new forms of organisation to meet and match the needs.
3. Market situation: change in market situation includes rapidly changing goals, needs and desires of customers, suppliers, unions, etc. If an organisation has to survive, it has to cope with changes in market situations.

• Social and political changes: organisational units literally have no control over social and political changes in the Country. Relationship between government and business or drive for social equality is some factors which may compel for organisational change.

1. Internal pressures (pressures for change from within the organisation).
2. Changes in the managerial personnel: one of the most frequent reasons for major change in the organisation is the change of executives at the top. No two managers have the same style, skills or managerial philosophies.
3. Deficiencies in the Existing organisation: many deficiencies are noticed in the organisations with the passage of time. A change is necessary to remove such deficiencies as lack of uniformity in the policies, obstacles in communication, any ambiguity etc.

HEALTH AND SOCIAL CARE ACT 2012

The health and social care Act 2012 is an act of the parliament of the United Kingdom. It provides for the most extensive reorganisation of the structure of the National Health Service (NHS) in England to date. It removed responsibility for the health of citizens from the Secretary of States for health, which the post had carried since the inception of the NHS in 1948. It abolished NHS primary care trusts (PCTs) and Strategic Health Authorities (SHA) and transferred between £60 billion and £80 billion of “commission” or health care funds, from the abolished PCTs to several hundred “clinical commissioning group”, partly run by the general practitioners (GPS) in England but major point of access for private service providers. A new executive agency of the Department of Health, Public Health England, was also abolished under the Act on April 2013.

The Health and Social Care Act 2012 highlights the following:

An Act to establish and make provision about a National Health Service Commissioning Board and Clinical Commissioning groups and to make other provision about the National Health Service in England; to make provision about. Public health in the United Kingdom; to make provision about regulating health and adult social care services; to make provision about public involvement in health and social care matters, scrutiny of health matters by local authorities and cooperation between local authorities and commissioners of health care services; to make provision about regulating health and social care workers; to establish and make provision about a National Institute for Health and Care Excellence; to establish and  make provision about a health and social care information centre and to make other provision about information relating to health or social care matters; to abolish certain public bodies involved in health or social care; to make other provision about health care; and for connected purposes.

The Act had implications for the entire NHS. NHS Primary Care Trusts (PCTS) and Strategic Health Authorities (SHAs) were abolished, with projected redundancy costs of £1 billion for around 21,000 staff.

£60 to £80 billion worth of commissioning were to be transferred from PCTs to several hundred clinical commissioning groups, partly run by GPs. Around 3,600 facilities owned by PCTs and SHAs were transferred to NHS property services, a limited company owned by the Department of Health.

IMPLICATIONS OF NHS REFORMS FOR NHS STAFF

It is already clear that when there is competitive tendering to provide NHS services, contracts are usually awarded to the lowest bidder, regardless of quality. Thus, if private companies are to make the lowest bid and still maximize profits, a common approach is to employ undertrained or cheaper staff, and replace doctors with nurses, and nurses with auxiliaries. At the same time, within NHS organisations, financial pressures (arising for instance from PFI debt and government cuts) have led to redundancies and poor staffing levels. Apart from its impact on patient care, understaffing leads to intense pressure on staff.

Also, the growing privatization of the NHS means more and more NHS staff migrating to the private sector, often with poorer terms and conditions. Those who remain employed by the NHS may have to re-apply for their job on several occasions, and/or face wage cuts, if not downgrading. In addition, there has been a freeze on NHS pay. Along with other public-sector workers, pay rises are now capped until 2020. As a result, morale in many NHS organisations is extremely low.

During the years of the coalition government, NHS staff were urged to accept pay restraint as part of seeing the NHS through hard times. Consequently, nursing pay in England lagged behind inflation by up to 8 percent-an average real term cut of more than £2,600. In 2014 many nurses did not get a pay rise at all. At the same time, research showed that of all the Trusts that responded to a Freedom of Information Request, 50 percent had offered pay increases of at least £5,000 to one or more of its executive directors. There were also numerous cases where executives received bonuses on top of their salaries – with two chief executives getting bonuses of more than £40,000 or the equivalent of the annual pay of a district nurse or a senior sister.

A more recent RCN report, the Fragile Frontline, finds that while the number of full time nursing posts may have risen over all between 2010 and 2014, the number of nurses filling these posts has dropped-meaning that fewer staff are providing more care for a record number of patients. One indication of the shortage of nurses is the increase in the NHS nurse agency bill which has increased by 150 percent in the last two years. It is estimated that the NHS has spent £80million on agency nurses over the 2014-15 financial year. There was also a reduction in the number of places funded for nurse-training in recent years as Trusts Chief Executives were trying to save money Looking at what is happening in medicine, famously, department of health and NHS employers has been trying to impose a new contract on junior doctors. What is less well known is that contract negotiations, which began in 2013, coincided with the setting up of a consortium of 13 NHS Trusts that tried to implement a local system for reducing pay, and introducing poorer terms and conditions for all staff i.e. a scheme that was different to the existing nationwide NHS agreement. Their plans include less maternity leave and sick pay, the end of some on-call payments and an increase in contracted working hours.

The consortium’s plan, having met with strong opposition from unions and parliament, was not implemented. However there are strong links or overlap between some members of the consortium on the one hand, and NHS employers, advisors to the DOH, and other powerful NHS stakeholders on the other hand. And there are also strong similarities between the plans of the consortium and the pay, terms, and conditions proposed in the junior doctor’s contract. This includes changes in on-call payments, the linking of pay progression to performance, and changes in what are classified as unsocial hours. The usual reason given to the public for the new contract is that it enables a ‘7-day’ NHS – that the public deserves a safer service over the weekend (or sometimes it is because they deserve to have access to routine services over the weekend). However, the background to the deal suggests that is really a cost-cutting exercise, with dubious benefits for patients.

Consequently, increasing privatization of the NHS means that, in future, many NHS staff will have to work in the private sector. Staff who are transferred from NHS to non NHS organisations retain their NHS terms and conditions at the time of transfer, at least for a while. However, staff were no longer covered by national negotiating agreements in the NHS so, for example, they would lose future pay increases agreed for NHS staff. And if they move to another non-NHS staff organisation after this initial transfer, they become treated as ‘new staff’- i.e. those not (directly) transferring from the NHS-are not entitled to NHS terms and conditions, or access to the NHS pension scheme. This means that a two tier system is developing for staff working in NHS-funded services, with employees who are carrying out similar roles receiving different pay and terms and conditions.

ORGANISATIONAL CHANGE AND MORALE IN THE NHS

Morale often suffers generally as a result of alienating and disruptive organisational change (Allcorn et al, 1996). As long as 1997, research showed that 26.8 percent of NHS staff were suffering damaging levels of stress, compared with 17.8 percent of the general population. Evidence suggests that little has changed in the intervening years, and health professionals (nurses in particular) have consistently reported the highest rates of work-related stress, depression, or anxiety in recent years.

In the last NHS staff survey, 39 percent of NHS staff reported that during the past 12 months, they had felt unwell because of work-related stress. 65 percent reported that they had attended work despite not feeling well enough (physically or mentally) to perform their duties, while only 43 percent said that their organisation took positive action on health and wellbeing.

With serious and concerted effort being made to save costs and very little attention given to boosting staff morale in the NHS, the authorities of the NHS are inadvertently creating conditions in which the health, wellbeing and quality of life of those who have committed their working lives to the NHS are being profoundly damaged.

Recently, there has been growing concern and signs that a sense of detachment and demoralisation has penetrated the NHS workforce. And it is threatening to undermine the huge change programme required to deliver the savings that are needed and the five year forward view. How are staffs expected to champion far-reaching changes to transform care if they are demotivated and disaffected?

In the latest survey of staff, only 42 percent were satisfied with the extent to which their work was valued by their organisation, while 57 percent said they were unable to meet the conflicting demands made on them. The Nuffield Trust’s most recent survey of 100 health leaders found almost 60 percent thought that morale had deteriorated at their organisation, with workload cited as the main factor, closely followed by the financial position of the organisation and the NHS more generally.

Because of organisational change in the NHS, staff size has reduced, causing longer working hours, fewer opportunities to recharge and relax, and greater responsibilities for the remaining employees. Thus, it is likely that these changes in the workplace dynamic could cause reductions in staff morale and an increase in burnout in a hitherto bright and happy workforce.

STAFF BURNOUT

The term “burnout: first appeared in the 1970s and was most prevalent among human services professional (Shauvel and Enzmann, 1998). Human services professionals focus on improving the quality of life of the individuals and communities that they serve; hence all NHS staff are human services professionals. Staff burnout is defined as “a condition of emotional exhaustion, depersonalisation, and reduced personal accomplishment that can occur among individuals who work with people in some capacity. “(Maslach, Jackson and Leiter, 1996 p.4).

To gain a better understanding of staff burnout, it is important to look at the definition more closely. The symptoms, which are mentioned in the definition of burnout, include emotional exhaustion, depersonalisation, and reduced personal accomplishment. Emotional exhaustion refers to the energy discharge of emotional resources, which is considered the keystone of staff burnout. Secondly, depersonalisation can be explained as people behaving with a “cold” heart or an indifferent attitude. Finally, reduced personal accomplishment is the tendency to devalue one’s work, which leads to a negative self-assessment (Maslach, Jackson and Leiter, 1996).

According to researchers, staff burnout could lead to the following adverse effects in the work setting: higher rates of illness, lower staff morale, increased use of alcohol and drugs, lower career satisfaction, high staff turnover, reduce quality of service, and poor customer outcomes (Barnett, Brennan and Garers, 1999: Maslach and Jackson, 1986; Moore and Cooper, 1996). Furthermore, staff burnout can influence the psychological health of staff. For example, Hegarty (1987) conducted a case study on British staff workers who served community members with learning disabilities. One staff worker stated that she needed to leave her work and enter psychotherapy to treat her own health because of staff burnout. It is also important to note that staff burnout does not only apply to one specific work class (e.g. healthcare, operational parks, administration, seasonal). Carton et al (1988) measured the burnout of four different staff groups (Professional staff, direct care staff. Educational development assistants and support staff) and they found the level of burnout among all of these groups to be at moderate or high levels.

POSSIBLE DETERMINANTS OF BURNOUT

Boritz (2006) explains that the causes of staff burnout can be classified into four factors. The first factor through differences at the personal level. This factor includes situational and personal influences that may lead to burnout, such as personality, over commitment, and setting unrealistic job expectations (Beasley, Thompson, and Davidson, 2003, Pines and Aronson, 1988). Secondly, burnout may occur at the interpersonal level. The most representative example of this is when employee’s resources become unbalanced with the client’s demands (Maslach, 1993). Generally, organisations may look at it as a good thing when clients’ demands exceed employee’s resources, since it would (presumably) create the opportunity to learn, improve and increase sales (Ulrich, 1997). However, when clients’ demands exceed the employee’s resources, this may lead to staff apathy, causing them to feel like they cannot do anything about it. Thirdly, staff burnout may be a result of organisational factors. Organisational factors have been developed in the field fairly recently compared to the individual and interpersonal factors. (Maslach, Schaufeli and Leiter, 2001). Organisational factors were based upon the perception of the level of respect that employees receive from the organisation in which they work. According to Grandey (2003), emotional exhaustion may be caused by the perceived need of employees to disguise their feelings of disrespect for their employer to their clients. The final reason for burnout stems from a slightly different concept called emotional labour.

It refers to the process by which workers are expected to manage their feelings in accordance with organisationally defined rules and guidelines (Hochschild, 1993), the expenditure of emotional labour is especially critical in the healthcare profession, since staff have a high frequency of interaction with co-workers, patients, community members and patrons, they need not only use physical labour, but also emotional labour. This could easily cause staff to become emotionally exhausted.

UNDERSTANDING STAFF MORALE

Staff morale is a very delicate issue that affects job performance. Researchers have defined morale in many ways. Among the definitions, Mcknight, Ahmad and Schroeder (2001) described it as “the degree to which an employee feels good about his or her work and work environment. The factors that help to define morale are intrinsic motivation, job satisfaction, work meaningfulness, organisational commitment and work pride (Mcknight, Ahmad and Schroeder, 2001).

Since staff morale is related to how staff feels about the organisation, it is an important factor in creating a healthy work environment. A study by Millet (2010) listed six reasons why high staff morale is important. Organisations that incorporated these six concepts displayed a higher staff morale culture and noticed improved productivity, improved performance and creativity, reduced number of days taken for leave, higher attention to detail, a safer workplace and an increased quality of work. In addition, Mazin (2010) found that agencies with higher morale, have more staff who arrive to work on time, communicate better, waste less time on gossip, have higher rates of recruitment and retention, and Hasiri (2010) found that employees who work for organisations with high morale develop higher rates of job satisfaction, creativeness and innovation, job honorability (respect for their own job), commitment to the organisation, eagerness to satisfy group objectives instead of individual objectives, and the desire to improve organisation’s performance.

On the other hand, low staff morale can be costly to organisations according to the Gallup organisation (2008), organisations could stand to lose £350 billion per year because of the loss of productivity caused by low staff morale. Also, several researchers assert that low levels of morale could cause increased costs, absenteeism, strikes, lack of motivation and interest, decreased efficiency and could lead to staff’s refusal to provide services (Cappelli 1997; Firth et al, 1997; Norsworthy et al, 1982, Reed 2009; Straka 1993). There are many reasons behind low staff morale, but the top reason mentioned the most by researchers is poor leadership. Fretwell (2002) emphasized the importance of the leader’s role, since organisations are significantly influenced by the leader’s vision and decisions. Psychometrics Canada (2010) also reported that poor leadership has negative effects on staff morale. Also, the distrust of management, poor interpersonal relations (relationship between leaders and staff), and inflexible working conditions could be other factors that affect staff morale (Dye and Garman, 2006).

Finally, it should also be noted that low morale may be caused by departmental layoffs or closures, labour negotiations and contract disputes, high employee turnover rates, changes in leadership, and unclear expectations. Lack of opportunity for personal growth because of unchallenging environment can also lead to low morale.

CHAPTER THREE

CHANGE MANAGEMENT

Change management (sometimes abbreviated as (OCM) is a collective term for all approaches to prepare and support individuals, teams and organisations in making organisational change. The most common change drivers include technological evolution, process reviews, crisis, and consumer habit changes, pressure from new business entrants, acquisitions, mergers and organisational restructuring. It includes methods that redirect or redefine the use of resources, business process, budget allocations, or other modes of operation that significantly change a company or organisation (Wikipedia, July, 2018).

Organisational change management (OCM) considers the full organisation and what needs to change, while change management may be used solely to refer to how people and teams are affected by such organisational transition. The ability to manage and adapt to organisational change is an essential ability required in the workplace today. Organisational change management employs a structured approach to ensure that changes are implemented smoothly and successfully to achieve lasting benefits. However, it has been observed that major and rapid organisational change is profoundly difficult because the structure, culture, and routines of organisations often reflect a persistent and intricate “imprint” of past periods, which are resistant to radical change even as the current environment of the organisation changes rapidly.

• Organisational change directly affects all departments and employees; hence the entire company must learn how to handle changes to the organisation. The effectiveness of change management can have a strong positive or negative impact on employee morale. Change management processes should include creative marketing to enable communication between changing audiences, as well as deep social understanding about leadership styles and group dynamics.
• Organisational change management also aligns group’s expectations, integrates teams, and manages employees training. It makes use of performance-metrics, such as financial results, operational efficiency, leadership commitment, communication effectiveness, and the perceived need for change in order to design appropriate strategies, resolve troubled change projects, and avoid change failures.
• Change management is faced with the fundamental difficulties of integration and navigation, and human factors. Thus, change management must always consider the human aspect where emotions and how they are handled play a significant role in implementing change successfully.

Organisational change is all about optimizing the performance standards of an organisation and this may sometimes occur as either due to the ability of the organisation’s managerial staff to be proactive or reaction to environmental changes or the presence of a crisis. Whatever the case may be, the organisation will always require a well talented and very capable managerial staff to trigger any change and for it to be successful, Van de Ven and Poole (1995) made some valuable propositions to the causes of organisational change. They proposed that organisational change can best be explained with the aid of theories such as the life cycle theory, the dialectical theory and the teleological theory.

The dialectical theory believes that an organisation is just like a culturally diverse society with varying views and opinions wherein new organisational values develop because of one force dominating the other and a goal is thereafter established thus culminating in organisational change. Increased comprehensiveness of more planners with more resources would thus lead to better planning teams, better analysis of the environments, better options for new systems, better choices of such systems and better implementation plans, all of which will lead eventually to improved performance. Organisational change is all about reviewing and modifying structures, specifically management structures and business processes. To avoid falling behind, or to remain a step ahead of its rivals, a business must seek out ways to operate more efficiently and cost effectively. Change is something that should be embraced not feared. Only with change will organisations be able to lay the foundations for long-term success. However for any change to be successful and sustainably effective, the interest of all stakeholders in the organisation must be adequately considered.

ORGANISATIONAL CHANGE AND STRESS

The problem of stress in organisations has generated a lot of debates and studies. As the needs of man increase, the burden of business managers, workers and professionals in various organisations continually multiply as they strive to meet societal and workplace expectations in the midst of other demands of existence. The outcome is usually stress, fatigue, burnout etc. Organisational change and stress management are widely accepted as two major issues in organisational life today (Vokola and Nikolau, 2005). If there is one constant in the business world it is change (Washington and Hacker, 2005), but with change, stress will normally follow. Change is defined as a dynamic condition in which an individual is confronted with an opportunity, a demand or a resource related to what the individual desires and for which the outcome is perceived to be both uncertain and important. Stress can be defined as any physical or emotional factor that causes bodily or mental tension.

Today, workplace stress is becoming a major issue of increasing concern to employees and organisations. It has become a part of life for employees, as life today has become so complex at home as well as outside that, it is impossible to avoid stress. Many individuals in the workforce have to deal with at least some sort of stress in their lives. Sometimes stress stems from family problems, finances and other personal issues, and other times stress comes directly from the workplace. Experts opine that stress is the main cause of all the problems of the modern world and that it affects both the individual and organisational health.

Olagunju (2010) defines stress as a chronic complex emotional state with apprehension and is characteristic of various nervous and mental disorders. For Topper (2007), stress is a person’s psychological and physiological response to the perception of demand and challenge. Thus, work-related stress is a pattern of psychological, emotional, cognitive and behavioral reactions to some extreme tasking aspects of work content, work organisation and work environment. Among life situations, the work place stands out as a potentially important source of stress purely because of the amount of time spent in this setting (Erkutlu and Chafra, 2006). Stress is an unavoidable consequence of modern living. It is a condition of strain that has direct bearing on emotions, thought process, and physical conditions of a person (Jayashree, 2010). In fact, stress is much more common in employees at lower levels of workplace hierarchies, where they have less control over their work situation (Beheshtifar and Nazarian, 2013).

During the life span of an individual, job period is very important because it is directly linked with the stress. In those organisations where employees are often maltreated, low satisfaction and high stress levels are common reactions. Stress is not good for the human body. It increases blood pressure, sugar, suppression of immune system, decreased digestive system activity and reduced urine output. Stress can also be further described as the adverse psychological and physical reactions that occur in an individual as a result of his/her inability to cope with the demands being made on him or her (Moorhead and Griffen, 1998).

Many organisations in the world are witnessing an alarming increase of the negative effects of stress on employees’ productivity. Typical examples are organisations in America, the United Kingdom, the Caribbean, East and Central Africa, West Africa and in other parts of the world.

The America Academy of family physicians reported that, about two-thirds of the visits to family physicians are the result of “stress-related symptoms” (Henry and Evans, 2008). According to Maxon (1999), no individual reaches peak performance without being stressed, whether an athlete, an office worker or a manager. The natural pattern of human behavior is to experience a stress-causing event or situation, react to it with increased tension and then return to a normal relaxed state. However, the problem occurs when stress becomes so overwhelming or constant to the extent of breaking normal human functioning.

Stress in the workplace is globally considered a risk factor for workers health and safety. More specifically, the health care sector is a constantly changing environment, and the working conditions in hospitals are increasingly becoming demanding and stressful. According to the World Health Organisation (WHO), “a healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety, and wellbeing of all workers and the sustainability of the workplace”.

STRESS IN THE NHS

Stress is believed to account for over 30 percent of sickness absence in the NHS, costing the service £300-400 million per year. The NHS annual survey (2014) found that 30 percent of NHS staff reported that they had suffered from work-related stress.

The Health and Safety Executive (HSE) defines stress as an adverse reaction that people have due to excessive pressures or other types of demands placed on them. Stress can happen in different ways in different NHS organisations but there are common factors that can lead to stress and poor health. Some NHS staff have to deal with violent and unpredictable patients, others deal with traumatic and harrowing circumstances, others have a lack of support or are not receiving enough communication about changes affecting them. The most important fact is the impact on the individual and how they feel able to manage those feelings.

According to the Daily Mail (Jan, 2018), more than 91,000 NHS employees have taken at least a month off work to deal with stress in the last three years. The number of staff taking long term stress leave increased by 19 percent between 2014 and 2016. Figures released by 170 trusts across Britain showed a total of 204,573 employees took time off to deal with stress, anxiety, or another mental health-related issue, while 91,364 were off for a month or more.

Nurses were the most stressed group, with at least 46,341 taking time off in the last three years. This is happening at a time when the NHS is facing a staffing crisis, as an estimated 40,000 nursing posts are currently vacant. Out of the 96 trusts that provided staff breakdowns, nurses made up 37 percent of those who took time off. While under-pressure nurses were the most absent staff group, doctors made up less than two percent of those who took stress leave. Just 2,147 doctors took time off to deal with stress, a fraction of the number of nurses who took leave. The total number of absences increased by 20 percent in the three years, from 62,245 in 2014 to 74,563 in 2016 according to Freedom of Information requests.

The Daily Mail findings revealed that Sheffield Training Hospitals had one of the largest numbers of staff absences, with 3,820 employees taking time off over the three years. 2,448 employees took stress leave in University Hospitals of North Midlands, while 2,281 were absent from Tyn and Wear Trust. Danny Mortimer, Chief Executive of NHS employers, said: “many NHS staff undertake emotionally demanding roles, helping others through moments of extreme need. Addressing mental health issues in NHS workplaces, the NHS provides a variety of support to staff who may be suffering from mental health problems. Support will come in a range of forms across results, but could include, for example, rapid access to treatment schemes, maintaining contact if an employee needs to take the off, and support for returning to work”.

According to a March, 2018 report, the number of NHS staff suffering work-related stress is on the rise, with 38.4 percent feeling physically unwell as a result over the past year (2017), compared with 36.7 percent in 2016. And the pressure appears to be taking its toll, with almost a third of staff (29%) reporting having witnessed “potentially harmful errors, near misses or incidents within the last month”, according to NHS England’s latest annual staff survey.

The survey was sent to 1.1 million NHS England employees, of who 487,227 responded. The resulting report (published on March 6, 2018) is the largest workforce survey in the world. The 2017 survey also found that 52.9% of staff had gone into work despite feeling unwell over the last three months, because they felt under pressure from their manager, colleagues or themselves. Just over 15 percent of staff said, they experienced physical violence from patients, relatives or the public over the past year, and 28 percent experienced harassment, bullying or abuse.

NHS STAFF SURVEY

In the last 12 months

n= 487,227 NHS staff members, conducted September to November, 2017

Source: NHS Staff Survey, 2017

Less than a third of all NHS staff said they were satisfied with their salaries last year, while more than 58 percent said they worked additional unpaid hours. All these factors often combine to predispose staff to stress in the organisation.

CHAPTER FOUR

RESEARCH METHODOLOGY

This chapter explores the research method and the procedure followed in collecting and processing the data. The chapter will look at the research design and methodology, as well as the research process, limitations of study, ethical issues and the rationale for the study.

I used the structured questionnaire to gather my data for this study. The questionnaire was administered on my target population, which is the staff of NHS England. The reason for using the staff of NHS England is none other than the fact that the research topic revolves around them-that is both the management staff and other categories of staff as they are the ones in the position to better explain the impact of the reforms in a no-holds-barred manner. I applied the type of questionnaire method called delivery and collection while gathering my data.

RESEARCH DESIGN

A research design is a plan or a blueprint for conducting the study that maximizes control over factors that could interfere with the validity of the findings (Burns and Grove, 2005:223). A research design provides a framework for the collection and analysis of data (Bryman and Bell, 2007). There are two types of research design that are widely used and they are quantitative or positivist research design and the qualitative or phenomenological research design. They are actually two ends of a continuum with a combination of two models occurring in varying shades of emphasis along the continuum (MANCOSSA 2002, Section 1, P.140). An exploratory qualitative phenomenological study was conducted for the research.

EXPLORATORY

This is a means of finding out ‘what is happening’ and to help in the clarification of a problem. Exploratory studies are aimed at gaining insights and understanding regarding a new interest, a relatively new subject of study or a persistent phenomenon. They are done to satisfy the researcher’s curiosity, desire for better understanding, and to explicate the central concepts and constructs of a study. The researcher wanted to gain insights and comprehension into the workings of the NHS England, strategic management in the organisation, NHS reforms and staff wellbeing. Exploratory research can also determine priorities for future research (Babbie and Mouton 2006: 79-80; Vys and Basson 1991:38). This helped the researcher’s data collection because it afforded the researcher an insider account of the whole operations of NHS England. The researcher was able to deal first hand with both high-ranking staff and junior staff and this enabled him to easily gather information that helped the study.

QUALITATIVE

Qualitative research refers to a series of broadly divergent and related methodologies that cluster under a paradigmatic umbrella (Schneider, Whitehead and Elliot 2007:106). It takes its departure point as the insider perspective on social action. Qualitative research is naturalistic since it studies phenomena or people in their natural setting applying low control designs. Qualitative research involves conducting the inquiries in a way that does not disturb the context of the phenomena studied (Struedert Speziale and Carpenter 2003:18). The research design is flexible enabling the researcher to adapt the inquiry as an understanding deepens or the situation changes (Burns and Grove 2005:535). The purpose of qualitative research is to describe, explore and explain phenomena being studied (Marshall and Rossman, 1995).

PHENOMENOLOGICAL

The study is a phenomenological one. It is a systematic, interactive and subjective approach to describe life experiences and give them meaning. The aim of phenomenological approach to qualitative research is to describe accurately the lived experience of the people and not to generate theories or models of the phenomenon being studied (Leininger in Burns and Grove 2005:23). Phenomenological study seeks to understand people’s perception, perspective and understanding of a particular situation, giving answers to the research question (Leedy and Ormrod 2005:139). To understand the experiences of people affected by organisational change in the NHS England and other such organisations, a phenomenological study is best so as to get an insider perspective in a naturalistic setting with enough flexibility and being as non-intrusive as possible.

RESEARCH METHODS

Research method is specific research techniques which involves sample selection, data collection, and data analysis techniques (Silverman 2000:79). The research method applied by the researcher was very relevant to the study because the researcher had a one on one session with most of the relevant authorities in the NHS England. With the questionnaires applied and the interview sessions done across various NHS departments, the researcher was able to come up with accurate responses and data concerning the impact of the topic researched, on the activities of NHS workers.

POPULATION AND SAMPLE

Sampling is the process of selecting a group of people, events, behaviors or elements with which to conduct a study. A sample is selected from a target population through probability or non-probability methods. A study population is that theoretically specified aggregation of elements from which the sample is actually selected. An element is that unit about which information is collected and that provides the basis of analysis (Babbie and Mouton. 2006:173-174).

POPULATION

Sampling criteria lists the characteristics essential for membership in the target population. Criteria are developed from research problem, the purpose and the conceptual and operational definition of study variables and the design of the study. A sample is selected from the population that meets the criteria. Inclusion criteria are characteristics that must be present for elements to be included in the study (Burns and Grove, 2001:365-367).

To match the research objectives, those experts in policy and planning and the key administrators who are directly involved in introducing, monitoring, evaluating and bearing other responsibilities associated with organisational change in the NHS are defined as the target population. These would be the key informants, thus persons who have been thoughtfully and purposefully selected because they are considered to be knowledgeable about the subject of inquiry. They are information rich (Leininger 2002:93).

Population size used for this study was 120 informants all of whom are staff of NHS England so as to get credible and correct information.

SAMPLE SIZE

“A sample size is a selection from the population” (Robson 2002:260). “A sample consists of the limits of the population that are drawn for the questionnaires” (Dilman 2000:126). There are two major types of sampling which are: probability and non probability sampling. With probability samples, the chance or probability of each case being selected from the population is known and is usually equal for all cases (Saunders et al 2003:152). The possibility of selecting any member of the population is known. This is not the same with the non-probability sampling, as the possibility of selecting any member is not known. For non-probability samples, the probability of each case being selected from the total population is not known (Saunders et al 2003:172). This research used the non probability sampling and there are five commonly used types which are, quota sampling, purposive sampling, snowball sampling, self selection sampling and convenience sampling. Quota sampling is entirely non-random and is normally used for interview surveys. It is based on the premise that your sample will represent the population as the variability in your sample for various quota variables is the same as that in the population (Saunders et al 2003:172). Purposive or judgmental sampling enables you to use your judgment to select cases that will best enable you to answer your research question(s) and meet your objectives (Saunders et al 2003:175). Snowball approach allows the researcher to make initial contact with a few group of individuals who are relevant to the research topic and use them to reach the other relevant members of the group (Bryman and Bell, 2007). Self selection sampling occurs when you allow a case usually an individual to identify their desire to take part in the research. (Saunders et al. 2003:117). In most cases, people often opt to participate because of their feelings about the research questions or objectives. Convenience sampling involves- choosing the nearest and most convenient persons to act as respondents (Robson 2002:265). The process is continued until the required sample size is reached.

The study used a non-random purposive sampling scheme, that is, selecting members of the target population who are likely to provide the most valuable data addressing the research objectives (Leedy and Ormrod 2005:145).

CHAPTER FIVE

PRESENTATION AND ANALYSIS OF DATA

This chapter concentrates on critical analysis and assessment of the impact of organizational change on the staff of NHS, England, which is the focus of the study. Thus we are looking at the findings and presentation of the data collected. Each questionnaire is presented pictorially by a bar chart.

A hundred and twenty (120) questionnaires were sent out however, of which one hundred and one (101) responded.

Table 5.22 Job satisfaction

Job Satisfaction fig.4.22

100 –

80 –

60 –

40 –

20 –

0 –

Yes              No            Not Sure

Job Satisfaction

Yes

No

Not Sure

Table 4.23 Challenging work

Work Challenge

80 –

60 –

40 –

20 –

0 –

Yes       No           Not Sure

Fig.4.24

Yes

No

Not Sure

Figure 4 .25

Table 4.23 shows the response towards work challenge in NHS, England. And we see that out of 101 respondents, 72 said Yes responding 71.3% of the population used for sample, 15.8% said No, while 12.9% were Not sure. Fig. 4.24 and Fig. 4.25 also show the same.

Table 4.26 clear understanding of strategic objectives

Clear understanding of strategic objectives

Clear understanding of strategic objectives

100 –

80 –

60 –

40 –

20 –

0 –

Yes                      No                   Not Sure                     Fig.4.26

Clear understanding of strategic objectives

Yes

No

CHAPTER SIX

SUMMARY OF FINDINGS

The purpose of his concluding chapter is firstly, present a summary of the research design secondly, to present a summary of the findings in relation to the objectives of the study, thirdly, to offer a conclusion and fourthly, to outline the implications of this study for further research.

The focus of this study was on the impact of organizational change on staff of NHS, England. The research has examined past and recent NHS reforms and how they affect NHS staff in variety of ways. Since an organizations success is most often attributed to internal and external parameters which play overall success, the organization to be able to achieve a competitive advantage and ensure optimal service delivery more emphasis must be laid on the personnel in the organization as this constitutes the real assets of every organization. With regards to NHS England, it was discovered that while the organization was constantly trying to raise the quality of service delivery to patients, coupled with strict policies aimed at cutting cost, very little confederation was being given to staff welfare and well being.

The researcher found out that the reforms have led to greater marketization of the NHS, although claims of mass privatization have been exaggerated. Also, the absence of system leadership has become increasingly problematic at a time when major service changes are needed within the health service. The top-down re-organization of the NHS as instituted by the reforms has been damaging and distracting the concept of organizational changes comes from the nature and environment of the organizations change basically means series of events which supports the process of development in organizations generally, organizational change means right signing, new development and change in technologies, re-scheduling operations and major partnerships. Organizational change includes mission changes, strategic changes operational changes (including structural change), technology changes, changing the attitudes and behavior of staff, counter resistance from different employees of companies and aligning them to strategic decisions of the organization (Kreitner and Kinick, 2007).

The research highlights two elements which can make an employee to perform well. They are the tangible element deals with recruiting the right persons for a given task, having the right tools for the job, good physical working environment and having an appropriate reward for the job. On the other hand, intangible element range from having a sense of belonging, feeling valued and recognized by ones organization/employer among other variables. Changes affect performance at the individual, team and organizational level, Individuals learn through curiosity and experimentation, team learn by encouraging diversity of ideals and inputs, while organizations learn by discipline, experience, continuous improvement and experimentation.

Organizational change in the HNS, England, has a profound impact on employee performance and by extension, service delivery.

Employee performance is vital for the success of every organization. Most of the organization struggling with contemporary challenges put more emphasis on employee performance. However, if employees feel maltreated and there s no job satisfaction, many of the organization’s goals will not be met. Downsizing, mergers, innovations and restructuring of organizations, usually decrease employees’ performance. In addition to that, task, quantity and quality, changing location and time constraints radically affect the work life of employees. These attributes were discovered to be very prominent in recent NHS reforms and how they affect NHS staff. Sometimes, when the changes are broad in reach and several changes occur simultaneously, they culminate in increased stress-related conditions for the employees. There maybe many causes for increased stress levels including g perceived injustices or unfairness, like of timely communication by management or fear of future changes. Also, loss of loyalty is another impact of organizational change on employee performance. Many organizations look to salaries and benefits as the first places to cut back when looking to make changes that involves saving cost.    When this happens, it is inevitable that some employees will leave the organization to seek employment elsewhere. The employees that remain, whether they stay voluntarily or because they could not find employment elsewhere, are often resentful and non-committal. Motivation decreases, taking job performance along with it. Employees become disloyal and My even become angry enough to purposefully sabotage the organization.

The researcher believes that employers and managers need to let employees have more power to design their jobs and roles.

RECOMMENDATION

The impact of organizational change on staff of NHS, England, cannot be under-estimated. It is on this premise that the researcher is making the following recommendations.

1. The issue of leadership is very critical for all organizations, hence, good leadership that will strike a balance between cutting costs, ensuring quality service delivery to patients, and meeting employees’ expectations is essential for NHS, England.
2. Proper and appreciable communication channels should be established to encourage mutual interaction and cooperation between management and staff and by so doing, eliminate fears and insinuations that most staff are often not carried along in the decision-making sessions that eventually result in reforms.
3. The NHS should constantly formulate policies that will engender employee development and boost their morale. The employees should not be regarded as ‘mere working tools’. They should be seen as partners in organizational progress and evolution.

CONCLUSION

This research focused on the impact of organizational change on staff of NHS, England.The research sought to consider the implications of numerous NHS reforms for NHS staff welfare and wellbeing. The most significant changes which have occurred as a result of NHS reforms have been in staffing change and organizational culture, and the individual attitudes of NHS management and staff. Attempts to alter methods of conducting employee relations and determining pay and condition of employment have not been very successful. The importance of NHS staff to the success or failure of the health sector reform can not be wished away. Health sector reforms in many countries have focused on structural change, cost containment, the introduction of market mechanism and consumer choice (Cassels, 1995; Mills, 1995; Sen and Coivusalor 1998). This focus has inevitably challenged ‘custom and practice’ in the ways that help professionals and other staff are employed and deployed and has also raised questions about the public/private mix and impact of NHS staff. How the NHS manage its human resources may in itself be a major constraint or facilitator in achieving the objectives of health sector reform.

Thus, it is concluded that in line with the health sector reforms and with serious and concerted efforts being made to cut cost and very little attention given to boosting staff morale in the NHS, the NHS authorities are inadvertently creating condition in which the health, well-being and quality of life of those who have committed their working lives to the NHS are being profoundly damaged.

By so doing, they will see themselves as being part of the organizational change process. This is vital for optimal employee performance and job satisfaction.

LEARNING STATEMENT

Having finished my dissertation, I do believe I am in a better position to reflect on the work done and how things could have been done better. It has not been an easy process at all. Initially I thought I would be able to combine being a full time parent and wife with a part time course and full time job without much difficulty because this was a dream come true. The opportunity to further my studies, however nothing prepared me for what I now recognise as being burnout.

Whilst juggling all these facets of my life, my ability to prioritize was thoroughly tested. I encountered many up and down moments in particular my mental health. This was like a double-edged sword. I could empathise with how the respondents to my questionnaire must have felt dealing with the effects of constant organizational change.

I came to understand how I could learn effectively to enable me reach my goals by writing things down help to clarify thoughts and emotion in this regard.

I kept a notebook of scribbles and post it notes.

Reflection  also helps to focus and actively participate in development as an effective independent and critical learner. The journal kept will become a record of progress throughout ones study and will help to discover the strategies and process that work well for individuals. Reflection is itself a way of learning and helps to evaluate own performance as a learner. Reflective practice is a life skill, not just a university requirement. By engaging in reflective learning, one is taking an active role in learning and recognizing personal responsibility for own lifelong learning thinking and writing are closely connected processes and in order to write reflectively, you need to think carefully about yourself as a learner ( coughan 2007: 8).

Students sometimes view reflective writing as an annoying interruption to the serious business of developing content knowledge in their subject area. However, there are sound reasons why reflective writing is included in student assessment.

Reflection is indicative of deep learning, and where teaching and learning activities such as reflection are missing. Only surface learning can result (Biggs 1999) “Reflection leads to growth of the individual morally, personally, psychologically and emotionally, as well as cognitively” (Branch and paranjape 2002: 187).

Reflection can lead to greater self-awareness, which in turn is a first step to positive change it is a necessary stage in identifying areas for improvement and growth in both personal and professional contents. Taking time to reflect can help one identify approaches that have worked well and in that way reinforce good practice enrolling into this Masters Programme has always been a dream that fascinated me. I have been one person who believes that getting a doctorate in life is what I want and when the opportunity came to start this programme, I embraced it with both hands. Hence the fact that I wanted ti improve my academic qualification prepared me for the task ahead. It was very challenging because of the fact that one was  expected to combine office work and turning out for classes as well as participating in the group and individual assignment. The group discussion and assignments made me realize how difficult this programme would be and combining it with the pressures of work was aso much burden for one personal. I must also confess that the assignament due dates made it possible for me to apply my time management skills luckily I didn’t miss out on any of the due dates as I always submitted my tasks on time all my assignments ant it will be agood start for me because shifting the date will iple more pressure on me drawing up a time -table for my dissertation was helpful because I start to my time, but nothing prepared me for the challenges I faced in effort to penetrate different NHS department to distribute my questionnaires to respondents. It was quite challenging in retrospect, I can say that there are things I could have done better if given another opportunity to do the dissertation again. I will in future try to interact more with the people I am writing about before going ahead with the research.

Generally, the experience has been good but challenging. I do belive that I am better equipped now to face the challenges any onecan throw at me with regard to organization change and its impact on employees, especially those in the NHS, England

APPENDIX ONE.

QUESTIONNAIRE

(1)       Dissertation questionnaire on the impact of organizational change on staff of NHS, England

Date : …………………………..

Section A – Personal data

Name of Respondent (optional)

Current NHS Trust

Previous NHS trust

Gender: Male ( )       female ( )

Section B : Please tick (x) in the brackets provided

Are you satisfied with your job?

(a) Yes                       (  )

(b) Not sure               (  )

(c) Not applicable   (  )
(2)       is your work challenging
(a) not sure
(b) not applicable
(3)       is there a clear understanding of the strategic objectives of the NHS?
(a) Yes
(b) no
(c) Not sure
(d) Not applicable

(4)       Do you believe that there is an opportunity for individual career growth and development within the NHS?
(a) Yes
(b) No
(c) Not sure
(d) Not applicable

(5)       Do you think the NHS reforms are favorable to NHS employees?
(a) yes
(b) no

(6)       do you feel you are adequately rewarded for your dedication and commitment towards your work?(a) yes (b) no

(7)       Does the management involve you while taking leadership related de
(b) no
(c) not sure
(d) not applicable

(8)         In a typical week< how often do you feel stressed at work?
(a)

(b)

(c)

(c)

(9)         Does your job cause born-out to you?

(a)

(b)

(c)

(c)

(10)     Do you think the environment at work helps you strike the right balance between your work life and personal life?
(a)
(b)
(c)
(d)

APPENDIX TWO.

ETHICS APPLICATION

APPENDIX THREE.

SUPERVISION RECORD

APPENDIX FOUR

DISSERTATION PROPOSAL

Topic: The impact of Organisational Change on the wellbeing of staff in NHS England. 

Introduction

The aim of this topic is to explore what impact organisational change has on the wellbeing of staff working within NHS England.

About NHS England

NHS England was set up as an executive non-departmental public body which plans and funds the NHS, so as to improve health and well-being, secure high quality care and ensure the future NHS is sustainable.

NHS funding is entrusted to NHS England which shares with the Secretary of State for Health the legal duty to promote a comprehensive health service in England in accordance with the NHS Act 2006 (as amended by the Health and Social Care Act 2012).

Each year, the Government sets out its expectations of NHS England and the funding it will receive, in the form of a mandate which is also laid before Parliament. This sets the

direction for the NHS, and helps ensure it is held accountable to Parliament and the

public.

For the purpose of my study, I have chosen to focus on how the organisational changes in 2016/2017 affected the well being of staff.

A PESTLE analysis will enable me understand the factors which may have contributed to the organisational changes during this period.

Following on from the PESTLE Analysis, I will be able to identify key changes which took place and how these changes were implemented within NHS England. Also I will be looking at how these changes have affected employees in the work place.

Staff Wellbeing has been at the forefront of many organisations focus most especially in recent times as mental health is now being talked about more freely than ever before. The British Government has highlighted the state of the nation’s mental health and how it is investing in ensuring that there are services available to help individuals.

NHS England has taken this on board and its’s five year forward view reflects its commitment to its employees. To ensure that it has a healthier workforce, various plans and initiatives have been put in place or commissioned to improve the health of staff.

In light of this, I will be investigating Stress, which is one of the well-known impacts of organisational change.

AIM

To investigate the impact of organisational change and stress on employees in NHS England and to derive conclusions regarding the wellbeing programmes introduced by NHS England to address this.

Conclusion

NHS England has have a culture of permanent revolution and always changing. Whilst some may argue that in healthcare change is needed continuously, it may also be worth asking if some of the changes embarked upon by NHSE were necessary. Also whilst looking at the impact that these changes have had on employees, are some of the wellbeing activities introduced just as another tick box exercise or is it really having an impact on the wellbeing of staff most especially the mindfulness programme which NHS England has encouraged its staff to become involved in. Is this yet another fad that the organisation is buying into or is this actually being of benefit to staff.

Research Methodology

I have decided to use a mixed method approach in my research to collect descriptive quantitative measures and qualitative interview data. The data will be gathered from the survey conducted by NHS England on the wellbeing of its staff, from the human resources department in NHS England regarding absenteeism and its cost as well as interviewing personnel within the Wellbeing department in NHS England

I have decided to use qualitative research because of its ability to provide complex descriptions of how people experience a given research issue. It provides information about the “human” side of an issue – that is, the often-contradictory behaviours, beliefs, opinions, emotions, and relationships of individuals.

Qualitative methods are also effective in identifying intangible factors, such as social norms, socioeconomic status, gender roles, ethnicity, and religion, whose role in the research may not be readily apparent. Using both quantitative and qualitative research methods will help me interpret and better understand the complex reality of a given situation and the implications of quantitative data.

The questions will be directed at perception of whether there is a link between organisational change and stress and if the wellbeing measures in place actually work. By using a qualitative method I aim to be able to describe and translate how or if there is a link between organisational change and stress. I intend to use a positivistic approach which will allow me to use fairly standardized questions but also offer some flexibility. This will give me the opportunity to pick up on nonverbal clues and offer a valuable insight into the meanings the interviewees attach to issues. I am hoping to also uncover some other lines of enquiry I may not have considered.

As it is also important to understand how NHS England defines stress and how measures stress, using my intended approach, I will be able to tease out this information which is not the usual corporate response.

I intend to approach NHS England for permission to conduct my qualitative information gathering. Also some of the quantitative data required is already available to the general public however as a member Mental health first aider within NHS England, there will be information which I will be able to have access to via the network.

Being a participant observer will be the most appropriate method to use for collecting data on naturally occurring behaviours in their usual contexts as an employee of NHS England.

Using a quantitative method will help identify if there is a standard for measuring stress in organisations.

The case study research design is also useful for testing whether scientific theories and models actually work in the real world. So I will be using NHS England as a Case Study. This will allow for an in depth study of the particular situation of looking at employee wellbeing and organisational change within NHS England rather than just a survey of NHS.

This method will allow me to narrow down a very broad field of research of employee wellbeing down to Stress. Whilst it will not answer my questions completely, I hope it will give some indications and allow further elaboration and hypothesis creation on this subject.

LITERATURE REVIEW

Conceptualisation of Stress In Organisations

“Stress in organisations is becoming an increasingly important concern in both academic research and organisational practices. Yet there is still a great deal not known about stress in organizations (Zaleznik, Kets de Vries, & Howard, 1977; Beehr & Newman, 1978; House, 1974; Cooper & Marshall, 1976). What is known about stress, however, suggests that the importance being given is warranted, perhaps overdue. The preponderance of stress knowledge has been derived from the research done in the medical and health sciences; thus application of that knowledge and generation of new research knowledge on stress in organizational behaviour research are needed. The evidence in the medical and health sciences suggests that the influence of stress in organizations may be reaching epidemic proportions.” (SCHULER, 1980)

Occupational stress is often described negatively and negative environmental factors for instance work overload, or poor working conditions are often used tagged as descriptions of what it means. When looking into Stress, it becomes almost apparent that these are common definitions of stress and when one looks at the environmental factors it doesn’t immediately become clear why the environment fails to supply the needs of the individual other than that they are generally a threat or exceed a person’s capabilities or abilities.

When French’s (1974) defined stress, he looked at both the individual and environmental factors and tried to offer an explanation as to why environmental factors may be stressors, and how they help determine the extent to which some needs are met.

“Stress is the nonspecific response to any demand” (Selye, 1956). “Stress is an external force operating on a system, be it an organization or a person. Strain is the change in the state of the internal system which results from this external stress–stress and strain, they are not synonymous” (Hall & Mansfield, 1971).”

French et al. have defined Stress as a” misfit between a person’s skills and abilities and demands of the job (French, Rogers, & Cobb, 1974).  Also Caplan, Cobb, French, Van Harrison, and Pinneau (1975) define it as “any characteristic of the job environment which poses a threat to the individual.” (SCHULER, 1980)  Whilst “ Beehr and Newman (1978) after an extensive review of stress defined  “job stress as a condition wherein job related factors interact with the worker to change (disrupt or enhance) his or her psychological or physiological condition such that the person (mind or body) is forced to deviate from normal functioning.” Beehr and Newman also suggest that stress arises from conditions which may be regarded as either positive (enhancement) or negative (disruption). McGrath (1976) prefers to define stress in terms of a set of conditions as having stress in it. “Stress involves an interaction of person and environment. Something happens “out there” which presents a person with a ducted in the health and medical sciences. Stress at that time was regarded primarily from a physiological (or biological or physical) perspective, a perspective which almost regarded stress as desirable because it prepared an individual to help deal with the “enemy” (the stressor).  (SCHULER, 1980)

“Cannon coined the phrase “fight or flight” response to indicate a choice of behaviours in which an individual must engage when encountering stressful situations (Cannon, 1929). The response is a reflexive integrated physiological response that prepares an individual for running or fighting. However, when looking at organisations today, it is almost impossible to see individuals engaging in a fight or flight behaviour which could result in dysfunctional physiological reactions” (Gal & Lazarus, 1975, (SCHULER, 1980)

“Much of the research on stress in the areas of organisational behaviour and industrial psychology has investigated the association of psychological symptoms and stress (as suggested most of this research is actually between stressors and psychological symptoms, with stress essentially unspecified). The most frequently used variables to represent psychological symptoms are satisfaction, job involvement, self-esteem, tension, anxiety, depression, boredom, and psychological fatigue (House, 1974; Cooper & Marshall, 1976).”

“The stress research using behavioural symptoms, such as absenteeism and turnover, indicates that the higher the stress (as measured for example by role conflict and ambiguity) the more the absenteeism and turnover (Van Sell et al., 1979). The results using performance appear to be more complex. Sales (1969) found that individuals increased their performance with increased load (stress); however, that was only when quantity was the performance measure. With quality (error rate) as the performance measure, performance declined with in- creased load. McGrath (1976) reported that “if one takes account of task difficulty, then performance increases monotonically with increasing demand and with increasing arousal.” (SCHULER, 1980)

Whereas Sales accounted for differences in performance measures but not task characteristics, McGrath accounted for differences in task characteristics but not performance measures. These results suggest that an individual’s performance increases as stress increases but only on simple tasks and where quantity is the measure of performance. This, however, is inconsistent with activation theory (Scott, 1966) which suggests that performance will eventually decline due to the increased stimulation. If the task is difficult, with increased stress, performance (quality or quantity) increases up to a point and then declines.

A resilient workforce has become increasingly important as many organisations are facing challenging times. Resilience can be developed in individuals and Employees. To promote resilience amongst individuals and employees, their wellbeing is a key factor in ensuring that they have the right tools which will aid the development of a sustainable Workforce.

The direction of travel for mental health and wellbeing in the workplace is one of Importance and over the last two years, the Workforce Development Programme (WFDP) in NHS England has been gathering evidence on the best interventions and approaches that will support the development and delivery of an organisational workforce mental health, health and wellbeing approach from both a practical and a strategic workforce policy level.

NHS England in 2016/17, commissioned a report to see if there was a link between employee engagements, sickness absence and spends on agency staff .The analysis of this report proposed it was possible that where employee engagement was low, there could be a higher level of sickness absence amongst staff. This information has helped to lay the basis of my research. Also with the NHS coming under tighter management and more pressure to contain costs and improve outcomes, and the reality of how this impacts on staff that are called upon to make these changes. The reality is not necessarily inconsistent with delivering a quality service and the rate at which these changes occur or are expected to happen do have a huge impact on the. Although a lot will have been written about Organisational change, I will be looking at the different types of changes NHS England may have undergone and how these changes were incorporated. The ability of an organisation to incorporate change depends, in part, on its organisational culture and how employees are in adapting to this change.

Dissertation TIME LINE

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Student ID: 33413882     

Supervisor: Paul Jones                                                                              

The impact of Organisational Change on the wellbeing of staff in NHS England. 

CONTENTS

CHAPTER ONE

• INTRODUCTION

• BACKGROUND TO THE PROBLEM
• STATEMENT OF RESEARCH PROBLEM
• RESEARCH OBJECTIVES
• RESEARCH QUESTIONS
• SIGNIFICANCE OF STUDY
• RESEARCH STANCE
• PURPOSE OF STUDY

CHAPTER TWO

• THE CONCEPT OF ORGANISATIONAL CHANGE
• CAUSES OF ORGANISATIONAL CHANGE
• HEALTH AND SOCIAL CARE ACT 2012
• IMPLICATIONS OF NHS REFORMS FOR NHS STAFF
• ORGANISATIONAL CHANGE AND MORALE IN THE NHS
• STAFF BURNOUT
• POSSIBLE DETERMINANTS OF BURNOUT
• UNDERSTANDING STAFF MORALE
• CHANGE MANAGEMENT

CHAPTER THREE

• CHANGE MANAGEMENT
• ORGANISATIONAL CHANGE AND STRESS
• STRESS IN THE NHS
• NHS STAFF SURVEY

CHAPTER FOUR

• RESEARCH METHODOLOGY
• RESEARCH DESIGN
• EXPLORATORY
• QUALITATIVE
• PHENOMENOLOGICAL
• RESEARCH METHODS
• POPULATION AND SAMPLE
• POPULATION
• SAMPLE SIZE

CHAPTER FIVE

• PRESENTATION AND ANALYSIS OF DATA

CHAPTER SIX

• SUMMARY OF FINDINGS
• RECOMMENDATION
• CONCLUSION

BIBLIOGRAPHY

LEARNING STATEMENT

APPENDIX ONE: QUESTIONNAIRE

APPENDIX TWO: ETHICS APPLICATION

APPENDIX THREE:  SUPERVISION RECORD

APPENDIX FOUR: DISSERTATION PROPOSAL

ACKNOWLEDGEMENT

CHAPTER ONE

The National Health Service (NHS) is the publicly funded national healthcare system in England. It is also the largest single-payer health care system in the world primarily funded through the general taxation system and overseen by the Department of Health, NHS England provides healthcare to all legal English residents, with most services free at the point of use. Some services, such as emergency treatment and treatment of infectious diseases are free for everyone, including visitors.

The NHS was established through differing legislations; which resulted into four health services in the United Kingdom; NHS England, the NHS Scotland, HSC Northern Ireland and NHS Wales. The respective UK government ministries for each home nation had its own control before falling under the control of devolved governments in 1999. In 2009, NHS England agreed a formal NHS constitution, which set out the legal rights and responsibilities of the NHS, its staff, and users of the service. The establishment of the Health and Social Care Act 2012, came into effect in April 2013 and GP-led groups were given responsibility for commissioning most local NHS services.

Under the new system, a new NHS Commissioning Board, called NHS England, oversees the NHS from the Department of Health. The Act has also become associated with several reforms that have taken place in the NHS in recent times, coupled with the perception of increased private provision of NHS Services. This development has inevitably led to concerns that the new role of the healthcare regulator (‘Monitor’) could lead to increased use of private sector competition, balancing care options between private companies, charities and NHS organisations.

This study focuses on NHS England. Its activities and reforms and how they affect NHS staff particularly their morale, psychology and overall wellbeing. It  will also examine the impact of organisational change on the human resource aspect of the organisation and whether they are being considered or overlooked in the decision making process. Finally, the conclusion and recommendations will be reflective of the overall view of the research counterpoints of arguments and debate.

BACKGROUND

The concept of organisational change comes from the nature and environment of organisations. Organisations must change and adapt regularly to maintain pace with competitors in a rapidly changing business environment. Change means a series of events, which support the process of development in organisations (Kassim, Tahajudin et al, 2010). Change can also occur because of a variety of internal and external factors, over which organisational leaders sometimes have very little or no control.

Organisational change generally means right sizing, new developments and change in technologies, re-scheduling operations and major partnerships (MCNamara, 2011). Also, organisational change includes mission changes, strategic changes, operational changes (including structural change), technological changes and changing the attitudes and behaviours of employees to align with the strategic direction of the organisations.

Organisational change is about the process of changing an organisation’s strategies, processes, procedures, technologies, and culture, as well as the effect of such changes on the organisation.

Change is a fact of working life. A static environment can quickly antiquate an organisation, hence change is a constant and necessary requirement for organisations to perpetually evolve, stay competitive and survive in this volatile global economy.

NHS (England) in particular, has been undergoing rapid change with the introduction of patient choice, the transition to a system of payment by results and the move towards practice-based commissioning among recent developments.

Organisational change can help streamline business processes and eliminate redundant systems or groups. However, it can also have negative consequences. It is a fact of working life that the way staff feel about their workplace has an impact on the quality of patient-care, as well as on the efficiency and financial performance of an organisation. This is driven home by the Boorman review on the importance of health and wellbeing in the NHS. The Research demonstrates the link between staff satisfaction and mortality rates. It suggests that higher staff satisfaction is linked to higher patient satisfaction and that staff experience shapes patience experience, rather than the other way round.

To minimise the negative impacts of change in organisations like NHS England, strategic change in an organisation should always seek to achieve advancement in both business and employee performance. The overall change process should reflect a ‘win-win’ situation for both the organisation and its employees. Much of the literature on organisational change admits that change tends to cost more, takes longer, and results in fewer benefits than originally anticipated. Thus, successful (and positive) organisational change depends on inter-facing and properly engaging with all the people involved.

Health sector reform(s) has generally focused on changes in financing or organisational structure, often to the neglect of the key resource-the staff. A primary reliance on achieving reform through organisational restructuring can be self-limiting in this labour-intensive sector. Form should follow function, and function is the delivery of health care, which depends on having the right mix of motivated staff in place. Staffing is a key input, but it is also the main cost in most health systems. Without effective staffing and committed staff, it is unlikely that health sector reform will be successful.

STATEMENT OF RESEARCH PROBLEM

The Care Quality Commission (CQC) reported that 17 NHS hospitals were failing to operate within safe staffing levels. This is yet more clear evidence of the impact of constant reforms (organisational change) on staff of NHS England.

The problems with NHS staffing are long standing and started in the Thatcher era, when the NHS budget was severely squeezed for many years. Though the previous labour government addressed the problem when it significantly increased NHS funding to match EU average  spending, however, all the good work was undone when the labour government brought in their damaging £20 billion “efficiency savings” plans in 2009 (“the Nicholson challenge”), which are now financially crippling many NHS foundation trusts up and down the Country. Since 65% of the NHS budget is spent on staffing, it was inevitable that these unprecedented levels of “efficiency savings” would result in staff cuts. Moreover, it was not just the problem of cuts in the absolute numbers of staff; but equally about the cuts in the levels of the most qualified staff. To save money, cheaper, less qualified staffs were replacing staffs deemed to cost more. This will clearly had implications for the quality of care delivered.

Another problem was the multibillion-pound top-down reorganisation of the NHS. Professor Patrick Dunleavey from the LSE (London School of Economic Science) has estimated that the coalition reforms will cost upward of £4 billion and he went on to label them as “policy fiasco”. In addition, the reforms would introduce more competition and choice into the NHS with much more private sector provision. This requires excess capacity in the service, which not only wastes resources, but will also take NHS staff out of NHS hospitals and into the private sector to duplicate services. This is clearly an inefficient use of money and will have detrimental effects on NHS England staffing levels.

The growing privatisation of the NHS England means more NHS England staff migrating to the private sector, often with poorer terms and conditions. Those who remain employed by NHS England may have to reapply for their jobs on several occasions, and/or face wage cuts, if not downgrading. Consequently, there has been a freeze on pay in NHS England. Along with other public sector workers, pay rises were capped until 2020. Not surprisingly, morale in many NHS organisations became low. At the same time, wide scale reorganisation and fragmentation of the NHS made it difficult to ensure sound work force planning.

Another problem was in the area of employment. For instance in the nursing sector. In 2013, a report by the Royal College of Nursing (Running the red light) estimated that the NHS was on the verge of a work force crisis with, for example, there was an estimated 20,000 unfilled vacancies across England. Barts Health NHS Trust was coping with the largest private finance initiative debt in the Country, and this provides one snapshot of what this means. Following a nursing skill mix review in October 2013, the trust announced that 161 whole time equivalent posts nursing posts were to be cut, and a further 472 posts for nursing and healthcare assistants were being down-banded (i.e. put on a pay grade lower than the one already identified as appropriate for the role they are undertaking).

The effects of downgrading are pretty obvious-loss of staff morale, eventual loss of pay once an initial period of pay protection has expired, heavier workloads, increased stress, burn-out and reduced quality of care provision. These effects were experienced along with long-term anxieties about redundancy and career path. Worker’s unions also pointed out that if nurses were down-banded, they were no longer obliged to undertake the duties associated with their previous grade; hence nurses in this position were often pushed into ‘choosing’ between becoming de-skilled or deploying their skills without getting their due recognition (either financially or professionally).

RESEARCH OBJECTIVES

The main objectives of this study were based on organisational change in the NHS England and how it affects staff of NHS. They are as follows:

• The study sought to unravel the intricacies of organisational change in the NHS and how they influence workforce planning in the organisation.
• Explore the experiences of governance and incentives during organisational change for managers and clinical staff.
• Establish a link between organisational change and organisational problems like stress, burn-out and low productivity
• Find solutions to workforce crisis necessitated by organisational change by analysing strategic management, human resource management and strategic decisions that enhance organisational goals in the NHS.

RESEARCH QUESTIONS

The following research questions were generated to guide the study:

• What is the impact of organisational change in NHS England?
• What is the impact of organisational change on staff in NHS England?
• Can organisational change lead to stress, burnout and other crisis in NHS England?
• What should be done to promote staff-friendly organisational change in NHS, are there any possible solutions?

SIGNIFICANCE OF STUDY

The significance of this study was to assist and serve as a guide to public and private health institutions, corporate organisations, consultants, managers, and administrators when formulating policies or engaging with the performance management system. Furthermore, it could enable the NHS England, related agencies and similar organisations across the world to enhance their understanding and attitudes towards organisational change, human resource management and performance management system.

Ultimately, it helps to shape the thinking of policy makers by hinging their ideas on the issues raised in this study.

RESEARCH STANCE

The study used interpretivism as its research philosophy. Interpretivism is the necessary research philosophy for this study because it allowed the researcher to understand the details of the situation, to understand the reality or perhaps a reality working behind them

PURPOSE OF STUDY

The purpose of the study is to define and study the concept of organisational change in NHS England, explore the relationship between the concept of organisational change and organisational performance and  analyse the effect of organisational change on staff wellbeing in the organisation. The study will make recommendations that would proffer solutions to the identified problems.

FORMAT OF STUDY

Chapter 1 gives a brief insight on what the study would entail; from the background through to the format of the study. The subsequent chapters of this study will shed more light on the impact of organisational change on the staff of NHS England.

Chapter 2 investigates the literature, which will be based on theories and relevant approaches to management quality. The theories will be derived from academic reviews, journals, articles, past research and published texts.

Chapter 3 discusses the research methodology. It presents the type of research and its design. The research instrument is also presented which in this case is the questionnaire. It further explains the method of data analysis while also detailing the issue of the limitations of the study, validity and reliability.

Chapter 4 presents the findings of the test questions and also analyzed the data collected.

Chapter 5 shows conclusions drawn from the analysis of the results and suggests recommendations that could be employed to deal with the problems observed. It also suggests area of future research.

CHAPTER TWO

THE CONCEPT OF ORGANISATIONAL CHANGE

This chapter presents recent studies carried out on organisational change and NHS England, which are relevant to the research study. In this chapter, a closer look is taken at organisational change, NHS England, management approaches, human resources and their impact on organisational performance and the overall wellbeing of NHS Staff. Furthermore, it dissects a variety of ideas (related to the research topic) as contained in books, Articles, Journals, Conference papers, Newspaper publications and the internet; with a view to validating the research and giving it an objective basis.

Grimsley (2018) defines organisational change as both the process in which an organisation changes its structure, strategies, operational methods, technologies, or organisational culture to affect change within the organisation and the effects of these changes on the organisation. He added that organisational change could be continuous or occur for distinct periods. All organisations undergo ongoing change, and studying the ways organisations change provides perspective on the process.

Organisational change also refers to any alteration that occurs in total work environment, including alteration of structural relationships and roles of the people in the organisation. It is an important characteristic of most organisations. An organisation must develop adaptability to change otherwise it will either be left behind or swept away by the forces of change; hence organisational change is inevitable in a progressive culture. Every modern organisation is expected to be highly dynamic, versatile and adaptive to multiplicity of change.

Organisational change is largely structural in nature. An enterprise can be changed in several ways. Its structure, its technology, its staff and other elements can be changed. Organisation change also calls for a change in the individual behavior of employees. Organisations survive; grow, decay depending upon the changing behavior of the employees. Most change disturbs the equilibrium of situation and environment in which the individuals or groups exist. If a change is perceived to be detrimental to the interest of the individuals or groups, there is always a tendency that they will resist the change.

CAUSES OF ORGANISATIONAL CHANGE

1. External pressure:
2. Change in technology and equipment: advancement in technology is the major cause (i.e. external pressure) of change. Each technological alternative results in new forms of organisation to meet and match the needs.
3. Market situation: change in market situation includes rapidly changing goals, needs and desires of customers, suppliers, unions, etc. If an organisation has to survive, it has to cope with changes in market situations.

• Social and political changes: organisational units literally have no control over social and political changes in the Country. Relationship between government and business or drive for social equality is some factors which may compel for organisational change.

1. Internal pressures (pressures for change from within the organisation).
2. Changes in the managerial personnel: one of the most frequent reasons for major change in the organisation is the change of executives at the top. No two managers have the same style, skills or managerial philosophies.
3. Deficiencies in the Existing organisation: many deficiencies are noticed in the organisations with the passage of time. A change is necessary to remove such deficiencies as lack of uniformity in the policies, obstacles in communication, any ambiguity etc.

HEALTH AND SOCIAL CARE ACT 2012

The health and social care Act 2012 is an act of the parliament of the United Kingdom. It provides for the most extensive reorganisation of the structure of the National Health Service (NHS) in England to date. It removed responsibility for the health of citizens from the Secretary of States for health, which the post had carried since the inception of the NHS in 1948. It abolished NHS primary care trusts (PCTs) and Strategic Health Authorities (SHA) and transferred between £60 billion and £80 billion of “commission” or health care funds, from the abolished PCTs to several hundred “clinical commissioning group”, partly run by the general practitioners (GPS) in England but major point of access for private service providers. A new executive agency of the Department of Health, Public Health England, was also abolished under the Act on April 2013.

The Health and Social Care Act 2012 highlights the following:

An Act to establish and make provision about a National Health Service Commissioning Board and Clinical Commissioning groups and to make other provision about the National Health Service in England; to make provision about. Public health in the United Kingdom; to make provision about regulating health and adult social care services; to make provision about public involvement in health and social care matters, scrutiny of health matters by local authorities and cooperation between local authorities and commissioners of health care services; to make provision about regulating health and social care workers; to establish and make provision about a National Institute for Health and Care Excellence; to establish and  make provision about a health and social care information centre and to make other provision about information relating to health or social care matters; to abolish certain public bodies involved in health or social care; to make other provision about health care; and for connected purposes.

The Act had implications for the entire NHS. NHS Primary Care Trusts (PCTS) and Strategic Health Authorities (SHAs) were abolished, with projected redundancy costs of £1 billion for around 21,000 staff.

£60 to £80 billion worth of commissioning were to be transferred from PCTs to several hundred clinical commissioning groups, partly run by GPs. Around 3,600 facilities owned by PCTs and SHAs were transferred to NHS property services, a limited company owned by the Department of Health.

IMPLICATIONS OF NHS REFORMS FOR NHS STAFF

It is already clear that when there is competitive tendering to provide NHS services, contracts are usually awarded to the lowest bidder, regardless of quality. Thus, if private companies are to make the lowest bid and still maximize profits, a common approach is to employ undertrained or cheaper staff, and replace doctors with nurses, and nurses with auxiliaries. At the same time, within NHS organisations, financial pressures (arising for instance from PFI debt and government cuts) have led to redundancies and poor staffing levels. Apart from its impact on patient care, understaffing leads to intense pressure on staff.

Also, the growing privatization of the NHS means more and more NHS staff migrating to the private sector, often with poorer terms and conditions. Those who remain employed by the NHS may have to re-apply for their job on several occasions, and/or face wage cuts, if not downgrading. In addition, there has been a freeze on NHS pay. Along with other public-sector workers, pay rises are now capped until 2020. As a result, morale in many NHS organisations is extremely low.

During the years of the coalition government, NHS staff were urged to accept pay restraint as part of seeing the NHS through hard times. Consequently, nursing pay in England lagged behind inflation by up to 8 percent-an average real term cut of more than £2,600. In 2014 many nurses did not get a pay rise at all. At the same time, research showed that of all the Trusts that responded to a Freedom of Information Request, 50 percent had offered pay increases of at least £5,000 to one or more of its executive directors. There were also numerous cases where executives received bonuses on top of their salaries – with two chief executives getting bonuses of more than £40,000 or the equivalent of the annual pay of a district nurse or a senior sister.

A more recent RCN report, the Fragile Frontline, finds that while the number of full time nursing posts may have risen over all between 2010 and 2014, the number of nurses filling these posts has dropped-meaning that fewer staff are providing more care for a record number of patients. One indication of the shortage of nurses is the increase in the NHS nurse agency bill which has increased by 150 percent in the last two years. It is estimated that the NHS has spent £80million on agency nurses over the 2014-15 financial year. There was also a reduction in the number of places funded for nurse-training in recent years as Trusts Chief Executives were trying to save money Looking at what is happening in medicine, famously, department of health and NHS employers has been trying to impose a new contract on junior doctors. What is less well known is that contract negotiations, which began in 2013, coincided with the setting up of a consortium of 13 NHS Trusts that tried to implement a local system for reducing pay, and introducing poorer terms and conditions for all staff i.e. a scheme that was different to the existing nationwide NHS agreement. Their plans include less maternity leave and sick pay, the end of some on-call payments and an increase in contracted working hours.

The consortium’s plan, having met with strong opposition from unions and parliament, was not implemented. However there are strong links or overlap between some members of the consortium on the one hand, and NHS employers, advisors to the DOH, and other powerful NHS stakeholders on the other hand. And there are also strong similarities between the plans of the consortium and the pay, terms, and conditions proposed in the junior doctor’s contract. This includes changes in on-call payments, the linking of pay progression to performance, and changes in what are classified as unsocial hours. The usual reason given to the public for the new contract is that it enables a ‘7-day’ NHS – that the public deserves a safer service over the weekend (or sometimes it is because they deserve to have access to routine services over the weekend). However, the background to the deal suggests that is really a cost-cutting exercise, with dubious benefits for patients.

Consequently, increasing privatization of the NHS means that, in future, many NHS staff will have to work in the private sector. Staff who are transferred from NHS to non NHS organisations retain their NHS terms and conditions at the time of transfer, at least for a while. However, staff were no longer covered by national negotiating agreements in the NHS so, for example, they would lose future pay increases agreed for NHS staff. And if they move to another non-NHS staff organisation after this initial transfer, they become treated as ‘new staff’- i.e. those not (directly) transferring from the NHS-are not entitled to NHS terms and conditions, or access to the NHS pension scheme. This means that a two tier system is developing for staff working in NHS-funded services, with employees who are carrying out similar roles receiving different pay and terms and conditions.

ORGANISATIONAL CHANGE AND MORALE IN THE NHS

Morale often suffers generally as a result of alienating and disruptive organisational change (Allcorn et al, 1996). As long as 1997, research showed that 26.8 percent of NHS staff were suffering damaging levels of stress, compared with 17.8 percent of the general population. Evidence suggests that little has changed in the intervening years, and health professionals (nurses in particular) have consistently reported the highest rates of work-related stress, depression, or anxiety in recent years.

In the last NHS staff survey, 39 percent of NHS staff reported that during the past 12 months, they had felt unwell because of work-related stress. 65 percent reported that they had attended work despite not feeling well enough (physically or mentally) to perform their duties, while only 43 percent said that their organisation took positive action on health and wellbeing.

With serious and concerted effort being made to save costs and very little attention given to boosting staff morale in the NHS, the authorities of the NHS are inadvertently creating conditions in which the health, wellbeing and quality of life of those who have committed their working lives to the NHS are being profoundly damaged.

Recently, there has been growing concern and signs that a sense of detachment and demoralisation has penetrated the NHS workforce. And it is threatening to undermine the huge change programme required to deliver the savings that are needed and the five year forward view. How are staffs expected to champion far-reaching changes to transform care if they are demotivated and disaffected?

In the latest survey of staff, only 42 percent were satisfied with the extent to which their work was valued by their organisation, while 57 percent said they were unable to meet the conflicting demands made on them. The Nuffield Trust’s most recent survey of 100 health leaders found almost 60 percent thought that morale had deteriorated at their organisation, with workload cited as the main factor, closely followed by the financial position of the organisation and the NHS more generally.

Because of organisational change in the NHS, staff size has reduced, causing longer working hours, fewer opportunities to recharge and relax, and greater responsibilities for the remaining employees. Thus, it is likely that these changes in the workplace dynamic could cause reductions in staff morale and an increase in burnout in a hitherto bright and happy workforce.

STAFF BURNOUT

The term “burnout: first appeared in the 1970s and was most prevalent among human services professional (Shauvel and Enzmann, 1998). Human services professionals focus on improving the quality of life of the individuals and communities that they serve; hence all NHS staff are human services professionals. Staff burnout is defined as “a condition of emotional exhaustion, depersonalisation, and reduced personal accomplishment that can occur among individuals who work with people in some capacity. “(Maslach, Jackson and Leiter, 1996 p.4).

To gain a better understanding of staff burnout, it is important to look at the definition more closely. The symptoms, which are mentioned in the definition of burnout, include emotional exhaustion, depersonalisation, and reduced personal accomplishment. Emotional exhaustion refers to the energy discharge of emotional resources, which is considered the keystone of staff burnout. Secondly, depersonalisation can be explained as people behaving with a “cold” heart or an indifferent attitude. Finally, reduced personal accomplishment is the tendency to devalue one’s work, which leads to a negative self-assessment (Maslach, Jackson and Leiter, 1996).

According to researchers, staff burnout could lead to the following adverse effects in the work setting: higher rates of illness, lower staff morale, increased use of alcohol and drugs, lower career satisfaction, high staff turnover, reduce quality of service, and poor customer outcomes (Barnett, Brennan and Garers, 1999: Maslach and Jackson, 1986; Moore and Cooper, 1996). Furthermore, staff burnout can influence the psychological health of staff. For example, Hegarty (1987) conducted a case study on British staff workers who served community members with learning disabilities. One staff worker stated that she needed to leave her work and enter psychotherapy to treat her own health because of staff burnout. It is also important to note that staff burnout does not only apply to one specific work class (e.g. healthcare, operational parks, administration, seasonal). Carton et al (1988) measured the burnout of four different staff groups (Professional staff, direct care staff. Educational development assistants and support staff) and they found the level of burnout among all of these groups to be at moderate or high levels.

POSSIBLE DETERMINANTS OF BURNOUT

Boritz (2006) explains that the causes of staff burnout can be classified into four factors. The first factor through differences at the personal level. This factor includes situational and personal influences that may lead to burnout, such as personality, over commitment, and setting unrealistic job expectations (Beasley, Thompson, and Davidson, 2003, Pines and Aronson, 1988). Secondly, burnout may occur at the interpersonal level. The most representative example of this is when employee’s resources become unbalanced with the client’s demands (Maslach, 1993). Generally, organisations may look at it as a good thing when clients’ demands exceed employee’s resources, since it would (presumably) create the opportunity to learn, improve and increase sales (Ulrich, 1997). However, when clients’ demands exceed the employee’s resources, this may lead to staff apathy, causing them to feel like they cannot do anything about it. Thirdly, staff burnout may be a result of organisational factors. Organisational factors have been developed in the field fairly recently compared to the individual and interpersonal factors. (Maslach, Schaufeli and Leiter, 2001). Organisational factors were based upon the perception of the level of respect that employees receive from the organisation in which they work. According to Grandey (2003), emotional exhaustion may be caused by the perceived need of employees to disguise their feelings of disrespect for their employer to their clients. The final reason for burnout stems from a slightly different concept called emotional labour.

It refers to the process by which workers are expected to manage their feelings in accordance with organisationally defined rules and guidelines (Hochschild, 1993), the expenditure of emotional labour is especially critical in the healthcare profession, since staff have a high frequency of interaction with co-workers, patients, community members and patrons, they need not only use physical labour, but also emotional labour. This could easily cause staff to become emotionally exhausted.

UNDERSTANDING STAFF MORALE

Staff morale is a very delicate issue that affects job performance. Researchers have defined morale in many ways. Among the definitions, Mcknight, Ahmad and Schroeder (2001) described it as “the degree to which an employee feels good about his or her work and work environment. The factors that help to define morale are intrinsic motivation, job satisfaction, work meaningfulness, organisational commitment and work pride (Mcknight, Ahmad and Schroeder, 2001).

Since staff morale is related to how staff feels about the organisation, it is an important factor in creating a healthy work environment. A study by Millet (2010) listed six reasons why high staff morale is important. Organisations that incorporated these six concepts displayed a higher staff morale culture and noticed improved productivity, improved performance and creativity, reduced number of days taken for leave, higher attention to detail, a safer workplace and an increased quality of work. In addition, Mazin (2010) found that agencies with higher morale, have more staff who arrive to work on time, communicate better, waste less time on gossip, have higher rates of recruitment and retention, and Hasiri (2010) found that employees who work for organisations with high morale develop higher rates of job satisfaction, creativeness and innovation, job honorability (respect for their own job), commitment to the organisation, eagerness to satisfy group objectives instead of individual objectives, and the desire to improve organisation’s performance.

On the other hand, low staff morale can be costly to organisations according to the Gallup organisation (2008), organisations could stand to lose £350 billion per year because of the loss of productivity caused by low staff morale. Also, several researchers assert that low levels of morale could cause increased costs, absenteeism, strikes, lack of motivation and interest, decreased efficiency and could lead to staff’s refusal to provide services (Cappelli 1997; Firth et al, 1997; Norsworthy et al, 1982, Reed 2009; Straka 1993). There are many reasons behind low staff morale, but the top reason mentioned the most by researchers is poor leadership. Fretwell (2002) emphasized the importance of the leader’s role, since organisations are significantly influenced by the leader’s vision and decisions. Psychometrics Canada (2010) also reported that poor leadership has negative effects on staff morale. Also, the distrust of management, poor interpersonal relations (relationship between leaders and staff), and inflexible working conditions could be other factors that affect staff morale (Dye and Garman, 2006).

Finally, it should also be noted that low morale may be caused by departmental layoffs or closures, labour negotiations and contract disputes, high employee turnover rates, changes in leadership, and unclear expectations. Lack of opportunity for personal growth because of unchallenging environment can also lead to low morale.

CHAPTER THREE

CHANGE MANAGEMENT

Change management (sometimes abbreviated as (OCM) is a collective term for all approaches to prepare and support individuals, teams and organisations in making organisational change. The most common change drivers include technological evolution, process reviews, crisis, and consumer habit changes, pressure from new business entrants, acquisitions, mergers and organisational restructuring. It includes methods that redirect or redefine the use of resources, business process, budget allocations, or other modes of operation that significantly change a company or organisation (Wikipedia, July, 2018).

Organisational change management (OCM) considers the full organisation and what needs to change, while change management may be used solely to refer to how people and teams are affected by such organisational transition. The ability to manage and adapt to organisational change is an essential ability required in the workplace today. Organisational change management employs a structured approach to ensure that changes are implemented smoothly and successfully to achieve lasting benefits. However, it has been observed that major and rapid organisational change is profoundly difficult because the structure, culture, and routines of organisations often reflect a persistent and intricate “imprint” of past periods, which are resistant to radical change even as the current environment of the organisation changes rapidly.

• Organisational change directly affects all departments and employees; hence the entire company must learn how to handle changes to the organisation. The effectiveness of change management can have a strong positive or negative impact on employee morale. Change management processes should include creative marketing to enable communication between changing audiences, as well as deep social understanding about leadership styles and group dynamics.
• Organisational change management also aligns group’s expectations, integrates teams, and manages employees training. It makes use of performance-metrics, such as financial results, operational efficiency, leadership commitment, communication effectiveness, and the perceived need for change in order to design appropriate strategies, resolve troubled change projects, and avoid change failures.
• Change management is faced with the fundamental difficulties of integration and navigation, and human factors. Thus, change management must always consider the human aspect where emotions and how they are handled play a significant role in implementing change successfully.

Organisational change is all about optimizing the performance standards of an organisation and this may sometimes occur as either due to the ability of the organisation’s managerial staff to be proactive or reaction to environmental changes or the presence of a crisis. Whatever the case may be, the organisation will always require a well talented and very capable managerial staff to trigger any change and for it to be successful, Van de Ven and Poole (1995) made some valuable propositions to the causes of organisational change. They proposed that organisational change can best be explained with the aid of theories such as the life cycle theory, the dialectical theory and the teleological theory.

The dialectical theory believes that an organisation is just like a culturally diverse society with varying views and opinions wherein new organisational values develop because of one force dominating the other and a goal is thereafter established thus culminating in organisational change. Increased comprehensiveness of more planners with more resources would thus lead to better planning teams, better analysis of the environments, better options for new systems, better choices of such systems and better implementation plans, all of which will lead eventually to improved performance. Organisational change is all about reviewing and modifying structures, specifically management structures and business processes. To avoid falling behind, or to remain a step ahead of its rivals, a business must seek out ways to operate more efficiently and cost effectively. Change is something that should be embraced not feared. Only with change will organisations be able to lay the foundations for long-term success. However for any change to be successful and sustainably effective, the interest of all stakeholders in the organisation must be adequately considered.

ORGANISATIONAL CHANGE AND STRESS

The problem of stress in organisations has generated a lot of debates and studies. As the needs of man increase, the burden of business managers, workers and professionals in various organisations continually multiply as they strive to meet societal and workplace expectations in the midst of other demands of existence. The outcome is usually stress, fatigue, burnout etc. Organisational change and stress management are widely accepted as two major issues in organisational life today (Vokola and Nikolau, 2005). If there is one constant in the business world it is change (Washington and Hacker, 2005), but with change, stress will normally follow. Change is defined as a dynamic condition in which an individual is confronted with an opportunity, a demand or a resource related to what the individual desires and for which the outcome is perceived to be both uncertain and important. Stress can be defined as any physical or emotional factor that causes bodily or mental tension.

Today, workplace stress is becoming a major issue of increasing concern to employees and organisations. It has become a part of life for employees, as life today has become so complex at home as well as outside that, it is impossible to avoid stress. Many individuals in the workforce have to deal with at least some sort of stress in their lives. Sometimes stress stems from family problems, finances and other personal issues, and other times stress comes directly from the workplace. Experts opine that stress is the main cause of all the problems of the modern world and that it affects both the individual and organisational health.

Olagunju (2010) defines stress as a chronic complex emotional state with apprehension and is characteristic of various nervous and mental disorders. For Topper (2007), stress is a person’s psychological and physiological response to the perception of demand and challenge. Thus, work-related stress is a pattern of psychological, emotional, cognitive and behavioral reactions to some extreme tasking aspects of work content, work organisation and work environment. Among life situations, the work place stands out as a potentially important source of stress purely because of the amount of time spent in this setting (Erkutlu and Chafra, 2006). Stress is an unavoidable consequence of modern living. It is a condition of strain that has direct bearing on emotions, thought process, and physical conditions of a person (Jayashree, 2010). In fact, stress is much more common in employees at lower levels of workplace hierarchies, where they have less control over their work situation (Beheshtifar and Nazarian, 2013).

During the life span of an individual, job period is very important because it is directly linked with the stress. In those organisations where employees are often maltreated, low satisfaction and high stress levels are common reactions. Stress is not good for the human body. It increases blood pressure, sugar, suppression of immune system, decreased digestive system activity and reduced urine output. Stress can also be further described as the adverse psychological and physical reactions that occur in an individual as a result of his/her inability to cope with the demands being made on him or her (Moorhead and Griffen, 1998).

Many organisations in the world are witnessing an alarming increase of the negative effects of stress on employees’ productivity. Typical examples are organisations in America, the United Kingdom, the Caribbean, East and Central Africa, West Africa and in other parts of the world.

The America Academy of family physicians reported that, about two-thirds of the visits to family physicians are the result of “stress-related symptoms” (Henry and Evans, 2008). According to Maxon (1999), no individual reaches peak performance without being stressed, whether an athlete, an office worker or a manager. The natural pattern of human behavior is to experience a stress-causing event or situation, react to it with increased tension and then return to a normal relaxed state. However, the problem occurs when stress becomes so overwhelming or constant to the extent of breaking normal human functioning.

Stress in the workplace is globally considered a risk factor for workers health and safety. More specifically, the health care sector is a constantly changing environment, and the working conditions in hospitals are increasingly becoming demanding and stressful. According to the World Health Organisation (WHO), “a healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety, and wellbeing of all workers and the sustainability of the workplace”.

STRESS IN THE NHS

Stress is believed to account for over 30 percent of sickness absence in the NHS, costing the service £300-400 million per year. The NHS annual survey (2014) found that 30 percent of NHS staff reported that they had suffered from work-related stress.

The Health and Safety Executive (HSE) defines stress as an adverse reaction that people have due to excessive pressures or other types of demands placed on them. Stress can happen in different ways in different NHS organisations but there are common factors that can lead to stress and poor health. Some NHS staff have to deal with violent and unpredictable patients, others deal with traumatic and harrowing circumstances, others have a lack of support or are not receiving enough communication about changes affecting them. The most important fact is the impact on the individual and how they feel able to manage those feelings.

According to the Daily Mail (Jan, 2018), more than 91,000 NHS employees have taken at least a month off work to deal with stress in the last three years. The number of staff taking long term stress leave increased by 19 percent between 2014 and 2016. Figures released by 170 trusts across Britain showed a total of 204,573 employees took time off to deal with stress, anxiety, or another mental health-related issue, while 91,364 were off for a month or more.

Nurses were the most stressed group, with at least 46,341 taking time off in the last three years. This is happening at a time when the NHS is facing a staffing crisis, as an estimated 40,000 nursing posts are currently vacant. Out of the 96 trusts that provided staff breakdowns, nurses made up 37 percent of those who took time off. While under-pressure nurses were the most absent staff group, doctors made up less than two percent of those who took stress leave. Just 2,147 doctors took time off to deal with stress, a fraction of the number of nurses who took leave. The total number of absences increased by 20 percent in the three years, from 62,245 in 2014 to 74,563 in 2016 according to Freedom of Information requests.

The Daily Mail findings revealed that Sheffield Training Hospitals had one of the largest numbers of staff absences, with 3,820 employees taking time off over the three years. 2,448 employees took stress leave in University Hospitals of North Midlands, while 2,281 were absent from Tyn and Wear Trust. Danny Mortimer, Chief Executive of NHS employers, said: “many NHS staff undertake emotionally demanding roles, helping others through moments of extreme need. Addressing mental health issues in NHS workplaces, the NHS provides a variety of support to staff who may be suffering from mental health problems. Support will come in a range of forms across results, but could include, for example, rapid access to treatment schemes, maintaining contact if an employee needs to take the off, and support for returning to work”.

According to a March, 2018 report, the number of NHS staff suffering work-related stress is on the rise, with 38.4 percent feeling physically unwell as a result over the past year (2017), compared with 36.7 percent in 2016. And the pressure appears to be taking its toll, with almost a third of staff (29%) reporting having witnessed “potentially harmful errors, near misses or incidents within the last month”, according to NHS England’s latest annual staff survey.

The survey was sent to 1.1 million NHS England employees, of who 487,227 responded. The resulting report (published on March 6, 2018) is the largest workforce survey in the world. The 2017 survey also found that 52.9% of staff had gone into work despite feeling unwell over the last three months, because they felt under pressure from their manager, colleagues or themselves. Just over 15 percent of staff said, they experienced physical violence from patients, relatives or the public over the past year, and 28 percent experienced harassment, bullying or abuse.

NHS STAFF SURVEY

In the last 12 months

n= 487,227 NHS staff members, conducted September to November, 2017

Source: NHS Staff Survey, 2017

Less than a third of all NHS staff said they were satisfied with their salaries last year, while more than 58 percent said they worked additional unpaid hours. All these factors often combine to predispose staff to stress in the organisation.

CHAPTER FOUR

RESEARCH METHODOLOGY

This chapter explores the research method and the procedure followed in collecting and processing the data. The chapter will look at the research design and methodology, as well as the research process, limitations of study, ethical issues and the rationale for the study.

I used the structured questionnaire to gather my data for this study. The questionnaire was administered on my target population, which is the staff of NHS England. The reason for using the staff of NHS England is none other than the fact that the research topic revolves around them-that is both the management staff and other categories of staff as they are the ones in the position to better explain the impact of the reforms in a no-holds-barred manner. I applied the type of questionnaire method called delivery and collection while gathering my data.

RESEARCH DESIGN

A research design is a plan or a blueprint for conducting the study that maximizes control over factors that could interfere with the validity of the findings (Burns and Grove, 2005:223). A research design provides a framework for the collection and analysis of data (Bryman and Bell, 2007). There are two types of research design that are widely used and they are quantitative or positivist research design and the qualitative or phenomenological research design. They are actually two ends of a continuum with a combination of two models occurring in varying shades of emphasis along the continuum (MANCOSSA 2002, Section 1, P.140). An exploratory qualitative phenomenological study was conducted for the research.

EXPLORATORY

This is a means of finding out ‘what is happening’ and to help in the clarification of a problem. Exploratory studies are aimed at gaining insights and understanding regarding a new interest, a relatively new subject of study or a persistent phenomenon. They are done to satisfy the researcher’s curiosity, desire for better understanding, and to explicate the central concepts and constructs of a study. The researcher wanted to gain insights and comprehension into the workings of the NHS England, strategic management in the organisation, NHS reforms and staff wellbeing. Exploratory research can also determine priorities for future research (Babbie and Mouton 2006: 79-80; Vys and Basson 1991:38). This helped the researcher’s data collection because it afforded the researcher an insider account of the whole operations of NHS England. The researcher was able to deal first hand with both high-ranking staff and junior staff and this enabled him to easily gather information that helped the study.

QUALITATIVE

Qualitative research refers to a series of broadly divergent and related methodologies that cluster under a paradigmatic umbrella (Schneider, Whitehead and Elliot 2007:106). It takes its departure point as the insider perspective on social action. Qualitative research is naturalistic since it studies phenomena or people in their natural setting applying low control designs. Qualitative research involves conducting the inquiries in a way that does not disturb the context of the phenomena studied (Struedert Speziale and Carpenter 2003:18). The research design is flexible enabling the researcher to adapt the inquiry as an understanding deepens or the situation changes (Burns and Grove 2005:535). The purpose of qualitative research is to describe, explore and explain phenomena being studied (Marshall and Rossman, 1995).

PHENOMENOLOGICAL

The study is a phenomenological one. It is a systematic, interactive and subjective approach to describe life experiences and give them meaning. The aim of phenomenological approach to qualitative research is to describe accurately the lived experience of the people and not to generate theories or models of the phenomenon being studied (Leininger in Burns and Grove 2005:23). Phenomenological study seeks to understand people’s perception, perspective and understanding of a particular situation, giving answers to the research question (Leedy and Ormrod 2005:139). To understand the experiences of people affected by organisational change in the NHS England and other such organisations, a phenomenological study is best so as to get an insider perspective in a naturalistic setting with enough flexibility and being as non-intrusive as possible.

RESEARCH METHODS

Research method is specific research techniques which involves sample selection, data collection, and data analysis techniques (Silverman 2000:79). The research method applied by the researcher was very relevant to the study because the researcher had a one on one session with most of the relevant authorities in the NHS England. With the questionnaires applied and the interview sessions done across various NHS departments, the researcher was able to come up with accurate responses and data concerning the impact of the topic researched, on the activities of NHS workers.

POPULATION AND SAMPLE

Sampling is the process of selecting a group of people, events, behaviors or elements with which to conduct a study. A sample is selected from a target population through probability or non-probability methods. A study population is that theoretically specified aggregation of elements from which the sample is actually selected. An element is that unit about which information is collected and that provides the basis of analysis (Babbie and Mouton. 2006:173-174).

POPULATION

Sampling criteria lists the characteristics essential for membership in the target population. Criteria are developed from research problem, the purpose and the conceptual and operational definition of study variables and the design of the study. A sample is selected from the population that meets the criteria. Inclusion criteria are characteristics that must be present for elements to be included in the study (Burns and Grove, 2001:365-367).

To match the research objectives, those experts in policy and planning and the key administrators who are directly involved in introducing, monitoring, evaluating and bearing other responsibilities associated with organisational change in the NHS are defined as the target population. These would be the key informants, thus persons who have been thoughtfully and purposefully selected because they are considered to be knowledgeable about the subject of inquiry. They are information rich (Leininger 2002:93).

Population size used for this study was 120 informants all of whom are staff of NHS England so as to get credible and correct information.

SAMPLE SIZE

“A sample size is a selection from the population” (Robson 2002:260). “A sample consists of the limits of the population that are drawn for the questionnaires” (Dilman 2000:126). There are two major types of sampling which are: probability and non probability sampling. With probability samples, the chance or probability of each case being selected from the population is known and is usually equal for all cases (Saunders et al 2003:152). The possibility of selecting any member of the population is known. This is not the same with the non-probability sampling, as the possibility of selecting any member is not known. For non-probability samples, the probability of each case being selected from the total population is not known (Saunders et al 2003:172). This research used the non probability sampling and there are five commonly used types which are, quota sampling, purposive sampling, snowball sampling, self selection sampling and convenience sampling. Quota sampling is entirely non-random and is normally used for interview surveys. It is based on the premise that your sample will represent the population as the variability in your sample for various quota variables is the same as that in the population (Saunders et al 2003:172). Purposive or judgmental sampling enables you to use your judgment to select cases that will best enable you to answer your research question(s) and meet your objectives (Saunders et al 2003:175). Snowball approach allows the researcher to make initial contact with a few group of individuals who are relevant to the research topic and use them to reach the other relevant members of the group (Bryman and Bell, 2007). Self selection sampling occurs when you allow a case usually an individual to identify their desire to take part in the research. (Saunders et al. 2003:117). In most cases, people often opt to participate because of their feelings about the research questions or objectives. Convenience sampling involves- choosing the nearest and most convenient persons to act as respondents (Robson 2002:265). The process is continued until the required sample size is reached.

The study used a non-random purposive sampling scheme, that is, selecting members of the target population who are likely to provide the most valuable data addressing the research objectives (Leedy and Ormrod 2005:145).

CHAPTER FIVE

PRESENTATION AND ANALYSIS OF DATA

This chapter concentrates on critical analysis and assessment of the impact of organizational change on the staff of NHS, England, which is the focus of the study. Thus we are looking at the findings and presentation of the data collected. Each questionnaire is presented pictorially by a bar chart.

A hundred and twenty (120) questionnaires were sent out however, of which one hundred and one (101) responded.

Table 5.22 Job satisfaction

Job Satisfaction fig.4.22

100 –

80 –

60 –

40 –

20 –

0 –

Yes              No            Not Sure

Job Satisfaction

Yes

No

Not Sure

Table 4.23 Challenging work

Work Challenge

80 –

60 –

40 –

20 –

0 –

Yes       No           Not Sure

Fig.4.24

Yes

No

Not Sure

Figure 4 .25

Table 4.23 shows the response towards work challenge in NHS, England. And we see that out of 101 respondents, 72 said Yes responding 71.3% of the population used for sample, 15.8% said No, while 12.9% were Not sure. Fig. 4.24 and Fig. 4.25 also show the same.

Table 4.26 clear understanding of strategic objectives

Clear understanding of strategic objectives

Clear understanding of strategic objectives

100 –

80 –

60 –

40 –

20 –

0 –

Yes                      No                   Not Sure                     Fig.4.26

Clear understanding of strategic objectives

Yes

No

CHAPTER SIX

SUMMARY OF FINDINGS

The purpose of his concluding chapter is firstly, present a summary of the research design secondly, to present a summary of the findings in relation to the objectives of the study, thirdly, to offer a conclusion and fourthly, to outline the implications of this study for further research.

The focus of this study was on the impact of organizational change on staff of NHS, England. The research has examined past and recent NHS reforms and how they affect NHS staff in variety of ways. Since an organizations success is most often attributed to internal and external parameters which play overall success, the organization to be able to achieve a competitive advantage and ensure optimal service delivery more emphasis must be laid on the personnel in the organization as this constitutes the real assets of every organization. With regards to NHS England, it was discovered that while the organization was constantly trying to raise the quality of service delivery to patients, coupled with strict policies aimed at cutting cost, very little confederation was being given to staff welfare and well being.

The researcher found out that the reforms have led to greater marketization of the NHS, although claims of mass privatization have been exaggerated. Also, the absence of system leadership has become increasingly problematic at a time when major service changes are needed within the health service. The top-down re-organization of the NHS as instituted by the reforms has been damaging and distracting the concept of organizational changes comes from the nature and environment of the organizations change basically means series of events which supports the process of development in organizations generally, organizational change means right signing, new development and change in technologies, re-scheduling operations and major partnerships. Organizational change includes mission changes, strategic changes operational changes (including structural change), technology changes, changing the attitudes and behavior of staff, counter resistance from different employees of companies and aligning them to strategic decisions of the organization (Kreitner and Kinick, 2007).

The research highlights two elements which can make an employee to perform well. They are the tangible element deals with recruiting the right persons for a given task, having the right tools for the job, good physical working environment and having an appropriate reward for the job. On the other hand, intangible element range from having a sense of belonging, feeling valued and recognized by ones organization/employer among other variables. Changes affect performance at the individual, team and organizational level, Individuals learn through curiosity and experimentation, team learn by encouraging diversity of ideals and inputs, while organizations learn by discipline, experience, continuous improvement and experimentation.

Organizational change in the HNS, England, has a profound impact on employee performance and by extension, service delivery.

Employee performance is vital for the success of every organization. Most of the organization struggling with contemporary challenges put more emphasis on employee performance. However, if employees feel maltreated and there s no job satisfaction, many of the organization’s goals will not be met. Downsizing, mergers, innovations and restructuring of organizations, usually decrease employees’ performance. In addition to that, task, quantity and quality, changing location and time constraints radically affect the work life of employees. These attributes were discovered to be very prominent in recent NHS reforms and how they affect NHS staff. Sometimes, when the changes are broad in reach and several changes occur simultaneously, they culminate in increased stress-related conditions for the employees. There maybe many causes for increased stress levels including g perceived injustices or unfairness, like of timely communication by management or fear of future changes. Also, loss of loyalty is another impact of organizational change on employee performance. Many organizations look to salaries and benefits as the first places to cut back when looking to make changes that involves saving cost.    When this happens, it is inevitable that some employees will leave the organization to seek employment elsewhere. The employees that remain, whether they stay voluntarily or because they could not find employment elsewhere, are often resentful and non-committal. Motivation decreases, taking job performance along with it. Employees become disloyal and My even become angry enough to purposefully sabotage the organization.

The researcher believes that employers and managers need to let employees have more power to design their jobs and roles.

RECOMMENDATION

The impact of organizational change on staff of NHS, England, cannot be under-estimated. It is on this premise that the researcher is making the following recommendations.

1. The issue of leadership is very critical for all organizations, hence, good leadership that will strike a balance between cutting costs, ensuring quality service delivery to patients, and meeting employees’ expectations is essential for NHS, England.
2. Proper and appreciable communication channels should be established to encourage mutual interaction and cooperation between management and staff and by so doing, eliminate fears and insinuations that most staff are often not carried along in the decision-making sessions that eventually result in reforms.
3. The NHS should constantly formulate policies that will engender employee development and boost their morale. The employees should not be regarded as ‘mere working tools’. They should be seen as partners in organizational progress and evolution.

CONCLUSION

This research focused on the impact of organizational change on staff of NHS, England.The research sought to consider the implications of numerous NHS reforms for NHS staff welfare and wellbeing. The most significant changes which have occurred as a result of NHS reforms have been in staffing change and organizational culture, and the individual attitudes of NHS management and staff. Attempts to alter methods of conducting employee relations and determining pay and condition of employment have not been very successful. The importance of NHS staff to the success or failure of the health sector reform can not be wished away. Health sector reforms in many countries have focused on structural change, cost containment, the introduction of market mechanism and consumer choice (Cassels, 1995; Mills, 1995; Sen and Coivusalor 1998). This focus has inevitably challenged ‘custom and practice’ in the ways that help professionals and other staff are employed and deployed and has also raised questions about the public/private mix and impact of NHS staff. How the NHS manage its human resources may in itself be a major constraint or facilitator in achieving the objectives of health sector reform.

Thus, it is concluded that in line with the health sector reforms and with serious and concerted efforts being made to cut cost and very little attention given to boosting staff morale in the NHS, the NHS authorities are inadvertently creating condition in which the health, well-being and quality of life of those who have committed their working lives to the NHS are being profoundly damaged.

By so doing, they will see themselves as being part of the organizational change process. This is vital for optimal employee performance and job satisfaction.

LEARNING STATEMENT

Having finished my dissertation, I do believe I am in a better position to reflect on the work done and how things could have been done better. It has not been an easy process at all. Initially I thought I would be able to combine being a full time parent and wife with a part time course and full time job without much difficulty because this was a dream come true. The opportunity to further my studies, however nothing prepared me for what I now recognise as being burnout.

Whilst juggling all these facets of my life, my ability to prioritize was thoroughly tested. I encountered many up and down moments in particular my mental health. This was like a double-edged sword. I could empathise with how the respondents to my questionnaire must have felt dealing with the effects of constant organizational change.

I came to understand how I could learn effectively to enable me reach my goals by writing things down help to clarify thoughts and emotion in this regard.

I kept a notebook of scribbles and post it notes.

Reflection  also helps to focus and actively participate in development as an effective independent and critical learner. The journal kept will become a record of progress throughout ones study and will help to discover the strategies and process that work well for individuals. Reflection is itself a way of learning and helps to evaluate own performance as a learner. Reflective practice is a life skill, not just a university requirement. By engaging in reflective learning, one is taking an active role in learning and recognizing personal responsibility for own lifelong learning thinking and writing are closely connected processes and in order to write reflectively, you need to think carefully about yourself as a learner ( coughan 2007: 8).

Students sometimes view reflective writing as an annoying interruption to the serious business of developing content knowledge in their subject area. However, there are sound reasons why reflective writing is included in student assessment.

Reflection is indicative of deep learning, and where teaching and learning activities such as reflection are missing. Only surface learning can result (Biggs 1999) “Reflection leads to growth of the individual morally, personally, psychologically and emotionally, as well as cognitively” (Branch and paranjape 2002: 187).

Reflection can lead to greater self-awareness, which in turn is a first step to positive change it is a necessary stage in identifying areas for improvement and growth in both personal and professional contents. Taking time to reflect can help one identify approaches that have worked well and in that way reinforce good practice enrolling into this Masters Programme has always been a dream that fascinated me. I have been one person who believes that getting a doctorate in life is what I want and when the opportunity came to start this programme, I embraced it with both hands. Hence the fact that I wanted ti improve my academic qualification prepared me for the task ahead. It was very challenging because of the fact that one was  expected to combine office work and turning out for classes as well as participating in the group and individual assignment. The group discussion and assignments made me realize how difficult this programme would be and combining it with the pressures of work was aso much burden for one personal. I must also confess that the assignament due dates made it possible for me to apply my time management skills luckily I didn’t miss out on any of the due dates as I always submitted my tasks on time all my assignments ant it will be agood start for me because shifting the date will iple more pressure on me drawing up a time -table for my dissertation was helpful because I start to my time, but nothing prepared me for the challenges I faced in effort to penetrate different NHS department to distribute my questionnaires to respondents. It was quite challenging in retrospect, I can say that there are things I could have done better if given another opportunity to do the dissertation again. I will in future try to interact more with the people I am writing about before going ahead with the research.

Generally, the experience has been good but challenging. I do belive that I am better equipped now to face the challenges any onecan throw at me with regard to organization change and its impact on employees, especially those in the NHS, England

APPENDIX ONE.

QUESTIONNAIRE

(1)       Dissertation questionnaire on the impact of organizational change on staff of NHS, England

Date : …………………………..

Section A – Personal data

Name of Respondent (optional)

Current NHS Trust

Previous NHS trust

Gender: Male ( )       female ( )

Section B : Please tick (x) in the brackets provided

Are you satisfied with your job?

(a) Yes                       (  )

(b) Not sure               (  )

(c) Not applicable   (  )
(2)       is your work challenging
(a) not sure
(b) not applicable
(3)       is there a clear understanding of the strategic objectives of the NHS?
(a) Yes
(b) no
(c) Not sure
(d) Not applicable

(4)       Do you believe that there is an opportunity for individual career growth and development within the NHS?
(a) Yes
(b) No
(c) Not sure
(d) Not applicable

(5)       Do you think the NHS reforms are favorable to NHS employees?
(a) yes
(b) no

(6)       do you feel you are adequately rewarded for your dedication and commitment towards your work?(a) yes (b) no

(7)       Does the management involve you while taking leadership related de
(b) no
(c) not sure
(d) not applicable

(8)         In a typical week< how often do you feel stressed at work?
(a)

(b)

(c)

(c)

(9)         Does your job cause born-out to you?

(a)

(b)

(c)

(c)

(10)     Do you think the environment at work helps you strike the right balance between your work life and personal life?
(a)
(b)
(c)
(d)

APPENDIX TWO.

ETHICS APPLICATION

APPENDIX THREE.

SUPERVISION RECORD

APPENDIX FOUR

DISSERTATION PROPOSAL

Topic: The impact of Organisational Change on the wellbeing of staff in NHS England. 

Introduction

The aim of this topic is to explore what impact organisational change has on the wellbeing of staff working within NHS England.

About NHS England

NHS England was set up as an executive non-departmental public body which plans and funds the NHS, so as to improve health and well-being, secure high quality care and ensure the future NHS is sustainable.

NHS funding is entrusted to NHS England which shares with the Secretary of State for Health the legal duty to promote a comprehensive health service in England in accordance with the NHS Act 2006 (as amended by the Health and Social Care Act 2012).

Each year, the Government sets out its expectations of NHS England and the funding it will receive, in the form of a mandate which is also laid before Parliament. This sets the

direction for the NHS, and helps ensure it is held accountable to Parliament and the

public.

For the purpose of my study, I have chosen to focus on how the organisational changes in 2016/2017 affected the well being of staff.

A PESTLE analysis will enable me understand the factors which may have contributed to the organisational changes during this period.

Following on from the PESTLE Analysis, I will be able to identify key changes which took place and how these changes were implemented within NHS England. Also I will be looking at how these changes have affected employees in the work place.

Staff Wellbeing has been at the forefront of many organisations focus most especially in recent times as mental health is now being talked about more freely than ever before. The British Government has highlighted the state of the nation’s mental health and how it is investing in ensuring that there are services available to help individuals.

NHS England has taken this on board and its’s five year forward view reflects its commitment to its employees. To ensure that it has a healthier workforce, various plans and initiatives have been put in place or commissioned to improve the health of staff.

In light of this, I will be investigating Stress, which is one of the well-known impacts of organisational change.

AIM

To investigate the impact of organisational change and stress on employees in NHS England and to derive conclusions regarding the wellbeing programmes introduced by NHS England to address this.

Conclusion

NHS England has have a culture of permanent revolution and always changing. Whilst some may argue that in healthcare change is needed continuously, it may also be worth asking if some of the changes embarked upon by NHSE were necessary. Also whilst looking at the impact that these changes have had on employees, are some of the wellbeing activities introduced just as another tick box exercise or is it really having an impact on the wellbeing of staff most especially the mindfulness programme which NHS England has encouraged its staff to become involved in. Is this yet another fad that the organisation is buying into or is this actually being of benefit to staff.

Research Methodology

I have decided to use a mixed method approach in my research to collect descriptive quantitative measures and qualitative interview data. The data will be gathered from the survey conducted by NHS England on the wellbeing of its staff, from the human resources department in NHS England regarding absenteeism and its cost as well as interviewing personnel within the Wellbeing department in NHS England

I have decided to use qualitative research because of its ability to provide complex descriptions of how people experience a given research issue. It provides information about the “human” side of an issue – that is, the often-contradictory behaviours, beliefs, opinions, emotions, and relationships of individuals.

Qualitative methods are also effective in identifying intangible factors, such as social norms, socioeconomic status, gender roles, ethnicity, and religion, whose role in the research may not be readily apparent. Using both quantitative and qualitative research methods will help me interpret and better understand the complex reality of a given situation and the implications of quantitative data.

The questions will be directed at perception of whether there is a link between organisational change and stress and if the wellbeing measures in place actually work. By using a qualitative method I aim to be able to describe and translate how or if there is a link between organisational change and stress. I intend to use a positivistic approach which will allow me to use fairly standardized questions but also offer some flexibility. This will give me the opportunity to pick up on nonverbal clues and offer a valuable insight into the meanings the interviewees attach to issues. I am hoping to also uncover some other lines of enquiry I may not have considered.

As it is also important to understand how NHS England defines stress and how measures stress, using my intended approach, I will be able to tease out this information which is not the usual corporate response.

I intend to approach NHS England for permission to conduct my qualitative information gathering. Also some of the quantitative data required is already available to the general public however as a member Mental health first aider within NHS England, there will be information which I will be able to have access to via the network.

Being a participant observer will be the most appropriate method to use for collecting data on naturally occurring behaviours in their usual contexts as an employee of NHS England.

Using a quantitative method will help identify if there is a standard for measuring stress in organisations.

The case study research design is also useful for testing whether scientific theories and models actually work in the real world. So I will be using NHS England as a Case Study. This will allow for an in depth study of the particular situation of looking at employee wellbeing and organisational change within NHS England rather than just a survey of NHS.

This method will allow me to narrow down a very broad field of research of employee wellbeing down to Stress. Whilst it will not answer my questions completely, I hope it will give some indications and allow further elaboration and hypothesis creation on this subject.

LITERATURE REVIEW

Conceptualisation of Stress In Organisations

“Stress in organisations is becoming an increasingly important concern in both academic research and organisational practices. Yet there is still a great deal not known about stress in organizations (Zaleznik, Kets de Vries, & Howard, 1977; Beehr & Newman, 1978; House, 1974; Cooper & Marshall, 1976). What is known about stress, however, suggests that the importance being given is warranted, perhaps overdue. The preponderance of stress knowledge has been derived from the research done in the medical and health sciences; thus application of that knowledge and generation of new research knowledge on stress in organizational behaviour research are needed. The evidence in the medical and health sciences suggests that the influence of stress in organizations may be reaching epidemic proportions.” (SCHULER, 1980)

Occupational stress is often described negatively and negative environmental factors for instance work overload, or poor working conditions are often used tagged as descriptions of what it means. When looking into Stress, it becomes almost apparent that these are common definitions of stress and when one looks at the environmental factors it doesn’t immediately become clear why the environment fails to supply the needs of the individual other than that they are generally a threat or exceed a person’s capabilities or abilities.

When French’s (1974) defined stress, he looked at both the individual and environmental factors and tried to offer an explanation as to why environmental factors may be stressors, and how they help determine the extent to which some needs are met.

“Stress is the nonspecific response to any demand” (Selye, 1956). “Stress is an external force operating on a system, be it an organization or a person. Strain is the change in the state of the internal system which results from this external stress–stress and strain, they are not synonymous” (Hall & Mansfield, 1971).”

French et al. have defined Stress as a” misfit between a person’s skills and abilities and demands of the job (French, Rogers, & Cobb, 1974).  Also Caplan, Cobb, French, Van Harrison, and Pinneau (1975) define it as “any characteristic of the job environment which poses a threat to the individual.” (SCHULER, 1980)  Whilst “ Beehr and Newman (1978) after an extensive review of stress defined  “job stress as a condition wherein job related factors interact with the worker to change (disrupt or enhance) his or her psychological or physiological condition such that the person (mind or body) is forced to deviate from normal functioning.” Beehr and Newman also suggest that stress arises from conditions which may be regarded as either positive (enhancement) or negative (disruption). McGrath (1976) prefers to define stress in terms of a set of conditions as having stress in it. “Stress involves an interaction of person and environment. Something happens “out there” which presents a person with a ducted in the health and medical sciences. Stress at that time was regarded primarily from a physiological (or biological or physical) perspective, a perspective which almost regarded stress as desirable because it prepared an individual to help deal with the “enemy” (the stressor).  (SCHULER, 1980)

“Cannon coined the phrase “fight or flight” response to indicate a choice of behaviours in which an individual must engage when encountering stressful situations (Cannon, 1929). The response is a reflexive integrated physiological response that prepares an individual for running or fighting. However, when looking at organisations today, it is almost impossible to see individuals engaging in a fight or flight behaviour which could result in dysfunctional physiological reactions” (Gal & Lazarus, 1975, (SCHULER, 1980)

“Much of the research on stress in the areas of organisational behaviour and industrial psychology has investigated the association of psychological symptoms and stress (as suggested most of this research is actually between stressors and psychological symptoms, with stress essentially unspecified). The most frequently used variables to represent psychological symptoms are satisfaction, job involvement, self-esteem, tension, anxiety, depression, boredom, and psychological fatigue (House, 1974; Cooper & Marshall, 1976).”

“The stress research using behavioural symptoms, such as absenteeism and turnover, indicates that the higher the stress (as measured for example by role conflict and ambiguity) the more the absenteeism and turnover (Van Sell et al., 1979). The results using performance appear to be more complex. Sales (1969) found that individuals increased their performance with increased load (stress); however, that was only when quantity was the performance measure. With quality (error rate) as the performance measure, performance declined with in- creased load. McGrath (1976) reported that “if one takes account of task difficulty, then performance increases monotonically with increasing demand and with increasing arousal.” (SCHULER, 1980)

Whereas Sales accounted for differences in performance measures but not task characteristics, McGrath accounted for differences in task characteristics but not performance measures. These results suggest that an individual’s performance increases as stress increases but only on simple tasks and where quantity is the measure of performance. This, however, is inconsistent with activation theory (Scott, 1966) which suggests that performance will eventually decline due to the increased stimulation. If the task is difficult, with increased stress, performance (quality or quantity) increases up to a point and then declines.

A resilient workforce has become increasingly important as many organisations are facing challenging times. Resilience can be developed in individuals and Employees. To promote resilience amongst individuals and employees, their wellbeing is a key factor in ensuring that they have the right tools which will aid the development of a sustainable Workforce.

The direction of travel for mental health and wellbeing in the workplace is one of Importance and over the last two years, the Workforce Development Programme (WFDP) in NHS England has been gathering evidence on the best interventions and approaches that will support the development and delivery of an organisational workforce mental health, health and wellbeing approach from both a practical and a strategic workforce policy level.

NHS England in 2016/17, commissioned a report to see if there was a link between employee engagements, sickness absence and spends on agency staff .The analysis of this report proposed it was possible that where employee engagement was low, there could be a higher level of sickness absence amongst staff. This information has helped to lay the basis of my research. Also with the NHS coming under tighter management and more pressure to contain costs and improve outcomes, and the reality of how this impacts on staff that are called upon to make these changes. The reality is not necessarily inconsistent with delivering a quality service and the rate at which these changes occur or are expected to happen do have a huge impact on the. Although a lot will have been written about Organisational change, I will be looking at the different types of changes NHS England may have undergone and how these changes were incorporated. The ability of an organisation to incorporate change depends, in part, on its organisational culture and how employees are in adapting to this change.

Dissertation TIME LINE

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