MAGAZINE EDITION

CONTRIBUTORS

BACK ISSUES

CONTACTS

CHANGING TIMES

By Roger Goldie
Contact the author via the editor by e-mail at christopher.johnstone@ntlworld.com

W C Fields once said life is just on damn thing after another. He should tried being a GP. As new initiatives, policies and regulations rain down like confetti upon practices, GPs and their managers are expected to embrace and implement ever more changes in they way they operate. Love it or loath it the future success of many practices will depend on how well they learn to live with and manage change.

From going paperless to deciding which patient-services to offer, practices of all sizes will have to embark on large scale change management projects, often with little extra time or resource.

With a general election approaching we will hear more and more how proposed changes in the NHS will improve health care in this country. What is not made clear is how busy practices are to deliver these changes, in an efficient and sustainable manner, whilst minimising any impact on patient-care.

The solution however maybe more intuitive than first appears. GPs are experts at identifying the need for specialist skills when it applies to patient-care. They must extend this ability to learn when to use specialist skills in managing their practices.

Specialists
Business has had some years now to come to terms with change as the only constant. The speed of change is increasing all the time however and nowhere is this faster than in health care.

Health care is therefore facing a growing challenge to manage the successful implementation of change.

This leads to the central question of where to find the appropriate skills, a variation on the build or buy question that business faces.

Does sufficient skilled resource exist internally, can it be developed, or should this be brought in on a bespoke basis?

Build?
There has been an enormous amount of effort in the commercial sphere to develop good change management practices. There is an opportunity for the health services to cherry-pick the best and most appropriate of these.

The challenge however is to identify the best practices and apply them appropriately. It is difficult to learn new disciplines in a vacuum, and for this reason the NHS have delivered a number of initiatives, including the excellent Organisational Change report of Valerie Iles and Kim Sutherland in 2001.

It is asking a lot however of practice management, medical or administrative, to learn, select and apply appropriate change models. It is also clear that taking an ad hoc approach, practice-by-practice, gives little opportunity to develop the insights that come from experience and specialisation, much in the same way as a doctor develops specialist expertise by focusing on a particular area of clinical practice.

Buy?
It is now recognised that management of change is an area of specialist expertise in its own right, with disciplines and skills that can be learned and developed. This can be considered alongside research that change initiatives are most successful when created combining internal effort with external perspective.

It becomes clear that, in common with other areas of general practice, the best results will come when the need for specialist skills is recognised and appropriately resourced. For this reason external change agents can be an important part of your management toolkit.

When considering the need for external involvement it can be instructive to consider three aspects of your organization's resources.

1. Does the organization currently have an internal management structure that can support and create the required change.

2. Does the organization hold sufficient managerial experience of creating and implementing change of this scale and nature?

3. Does the organization have sufficient familiarity with applying change models, methods and techniques in a business-critical environment?

If you can answer yes to question 1, then you are in with a shout at creating and delivering meaningful change to your working practices. If the answer is no, then see a doctor. A business doctor, that is not a medical one.

If question 2 is answered 'yes' the organization has a very valuable resource. However, can this experience be freed from their daily tasks to give the focus the project will demand?

If all three questions are answered affirmatively you have no need to buy in services in this area but have all the resources to build your own change team. However if this is not the case you and your change project would benefit from retaining external support.

When choosing external change consultants they should be able to display experience of handling generically similar challenges to your own, (HR, IT, Operations etc). Specific industry experience is not essential, it can even be obstructive, where views and positions are entrenched across an industry. Objectivity benefits can be the difference between success and failure. These benefits exist where skills and insight are imported into a context, whether it is a department, organization or industry, bringing freshness of thinking and new approaches.

Changing Places
Retaining management consultants used to be thought of as something only large commercial businesses did. This is due in part to consultancy firms that traditionally were large and inflexible. However specialisation has created greater flexibility amongst a newer breed of consultant, making them more user-friendly to small to mid-sized businesses. It is a sign of the times that as general medical practices become larger and more complex organisations they too are becoming alive to the advantages that bringing in such specialists can bring. Funny how things change.

Roger Goldie is a partner at Eutrapelia Consulting Ltd. Contact Roger at www.eutrapelia.com

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.