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Case Analysis: Moss Valley Practice

Case Analysis: Moss Valley Practice

            Over the years, demand for effective and efficient health care services in the society has drastically increased.  As a result medical practitioners and caregivers have had to adopt and change their leadership models and approaches to cater for the increasing demand (Louis 200).  Adoption of new systems and models as well as comparison of the operating systems with other successful ones is important to not only establish the present problems, but also integrate different concepts for higher efficiency.  Such was the case in Moss Valley Practice in its trial to revitalize provision of health services to the people in the region and spread the same to other medical practices in the region (Julie et al 2006).  Change management in the leadership demands highly effective visionary and result oriented approaches for tackling the prevalent problems while establishing a sustainable platform for proactive responses necessary for long term application (Linda & Russell  2008).  Under the leadership of Martin Mcshane, the practice was to harmonize the care provision in line with the UK policies under the support of the labour party.

Organization background

            Moss Valley practice was part of the greater North Eastern Derbyshire Primary Care Trust which had

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the major objective of improving health care services to the people in that region.  The practice was a modern built facility with five major partners and a teaching practice with medical students rotating through attachment process.  Other staff attached to the practice included nurses, health visitors, therapists and community psychiatric among others who offered primary health care services.  Like other health care practices in UK, the practice operated under the National Health Service created after the II World War.  However, the services provision to the general public had greatly declined and sank well below the public expectations as modern treatments were established amidst the dwindling resources supply towards it.  The practice was also strongly controlled by the political forces that saw Margaret Thatcher conservative government induce large waiting lists for treatment making it to be established as the measuring indicator for the success for the Health Care Services in Britain (Julie et al 2006) (Tim 2006).

            After the assumption of power the labour party under Prime Minister Tony Blair in the year 2005 established the NHS plan which all the health care systems were to use in order to revitalize provision of these essential services in the country.  In the year 2004, Moss Valley Practice had about 8,550 people on the waiting list with 20% of them being people over the age of 65 years (Julie et al 2006).  It also had a poorly utilized IT system that often resulted to delays and, poor follow up and hampered efficient and fast decision making processes.  For effective transformation to take place, a clear understanding of the organization immediate issues and position was necessary to easily integrate new concepts and ideologies into the system (Rigolosi 2005).  Understanding the demand for health services especially for the elderly in the region, change demanded a revolutionary consideration of the people and structures that would ensure a cohesive and harmonious operating environment of all the support systems.

Key areas and issues being addressed in the practice.

            According to the Adkar model of change management, understanding the major issues in an organization should act as the major platform for implementing change in organizations (James 2008).  Martin McShane established a clear analysis of the Molly Valley Practice to not only understand the problems, but also weigh the magnitude of the problem and establish the correct immediate starting point as well as the necessary procedure to be assimilated for efficiency.  As indicated by the transformational leadership theories of organizational management, vision in leadership ensures that a centre point is established as a reference point with an outward conceptualization that sub roots to all the other systems (Eileen et al 2008)  Therefore, Martin incorporated all the tools and processes that enhanced immediate and higher level management assimilation for the new propositions.

Unplanned and admissions of people above the age of 65.

            With the immediate need to overcome the prevailing inertia of the organization and assimilate the new system Martin understood that the practice had poorly planned admission system that saw unplanned admissions driving 30% of the high risk group (Julie et al 2006).  There was a strong proactive attitude towards treatment of the patients that led to increased levels of inefficiency in the practice.  As a result majority of the cases that could have been treated well in advance to avoid admissions became serious conditions demanding even for more personnel to take care of them.  Besides, there was poor consideration of the old people’s will during their admission as majority of them did not wish to get admitted and the services they got could easily be offered at their residential areas with ease.  Effective organizational leadership is highly dependent on the effectiveness and satisfaction of the end user’s satisfaction with the services provided (James 2008).  There was lack of systematic process that could identify the risky patients and therefore follow up was less emphasized.

Poor communication and care-coordination

            All the arms of the health practice had massive problems in relaying and coordinating among all the branches with strong harmony that acted as a major breakpoint and formed the major recipe for structure inefficiency.  Poor alert system alert for high risk patients by the primary care givers was a major threat for various patients.  All the subsidiaries of the practice were poorly interconnected making the flow of patient information hard and therefore demanding lengthy paper work that was highly ineffective for following specific patients’ details.  This brooded, poor cooperation from other health units as they operated independently and were sometimes hostile to request for information about particular patients.  According to situational leadership theories, poor communication forms the major cause of organization leadership failure and change implementation.  Leadership in the practice was poor and therefore articulation of new ideas and management practices was no easier.  After, establishing the new system in the practice, only the three heads attended while others watched from a distance until they got enough interest.  Also, Martin established that the dream of offering effective services to the people could not be done singly, therefore he requested the Professional Executive committee to implement the process through out the region to other practices (Julie et al 2006).  Besides indicating poor harmonization of policies, Martin found out that the practice also had discontinuity of ideologies and inability to emulate the effective processes from other regions.

Leadership and management

            Leadership theories demand immediate guidance for organizations management through leading charge that guides and implants new structures and systems with minimal disturbances in an organization (Linda & Russell 2008).  Poor coordination between the different departments and subsidiary practices acts as clear indicators of poor leadership.  There is lack of idea harmonization both in admission, coordination and focus for majority of the sectors in the practice.  Fiona admitted that the concept of checking the hospitals for elderly patients progress was there but poorly executed in the practice resulting to underutilization.  As a result, vision establishment was poor or non existent with major canyons and failures being reported with little impacts to the existing leadership.

            Leadership in organizations acts as the stepping stone and support for the staff and consumers of their services at all times (James 2008).  However, there was general lack of situational analysis and prioritization of aspects thereby threatening the patients’ lives.  Lack of comparison with other similar services providers acted as a platform for failure which meant endangering more lives especially the old people.  Immediate follow up for the routine operations and other activities was not present until Martin established the immediate weekly meetings for general assessment.  Major procedures in the practice lacked immediate follow up until Martin introduced them into the system.  As indicated above, the feedback mechanism was poorly instituted resulting to inefficient or total absence of relay mechanism responsible for adjusting and improving the available system.  As a major stage Martin, Grace and Fiona had to ensure a strong interlink for all the departments in different categories (Julie et al 2006).

Lack of team-work and trust in the organization.

            According to Rigolosi (2005), organization success can only be definite when they act as a team at all levels and branches.  Moss Valley Practice was highly uncoordinated with the employees and staff operations poorly harmonized in their operations leading to great laxity and irresponsibility.  Though the staffs was highly qualified for its major activities, lack of team work tended to concentrate the immediate achievement to few individuals and thus acting in a reverse model that killed instead of boosting the staff morale.  Motivation in organizations act as the main stepping stone for progress and immediate cooperation that ensures all the aspects is approached with a common agenda that the staff can associate themselves with (McNamee et al 2006).  Though this can partly be blamed on the political system that acted to destabilize the major operations depending with the prevailing administrative agendas, internal categorization and inbuilt management trust was totally absent.  The staff only operated during the working hours with surgery section running only during the daytime while the night patients were admitted for treatment in the following day.  Team coordination between the professionals and primary health care as previously established, was extremely poor.  Operation in organizations requires the staff and other employees to own them as a way of improving efficiency, reducing supervisory workload and cultivating individual responsibility and thus nurturing strong leadership skills and qualities from the top to the grass roots.

Change process establishment and execution.

Developing and selling the vision.

            The most important aspects of leadership and change management as indicated by transformational theories, is understanding the situation which helps in appreciating the immediate problem of an organization (Eileen et al 2008).  After assessing the situation, Martin evaluated the available options that would be most appropriate to effect change with minimal disturbances for the system and achieve the expected results (Julie et al 2006).  Leadership traits act as the guiding pointers and fulcrum for springing towards the right direction (Department of Health & Human Services 2007).  His decisiveness, analytical skills and strong background of medical practices assisted him in choosing the most appropriate model for the available resources, the type of staff in the practice and the nature of the patients who used the facility.  His presentation skills and systematic prioritization capacity made his proposals to easily win the hearts of the Moss Valley Practice management.  Besides he considered all the models pros and cons that would result to the main long term efficacy in the services delivery to the people.  Therefore, choosing Evercare model indicated his ability to visionary focus on the future perspectives that would not only be suitable to the patients through immediate health services delivery in an efficient way, but also highly appreciative of the staff at the work for higher motivation.

            According to SWOT analysis of organization management and change, it is clear that the Moss Valley Practice under the new leadership sought to reduce the major weaknesses while enlarging the capacity to improve and build on major opportunities and strengths (Antonio & Jonathan 2008).  Realizing that all the staff in the practice was highly qualified and the premise was located on a strategic position for full time accessibility, the decision to build on the opportunities was a correct one.  Besides, boost services could easily be improved in by the medical training school which formed part of the Moss Valley Practice.  To add to that, the present political mood supported provision of the health services in the practice having been the one which established it before the Conservative party took over.

            Yoo & Alavi (2004) argues that in order to reduce resistance of the people as the process is introduced, they must be fully involved in the change process.  Part of the prior failure was strongly contributed by autocratic leadership which excluded other people’s decisions in the immediate and general management therefore making the overall initiative appear largely individualistic. To make sure that all the people were brought aboard, Martin ensured that all his subordinates were included in major decision making and orientation throughout the practice.  Martin approached district nurse Fiona Chisnell to take part in implementing the plan and selling the idea to others in the Moss Valley Practice.  All the different parties in practice and primary health care givers worked under her and even encouraged her greatly when finances supply were scarce.  Besides, all the members of the staff fraternity were involved in decision making as they were free to attend the weekly meetings which not only analysed the immediate progress, but also established the required way forward of the practice.

            According to Antonio & Jonathan (2008), participative leadership is described as change tact by itself since change acts as the only main option in strategic approach models application.  Every step in the implementation of the planned strategy ensures that appropriate adjustments are made as new ideas on application and modification are derived and upgraded thereby improving the initial idea.  At instances, great adjustments sometimes overlap the original ideas making the achievement of the set objectives to not only be precise but faster than targeted (Nguyen et al 2008).  Though immediate appreciation was hard, later acknowledgements were made with immediate increase of meeting time from 15 minutes to 30 minutes improving greatly the overall services delivery to the people.

Team work and total quality management.

                        Though greatly criticised for subordinating staff, employees and their needs to those of other people, Robert House in his Path-Goal Theory emphasises that sacrifice and devotion must form the immediate drive for faster positive results to be realized (Yoo & Alavi  2004).  The nature of medical services provision demands total commitment to offering the best services to the patients in the Practice.  Contingency theories on the other hand demands that all the immediate working environment is taken into account for effective application of various recommendations either after readjustments or initially to propel the change agenda (Eileen et al 2008).  As a result, team work establishment imposes immediate circles among the organization fraternity that acts as immediate centralization of power and authority in their own jurisdiction.  The weekly meetings were intended to get the immediate reports and departmental progress of the teams while comparing them with others.  Therefore, immediate autonomy ensured that all the sections acted as a block and teams to give a common report of progress to be discussed on the weekly meetings.  As a result, coordination and networking was made part of the system that would not only keep the staff at the practice together, but also link the system for better analysis and thus faster and efficient decision making.

            To ensure that the fire was kept burning, all the staff attended the meetings where immediate success was celebrated by all the teams, departments and the whole practice at large.  For easier tracking of the main objective, situational theories points at establishment of short term objectives that are at par with the main goals of the organization.  They pose step by step progress towards making an organization be among the best in the services provision to the specific area of specialization.  Martin’s Friday meetings were utilized for assessing the speed, ability to track the main objective and identifying major adjustments that could enhance easier applicability of the adopted methods.  Though Martin opted to take the softer route towards achieving the main goal of offering the best and adequate health care to the people in the region, the quality of the services was maintained at the highest possible level at all the branches of the Moss Valley Practice.  In his initial study of the situation, Martin had established that there was lack of a clear systematic process that could identify the risky patients in the prior management.  He therefore established a patient risk-alert system for the primary health care that was to be available 24 hours and seven days a week for assisted home services delivery to the needy patients and alerting the professionals for the high risk patients.  Besides, information was sent to the nearest medical practice for follow up and easy periodic check ups.  Therefore total quality management was effected through induced networking, liaison, partnership and practical transfer to ensure safe transfer and care of the patients to their respective regions and homes.  It acted as the main step towards reducing the unnecessary admissions.

Organization culture and democratic organization.

            Organization culture has been categorized as one of the hardest things to transform in organization management setting (Louis 2008).  There is usually both external and intrinsic defiance towards the immediate changes that are viewed as a major part of breaking the ties, elimination, new procedures introduction and unnecessary work load addition.  Medical practices demand strong positive organizational culture that is holistically derived from empathy and the desire to restore the dignity and sanctity of the soul by caring for the body and all of its requirements (Yoo & Alavi 2004).  In Moss Valley Practice a culture of blame had enshrined itself so deeply that no single individual would accept to own up misdeeds in any department.   Martin introduced the immediate democratic culture that required all the staff to ensure that they were their own supervisors in all the applications.  Besides, he cultivated the proactive attitudes of assessing and attending to the old people before they actually went to seek medical services in the Moss Valley Practice and others in the region.  Without the coercion aspect, all the staff realized the need to attend the weekly meetings that ensured clear analysis of the immediate successes while hiccups were discussed and solutions deliberated.  Proposition of adding the deliberation time from 15 minutes to 30 minutes indicates a vast turn in the prior negative culture.

            Martin describes it as a major break through in changing the organization culture when partners started approaching him for prior discussion of the patients details for database management and easier diagnosis for old people in the region (Julie et al 2006).  Introducing new organization culture requires patience, procedural and persuasive mode that guarantees the staff and employees of simpler operation environment while ensuring better results are achieved from the process (McNamee et al 2006).  As indicated by the situational theories, the staff should be made to drive the change by first selling the ideas to them.  Then the resistance is reduced as the emergent leaders own the initiatives and ride in it creating an internal force that the staffs easily assimilates (Mary. & Russ 2007).  This was fast enacted by martin through increased motivation to the teams in their regions of work and the weekly meetings encouragements and assessment.  Besides, he negotiated on their behalf and working conditions making the employees to follow him with undoubted trust.  Also, he led from the front to establish the responsibility culture in all the services offered by the practice by making them understand that better services would be credited to them.

Major challenges

            Martin established very clear and systematic system that was easy to follow by majority of the staff and workers in the Moss Valley Practice.  However, various aspects posed major challenges with some of them being far above what he could control.  Major changes may act to kill the driving force and therefore requires strength of mind and soberness of the spirit to conquer (Hargreaves & Fink 2005) immediate political changes and realignment posed a major challenge to the long term sustainability of the project.  Various governments assume power with varying policies and programs which makes the future to be very uncertain.  Besides, people in majority of the organizations are usually resistant to change introduced to them.  This is because new systems act as major breaking point to prior cocoons that operate inside the honour systems that can turn out to be very destructive.  Response from some of the subsidiary centres in request for patients information was met with resistance and sometimes induced rudeness.  Martin had to request the higher authority to ensure that there was harmony in all the practices for better services delivery (Julie et al 2006).

            Medical care professionals have different ways of operation and thus attitudes towards work.  As a result, different sets of rules, regulations and working conditions may threaten the very essence of team work in the medical fraternity (Katherine 2008).  Moss Valley Practice being a multifaceted Medicare provider, required coordination of the primary and secondary health care givers alongside their immediate juniors and subordinate staff.  The cohesion of the combined professions posed major threat to the later success of the practice.  To add to that, the National Health Service culture was to provide a cure to all the people in the region.  However this was not clearly thought as health services should be geared towards preventing more than curing the major disease and ailments.  It acted as the main source of reactive attitudes that the staff and employees had adopted since time in history.

Improving the process and monitoring

            With the process indicating clear successes after the onset of implementation, it was clear that the health services provision was far from adequate to the high numbers of the old people in the region.  The process therefore required massive improvement to cement the present changes while increasing and devising new systems (James 2008).  Stronger policies that would make the entity run with minimal interference from the political system should be established.  A fixed figure adjustable to the adjacent inflation rates and subsequent demands for the services should be established for constant supply of the services.  To add to that, a clear legislative and policy framework should be laid down to support the staff and the practitioners in the old people health services provision.  This would be very necessary for motivating them in their daily chores.

            Staff in the medical services provision, form the most essential part for effective and efficient services delivery (Nguyen et al 2008).  Therefore, a more inclusive leadership should be introduced where the staffs are included in more rigorous activities of the practice at all times (Fullan 2006).  As indicated by the behavioural theory of change management, intrinsic motivation coupled with direct benefits should be outlined for the employees to increase their efforts in the practice.  Direct competition within the practice would ensure that clear rewarding system was appreciated and induce further motivation to the staff.  Compensations for overtime operations and risky operations should also be defined and out laid for all the medical practitioners in the practice (Julie et al 2006) (Michael 2008).

            To add to that, a more inclusive and authoritative leadership that would see the leaders move closer to the staff and other personnel should be instituted (Fullan 2006).  Laxity in majority of the staff arises as a result of the major lack of strong emphatic basis that curves the way to be followed (Michael 2008).  Meetings attendance should not be optional for the staff as matters affecting their issues and those colleagues, working conditions and possible future sustainability are discussed.  Therefore, immediate rules and regulations for the whole practice should be derived and possible penalties described for enhancing compliance (Louis 2008).  Training and mentor ship programs should be established in the Moss Valley Practice for improving the major services delivery to the patients.  International exchange program with other advanced similar health practices should also be initiated for faster cultural change and provoking innovation through out the system (Linda & Russell 2008).  Research and monitoring should also be established for easier tracking down the laid down procedures and practice while comparison with other similar establishments will ensure high standards (Hargreaves & Fink 2005).

            Future assessment of the progress in the organization should therefore be based on the following aspects;

l  Reduction in the waiting list of the patients to be served.

l  Number of admissions in the practice.

l  Change in attitude of the staff in the practice.

l  Cooperation between the varying professionals in the practice and the region.

l  Proactive management and responsibilities towards the services delivery to the people.

l  Patients satisfaction in the region

l  Comments by the authorities and the public about the services being offered in the practice.

l  The ability of the concept to flow to the other regions and improve the health care to the whole of England


            Leadership and change in organizations has been categorized as the main determinants of sustainability and suitability of their existence.  Arm twisted in political delineations that interlock the applicability of the major policies over time, Moss Valley Practice was in total misery and in dire need of change and leadership.  Therefore, a combination of different leadership models based on the immediate capacity and ability of the practice had to be assumed for faster and guaranteed results from the fast rising demands of the old people health care services in the region.  With poorly motivated staff with high levels of reactive attitudes from the top management, Martin entrenched strong cooperation and coordination capacity that was interlocked in a highly democratic leadership at all levels of the practice management.  Though achieving major success, the fruits hang precariously as the future is strongly uncertain for both the employees and thus the services they offer to the consumers due to external technological and political factors.

Reference list.

Antonio, M & Jonathan, G. 2008. Leadership Development.” Leadership: The Key Concepts. New York: Routledge.

Department of Health & Human Services. 2007. Medicare and You 2008.  New Jersey: DIANE Publishing.

Eileen, M., Sullivan-Marx & Deanna, G. 2008. Leadership and Management Skills for Long-Term Care. New York: Springer Publishing Company.

Fullan, M. 2006. Turnaround leadership. San Francisco: Josey-Bass.

Hargreaves, A. & Fink, D. 2005. Sustainable Leadership. San Francisco: Josey-Bas.

James, A.  2008. Health Organizations: Theory, Behavior, and Development. London: Jones & Bartlett Publishers.

Julie, B., Ann-Marie, C. & Tom, D. 2006. Leadership and change: Martin McShee at the Moss Valley Practice. London: INSEAD Business School.

Katherine, B. 2008.  “Health Security or Health Diplomacy? Moving Beyond Semantic Analysis to Strengthen Health Systems and Global Cooperation,” Health Policy and Planning journal, 10(23). pp. 376-378

Louis, Rowitz. 2008. Public Health Leadership: Putting Principles Into Practice. London: Jones & Bartlett Publishers.

Linda, R. & Russell, C. 2008. Management and leadership for nurse administrators. London: Jones & Bartlett Publishers. London: Jones & Bartlett Publishers.

Mary, U. & Russ, M. 2007. Complexity Leadership: Conceptual Foundations. Bonn: IAP.

Michael, F. 2008. The Six Secrets of Change: What the Best Leaders Do to Help Their Organizations Survive and Thrive. New York: John Wiley and Sons.

McNamee, S., Anderson, H. (Eds.). 2006. AI Practitioner. Expanding Organizational Practices: Lessons from Therapeutic Conversations, San Francisco, CA: Jossey-Bass

Nguyen, N., Anson, S. & Nathan, S. 2008.  “Putting a Good Face on Impression

Management: Team Citizenship and Team Satisfaction.” Journal of Behavioural and

Applied Management 9. (2): pp. 148-68.

Rigolosi, E. L. 2005. Management and leadership in nursing and health care: an experiential approach. New York: Springer Publishing Company.

Tim, S. 2006. Leadership development for rural health. North Carolina medical journal. 1(67):16-34.

Yoo, Y., & Alavi, M. 2004. Emergent leadership in virtual teams: What do emergent leaders do? Information and Organization, 5(14), 27–58.

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