Identify and critically discussthe key challenges facing managers in health and social care

KEY CHALLENGES FACING MANAGERS IN HEALTH AND SOCIAL CARE
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KEY CHALLENGES FACING MANAGERS IN HEALTH AND SOCIAL CARE
Introduction
This essay focuses on the definition and discussion of challenges that face managers in the running of health and social care organizations. Management is a social context that practices learning and influencing people’s behavior. On the other hand, leaders are the influencers of the culture that pervades an organization (Hintea, C. et al. 2009, 92). The management roles also include the supervising the employees and coordinating how they work and are driving forces behind the attainment of organizational goals. Moreover, they make decisions on utilization of resources that include finances, human capital and technology. Summarised below are some contributory factors facing the healthcare system in the United Kingdom.
A demographic shift is the transition from a population experiencing high rates of both birth and death to one that is undergoing suppressed mortality in addition to subdued fertility. Consequently, the society ends up being relatively composed of older citizens. Chief among the factors contributing to an aged citizenry is an improvement in the life expectancy levels (Layte, R. et al. 2009, 1).
The improvement in life expectancy levels is a precursor to the vast strides made in the quality of care that is attributable to technological change. Technological change is the explosion of technology which the led to the advancement of automation that has diffused into healthcare over time with consequences on economic output and welfare.

There are thus prospects of a conflict pitting the demand for technologically advanced healthcare facilities against social impact, medical requirement and financial implications (Tan, L. and Ong, K. 2002, 231).
The resultant high costs of health and social care services have led to funding constraints according to data from the National Health Service (Mossialos, E. et al. 2016, 56). There exists an intricate relationship between financial performance and the quality of health care and social services.
Meanwhile, the NHS is striving on having a good perception from the consumers of services that should be of appreciable quality. Patients who seek services of the healthcare system do so with preconceived beliefs and anticipation. Efforts geared at striking a balance between perceptions of a physician, expectations from the patients, targets, and goals set by health care planners are paramount (Lateef, F, 2011. 165).
For successful operation and growth of public health sector, there is need for exemplary management influenced by good leadership. The leaders as well as managers are operating under harsh conditions characterized by dwindling resources and a rise in demand for services. It requires possession of skills, qualities in addition to support to arrive at key decisions concerning changes to an organization and utilization of a budget. The aim of this work is to identify and discuss challenges that managers in the health sector face with emphasis being on challenges that affect quality. Reduction of rates of payment by the local authorities has led to deterioration of safety and in this essay; there will be analysis of a model based Lewin (1951) change theory and its potential towards combating the decline. Both autocracy and laissez-faire style of leadership will undergo comparison for effectiveness in influence, commitment and behavior they promote.
High priority given by the NHS to patient satisfaction and the quality of services on offer will gain input in the work herein. After discussion of the various challenges, bedeviling health and social system, proof of how the laissez-faire model of leadership confers a lot of influence of the manager on nurses will be on display. Unlike autocracy, our model shows that the laissez-faire style to be a booster to the driving forces desired by the Lewin theory whiles the former promotes the restraining forces.
Key challenges
As suggested above demographic changes have an impact on the provision of healthcare care services (Harper, S. and Walport, M. 2016, 6). Life expectancy in the UK currently stands at 79.0 and 82.5 years for men and women respectively. The strain on resources comes in the form of a dip in productivity exemplified by the vagaries of age that result in narrowing of the tax base. Evaluated on the background of the fact that it costs more to provide health care as an individual continues to age it is clear why the impact of treating the aging population is raising concern (Cracknel, R. 2010, 44). As population ages incidences of disability have the potential of increasing in addition to non-communicable diseases, both are proving to be important shapers of the mode used in delivery on health and social needs (Goldring, I. 2008, 9). As a result, this is influencing the revolution to present trend of policies based on research, a deviation from those based on available resources. Investment on improvement on care offered to the older section of the population that is mostly frail has thus become paramount (NHS England. 2014, 24). The caregivers also have to undergo training on innovative ways of working and the deployment of existing good practices (Smith, G. 2015, 3).
In the UK, by the year 2020, the segment of the population that will be aged 65 years will be approximately 16 million people rising to 20 million by 2050 (Cracknel, R. 2010, 45). The aging population implies introduction of long-term healthcare conditions resulting in a forecasted use of an additional £5 billion. Obesity among the old attributed to the intake of poor diet and general inactivity has led to the emergence of asthma (Yawn, P. et al. 2015, 1). Prior studies have opined on asthma being more prevalent at an advanced age in comparison when young (Yanez, A. 2014, 1).
The technological advancement has also seen the computerization, automation, internet penetration and the emergence of a digital economy. These changes have led to a subsequent alteration in the ways of working, the location of working and in circumstances where the working program automation is 100%, the positions become redundant. Since the pace of organizational change has been on increased productivity and employment of older citizens depends on their adaptation to the proposed changes. The technological advances mean that the aging workforce has to undergo regular retraining as well as reskilling to conform to the changes.
Literacy coupled with numeracy and qualification levels are bound to determine employment opportunities in the wake of automation. The timing of the training offered to the aged poses a challenge since carrying it out after the commencement of a period of unemployment will prove unhelpful. Lack of skills and technical expertise that would enable one to opt on working later in life would affect funding of the aged populace after their retirement (Harper, S. and Walport, M. 2016, 40). Once introduced in a healthcare setup Information Technology programs are mostly hard to improve on and lead to changes that were unanticipated in ways of working. Information technology has brought about the advent of Human-Computer Interaction whose usability is an important determinant of adoption. The system also brings about organizational in addition to social changes. The change in social structure breeds inertia among the patients while a change in the companies’ structure leads to sociotechnical resistance among the staff. Resistance from the staff is due to the notion that decision making which was once their obligation is a now a report expected from IT systems. Ultimately this leads to dissipation of motivation, working against set goals and diversion of resources (Lind, T. 2014, 18).
The UK is experiencing a good portion of aged individuals working until later in life. Policies like doing away with mandatory retirement age have seen many opt to work until late in life. Non-financial benefits related to working past formal retirement age include an exhibition of resilience during old age and improvement of cognitive functions that confer benefits to those suffering mental illness. Extended experience in an industry leads to the attainment of knowledge specific to the industry with a network to match. Older people are also working longer to save more. These savings help in maintaining a decent lifestyle after retirement. As a necessity, the training of managers on what an aged workforce requires is important. The workforce thus has the potential of having a slump on productivity (Harper, S. and Walport, M. 2016, 37).
The advent of the internet and proliferation of social media has meant that patients can access information and have a platform where they interact and exchange views. Potentially, this influences expectation from patients that hence needs management, and this requires nurturing of a patient to physician relationship based on factors like systems that offer open access to information. Managers must ensure that the physicians and staff go through rigorous training that inculcates values meant at achieving customer satisfaction. Care centering on the patients and adoption of their perspective into streamlining the healthcare system need implementation. It is also important to notice that patient demographics can also influence their expectations. Latest principles deserve consideration in the perspective of rapid transformation of the social and economic terrain (Hunter, D. 1996, 801).
Financial pressure experienced in the healthcare sector has resulted in a drop in NHS funding subsequently limiting its spending. The decline in the growth of funding occurred between 2011 and 2015. During the same period, it also happened that the NHS was involved in the treatment of the highest number of patients ever witnessed, with clinical contacts increasing by 15%. The narrow growth in funding is proving inadequate to the growing demand for healthcare. Both diabetes and dementia occur with aging hence the observed prevalence. The cost of diabetes and dementia to the NHS budget stands at £23.7 billion and £26 billion annually respectively (Hill, J. 2015, 149). As a result, there has been the development of strategies that include placing of restrictions to access to care by the patients, compromising of the quality of care offered and a hike in prices charged for services rendered. The funding constraints affect the quality of health and social care (Robertson, R. et al. 2017, 6).
Social care encompasses help remitted towards tasks performed in everyday life, and it prolongs the period a patient continues being independent while still in their own homes. The social service that is residentially oriented has gained traction especially among the elderly. Funding of social care services has also faced a reduction, with the biggest culprits being older persons, people of lower socioeconomic status and those whose conditions require high care. Access to state funding of social services for patients in England has also faced restriction. Local authorities have also limited the fees payable to providers of social services. The authorities only make payments for patients in need of critical and substantial care, and this has had an impact on the efficiency savings of the providers since management of the provider fees they charge is challenging. Dwindling funding from the local authorities has led to the polarization of the market as providers have turned their services solely to individuals who fund their care expensively. A situation that has resulted in a drop in slots meant for local authority placements and unaffordable fee levels. The decline in social care funding has led to the development of instability experienced in the market. There is thus potential of causing many providers to contemplate quitting the sector and leaving patients deserving of care unattended.
There should be a concerted effort to maintain innovations and the evaluation of changes in the sector and the various theories that offer guidance towards achieving this. Delivery of care based on the weight of evidence available on the suggested practice need to come into play (Mitchell, G. 2013, 32). Proposed organizational changes are due to various factors including, thinning workforce and ballooning financial implications of treatment. Also, professional expectations encompassing promotion of safety in health institutions, ethics, and codes of conduct, scientific evolution, an aging populace as well as focus on patient satisfaction, have led to the development of the changes (O’Neil, H. and Manley, K. 2007, 37).
There are four leadership styles in management theory namely autocratic, bureaucratic, laissez-faire and democratic style (Marquis, L. and Huston, J. 2009, 12). The dictatorial style seems appropriate for discerning whether there is a need for change to attain safety of social care users. The autocracy style exemplifies high predictability, enhanced productivity, dwindled motivation coupled to a decline in creativity. It comes in handy in crisis and, when there need be change. The desire for following a top-down approach necessitates the employment of autocratic style. Teamwork is not encouraged as decision-making is solely the leader’s mandate and does not involve others. Criticism in play in this mode of leadership falls short and is punitive. Coercion and measures deemed as constituting control is also a feature of autocracy. To complement the autocracy style the laissez-faire style of leadership will gain concurrent use. The mode is opposite to autocracy, lacks direction, and in some instances can be frustrating. As a result, managers working with it have tended to delegate control to their subordinates. Its main strengths include enhanced creativity, unparalleled motivation in addition to autonomy. The groups subjected to this sort of leadership show resistance thus necessitating deployment of multiple change agents. Communication is through the upward-downward mode.
As a model for change, the Lewin theory that prescribed three stages through which change agent must pass through to ensure entrenchment of the desired change in a system. The three steps include unfreezing win pursuit of change. The theory underwent modification and expansion by Rogers (2003) and Lippitt (1958). Lewin holds the view that behaviors gain influence from forces working at cross-purposes. The effects are driving and restraining forces. The driving forces help in the promotion of behavioral change while restraining factors offer resistance to the desired change in behavior. The intensity with more strength carries the day (Mitchell, G. 2013, 33). The Lewin theory thus comes across as rational and its orientation determined by goals and plans. The theory’s undoing is not taking into consideration personal facts that would lead to an effect on the desired change. These factors include feelings and experiences (Kritsonis, A. 2005, 6).
According to the Care Quality Commission, a decline in the safety of users is in the offing due to a limitation in funding of social care. A model of using Lewin theory to compare the autocracy and laissez-faire style of leadership would involve the nurses in social care set up assigned to two equal groups. They would be participants in the behavior change drive over a period. In the first batch, the manager is to act as an autocratic leader, and in the second batch; he employs the laissez-faire style of leadership. Observation of the changes in the nurses’ behavior undergoes monitoring on the culmination of the program.
Unfreezing- Attained by an increase in driving forces and a reduction in the restraining efforts observed during the change. In the autocracy led group, the nurses receive commandments to show motivation in carrying out their duties. Moreover, the manager will be the only one involved in the identification of problems and formulation of solutions that nurses get instructions to implement. The manager will be responsible for the coordination of care provided by the nurses who will have to trust the decision and reasons put forth by the manager without question. Nurses under the laissez-faire leadership would have more leeway in decision making which will involve everyone. The manager would exercise minimal control over the nurses’ activities while providing minimal direction. The nurses would also gain motivation through support that would be requiring the placing of a request. The team will act as a forum for the identification and the solving of problems.
Change- In the autocracy led group the nurse will have strict guidelines on the detriments emanating from the status quo. Reprimanding of nurses for failure to view the problem from a new perspective will be regular. In the laissez-faire style, led nurses there would be more freedom exemplified by the individuals working together as a group in research on the lack of safety to the patients. The decision on the available mechanisms to effect the change, remains distributed across the whole team.
Refreezing- The autocracy led nurses would be commanded to take note of best practice patterns through rigid procedures developed by the manager. Policies insisting on social care user safety undergo formulation by the manager, and subsequently nurses apply them. Laissez-faire style would be more liberal since the nurses would be the source of new patterns communicated to the manager who will give his opinion. Policy and procedure development will depend on the nurses’ own experience. The will be evaluation would be done through observation of the behavior of nurses and carrying out of patient satisfaction surveys.
Discussion and Analysis
Quality of care advanced to patients is of paramount importance to NHS. Driving forces identified in this scenario include enhancing of job satisfaction, and professional development. On the other hand, restraining efforts are insistent on staff conformity. Because of the relative freedom conferred by the laissez-faire style of leadership, it is expected that nurses under the it will display more satisfaction with their teamwork involved. The domineering control and demands meted out by autocracy would result in efforts aimed at achieving conformity from the nurses, which is a restraining force. The dictatorial tendencies are bound to create work-related stress, which is a good breeder of resistance. Better results in the improvement of safety standards for the users of social care will emanate from the nurses who underwent laissez-faire style of leadership.
Conclusion
Nurses are the point of contact between a hospital and patients, and so they are the last custodians of quality. Leadership in management is of paramount importance with its approach that revolves around the change in people. According to Lewin, restraining forces cannot face elimination but are ineffective through amplification of driving forces. A leadership style like laissez-faire that encompasses effective communication is crucial for a change in the attitude of the nurses. Motivated employees tend to exhibit satisfaction and increased cooperation. The mode of leadership and effectiveness of a theoretical model are thus paramount.
References
Cracknell, R, 2010. THE AGING POPULATION in Mellows-Facer, A, 2010. KEY ISSUES FOR THE NEW PARLIAMENT. London: House of Commons Library.
Goldring, I, 2008. CHANGE AND SOCIAL HEALTH SERVICES IN EUROPEAN CITIES. Brussels: Word Press.
Harper, S, and Walport, M, 2016. FUTURE OF AN AGEING POPULATION. London: Government Office for Science.
Hill, J, 2015. DIABETES AND DEMENTIA: THE IMPLICATIONS FOR DIABETES NURSING. Shropshire: Journal of Diabetes Nursing.
Hintea, C, Mora, C, and Ticlau, T, 2009. LEADERSHIP AND MANAGEMENT IN HEALTHCARE SYSTEM: LEADERSHIP PERCEPTION IN CLUJ COUNTY CHILDREN’S HOSPITAL. Cluj-Napoca: Transylvanian Review of Administrative Sciences.
Hunter, D, 1996. THE CHANGING ROLES OF HEALTHCARE PERSONNEL IN HEALTH AND HEALTHCARE MANAGEMENT. Peebles: Social Sciences & Medicine.
Kritsonis, A, 2005. COMPARISON OF CHANGE THEORIES. California: International Journal of Management, Business, and Administration.
Lateef, F, 2011. PATIENT EXPECTATIONS AND THE PARADIGM SHIFT OF CARE IN EMERGENCY MEDICINE. Singapore: Journal of Emergencies, Trauma, and Shock.
Layte, R, Barry, M, Bennett, K, Morgenroth, E, Normand, C, O’Reilly, J, Thomas, S, Tilson, L, Wiley, M. and Wren, M, 2009. DEMOGRAPHIC CHANGE ON THE DEMAND FOR AND DELIVERY OF HEALTHCARE IN IRELAND. Dublin: ESRI Research Series.
Lewin, K, 1951. FIELD THEORY IN SOCIAL SCIENCE. London: Tavistock Publications.
Lind, T, 2014. CHANGE AND RESISTANCE TO CHANGE IN HEALTHCARE. Uppsala: IT Licentiate Theses.
Lippitt, R, Watson, J, Westley, B, (1958). DYNAMICS OF PLANNED CHANGE. Harcourt, Brace: New York.
Lippitt, R, Watson, J, Westley, B, 1958. DYNAMICS OF PLANNED CHANGE. New York: Harcourt.
Marquis, L, and Huston, J, 2009. LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS IN NURSING: THEORY AND APPLICATION. Philadelphia: Williams & Wilkins.
Mitchell, G, 2013. SELECTING THE BEST THEORY TO IMPLEMENT PLANNED CHANGE. Belfast: RCN Publishing Company.
Mossialos, E, Wenzi, M, Osborn, R, and Sarnak, D, 2016. 2015 INTERNATIONAL PROFILES OF HEALTHCARE SYSTEMS. London: Commonwealth Fund Publication.
NHS, 2014. FIVE-YEAR FORWARD REVIEW: NHS.
O’Neal, H, and Manley, K, 2007. ACTION PLANNING: MAKING CHANGE HAPPEN IN CLINICAL PRACTICE. Nursing Standard: Art & Science
Robertson, R, Wenzel, L, Thompson, J, and Charles, A, 2017. UNDERSTANDING NHS FINANCIAL PRESSURES. London: The Kings Fund.
Rogers, E, 2003. DIFFUSION OF INNOVATIONS. New York: Free Press.
Smith, G, 2015. THE AGING SOCIETY AND ITS POTENTIAL IMPACT ON HEALTH AND SOCIAL CARE PROVISION. London: Health Sciences.
Tan, L, and Ong, K, 2002. THE IMPACT OF MEDICAL TECHNOLOGY ON HEALTHCARE TODAY. Hong Kong: Hong Kong Journal of Emergency Medicine.
Yanez, A, Cho, S, Soriano, J, Rosenwasser, L, Rodrigo, G, Rabe, K, Peters, S, Niimi, A, Ledford, D, Katial, R, Fabbri, L, Celedon, J, Canonica, G, Busse, P, Boulet, L, Baena-Cagnani, C, Hamid, Q, Bachert, C, Pawankar, R, Holgate, S, and WAO Special Committee on Asthma, 2014. ASTHMA IN THE ELDERLY: WHAT WE KNOW AND WHAT WE HAVE YET TO KNOW. Buenos Aires: WAO Journal.
Yawn, B, Rank, M, Bertram, S, and Wollan, P, 2015. OBESITY, LOW LEVELS OF PHYSICAL ACTIVITY AND SMOKING PRESENT OPPORTUNITIES FOR PRIMARY CARE ASTHMA INTERVENTION: AN ANALYSIS OF BASELINE DATA FROM THE ASTHMA TOOLS STUDY. Rochester: Nature Partner Journals.