In addition, this changes led to the management's decision-making over the employees and how the managers can handle the decision made if any crisis occur. Moreover, crisis can happen even if the managers' draw out plans to take up the decision for changes in the hospitals based on the departments concerned (Tim, 2003). The managers may look into situations like staffs undertaking a wider array of task as providing opportunities to show exceptional competence in order for the staffs to have flexibility and teamwork.
The classical value of system, traditional organisation theory represents an individualistic, rational approach to life that sets the highest values of achievement (Rokeach, 1972:160). Also, this achievement can be obtained when an employee's performance is well structured such as attendance of workers for an increase in their pay. These are those behaviours which may take up relatively little effort for an individual or a team, but which are very effective for performance in their organisation (Luthans and Kreitner, 1974; 1975).
This in the NHS Trust may be restricted for managers in the extent to which they can alter the level of pay scales and benefits, or decision-making about promotions (David, 1990). The NHS Trust is a way of culture where anything such as the task given to workers can bring about changes in culture. The changes in culture of the NHS Trust multi-skilled staffs resulted to how some ancillary nurses felt threatened because the Hotel Services believed their staff to be better trained (Fred, 1992, Organisational behaviour).
Organisational culture is the collection of traditions, values, policies, beliefs, and attitudes that constitute a persuasive context for everything we do and think in an organisation (Mullins 2005:891). It functions as to provide relatively fixed patterns for handling and solving problem, relating to the organisation's ability coping with changes (Deode, 1998). In a situation whereby, the change process involved needs reallocation of duties such as the NHS Trust staff moving from nursing to domestic staff and dispensing food to patients.
Cultural change will be necessary in this aspect, if change is very vital and may even be a condition, which will enable strategic renewal to take place and will allow the organisational structure to function properly in a different way like involving in various tasks (Oswick et al. 1996). Furthermore, this cultural change may be seen as the performance on mainly tasks and jobs in organisations and how it is strongly affected by the job relevant knowledge and skills of the individuals who do the work (Porter et. al). The pilot scheme managed by Dougie McEwen (NHS Trust) was effective and they were enthusiastic and dedicated.
Likewise, some of the staffs involved in the pilot scheme did not work towards the changes but thought such process that proves difficult. In the NHS Trust, several departments had an awareness workshop for senior managers, who would then take the initiative down to lower levels (Andrew, 2004). The management team was structured from the Director of Site Services, deputy and the managers of domestic and porter's staff for their decision-making. With this, organisational decision-making model can be used for the ideal stages, which management teams go through in solving their problems or in creating new opportunities.
The Kurt Lewin's model can be used to portray a target of change and such as a measure of change that has two forces (Hatch, 1997:353). They are the driving forces and restraining forces which is a merit and demerit for the task given to perform (Hatch, 1997:353). The changes in NHS way of life is that the organisation allows changes in order to adapt, which started in the form of fordism structure involving strong power and a pyramid structure to a post fordism structure with a flatter structure, self regulating units and horizontal communication.
There was resistance of change from staffs due to no approval of team working, from staffs even if they contributed to productivity and workers, which became more flexible in the organisation. It meant the change was basically effective and ineffectual. NHS is an organisation that truly needs a change and in order for this change to be completely effective, the organisation as a whole would have to hold unto the culture change and let go of traditions.
Also, this can be said to be a form to fix power and control as it is an evident through out the case study, every member of staff was to be multi-tasking from one department to another. The group leaders for example where bitter over their status and authority being worn. To add, this can be seen as an issue of power and control effectiveness used and not used to a specific group or individuals. This may be an advantage with time but the whole organisation will slowly embrace the change and then the NHS can modify it self as an organisation with successful transformational change.
However, the system of NHS is letting people down in the aspect of dentistry crisis, in a documentary which featured, the fact people have resorted to pulling their teeth out with pliers or fixing broken crowns with glue some of which are old people. Dentists also have their issues due to clinical problems such as recruiting or retaining dentists who no longer accept the NHS patients. This changes appears to having many patients being forced to go private because they do not want to loose their current trusted and respected dentist.