The populace of rural areas comprises mainly ageing population as compared to urban areas. As such the health condition is usually characterised by the occurrence of multiple chronic diseases such as dementia, diabetes, arthritis, and hypertension. Moreover, the health care system in the rural areas are usually underdeveloped and lack adequate healthcare practitioners to cater for all healthcare demands. Therefore, most of the healthcare systems in remote areas are made up of acute care models which predominantly focuses on curing emergency illness (Belova, 2017). Consequently, many people in remote areas usually opt to go to urban areas to seek better healthcare services. The process is costly, and in a matter of life and death situation, many lives can be lost in the process of seeking better health care owing to the geographical distance between rural and urban areas (Lin et al., 2014). As time passes, the scenarios in healthcare and chronic illnesses become more unpredictable thereby demanding changes in the healthcare delivery model to cater to all the changes (Langabeer II, & Helton, 2015). As a senior health manager working in a rural health care centre, my management plan proposal targets the shift from acute healthcare delivery model to a more advanced model. That is primary health care model that will involve the integration of curative and preventive measures, which will be in line with structural changes to curb the ever-growing problem of increased chronic disease cases in rural areas.
Primary health care (PHC) is continuous essential care given to an individual and the community as a whole. Its primary aim is to deliver sustainable health care services contrary to traditional means such as acute care models that focus mainly on curative measures rather than both curative and preventive. PHC model calls the need for collaboration between healthcare centres, practitioners and the whole community working together to achieve the goals and objective of the PHC delivery model (Ginter et al., 2018). The model further aims to make healthcare accessible to all people regardless of financial status, and it is usually community-based (Milani, & Lavie, 2015). PHC is vital in any community because of its protective approach that involves a scope of preventive measures such as family planning and vaccination. Moreover, it aids in improving the overall quality of healthcare that usually covers about 90 percent of all individual needs throughout their lifespan (Stokes et al., 2017). Consequently, well-developed PHC models transform the overall quality health of a community. However, despite the many advantages PHC presents it is not implemented in many rural areas due to various reasons such as lack of funds, inappropriate technology in the healthcare sector, and myths associated with the model (Lin et al., 2014). For instance, there was a misconception that family planning makes people infertile thus contributed to many individuals declining to use it (Whitehead et al., 2016). Additionally, a group of people started the myth that polio vaccinations were poisonous and used by the government as a way of reducing the population in third world countries (Wakerman et al., 2017). Furthermore, rural areas lack essential infrastructure such as well-developed roads that discourages investors from investing in such areas. Similarly, caregivers lack the motivation to provide their services in such remote areas that require proper infrastructure. Consequently, rural areas are popularised by unskilled practitioners who find it hard to find work in urban areas. Owing to the lack of essential PHC in rural areas, there is a need to implement managerial changes in health care centres for the development of sustainable caregiving for the whole community.
I manage the West Somerset Healthcare Centre which is located in the West Somerset district. The area is populated by around 34,900 people and is in the County of Somerset. The centre is underdeveloped compared to the contemporary urban healthcare centres. West Somerset Healthcare Centre is an acute health care delivery centre which mainly focuses on curative measures. As a healthcare manager in a rural area, I have witnessed a number of chronic diseases that would have been prevented or their impact reduced in a well-structured PHC model. Consequently, my change in management plan focuses mainly on structural reform to develop a primary health care model. Like many other remote areas, the healthcare centre lacks adequate healthcare practitioners to cater for all the health needs of local individuals (Wakerman et al., 2017). Moreover, changes will be implemented by increasing access to healthcare services.
West Somerset Healthcare Centre lacks skilled health caregivers. Moreover, the practitioners available are deficient in diversity as the centre opts for many doctors’ approach. Consequently, it lacks other caregivers such as nurses, lab technicians, and other vital caregivers. Therefore, the quality of health care delivered is usually below average (Whitehead et al., 2016). The problem is visible in many rural areas both in developed and underdeveloped nations. Rural areas are associated with low earning from community members which discourage caregivers and investors from venturing into such areas (Langabeer II, & Helton, 2015). The result of inadequate caregivers is healthcare models that are insufficient in catering to the health needs of all individuals. Therefore, chronic diseases are usually adamant in remote areas thus increasing the mortality rate (Milani, & Lavie, 2015). The case is also evident in West Somerset Healthcare Centre, as such, there is a need to implement changes that will result in a decline of such problems and ensure the sustainability of healthcare systems in West Somerset District. The area, further need to adopt new advanced technology in the healthcare world to cope with the rising cases of chronic diseases. Moreover, the facility relatively inaccessible to the interior residents due to various factors such as the state of the roads. Therefore, there is need to increase healthcare accessibility in the district.
Owing to the issues in the health centre I am managing; my proposed change is towards changing the structural composition of the health centre. That is, change the content of physicians available at the healthcare centre by diversifying care giver’s content. Since the centre comprises of mainly general doctors, the change will work towards hiring more diverse doctors who will cater to all healthcare fields. Additionally, the change will aim to increase the quality of care provided. Moreover, the move will entail bridging the gap between patients and the hospital by purchasing more developed ambulances and mobile hospital clinics. Similarly, the move process will invest in research to discover innovative ways to maintain and sustain the formed PHC model. Since the change in management is a dynamic process, the alterations need to be appropriately evaluated, efficient strategies developed and properly implemented in line with the financial capabilities of the centre.
Rather than employing doctors alone, the plan proposes that other practitioners be hired by West Somerset Healthcare Centre to increase the quality of care provided. More skilled nurses will be hired and also increase the number of lab technicians. Additionally, specialists such as a gynaecologist, paediatricians, opticians and other relevant medical professionals will be recruited to cater for every health need of the community. In doing so, the need to go to urban health centres will be reduced, and thus the centres will earn the funds that would have otherwise been given to urban health centres (Ginter et al., 2018). Moreover, to further advance the quality of physicians, training workshops will be organised to realise the goal of linking the health care workforce and the prevailing local needs.
To shift from an acute care delivery model to PHC, the quality of healthcare provided should be generally improved. Therefore, the proposed management change will work towards improving the quality of care provided to the West Somerset community. The change will move from curative to integrated approach by initialising the following measures.
- The healthcare facilities will develop relationship management plan between the caregivers and patients. The plan will aim towards using specialised communication techniques to convey specific messages to intended target groups. For instance, the intended information will be passed to patients in different geographical settings in the rural area, or to patients with specific conditions. The plans will result in motivating patients to be stakeholders in providing their own individual care (Salman, & Broten, 2017). Moreover, the channels will be used to keep in check physicians’ activities and ensure that they are in line with the healthcare systems’ goal of providing the best possible healthcare quality to patients.
- The change will also work towards empowering the whole primary caregiving system by improving the integration of data between caregivers and patients and comprehensively using the outcome to provide better healthcare. For example, health care centres will develop a call centre whereby the call centre agents will use the integrated information to better the interaction between the physicians and patients. Similarly, the agents would use the practitioners’ specialisation areas to further guide the patients on the best course of health care action (Stokes et al., 2017). Developing and proper use of call centres would lead to a personalised relationship between patients and caregivers that further enhances the incorporation of a continuum of care into PHC healthcare delivery model.
- The healthcare system will make practical and effective use of all patients’ information. The caregivers will use all the data about the patients’ disease condition, history of health care and behaviour to implement a personalised care system. Consequently, the measures will enhance the health of the patient as they can be used to predict future conditions and prevent them (Belova, 2017). Additionally, the caregivers will use insights about the families of patients to foresee any genetic conditions that may be inherited. By analysing the families’ historic health conditions, caregivers will be in a better position to provide improved healthcare quality.
- The plan further aims to create a proactive interaction between patients and practitioners. Such engagement can be achieved by creating a trustworthy environment where patients feel safe to consult about any condition (Goetsch, & Davis, 2014). The proactive engagement will help in the prevention of chronic diseases as they can be detected early and where possible curbed. The results should be the perennial management of chronic illnesses.
A well-developed PHC model is characterised by easy access to healthcare facilities. As such
vehicles will be purchased which will be used to construct mobile clinics that will be located in the interior parts of West Somerset. The clinics will be equipped with relevant equipment to provide basic healthcare services such as diagnosis of diseases (Dwivedi et al., 2016). In the event the illnesses cannot be treated via the mobile clinics, the patients will be transferred to the hospital by the newly purchased ambulances. The process is intended to prevent fatality. Moreover, the clinics will be used to increase patients’ consultations which would have otherwise been difficult. Therefore, the direct patient management will be beneficial in managing chronic diseases.
To further aid the successful transition from an acute care model to the PHC model, the change in a management plan will focus on researching an innovative better way to accomplish the move (Carnall, 2018). Newly advanced labs that are in line with the existing technology will be developed to further help in the research of better cure and prevention of chronic diseases. Moreover, the study will be directed towards discovering better ways of improving the relationship between physicians and patients to advance care delivery further. Furthermore, research will be directed towards inventing and enhancing already existing methods of creating integrated healthcare awareness.
The timeframe for the implementation of proposed change management plan is estimated to be over a period of two years. The table below shows the estimated period of implementation of all strategies.
|Diversifying caregivers content||Hiring specialised physicians||3|
|Consistent ameliorating of quality of healthcare||Enhancing communication with community members||6|
|Constructing a call centre||11|
|Investing in technology that will aid in linking all patients’ medical history||6|
|Mobile clinics||Purchasing ambulances||4|
|Constructing mobile clinics||13|
|Investing in research||Constructing advanced labs||18|
|Purchasing advanced equipment||6|
The best theoretical approach to achieve a victorious change from acute care delivery to PHC in West Somerset Healthcare Centre is using Kotter’s transformational change model. The model is famous for its ability in aiding the implementation and success of management change plan (Carnall, 2018). The model consists of eight steps that lead to the realisation of a successful change in the management plan.
Step 1: Urgency Creation
To develop a successful primary health care model, urgency needs to be created among all stakeholders (Marshall et al., 2015). They must be made to see the need to move to a better-advanced healthcare model to cater to the health needs of the whole community. Urgency can be created by communicating with stakeholders transparently and creating convincing conversations. Therefore, a SWOT, strengths, weaknesses, opportunities and threats, analysis of the proposed change need to be taken and stakeholders informed of the findings (Chappell et al., 2016). Consequently, the whole community, investors, and practitioners will be able to create the urgency by themselves and thereby all contribute towards developing a better healthcare model. According to Kotter, about 75% of the whole management needs to see the seriousness of taking part in the proposed change (Tan et al., 2016). Therefore, there is need to invest time and resources to ensure that they all see the need to take part in the transformation.
Step 2: Formation of Influential Alliance
After creating the need for change, the next step will be to identify important people and form partnerships with them to increase the number of people that will partake in the transformation thereby helping in the process (Tan et al., 2016). For any change to be successful, it is important to pinpoint the key leaders in a community who are vital in the activities in that community. Moreover, the step involves recognising influential people in different economic categories such as caregivers, financially well-off people, politicians and any other leader who can help in the realisation of the transition. Diverse coalition forming gives rise to an important team that is invested emotionally, socially and financially in developing the PHC model.
Step 3: Constructing a Vision for Change
It is important to create a vision for change as it will act as a driving force that motivates people to take part and contribute to forming a more advanced healthcare model (Chappell et al., 2016). I will pinpoint the important values such as the integrated (curative and preventive) approach, fair prices to show all stakeholders. Moreover, I will develop strategies that will ease the implementation of the proposed change. Additionally, I will urge the formed team leader to understand the visions and further be able to portray them in an understandable manner to all stakeholders.
Step 4: Communicating the Vision
After vision formulation, it is very vital to communicate it effectively. Efficient communication can be achieved by doing it as much as possible during the day to day activities to keep it relevant (Tan et al., 2016). Moreover, I will implement the vision of developing a PHC model in every event. For instance, encouraging patient and physicians’ interactions and making sure that health care services are accessible. Additionally, I will be transparent about all the question and issues about transforming into the PHC model from anyone.
Step 5: Eliminating Obstacles
According to Kotter, the fifth step in a successful management plan is eliminating any obstacle that hinders the change. The step involves being able to identify any challenges the change faces and finding an effective way of dealing with them (Hayes, 2018). Removing any obstacle serves in boosting the morale of people involved as they are assured that the proposed visions will be achieved. Additionally, the necessary workforce will be hired who will see through the successful development of a better healthcare delivery model. Therefore, it is fundamental to regularly check for any obstacles and dealing with them as needed.
Step 6: Forming Short-term Victories
Success acts as the ultimate motivator in the change process (Marshall et al., 2015). Consequently, the change management plan will have short-term goals that are cheaper to achieve. Therefore, they will be easier to explain how to minimise expenditure and everyone involved will be motivated. For instance, when stakeholders get to witness how mobile clinics increase healthcare services, they will be driven to work toward the achievement of a better healthcare delivery system. I will hire specialists in the PHC field to formulate the small goals and reward any involved party in the occurrence of a short-term win.
Step 7: Work on Continuous Change
For overall success, small wins should only serve as morale boosters; the real work should be towards achieving the end objectives of the change (Tan et al., 2016). Therefore, I will take lessons from every event that occurs and continue working towards achieving a primary health care model. I will further, form new and better coalitions as the transformation progresses and hire new and improved personnel.
Step 8: Anchor all Changes in Corporate Tradition
The final step entails making every change part of the new model. Every part of the new primary health care model should be a reflection of the initial goals and values of the change process (Hayes, 2018). Therefore, I will put plans in place to incorporate the change values with every new aspect of the model such as new staff. Furthermore, I will publicly recognise every person that took part in ensuring the success change in the management plan and ensure that their legacy moves on (Chappell et al., 2016). Similarly, I will ensure that I talk about the success of the change every chance that I get and continue forming important coalitions.
The stakeholders in the proposed change entail every person that will be affected by the implementation of the proposed changes (Hornstein, 2015). They include:
- All West Somerset residents.
- Every physician involved, both old and new.
- All West Somerset Healthcare Centrestaff such as receptionists, gardeners and security staff.
- All staff hired to foresee the change process.
In all instances of change, the natural instinct of all individuals is to resist. Individuals fear the unknown outcome nature of change and often result in doing everything possible to stay in the current state (Burnes, 2015). For instance, many residents may perceive the PHC model unfavourably possibly thinking that it will do more harm than good; consequently, they may be opposed to it. Additionally, many people in West Somerset District are illiterate thus may not wholly fathom the benefits of the model. Hence, they may opt stick to their traditional methods of healing sicknesses which in many cases is usually not utterly effective (Salman, & Broten, 2017). The existing staff may resist the transition to PHC model as they may feel that their jobs are threatened by the change (Menon, & Prabhu, 2016). The possibility of miscommunication may lead to West Somerset residents and investors perceiving the proposed management change in bad light thus become opposed to it.
To overcome any possible resistance, it is important to create effective communication plans (Burnes, 2015). I will ensure that internal communication is transparent and all involved parties notified of all true intentions of the plan. I will assure the old staff that their jobs are secure since the organised workshops will work towards improving their skills (Menon, & Prabhu, 2016). Moreover, throughout the change process, any issue raised will be answered honestly to eliminate any room for doubt (Doppelt, 2017). Furthermore, extensive and essential awareness pertaining to the benefits of the change will be raised to ensure that every stakeholder gets honest information.
The purpose of the management team including me entails supporting all the activities pertaining to the change. Additionally, I will create a transparent communication between all stakeholders to avoid doubt that may build resistance (Doppelt, 2017). Moreover, the team will continuously identify any resistance and deal with it as needed. Furthermore, the team will coach every partaker in the changes towards the success process.
For successful transit from an acute care model to the PHC model, a lot of funds need to be invested in West Somerset Healthcare Centre. Buying of advanced equipment and technology requires a lot of financial input. Moreover, there will be a need for finances to hire new and skilled practitioners needed for the new model. Furthermore, more funds are required for the non-medical staff and purchase of all healthcare materials.
The financial resources required for the change will be from:
- Government incentives
- The new charging system, price discrimination, will help in raising funds for sustaining the management change.
To ensure the continued success of the implemented change, strategies and policies will be put in place. Training programs will be developed to ensure that the healthcare providers are skilled as per the prevailing needs (Hornstein, 2015). Moreover, expenditure minimisation policies will be set in place to ensure that the healthcare facility has funds to sustain the change. The success of the change will further be incorporated into every new aspect of the healthcare centre to remind all stakeholders to keep working towards the sustainability of the change (Goetsch, & Davis, 2014). Furthermore, communication will be transparent at all the times, and only attainable goals will be set. Additionally, new important coalitions will be formed to ensure the continued success of the new health care delivery model.
The proposed management change plan is highly attainable. Consequently, efforts to work towards the goals will lead to a transformation from acute care delivery in the rural health centre I am managing, West Somerset Healthcare Centre, to a primary health care model. The new model will integrate both curative and preventive measures to ensure the effective management of chronic diseases in the rural area.
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