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• W2049767070 abstract "Moving hospital services is frequently proposed, and although this course of action is often the professionally correct solution, it is routinely resisted by staff. Is this response because we have not yet perfected ways for moving intricate systems properly? Where are the published research, the workshops, and the champions for good practice? Last year we moved twice, one move involving a third hospital, the next a merger of two previously rival units, one a single specialty hospital. This change was viewed with a certain anxiety in the minds of all concerned, but provided an opportunity for ambitious senior management to report their methods and for the accountants to enliven their days and make their reputations by modelling for exceptional circumstances. If they should fail, the already nervous staff have to cope with feeling that their future had been taken out of their hands and that major decisions that would affect their daily professional work get taken by men and women who are rarely identified. A consequence is that staff might resist change, being worried about immediate downsizing. Perhaps in such situations there is a feedback loop, so as to learn from previous mistakes–but not as far as we can tell. A routine report written by managers with little objective comment is produced in the end. Health-service academics and civil servants need to evaluate the management of site change. Case studies should be presented with no fault or blame attached to previous bad experiences, so that the successes can be preserved, elaborated, and propagated. A standard of good practice is needed. A dose of genuine democracy and respect rather than manipulation should be the order of the day, given that the clinicians at the sharp end are likely to have the purer motives than administrators, and at least as much vision. Such a charter for the staff would reduce anxiety levels so that they would then accept that any moves that may be challenging to them personally could be a correct and genuine revitalisation of health care in the longer term. Money is also an issue since appropriate relocation is cost-effective. The greatest inefficiency in any system is more delivery points than are strictly necessary, combined with a disenfranchised staff who would not only subconsciously work to rule but also make more clinical errors. The alternative to a proper academic study put rapidly into effect is that services evolve far too slowly with an unnecessary amount of resentment." @default.
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• W2049767070 title "Management of change" @default.
• W2049767070 doi "https://doi.org/10.1016/s0140-6736(05)63251-5" @default.
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