Management Consulting Assignment
1. Section One
a) Problems faced by the CEO and this hospital
With the government insisting the NHS hospitals to operate as business like entities by selling the services to people and patients having the power to choose from where they want to receive the services, the CEO of this Hospital Trust is concerned about the fact that five percent shift of patients from this Hospital to elsewhere would result in a deep financial trouble.
The five why analysis is a simple tool to identify the symptoms and get to the root cause of the problem quickly. The five why tool can be used in this case to analyse the problem of hospital getting to deep financial trouble when 5% of the patients decided to go to elsewhere for healthcare service.
Problem– Deep Financial trouble when 5% if patients decided to go elsewhere.
- Why do our patients decide to go elsewhere for healthcare service? Because the hospital had a high waiting time. There might also be a problem in the quality of the service offered. But considering the mention in the case about the highest grade the hospital achieved, the service quality might not be the real problem.
- Why high patient wait time? As per the case, the General Manager Helen points out that the clinic is not started on time and finishes earlier which is preventing the clinics to operate at its full capacity and thereby contributing to higher patient wait times. The delay in decision making process of addressing the backlogs and the wait time as highlighted in case by the general manager is the cause.
- Why is the delay in the decision making process to address the backlog and the wait times? The relationship between the consultants and managers is not really great and the problem of 'who manages whom' persists. There are also problems in the definition of roles and responsibilities which lacked accountability of the processes involved in the healthcare service delivery. This was expressed by the anaesthetic consultant Henning in the case. The inability of the staff to put together the basic information pertaining to income streams from various specialities also indicate the lesser understanding of how different operations work as a chain among the staff.
- Why are there so many operational issues? It appears that the consultants, managers and the clinicians do not have the expected level of communication and co operation among them.
Therefore, the root cause of the problem in the case is the lack of communication and co operation among the staff about the real danger the hospital is facing when trying to operate commercially.
b) Support needed from Internal Project Manager (Client Side) People:
Top management support is the key to the success of any project. The internal project manager should ensure Alan gets all the possible support from key people across the functional boundaries to help him gather the right information. The internal project manager could facilitate internal communication to staff members about the scope of the process improvement project and let Alan clearly mention the benefits out of the project to gain the trust of the consultants, clinicians and managers. This is a measure to help the staff associate and relate them to the project with that sense of belonging.
The project manager should facilitate Alan in gaining an understanding of the roles of consultants, managers and other workforce staff by guiding him to the right contacts. This is to make sure that Alan gains an understanding of the process followed by consultants, managers and nurses and how patient care service is delivered across functions.
Functional:
Understanding of the roles and process would enable Alan to visualise the methodologies which will help Alan in identifying the possible improvement areas in the process followed. The PM should also facilitate meetings and interactions with the end users to help Alan understand their views and inputs to the new project. The idea behind this is to lead the project as a pull system, where the business process improvements and ideas are gathered from the end users with a clear set of definitions and define the blue print for the future.
The internal PM should also help Alan in the scoping the impact analysis of the process improvement by getting him in touch with consultants, managers, nurses and other key stakeholders involved. The PM should also regularly update the status to the CEO and would facilitate a meeting once in a month to ensure the project is in the right track.
c) Potential Obstacles and ways to overcome them
In order to achieve the objective of the CEO which is 'zero wait time', the workforce and the management should be prepared for a change which will enable them to act more like a business and sell excellent healthcare services to people. The potential obstacles in achieving the CEO's vision are:
Tackling the 'Resistance to Change' – It is unlikely to achieve universal acceptance for a change in any organisation. This change will also need an attitude shift towards the service and become more customer focussed like a commercial business. Management of the consultant clinicians who were running individual practices and are not used to be told what to do is a key issue to be dealt as part of the change. It is the responsibility of the management and the process consultant to treat them properly, make them understand the objectives and involve them in the process to gain acceptance.
Communication – In this case, the Hospital is trying to become more commercially focussed as a healthcare service provider. It is a challenge to change the work style in any established organisation. But it can happen when the leader, in this case the CEO, has a clear set of objectives and a proper vision for the future of the hospital and makes his workforce understand the importance of achieving those objectives. The CEO has to start by setting the tone; Defining the vision and purpose and communicating the same to all staff members. The CEO's responsibility would be to remove the fear generated while disturbing the status quo of the clinicians. Creating a sense of willingness to co operate – When people understand the importance of the change and realise the benefits the change is going to introduce, the probability of them getting involved and being committed to the change increase.
Be more customer (patient) oriented – The mission of the hospital has to become customer oriented and the workforce has to be lead carefully through this change, as the focus shifts from general public sector type organisation to a more dynamic customer oriented business like organisation. The management has to help and facilitate the workforce to be more customers oriented and treat customer satisfaction as the key to success which will help in reducing the patient wait times and in turn help in retaining the patients.
2. Section Two
The researchers have developed many models and approaches to management consulting. Kubr (2003) points out that most of the consulting models are developed around the basic five step model of consulting. The consult delivery process suggested by Calvert Markham is a basic five step model to address the client's problems. In 'Flawless Consulting', Peter Block has also suggested the five phase approach to solve client's issues successfully. Hansen et al suggests two ways for managing knowledge and deliver solutions; one firms being personalised which provides creative, solutions to key strategic problems and the other being codified which is reusing of high quality reliable and tested information based solution. In this step the problems in the hospital are not just about reducing wait times. In this case it is very important to have a personalised approach towards addressing the issues and causes.
Tisdall (1982) suggests two general approaches to consulting interventions which are the expert approach and the facilitator approach. The expert approach is about the consultant being a highly skilled person offering his/her expert advice to the situation, where the client's input is limited. On the other hand, the facilitator approach, also called process approach in consulting and need not involve specialist. During the initial ages of consulting as a new industry, there has been more of process consulting and as the industry matured the trend in management consulting industry has been that both the types of consulting are evenly balanced.
Waterman and Peter's (1980) model of McKinsey 7S model on organisational excellence provides useful insights into an organisation (Cheal J.). The 7S corresponds to Strategy, Structure, Systems, Shared Values, Skills, Staff, Style aspects and proves useful to diagnose organisational issues and plans for change (Cheal J.). In this case, the first three S's (Strategy, Structure and Systems) are impacted by the vision of 'zero wait time' and the deployment of this model can be useful.
From the problems diagnosed for this hospital case, the facilitator role would suit Alan better. Even though the CEO approached Alan for his LEAN expertise, the problems faced by the hospital is more than reducing the patient wait times, as pointed in section1 and so it requires Alan's involvement as a facilitator. The five step model is a detailed one and will suit Alan in this case to help him to overcome the challenges which stand in between the current situation to the CEO's vision. The five steps of the model are detailed as below:
Step1 – Entry and Contracting
This is the first of the five step consulting process. It involves making the initial contact with the clients and is considered to be one of the most important steps as it could well be the make or break stage for a consultant. The formal agreement in this process assumes the consultant has a basic idea of the industry structure and the external environment affecting the industry. The signing of formal contract is a way to ensure that both parties (the client and the consultant) understand what they want out of the project.
In the case study, this phase is yet to start. But the initial meetings Alan had with the hospital staff, which can be the entry stage, should have given him a clear picture of the current state of the hospital and the challenges to be addressed. These information forms a vital part of the Alan's report to the CEO.
Step 2 – Data collection and Diagnosis
The basic idea is to collect details about all the problems faced by the key stakeholders. This is the step where the consultant puts himself in the shoes of the clients to really understand the problems they face. This is considered to be the step which adds value to the whole of the consultant work.
The model 'Rumsfield theorem' can be deployed for the data collection process. The research initially assumes you know nothing and builds up information and questions to be posed to the clients, so that the final project delivers the expected value to the client. This starts with initial analysis of the information needed for the project, then identifying the questions that need to be answered before the diagnosis part to give meaningful sense to the data collected.
The most important aspect of this step is that it facilitates a feedback process with the key stakeholders to make sure that both parties are in the same line. There can be times where the scope of the work can widen or change as a result of this feedback and discussion process with the clients and consultant should fairly be ready for this. The diagnosis part involves classification of causes and symptoms and then identification of measures to address the causes. There are many diagnostic models that can be used to identify the symptoms and causes like five why analysis, fish bone diagram etc.,
The five why model is worked out in the section1 for this case and the main causes for the problem has been identified as the lack of communication and co operation among the staff about the real danger (deep financial trouble) the hospital is facing, when trying to operate commercially.
Step 3 – Decision to Act (Action Planning)
The emphasis on this stage is to prepare a workable solution to the client and no more of just understanding of the client problems. To arrive at the best possible solution, the consultant should always involve the client and welcome their inputs and suggestions to alter the solution according to the needs of the client.
The consultant should also hold responsibility to inform the client in advance about the possible future states of the organisation based on the solution delivered. The consultant should always consider the appropriateness and the applicability of the solution and match them with the wants and needs of the situation.
Step 4 – Implementation
This is the implementation stage of the proposed solution for the problems reported and diagnosed. It is mandate that the client approves the consultant's proposal before moving to implementation phase. It is also important for both the parties to agree on a set of rules governing the closure of the implementation phase to avoid any room for misunderstandings.
This is considered to be a tricky phase, where the client has many options to choose from like wanting the consultant to take charge of the implementation or choosing a third partner for implementation because of the heavy cost involved in the consulting process. In some cases, the consultant will be on the client side, supervising the implementation phase and is not really accountable for it. In some cases, the client might prefer to rest the responsibility with the consultant, as they feel the consultant is the best person for the job. The decision really lies in the hands of the clients and consultant should be willing to cooperate with the client however he/she wishes to implement.
As per the case, the consultant has got the CEO's buy in and may well be opted to implement the solution for the hospital. Even otherwise, the CEO might expect Alan to be on the client side and supervise the project as he has got a proven expertise in LEAN methodology and solutions around it. The advantage the hospital would get in keeping Alan over the implementation phase is not only his expertise in LEAN methodology but also tips and pointers on future improvements as and when required.
Step 5 – Extension, Recycle or Termination
This final phase is the end of the consultant's assignment provided the client is happy with the project work and the solution has served the purpose. The association of the consultant in the project phases will usually be decided during the contractual terms of the project. But sometimes it is revisited and revised during or post the implementation phase.
There can be situations, where the client wants to extend the scope of the project or revisit some of the parts of implementation or extend it to some other parts of the organisation. In this case, the process recycles and it starts again.
This stage contains an evaluation phase to analyse whether the project has met the stated objectives and goals. It is considered to be a challenging process from both the perceptions i.e. the client as well as the consultant. The clients might face difficulty in measuring the benefits. This activity requires the participation of both the client and the consultant. Both parties will have discuss and come up with a sensible measure for measuring the outcomes. The alternative is to appoint an external consultant to evaluate. The objective is to evaluate whether the stated benefits are realised or not and a general feedback on the consulting process.
The termination phase is a sensitive one to handle which affects the client consultant relationship. This can help in building long term relationships as well.
The five step model provides a generic consulting process overview, which flows nicely into any consulting process. Alan can use this model while implementing the solution to reduce the patient wait time to zero, which is the CEO's vision.
3. References
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- Kubr, M. (2003). 'Management Consulting: A guide to the profession'. Geneva International Labour office.
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- Cheal J. 'The Logical Level 7S Matrix'. [online]. [Accessed 10th August 2009]. Available from World Wide Web: <http://www.gwiztraining.com/Logical%20Levels%207S%20Matrix.pdf>
- Waterman, R., Peters, T. (1980) 'Structure is not organization', M. Wiener.
