Executive Summary


In a country’s health care system changes are constant. Changes are done so that better services can be given to the public and probable solutions to problems can be discovered. The health care system is a very complicated and meticulous system wherein every profits and losses the industry acquired has to be carefully checked. The paper will focus on Hong Kong health care system and a situation where change was needed but there were some rejections to the change.



Introduction


There is surprisingly large government involvement in the provision of health care in Hong Kong and Singapore, but not so in Korea and Taiwan. The two Northeast Asian states concentrate on the public financing of health care through compulsory insurance, which co-exists with the largely private provision of health care. The different arrangements partially reflect the legacy of British rule in Hong Kong and Singapore and the extension of the National Health Service arrangement it involved, whereas Korea and Taiwan were influenced by the social-insurance arrangement that existed in Japan. The health system in Hong Kong is relatively equitable in terms of financing: the lowest income quintile spends 1.8 per cent of household income on health whereas the highest quintile spends 2.4 per cent (Ramesh 2003).  Moreover, there are only small differences in the rates of both in-patient and out-patient visits in different income quintiles. The government’s health expenditures too are largely equitable. In 1996, the poorest quintile attracted 25 per cent of Hospital Authority’s in-patient expenditures, compared to 16 per cent for the richest quintile. The government was the largest source of finance for in-patient services for all quintile groups, while for out-patient services it was the largest source only for the poorest quintile (Ramesh 2003).



However, the continuation of the privileged access enjoyed by civil servants and the superior ward classes available to them are inequitable and a blemish on an otherwise fair system. While lower-income households are more likely to use subsidized public facilities, even the top income group uses public facilities for both out-patient and in-patient services. The political implications of this are significant, as use of public facilities by upper-income groups ensures political support for the public system (Ramesh 2003).  Hong Kong’s accessible and equitable health-care system has been achieved at a rather modest cost, as described earlier. The concentration of public subsidies on in-patient care, which is expensive, has fostered a system that is both efficient and equitable. Centralized provision in public facilities reduces scope for supplier-induced demand and duplication of facilities, thus reducing overall costs. The reform efforts currently underway are unlikely to make a significant difference in the way health care is provided and financed in Hong Kong (Ramesh 2003).  The Hong Kong health care system satisfies most of its residents but it is currently under reform so that more needs of more people can be given more focus and so that more people can be given satisfaction.


Issues


Unfreezing


Potential barriers to change could be found in culture values and attitudes, social claims and obligations, or associated with perceptual differences between change agents and recipient groups. It is said that barriers to change can come from the value people place on their traditions, what they were taught as they became members of the culture, what they learned as true and behaviorally correct. Such things produce the pride in being identified with the group and with knowing the right way. In other words, the cultural forces consist of all those things that exist within the integrated culture and the logical order of things as they have been learned (Naylor 1996). It has become very clear, over many years of study, that the greater resistance to change comes where people place the greatest value, in association with core areas of culture. The social system of culture is such a core area of culture, if for no other reason than that humans group together. The enculturation system, which emphasizes cultural transmission and acquisition within a culture, is another core area on which great value is placed, for it ensures that the culture survives. Culture is reproduced through learning. Worldview provides the members of the group with some understanding or perception of the world around them (Naylor 1996).



Economic and political systems assist them in adapting to the resources with which they have to work and the social order within which all these things must exist. Changes that suggest altering basic beliefs and/or behaviors with regard to any of these core areas of culture, directly or indirectly, come into conflict with established patterns of belief and practice. In such circumstances, any of the traditional patterns can turn into barriers or stimulants to change. This is why it is so critical to understand the cultures involved in a change setting, not just as they may be ideally portrayed but as they actually exist and as individual members live them. Strategy is a question to be considered in the dynamics of change during implementation as well. Minimizing the potential barriers to change and maximizing the potential stimulants must become as much a part of planners’ strategy as the introduction of the change idea itself (Naylor 1996).



In the corporate world, this can mean the expected relations between management and employees, using established channels of communication, and recognizing that there are both formal and informal leaders. Cultural barriers can come from the value people have placed on tradition and the logical order of things as they have been learned (Naylor 1996). The major change that the Hospital would want to do is employ a Theatre Technical Assistant or scrub technicians as a pilot scheme. This technicians is a group of people of associate degree education but they done have any nursing or healthcare training. The change gives a permit to some people in the company to air their concerns about the change. Most nurses in the Hospital disagree with the change because they believe that it will replace the problem brought about by nurse manpower shortage, it will cut down the budget for the nursing group as well as they will have a hard time to reassign the theatre nurse.


Moving


The changes to be done for the hospital may be a bad thing for the welfare of the nursing staff but it may benefit the overall operation of the hospital. The change reduces some of the expenses of the hospital. Hiring licensed nurses costs the hospital more money but hiring scrub technicians costs the hospital lesser costs and lesser benefits cost. The change also helps the company save more time in hiring employees. It costs the company time to look for licensed nurses but in looking for scrub technicians the company can use diverse kinds of hiring advertisements.



Refreezing


Change should not be forgotten after implementation, it is a continuing process and it needs maintenance. The hospital needs to continuously explain to the nursing staff why is there a need for change. The hospital has to see that the changes implemented will follow a straight path in achieving its goals. Any hindrances or blockage should be given appropriate actions. Moreover the hospital should foresee what the change can do to the institution and what can be done to counter it.



Analysis of the process of change


Over the last two decades of the twentieth century, theories of organizational change have had a tremendous impact on business and not-for-profit companies. Many of the top corporations, have implemented one or other change program over the last twenty years, often at the cost of millions of dollars, and involving large-scale restructuring and extensive job losses (Mills 2003).  At the end of the day, while it is generally agreed that certain change programs have become widely popular, there is considerable debate about the success or failure of the subsequent changes themselves. Business critics blame suggested failure on incorrect implementation. Other business critics are less convinced, questioning the lack of evidence of a clear link between the implementation of selected change program and subsequent business success. It is argued that, within management thought and practice, the notion of organizational change has changed in significance over the last two decades, from one of many potential strategies of managing to a key influence on organizational effectiveness and survival. The focus has shifted from the strategic choice of the actor to one of incontrovertible external forces that managers need to anticipate, react to and manage. It is contended that organizational change as imperative has become an important management discourse that can be witnessed in the discursive practices of companies (Mills 2003).



Explaining the popularity of organizational change in sense making terms it can be argued that change has become a conventional management practice, developed and sustained through a powerful management discourse, whose on-going character influences the decision-making of large and small companies, profit and not-for-profit companies alike. Whether or not the adoption of a particular program of change is the right course of action for some companies doesn’t seem to matter. Decisions to implement change programs are based on plausibility rather than accuracy.  Prior to 1980, within business texts, organizational change as a management technique was either not mentioned at all or was limited to discussion of group dynamics and employee resistance to change (Mills 2003).



Over time, the emphasis on change programs has switched focus from ways to improve employee satisfaction to a goal today of customer-driven corporate effectiveness. But something more than a change in focus has occurred. The notion of organizational change has taken on new meaning. Since the early 1980s, it has become an imperative rather than a technique to be considered at appropriate times, a holistic rather than a piecemeal approach to organizational effectiveness (Mills 2003). Organizational change is done by a company when it believes that the company is not adjusting to the new trends in its environment. The Hospital wanted to make sure that change was done in a way that would not cause dissension and problems in the company. The change created tension among the nursing staff but through proper explanation and coordination with the staff the change went smoothly as it can.



Discussion


Changes in workforce


Organizations are downsizing, restructuring, merging, and reinventing themselves. Mid-level management layers are diminishing. Functions are being eliminated and replaced by online automation and networked infrastructures. Knowledge workers with technological and people skills must manage processes and themselves in cyberspace with speed, efficiency, and accuracy. These and other changes continue to impact the relationships, rights, and obligations between employee stakeholders and organizations. Organizations saw their workforce as permanent, and tried to build loyalty among employees by making financial investments in training and by providing guaranteed long-term employment (Sims 2003). Employees were committed to the organization and expected steady advancement up the corporate ladder. The seeds of change are taking root, and with these changes new social contracts are developing between organizations and their members. No longer is the traditional social contract that once existed between the organization and the employee valid. Changes like those cited thus far have profoundly changed the ways in which organizations and their employees relate (Sims 2003).



Three decades ago, employees stayed in the same company for years, and those companies rewarded that loyalty by offering job stability, a decent wage, and good benefits. Today’s typical worker has had nine jobs by the age of 30. The workforce of today is more mobile, less loyal, and more diverse. Their trust in their employers has eroded over the past twenty years to the point where only 38 percent of employees surveyed felt their employer was committed to them. Today’s employees aren’t looking for a promise of lifetime employment. Instead, they are seeking competitive pay and benefits coupled with opportunities for professional growth (Sims 2003). They want employers who provide them with opportunities, recognize their accomplishments, and communicate openly and honestly. These workforce changes have contributed to a newly emerging social contract between employers and employees. Employee stakeholders today are more sensitive about employee rights Issues because of experiences like those of the new hires and the new social contract. Employee rights may be afforded on the basis of economic, legal, or ethical sources of justification. Failure to understand and effectively manage the rights of employees can create many ethical dilemmas for organizations and further strain the social contract with employees (Sims 2003).



Many social investors are concerned about the ethics, social responsibility, and reputation of organizations in which they invest; and a growing corps of brokers, financial planners, portfolio managers, asset management, and mutual funds have made themselves available to help investors evaluate investments and purchase stock in ethical organizations for their social impacts (Sims 2003). As the world changes so thus the situation in the workplace changes particularly the attitudes of personnel. Personnel of this generation have changed the way they beliefs with regard to employment and opportunities. The personnel of this generation is more peculiar on opportunities rather than loyalty. The nursing of the Hospital have undergone significant changes in the way they think. They cannot be taken for granted because they make sure that every aspect of the company works fairly well in their favor.


HR practices and its role in a company


Human resources play a critical role in developing and implementing organizational strategies and structures. Successful HR professionals will be those who can align their organizational HR practices with the unique demands of team-based organizational structures. In addition to recognizing and adapting the assumptions on which they base their practices, HR professionals must also modify those practices to support teams. The practices to be modified cluster in five areas: recruitment and selection; task design; training; evaluation; and compensation. During recruitment, organizations aspiring to create a workforce of effective team members should clearly communicate the importance of these proficiencies (Korman & Kraut 1999).



The second set of practices that must be modified relate to task design. Effective teams are designed around the tasks they perform. Two key considerations are that teams should be relatively self contained and handle many aspects of their own functioning. First, teams should be collectively responsible for an identifiable and substantial part of the work of the organization. To the extent possible, support services should be included in the team so that it has the resources necessary to accomplish its goals (Korman & Kraut 1999).  Training constitutes a third set of practice modifications for effective team implementation. There is often a mistaken belief that people who are highly educated have the basic skills to work effectively in team settings. In fact, highly specialized individuals are often used to working alone and may lack some of the basic interpersonal skills necessary for collaboration. Training programs designed for interpersonal skills in teams take one of two approaches that includes traditional classroom instruction in which a lecturer delivers material about techniques or strategies for working in teams and creative off-site team-building sessions in which teams participate in athletic, artistic, or competitive activities unrelated to their actual day-to-day responsibilities (Korman & Kraut 1999).



A fourth set of practices that must be modified involves evaluation. If organizations wish to motivate teamwork, they must incorporate teamwork into their appraisal systems. It is important that the appraisal system not only reward good team players but also discourage behaviors that are not conducive to team effectiveness. An organization-specific job analysis should be conducted to determine the precise nature of the behavioral and performance measures to be included in the appraisal form for each individual team member. A final set of HR practices that should be examined when implementing teams pertains to compensation. Good practices for rewarding team performance require good processes for defining what the performance should be and for measuring and evaluating the performance (Korman & Kraut 1999). The HR practices dictate the performance of the employees.  An HR practice that is based on proper governance provides good employees that any company can rely upon. The role of the HR is to make sure that the nursing staff will still listen and follow the changes initiated by the company.


Conclusion


The major change that the Hospital would want to do is employ scrub technicians as a pilot scheme. The change gives a permit to some people in the company to air their concerns about the change. Most nurses in the Hospital disagree with the change because they believe that it will replace the problem brought about by nurse manpower shortage, it will cut down the budget for the nursing group as well as they will have a hard time to reassign the theatre nurse. The hospital needs to continuously explain to the nursing staff why is there a need for change. The hospital has to see that the changes implemented will follow a straight path in achieving its goals. Any hindrances or blockage should be given appropriate actions.



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