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The Defence Medical Services Organisational Change Program Economics Essay

In 2005 the Defence Medical Services embarked on a number of transactional proper development change programs to introduce the new Defence Medical Information Capacity Program (DMiCP) as an technology advancement to the Egton Medical Information System (EMIS) which had been in use for some 10 years. These Information Technology (IT) systems will be further referred to as Health Information Technology (Strike) for the purposes of this assignment. There's a basic consensus that changes in IT ability are primarily influenced by the anticipations of improved ability, reduced operating costs and increased versatility (Boer & Durning, 2001). From Senior Management Boards (SMB) point of view the new Strike would aid the launch of the new legislative conformity standards placed by the Care and attention Quality Percentage (CQC) through the introduction of the Expectations for Better Health (SfBH). As an away to this aspired functionality, it was also anticipated it the new HIT capability allows the senior management to interpret styles through damage/illness coding and data analysis (Shortliffe and Perreault 2001:774).

The Defence Medical Services Organisational Change Programme

There is wide spread acknowledgement that organisational change is happening with increasing regularity and magnitude in both general public and private sector; nothing more so than in today's global economic weather. However, having assessed a lot of the books and the published circumstance studies available, the primary focus because of this research is on private sector change to support a profit-driven change agenda. For the changes currently facing the DMS/NHS, where both organisations are funded by the taxes payer the drive for change is designed for greater general population accountability, the political agenda for maximising efficiencies and justifying affordability instead of to profit.

Change is induced by many factors including political, economic, societal technical, legal or environment (Wischnevsky, 2004); generically refereed too as the acronym PESTLE. There can be an argument made by Lewis (2002) that "change decisions are created, even apparently objective, reasonable decisions are established upon politics assumption"; with the primary current political drivers being monetary viability and the necessity for whole level down-sizing. Whilst it holds true that the DMS has created and conducted many reforms in its key business potential as well as initiatives to provide a more patient centric emphasis in its primary capability, much of this change has been delivered to integrate its functionality into the NHS. For most employees within each company this eyesight or 'political agenda' is not obviously understood. It really is widely accepted that political motives and methods are often at the fore entry of all general public sector change initiatives to provide better guarantee, efficiency, effectiveness, integration of services and/or in minimizing the organisational expenditure/budget.

In terms than it change, Burke (2002) recognizes that change is put in place through technological advancements or regulatory need which alone provides the organisation with opportunities and hazards whilst gratifying performance imperatives (Damanpour & Gopalakrishnon, 2001). This theory facilitates the Government authorities hidden-vision for integration of both organisations, providing significant cost savings and endemic organisation efficiencies. Much like all change, change within the DMS is conceived and implemented in support of the organisations Strategic Business Objectives (SBO) which form area of the overall military's Mission Statement as a way of maximising the success and efficiency of DMS patient care (Holms, 2001; Culbertson, 2005 and Heeks, 2006). The implementation of the new Strike, as with any IT task impacted upon the DMS tangible and intangible property (Clegg et al, 1996) and outputs as it attempted to utilise this capacity to support the SfBH competencies in the DMS key attention environment.

There is an increased level DMS and Royal Navy (RN) Control implication to delivering an effective Strike change programme with regards to the DMS Defence Health Programme (DHP) Strategic Perspective and the Strategic Motorists for Current and Planned Businesses, Future Procedures, DMS Employees, Future Effects and Efficiency and Change. Despite organisations best motives and planning, Szydlowski and Smith (2008) identify that it is not uncommon for organisations to spend significantly large amounts of money on utilizing innovation technology, bench marking systems (conformity measurements & supporting statistical evaluation) and organisational change, and then see them are unsuccessful or have elongated implementation times and poor end user tool because of poor change command.

Institutional Change (IC)

Unlike the institutional constraints placed upon the NHS by the government; regulation, auditing, rating and public awareness of its business procedures and hazards, the DMS hasn't was required to justify its previous expenses and business outputs for the public money invested in it (Ingram & Silverman ). Historically without any formal internal or external audit process or true accountability the DMS could be looked at to get been employed in a semi-unregulated manner (with the exception of clinical personnel professional sign up). The brand new HIT has generated an inter-dependence within the DMS and the change program can be viewed as to be prominent in the word of 'new-institutionalism'. It really is through the exploitation of this new potential that the DMS and NHS are actually interoperable and the divergence into a single service provider is being motivated (North, 1993).


Steigler's Theory of Economic Legislation is recognized by the sooner works of Kolko (1963) and argues that regulation is a item and is predominantly designed to gain business and the company. Regardless of if the regulation is externally enforced through legal or political plan requirements or if it's internally driven by the company, regulation is eventually aimed at providing an elevated level of gain to the company or for rectifying some determined deficiencies within the company. Ultimately, in relation to the DMS the launched regulation is considered to be in the eye of both the federal and wider NHS.

Since the intro of the SfBH the DMS is currently at the mercy of both legislation and regulatory routines (Snyder, Miller & Stavins, 2003); historically, this is never the truth and the DMS audited itself in a fairly adhoc manner that was open to both personal interpretation of the specifications and auditor effect to 'disguise' mistakes of poor practice or none of them compliance. To totally support the SfBH interior audit need the SGD aimed that every of the sole Services (RN, Military and RAF) to determine its own interior governance and assurance teams. These teams were tasked to assist in (governance) and audit (confidence) of the required compliance requirements for the SfBH Competency Platform known as the "Common Confidence Construction (CAF)" for the military services. The CAF was designed to act as an integration facilitator and launched the NHS Legal Conformity Governance Standards in to the DMS; procedures and plans that are patient centric and accomplish the establishment of auditable standardised medical health care and management process.

The governance and assurance groups were soon seen to show iso-morphic behaviours by using standardised none military services DMS dialect and behaviours. These used 'characteristics were seen as essential to display the DMS interoperability with the NHS fostering a sense of legitimacy to get the government tasking and to enforce the DMS legitimacy and a possible future convergence of the organisations to the exterior civilian audit body the CQC. In hindsight it has been identified these teams havent provided the amount of legislation required and have been open to 'manipulation' or 'coercion' in conditions of that which was audited and to what standard ( ). - inability of inside sourced audit teams reference.

Strategic Drivers for Change

Working in the Public Sector and financed by the federal government, the DMS most important care service does not have any competition and until recently no financial constraints or specific requirement of innovation and assurance. As a general public sector company, the DMS most important care capability was 'utilised' by the government and NHS to determine the ability of integrating the SfBH audit framework into 'military services' primary care and attention; before its wider program to civilian key treatment trust facilities having attended to any possible areas that the civilian primary health care trusts (PCTs) could possibly contest and seek to wait its roll-out. One of the governments concern is the fact that unlike secondary health care, primary good care is run as small, designed private businesses had by its partners, unregulated in terms of assessment capabilities yet still able to draw financing from the government for the provision of health care to the wider patient inhabitants. From your DMS SMB and Doctor Generals Department (SGD) perspective the launch of the new Reach to get SfBH was seen as a whole-scale PESTLE chance to meet the politics will, develop its center business, increase efficiency and offer a give attention to centralised patient good care whilst demonstrating its 'value for money' in dthe difficult monetary environment. In real conditions these changes present new opportunities and threats to both organisations (Burke, 2000).

The Changing Market

In terms of primary attention service providers, service employees are restricted to the DMS service provision. It could therefore be said that in terms of 'market' the DMS posses a company 'monopoly' of electric power in this service area and that the marketplace is 'focused' due to the one service agency (Baldwin, Hanel and Sabourin, 2002);

unlike the NHS where patients can decide for health care provision through private providers; at reduced. In conditions of providers exterior to the military, none military personnel in the united kingdom have to select between your NHS and private medical services such as BUPA that they pay a premium. The growing cost of the providing medical care and the increasing get older of the population indicates that this is an area which will be require significant financial investment in the a long time to meet up with the needs of an aging population. Reducing the financial burden for defence principal attention, through NHS integration will allow this financing and the associated manpower, training and pension costs to be diverted in to the wider primary care capability throughout the UK.

Economic Local climate and Change

Research by Reinhart and Rogoff (2009) has theorised that unnecessary people and private arrears, both inside and exterior has repeatedly led to financial crises in virtually all countries throughout the previous two centuries. This is clearly identifiable in todays gloabal monetary climate and the challenges facing very house holder, organisation and federal. Research by Kondratiev ( ) has identifed cyclic durations or waves (K-waves) of economical growth and drop more than a 40 - 50 12 months period focusing upon periods of scientific evolution and an interval of war/post-war as its basis. It is reported that the existing economic problems is the consequence of the near closing of the wave of the Information and telecommunications technical revolution. The books review also determined that there surely is no educational consensus about the beginning and the end many years of particular waves with even more scepticism over the cause of the K-wave trend. Perez (2004) and Schumpeter (1939) have both identifed that capital, both financial and development, has an similarly important role to learn in the cycles. For the author the problem of individual impact or mistake is under believed as problems in the national bank industry, gloabal financial irregularities, global management (Modelski & Thompson, 1996) and unregulated government investment are human impact/errors which require further concern.

In terms of holistic economic theory Macroeconomics targets the behavior an current economic climate at the aggregate level, as opposed to the amount of a particular subgroups or individuals. As macroeconomic systems take place over time, individuals and organizations are affected by new occasions that are being experienced. A administration can choose to improve its use of general public money to fund a variety of public services areas. Fiscal coverage is a government's attempt to change monetary activity by changing authorities expenses (Defence and NHS Reviews), taxation, borrowing and lending policies. According to the classical university, proper fiscal coverage is shown when Authorities spending is bound to defence, a judicial system, fire and police security, infrastructure, education, transportation and a little and reliable administrative system. Taxes should be relatively low and restrictions minimal; this may not be reported to be representative of the current countrywide or global economical climates.

In a bid to establish elements of a neo-classical monetary free market Clinical Guarantee (audit) teams were proven from internal candidates to (Steigler, ).

In terms of key research Steigler ( ) centered on the behavior of government businesses charged with legislation of monopolies, challenging the prevailing ''public interest'' view that regulators will mainly be encouraged by a sense of duty to protect consumers from the abuses of monopoly electricity. However Schumpter ( ) theorised that economical change was initiated through the stimuli provided by specific activities and their legislation and realisation of institutional co-existence with an increase of shapeless communal and legal constructions. His focus on innovation earnings through entrepreneurship (1934) centered on the ability of the organisation to build up novel value producing activities which transforms the monetary position of the company making them more competitive and permitting them to exercise market power over their competitors.

It has been theorised a war situation promotes radical cost-effective and cultural change.

Schumpeter's theory is grounded in the history of his own life-time and societal experience experienced in Austria in the 1920s. Whilst it could be argued that his model interpreted financial policy relevant to the needs and concerns of that time period, it isn't clear that model can be translated in to the current financial situation confronted by the DMS and NHS; as general population organisations there exists very little opportunity for entrepreneurship because of the operating, legal and obligation of health care constrains to patient health care. From the authors perspective the integration change necessity can be best seen through from a Contingency Theory aspect, it is proposed that change occurs in organisations following changes in the exterior environment and this for any such change to be wholly effective, organisations must create positioning with the exterior requirements (Lawrence & Lorsch, 1967); in conditions of the DMS it practices that the implementation of the HIT to assist in the NHS Guarantee process into the DMS would provide position of the principal care service capability and facilitate future changes for the provision of principal health care services; these will be complete in the final outcome.

The Troubles and Opportunities

In financially constrained times and times of monetary organisations are under extensive pressure to recognize personal savings at every level whilst retaining a concentrate on proper development. The political PESTLE dimension relates to the key political drivers that could influence an company. Political insurance policies are of course intertwined with associated financial factors and mutually political/economic funding motorists can have a major effect upon corporations. The PES(T)LE measurements - Political, Economic, Sociable, Legal and Environmental - were used as a construction to explore the exterior macro environment (i. e. the picture as a whole). Lots of the factors identified could be categorised as owned by more than one dimension. The physical location and spread of an establishment, its staff and its learners also offers a key effect on companies.

Upon as yet the DMS hasn't experienced the same internal political issues encountered by the NHS; however there is now a general breadth of sense across both general population and military sector health providers of any drive to minimise ready lists, increase efficiency and a general feeling of crisis and under investment hence the integration.

For private sector businesses/organisations economic agencies (employees) earn their money for the amount of services that are provided focusing on a primary of individual optimized performance for become successful. This is not the situation for the DMS as a public sector organisation. For quite some time the DMS handled in a home perpetuated specialised 'product/service' environment within a relatively unconstrained financial/budgetary environment. The provision of military health care to military staff prevented the availability of a free of charge market for patients and for that reason there is no conformity to the neo-classical monetary model and constrained the opportunities for invention and

Healthcare and Neo-Classical Change (NC)

In the real sense of the service provided by both DMS and NHS, they both work because of their patients; essentially the health services are the provider and the patient is the purchaser of the service through taxation. In terms of the language used within the SGD during producing the new strategic direction the necessity to support the current need for proper change was projected through dominating model language; economical, finance and efficiency. This terminology can be greatly seen in the Orthodox ECONOMIC CLIMATE (OES) utilized by the global market segments and widely referred to as the dominant economical discourse. OES is widely accepted in the global market and will not require promoting data, facts or proof which is therefore permitted to accomplish change without extensive consultation or thought.

From a Neo-Classical position, the integration and interoperability of two broadly similar public sector companies is straight forward and when talked about in conditions of OES makes sound reasoning for the federal government. The neo-classical overall economy is founded after the principal that individuals will continue to work hard to make it through and illustrate a personally produced drive to succeed. Historically, in its very simplest terms to succeed or endure could mean the difference between life and death. Community Sector employees (DMS/NHS) termed economic agents could be considered to work to a simple standard and achieve what they 'feel' is required in their role. Consumer Sector economic realtors are not powered by end result as they may have nothing to market; therefore success is uncontested as there is no immediate competition or market. With little reason to maximise personal drive it could be easily conceived that inherent inefficiencies are allowed prevail within the organisations. The 'eye-sight' of the neo-classical view point would start to see the release of entrepreneurial activity within each staff to increase their outputs and capacity to get the organisations deliverables. This vision would see maximum come back for taxes payers and the federal government. However, the OES model is a market based system that theorises that point, space and friction does not exist which things will improve and develop without influence. In terms of DMS/NHS integration and interoperability this reasoning is fundamentally flawed as that point, space and/or friction (transformation) all fail as they are all very real drivers for organisational change. The primary drivers or frictions being those of socio-technological and institutional

Kondratiev determined three stages in the long influx theory cycle: expansion, stagnation and recession. More prevalent today is the section into four intervals with a making point (collapse) between the first and second phases. Corresponding to Kondratiev, the ascendant stage of the long pattern is represented by an increase in prices and low interest rates, while the other phase consists of a decrease in prices and high interest rates.

Goldstein (1988) recognizes economic upswings associated with K-waves as increasing the probability of severe war. Brian Berry (1991) questions such a connection, and is troubled by the notion of an inherent inclination to conflict in the global political system.

The Very Long Kondratieff Cycle. A very long cycle, of more than 50 years duration, has come to be known as the Kondratieff wave

Can the use of the cyclic method of forecasting events and triggers that allows for capital investment and development in new economic development and federal government investment be recognized based upon the belief that innovation is the main element to future technological change?. There is no real clearness over authorities investment travelling future innovation and economic growth; maybe it's rationalised that government investment in specific areas can be too overdue to affect the current economic climate and drive balance.

Joseph Schumpeter's theory of "creative damage" strains the role of waves of substantial innovation (major scientific breakthroughs, launch of major services that create whole new industries) in precipitating major changes and reallocation of resources as old business die and are substituted by new ones

Socio-Technical Change (STC)

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From the government perspective, the intro of the Reach allows for a lower labor force (Defence 2020 vision) in principal care; fewer public sector employees equals increased outputs, streamed lined efficiencies and facilitates the neo-classical model; with services out-sourcing high on the political agenda for change. Given that the research pertaining to the out-sourcing of general public services can lead to both significant cost benefits or cost rises (Boardman and Hewitt, 2004) and the lessons learned following the closure of the MOD nursing homes and integration in to the NHS for extra care and attention, any future out-sourcing of primary care must be significantly considered by those in specialist and a full strategic analysis conducted.


The public and military sector healthcare providers are believed to be in a pervasive trend in the contemporary world. Both NHS and DMS are professional organisations in their own right, with the DMS being classified as a supplier of 'specialised' services. The integration of the two open public sector service organisations has an environment and capacity for collective action and a co-ordinated method of patient clinical care and attention. In conditions of change the DMS/PCT integration this could be described as attempting to comply with Schumpters (1934) explanation of innovation whereby the "carrying out of new mixtures" to facilitate increased effectiveness considers the recombination of conceptual and physical assets that were previously in existence (Nelson & Winter, 1982).

The provision of free professional medical in the UK is currently the 'right' for each and every UK resident; however this comes at a significant cost to the general public purse. As identified on 12 July 12, future costs on health care, despite numerous cost efficiency actions being put in place and significant organisational re-structuring the 'bill' for NHS medical care is likely to require a further financial treatment of some 17bn over another 17 years to meet the demands of an ever growing ageing population.

The author can easily see the logical behind the expected 'unpublicised' perspective for defence major care and realizes that true NHS integration will help accomplish the government's perspective for future health care based upon the recent Reach change project. In reality the release of the new Reach and the SfBH audit compliance goes way beyond the easy integration of general population sector bodies. To deliver the joint (or a single) effective, reliable and sustainable outcome the outcomes require a critical mass of folks to be focused on the change engaged, learn new behaviours, work within an efficient and best manner also to support them willingly; this would be the greatest challenge to face both general public sector bodies. The organisation needs to plan effectively considering the multi-facets of the PESTLE factors and regularly review its improvement with the NHS.

Future change is formed by its legacy and previous achievements; by this assertion the DMS has a way to go to be able to deliver this is an efficient, efficient and sustainable business viable manner. As the general public and economic local climate continue to change and the government endeavors to exhort maximum production and efficiencies from public sector employees in the DMS/NHS it urgently must obtain 'buy-in' to assist in increased outputs and efficiency. The author believes that the real 'eyesight' must be publicised to the organisations workers to aid the change, however the military must be mindful not to let government 'incentives' and wider politics detract from the military's core business to achieve these efficiencies; warfare is an unavoidable part of global politics and posturing and we will sooner or later be deployed again and a full the pre-deployment arrangements for wide size conflict can't be fulfilled by the NHS major good care services whilst retaining key goals for the wider civilian patient human population. The 'hidden-agenda' of complete interoperability between both of these organisations must be better identified, integrated and the strategic vision must be fully defined and articulated; subversive change on this level can never be successful and can lead to increased inefficiencies, additional expenses and a longer transition period which will prevent scenario planning to mitigate against future dangers and identify opportunities for development, development, investment and research.

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