Case study
PrimeReach Care is a government funded, acute health care service to around 500,000 people in its local region. Located across multiple, geographically dispersed sites, it employs over 15,000 people in a wide variety of professional and ancillary roles and maintains a variety of important partnerships with dozens of other organisations.
PrimeReach Care has faced very substantial challenges in recent years. Some, like the covid pandemic were exceptional, but thankfully quite short-lived. Others, such as a fast-aging population and the emergence of some chronic skills shortages in key areas, are longer term in nature, but equally concerning in terms of their potential impact on PrimeReach Care’s capacity to provide the highest standards of healthcare. Skills shortages in some specialist areas are becoming increasingly
severe. PrimeReach Care has plugged gaps by recruiting overseas but is finding it hard to retain these recruits for longer periods of time.
During 2024, employee voice activities highlighted that groups of staff were dissatisfied about pay and conditions within the organisation. This has now abated due to significant government-funded pay rises, but discontent among staff in respect of terms and conditions continues to simmer. Staff retention is a particular current challenge, as is absence. A higher percentage of PrimeReach Care’s employees are currently taking extended periods of sick leave than has ever been the case before, and in over 50% of these cases poor mental health comprises at least one of the causes. Senior managers at PrimeReach Care have recently attended a briefing given by ministers and officials, at which some very clear messages were communicated regarding the next five years. The most important concerned funding. Put simply, health care services like PrimeReach Care should plan for very tight, ongoing financial settlements in the next five years. They should not expect above- inflation increases in their regular operating budgets, which include pay for staff. Any additional funds that become available will be focused specifically on priorities such as bringing waiting lists and waiting times down. Capital budgets will also be very constrained, reducing the availability of funds for new buildings and equipment. Repair bills will have to be met out of current expenditure. Substantial efficiency improvements and increased productivity are both needed and expected.
Senior Managers have asked the People Department to provide recommendations about appropriate future actions at PrimeReach Care in some key areas. You work in a generalist, mid-level People management role on PrimeReach Care’s main site but are considered to be someone who is appropriate for promotion into a more senior role on completion of your studies. The People Director has asked you to provide answers to the following questions that will provide insight into some of the major challenges facing PrimeReach Care and help to inform the recommendations.
In large and complicated organization, resistance to change is a real threat to implementing changes. PrimeReach Care faces this issue while pursuing a productivity improvement agenda over the next three years. However, to implement the desired changes, it is important for change managers to treat resistance as information, not obstruction. The organization need to diagnose its sources, remove avoidable barriers, and build sustained employee commitment. Below is a concise, practical approach with specific recommendations.
Root causes of resistance
It is important to understand the root cause of resistance. One possible reason for the resistance is to the presence of unclear purpose when implementing the desired change. In those chances, there is an unclear link between the goals of attaining higher productivity especially in relation to patient care (Department for Digital, Culture, Media and Sport, 2018). In this case, the employees could be fearing that higher productivity means more workload and thus inviting resistance from the employees. Employees worry that productivity drives will raise pressure without support.
Another reason for the resistance is Trust deficit within the organization. employees could be examining Past initiatives that failed and thus erode faith in leadership promises.
There is also the issue of Loss of identity. Professional groups may see new processes as a threat to clinical autonomy. In offering care, doctors, nurses, and clinicians love their autonomy to make diagnosis, arrange for care schedule, and conduct other activities around the provision of care. The promise of higher productivity could mean, in the years of those offering care, as an erosion of their independence and thus cause resistance to the planned changes to deliver higher productivity.
Skill gaps can cause resistance as well. New ways of working require skills that some staff do not hold yet. For such employees, new changes including the promise of delivering care under conditions of higher productivity could threaten their existing skills and thus produce resistance. Employees who are comfortable with their own skills are less likely to cause resistance.
Poor communication and messaging could deliver the wrong messages. Messages arrive late or in technical language, leaving staff confused. Under those conditions, the employees might not understand the goals of the potential changes. In this case, the goal of the planned changes is to deliver care under conditions where they treat or manage more patients using the same resources are before (Department for Digital, Culture, Media and Sport, 2018). With proper messaging, the employees are less likely to resistance but the converse is true if the messaging is convoluted and confused.
Weak involvement can cause resistance. According to the current theories and frameworks for changes, it is important to involve the employees in any changes. This involvement allows employees to take ownership of the changes and strive towards their implementation. Therefore, when the Frontline staff get excluded from design work, so they resist implementation.
Diagnosis approach
Under this method, the organization can Use mixed methods to learn why staff resist. The reasons could vary as already described earlier. The reason could be poor messaging, weak involvement, among other reasons. Therefore, using diagnosis approach, the organization could Run short, focused surveys for all staff groups. However, it is important to Keep questions simple and action oriented to understand the reasons for the resistance. Moreover, the organization could hold facilitated focus groups with clinical and nonclinical teams and use neutral moderators (Department for Digital, Culture, Media and Sport, 2018). These moderators could allow the organization to conduct proper and objective research to understand the reasons for the resistance to change. Another approach to conducting the research is to Carry out rapid process observations on wards and clinics. Note friction points that reduce productivity.
Map stakeholder influence and likely resistance. Identify professional groups with the strongest impact on delivery.
Design principles for change
The planned changes are likely to make working for the organization between for all employees and ensure that the desired productivity is reached. Therefore, the organization need to Make improvement purpose clear, simple, and patient centred. Link productivity to safer care and better experience while also productivity the professional judgement. Frame changes as tools to support clinical decision making, not replacements. Another approach is to start local, scale fast. Pilot small improvements in willing departments. Use results to spread proven practices.
Use data for clarity not blame. Show productivity measures alongside workload and staffing context. Build quick wins. Early wins build momentum and restore trust. Provide visible leadership. Leaders should visit sites, show interest, and respond to concerns.
Tactics to reduce resistance
Engage early and repeatedly. Invite frontline staff into design teams. Offer paid, protected time for participation. Use clinician champions. Select respected clinicians in each specialty to lead local trials. Compensate them with role recognition and development credit.
Hybrid change teams. Combine clinical staff, operational managers, and HR advisors in each workstream. Transparent communications. Share baseline metrics, pilot aims, timelines, and expected staff impacts (Department for Digital, Culture, Media and Sport, 2018). Use short, plain language messages. Training and skills development. Offer role-specific training bundles. Include practical simulations and on-shift coaching.
Safe feedback loops. Create mechanisms for anonymous feedback, rapid problem solving, and visible follow up. Adjust workload plans. When introducing productivity measures, reduce nonessential tasks for affected teams during the transition. Wellbeing protection. Offer extra mental health support and temporary relief rostering while new processes embed.
Leadership and governance
Assign a single sponsor at executive level for the productivity agenda. That person should hold monthly reviews with clear escalation routes.
