How successful is DEP’s cost saving methods?Explain

Global MBA Research proposal

Global MBA Research Proposal

Name: Hodan Jama
Project Title: ‘Contribution of Project Management and Change Management Methodologies in the Department of Eye Pathology’s pursuit of financial independence’
Research Area: Project Management
Company: Department of Eye Pathology, Institute of Ophthalmology, UCL.
Submission: August 2015
Confidentiality: Due to the sensitive information about the company’s business, the final Project Report will be classified as CONFIDENTIAL.
ABSTRACT
The proposed project will examine how the Department of Eye Pathology can improve to adopt effective method to manage challenges in the NHS spending plan cuts. It is going to inspect how project management and change management approaches can be used to help the ophthalmic specialist service provider increment efficiency and potentially develop a degree of financial independency to develop resilience to NHS budget cuts.
This exploration will be taken from an evidence-based reasoning perspective, deductive methodology, cross sectional of nature and shall use secondary data, interviews and surveys as an information gathering tool. Upon information examination, it is hoped to set focused strategies to be recommended to the DEP and reflection upon the extent in which project management and change management can be used and their contribution shall be reported.

1. BACKGROUND AND SCOPE
The Department of Eye Pathology (DEP) is a National Specialist Ophthalmic Pathology Service (NSOP) laboratory and it benefits from a close and long-standing relationship with UK’s largest Eye hospital, Moorfields. Institute of Ophthalmology (IoO) and Moorfields Eye Hospital make up the largest single site for research and eye care in the world (UCL, 2015). DEP structural set up is slightly unorthodox in the sense that the service, although part of university college London and located within a university location (IoO), it provides services to NHS and private sector as well as support to researchers in the UK and internationally. DEP’s core functions are to understand the processes of vision and to develop new diagnostic and therapeutic strategies for the benefit of patients (IoO, 2015).

Healthcare spending plans cuts in the UK are leaving a £30 billon ‘black hole’ in its financial plan by 2020-21and this thusly are confronting increasing pressure to reduce cost and enhance proficiency, while looking after quality (NHS England, 2014). Laboratory services are not getting away from this pressure, especially since pathology examinations cost the NHS £2.5 billion for each year (Rcpath, 2015). Carter Review, a UK Department of Health-appointed audit of pathology administrations in England, assessed that 20% of this could be spared by enhancing pathology services (Carter Review, 2015). Consequently, the norm of pathology laboratories in the UK is undergoing fundamental changes at a rapid pace. In some areas, multiple hospital laboratories are being requested to merge into a solitary regional laboratory organisation to cope with these changes caused by spending cuts (Kind’s Fund, 2014).

The Carter Review recommend that one of the ways that these investment funds can happen is by dealing with the requests of pathology tests and diminishing inappropriate requesting. As of now, numerous labs are utilising different methodologies to investigating demand management. Another road is that price competition for pathology testing has turned into an element (Kings Fund, 2014). Inside of the NHS, essential consideration trust now tender for pathology testing services and commission those pathology laboratories that offer the most competitive prices (NHS England, 2015).

In spite of these troubles, pathology laboratories have the chance to bring new testing and conveyance systems that deliver and increase the value for service users. However, these new diagnostic advancements requires capital and new scientific abilities, both of which are hard to find as the NHS attempts to shrink budget and squeeze more out of existing assets. In light of these variables, pathology testing in the UK is managing more threats and a faster change than any other time during the six decades of the NHS has been in existence.
One theme of unmistakable fascination is the ways to manage pathology spending plans and deal effectively with commissioners and tenders that could prompt reduced prices for pathology test services. In what capacity can project management systems be utilised to use the pricing opportunities while minimising the difficulties? This research will attempt to provide a ‘framework’ to allow the Department of Eye Pathology to develop financial independence strategies based on project management methodologies and change management system. This ‘framework’ is for the sole purpose to help the DEP directors and managers deal with the new realities of healthcare and associated reforms. This research main focus is the DEP, London, but there is however impossible to exclude all of the National Specialist Ophthalmic Pathology Service (NSOP) in the UK.
1.1. Research aim(s) and objectives:
The long term goal of the research is to develop a formalised strategy based on project management and change management system. The short term goal is to provide a comprehensive review of literature and industry practices in relation to project management and change management analysis and outline a conceptual framework for operation efficiency. Particularly, the study has the following sub-objectives
 To optimise methods that strive to continuously improve the quality of specialised pathology services.
 To provide a complete survey of sources and qualities of limitations commonly found in pathology operation efficiency.
 To review current industry practices and researches in regards to project management and change management.
 To blueprint a theoretical system for utilisation of project management and change management for pathology financial independence.

1.2. Significance of the Research
From an empirical point of view, this proposal could potentially assist pathology service professionals in the NHS laboratory to plan and execute appropriate project management methodologies to help expand laboratory proficiency to adapt to spending plan cuts. The consequence of this study will be valuable to the pathology managers and in addition related pathology services in developing better practice and apparatuses for dealing with budget restraints and opportunities for model that allow independence in the public sector. Additionally, it also strives to utilise change management approaches to enhance staff involvement and easy transaction of changes. As a consequence, this will assist the organisation in saving costs as well as the laboratory’s reputation. This research has the potential to help the specialised laboratories fabricate more grounded relationships with service users as well as NHS commissioner officials.

From an individual reflection this research will contribute more knowledge to my comprehension of spending plan confinement on quality of care and help me utilise my insight acquired from the Global MBA in structuring a framework for the department that can be utilised to permit the service to proceed with operation without commission.
1.3. Research Hypothesis:
The research proposes that the higher the service quality, the higher the possibility of financial independence.

Evidence-based project management and change management ‘framework’ would increase the service quality and thus increase the department resistance to budget cuts and in time increase chance of financial independence. The relevant hypotheses relate to introducing project management and change management in the existence and mode of operation of specialised pathology services.

1.4. Research question
The following specific research questions will be addressed to fulfil the above purpose:
1) How successful is DEP’s cost saving methods? And to what extend are they to be limited in order to not have a detrimental effect on the service quality?
2) Is Prince2 project management methodology the only suitable approach to pathology services? If not, what are the proper project management approaches that should be adopted to ensure implementation?
3) How can change management be used to drive long term goal of a hybrid commissioned and independent service?
4) Can the key factors that led to successful project management implementation, including user acceptance and satisfaction levels, effective business strategies and practices be identified and evaluated in both the long and short terms?
5) Is it possible to review the current Key Performance Indicators (KPIs) of the DEP service, with a view to investigate factors deterring the department to strive for revenue growth? And is it possible to develop the most valid and informative measures to assist in settling these ‘fears’ of service disruptions that prevents DEP from pursuing these avenues?
The result of these enquiries will help the DEP team to assist the department to become a patient-centred, user service-driven business and a key player in the specialised pathology service industry.
2. LITERATURE REVIEW (RELEVANT LITERATURE / SECONDARY SOURCE)

DEP foundation is high-level expertise in services for diagnostic and therapeutic procedures, as well as ophthalmic service-based research solutions. The diagnostic and therapeutic services are where materials, methods and expertise are used that allows morphological, chemical, immunological analysis obtained from human tissue and fluid. This commissioned specialised diagnostic service is provided to the NHS in England for free and is chargeable for private hospitals/laboratories (Bonshek, 2013). DEP currently has the largest NSOP eye pathology share in the UK. DEP service covers patients resident in England and is accessible regardless of age, sex, race, or gender.

It is estimated that someone suffers visual impairment every 5 seconds in the world (WHO, 2012), this equates to an approximately of 285 million visually impaired people worldwide. There are many factors that can contribute to blindness but the most common factors are biological (age) and social-economic factors; 90% of the world’s visually impaired live in low-income settings and 82% are aged 50 and above (Access Economics, 2009). The cruel reality is that 80% of all visual impairment can be prevented or cured (WHO, 2014). Currently, the market need is increasing due to aging population and the market is underserved (ESRI, 2007). At this point in time, NHS hospital, researcher and private referral clients come to DEP for scalable, temporary expertise with state-of-the art solutions. They understand that this kind of expertise would be very difficult and expensive to get from full-time, permanent employees as their needs are temporary. Clients requiring long term solution come to DEP for the same reasons and it would not only be expensive but also time consuming to train staff to the expert level required for this field. Commercial companies (Chemical, Biosystem, Biotechnology and pharma) are currently not served by DEP and this is lost opportunity.

Data (WHO, 2012) collected over the last 20 years shows that there has been significant progress in preventing and curing visual impairment in many countries, especially those resulting from infectious diseases. The civil societies effort to prevent and cure blinding disease and rehabilitate people who are irreversibly visually impaired or blind, include FightforSight, SightFirst and WHO.

Although all age groups can be affected, the main causes of visual impairment in the UK have a higher incidence among people aged 65 years and over. With an increasing elderly population in many countries, more people will be at risk of visual impairment due to chronic eye diseases and ageing processes. The number of people with impaired vision (both eyes) in the UK is to increase to nearly 4 million people by 2050 (Eyepathuk, 2014). The prevalence of glaucoma, cataract, diabetes and macular eye disease increases substantially and progressively with age, and one can expect a corresponding increase in the demand for eye services not only in the UK but globally (Sight loss UK, 2013 and WHO, 2012).
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As the market needs are increasing and the market itself is underserved, it is fair to say that at this current point in time DEP has no direct competitors in its niche market. The market demand has led to services providers leaning on and seeking support from each other. Same conclusion is made internationally as well. There is no possibility, for international eye pathology services to seek a share in the UK market as the global market is also underserved. This is not to say that the situation might not change and for this reason a closer inspection of this possibility in the future will now be investigated.

The health care market has become consumer centred and as we are moving to service economy, where customers accept nothing less than quality services and high standards (Vasco and Figueirdeo, 2015). During the recent period DEP have been receiving more and more focus from both national and international researchers and attention based on the appreciation of valuable resources, expertise knowledge and low turnaround time.
The main focus of the literature review will be to survery the latest development in project management, including concept, theories, and best and worst practices, in particular emphasising on successful factors of cost management and strategies to improve user acceptance. The related research on change management and KPIs for the DEP’s performance evaluation will also be explored.

Every organisation whether for profit or charity needs a strategic plan to define direction, make decisions on allocating its resources to pursue this strategy, include capital and people (Thompson et al, 2008). The NHS pathology services commonly apply bottom up tends to capture the current service and product issues and constraints that need to be addressed (HSJ, 2012). The adopted strategy should focus on outcome and value to the business. Building an efficiency does not only mean reducing cost but includes service quality still have to be achieved in order to keep existing customers and revenue (APICS, 2013). With this in mind the efficient method must also be effective.

A project is one that adopts the principles of being a finite process with a definite start and end. Although, success can mean different things to different people, it can be seen as one that fulfil the set condition and is delivered within the given time and do not exceed the budget. Project management in the healthcare sector focuses primary on: cost, time, scope, quality, operational risk, collaboration, integration and human resource. PMM tools can be utilised to provide the right blend of usability and flexibility. A good project management method will guide the project though a controlled, well-managed, visible set of activities to achieve the desired results. Some common causes of failures include lack of co-ordination and inadequately planning of activities with scare resources, lack of communication with interested parties leading to the delivery of poor quality products, and lack of quality control resulting in the delivery of unacceptable service that does not met the commission conditions. PRINCE2 is the pm technique mandated by the NHS and is a structured method for effective pm (Office of Government Commerce, 2002).

Change is initiated to support or grow the business to meet the organisation’s strategy. Change is all about modifying, introducing or removing business processes to service evolving set of products to meet customer needs. All change should have a business imperative, otherwise why would the change be incepted. Change Management Methodology focuses on the “the people side of change” (Dean and Bowen, 1994).

Prosci’s model reinforces the need for individuals to change and understand change by instilling (Prosci, 2015): awareness in order to recognise the need for change; desire to establish who needs to participate in the change; knowledge capability in order to guide the change; ability to implement skill sets and change behaviours and reinforcement to identify the change driver and the leader to establish the foundation for change.

Organisation culture has an impact on the operation environment and describes what governs the way the organisation and employees think, feel and act. This covers the aspect of the manner in which the organisation conducts its business, treats its employees and service users. It also covers the extent to which autonomy and freedom is allowed in decision-making, developing new ideas, and personal expression. The strength of employee commitment towards collective objectives. It impacts the organisation’s productivity and performance, and provides guidelines on customer service and product quality. A coporate culture aligned with business strategy can be utilised as competitive advantages (Kotler, 2006)
3. METHODOLOGY
The report is in light of two different strands of investigation. The main is to review UK and worldwide research literature about approaches to enhance pathology laboratory proficiency. The second will be hands on work, comprising of a little survey of specialised service providers and how they have adapted to current budgetary troubles and how they plan to overcome further spending plan cuts, without reducing their quality of care. The examination will additionally conduct face-to-face interview the five NSOP laboratories in the UK to test emerging ideas and potential of a standardised ‘framework’.

The primary exploration strategy for this study is literature review of evidence-based practice and conceptual modelling. Operation efficiency, constraint identification and classification through a structured approach will be the very first step toward a “financial independent” environment. This study will first review various types of constraints in NHS pathology services and their characteristics. In light of this understanding, a classification method will be developed to categorise constraint factors for the purpose of identifying operation efficiency modelled around quality of care. In the second stage of this study, existing project management and change management methods will be identified based on a comprehensive review of current industry practices and academic researches. The evident from the second stage will be inspected to examine how these strategies could add value on operation efficiency in the DEP. Finally, once this is expert, a theoretical structure for aggregated operational efficiency management will be sketched out. This study will be directed between September 2015 and January 2015.
The strategy for this project is driven, in this way, to a great extent by successful approaches taken by previous analysts in this area. The type of research can be extensively classified as descriptive and inductive in nature, as it tries to recognise key segments and quality of successful project management and change management implementation in the healthcare.
As proposed before, the best way to deal with research of this sort can be depicted as “action research” (Lewin, 1946). It unequivocally concentrates on research connected to a fast-moving situation and on advancing change inside of the organisation. It perceives that time should be given to surveillance and evaluation and the contribution of employees all through the procedure. The participant of DEP staff will be encouraged as part of change management through this research and will aid in team spirit, shared vision and understanding of implementation practice at first hand.
Primary information that will be collected via:
 Interviews with DEP management
 Questionnaire surveys from NSOP service providers.
 Participant observation in change management

Secondary data will be gathered from the DEP internal documents, publications and industry reports.
The DEP internal documents:
 Annual Service-User Survey of DEP
 DEP KPI for service quality and cost saving policies
 Survey of project management methodologies used in the DEP and NSOP laboratories.
Publications from the relevant areas below.
 Project Management
 Change Management
 Strategic Management
 Marketing Management
 NHS commissioners: documents and guidance
 The Pathology Services Commissioning Toolkit
 Carter Review
 NHS England
 The King’s Funds ‘ ideas that change health care’
 NHS confederation
 UKCAS and ISO standards
 Pathology Quality Assurance
 Institute of Biomedical Scientist
Industry and market results:
 Trends in healthcare Industry in UK
 Cost saving strategies for NHS pathology services.
3.1. Research time plan
Task Start Finish
Preliminary and background reading (company profiles, PPM, Change Management, Research Method) 01-Sept-15 18-Sept-15
Further and focused reading 21-Sept-15 30-Sept-15
Write introduction and literature review chapter (ch1 – ch3) 05-Oct-15 16-Oct-15
Prepare interview sheets and cover letter 19-Oct-15 23-Oct-15
Interview with top management 26-Oct-15 30-Oct-15
Interview with DEP team 02-Nov-15 06-Nov-15
Initial analysis of Interview data 09-Nov-15 10-Nov-15
Design questionnaire 24-Oct-15 14-Nov-15
Issue questionnaire to NSOP service providers 16-Nov-15 18-Nov-15
Deadline for questionnaire response 11-Dec-15 14-Dec-15
Initial analysis of questionnaire response 16-Dec-15 18-Dec-15
Draft complete 19-Dec-15 23-Dec-15
Finalise Thesis 02-jan-15 03-jan-15
Submit 04-jan-15 05-jan-15

4. REFERENCE
1. Reference
2. UCL (2014) http://www.ucl.ac.uk/
3. Institute of Ophthalmology (IoO) (2015) http://www.ucl.ac.uk/ioo/departments/pathology
4. NHS England (2014) ‘fiver year forward view’ https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
5. RcPath (2015) ‘Report of the Second Phase of the Review of NHS Pathology Services in England’ http://www.rcpath.org/Resources/RCPath/Migrated%20Resources/Documents/R/Review_Report_final_proof08.pdf
6. Carter Review(2015) ‘ Review of Operational Productivity in NHS providers’ https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/434202/carter-interim-report.pdf
7. King’s Fund (2014) http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/the-nhs-productivity-challenge-kingsfund-may14.pdf
8. Bonshek, 2013
9. (WHO, 2012),
10. (Access Economics, 2009).
11. (WHO, 2014)
12. (ESRI, 2007)
13. (WHO, 2012)
14. (Eyepathuk, 2014)
15. (Sight loss UK, 2013 and WHO, 2012)
16. Vasco and Figueirdeo, 2015
17. Vasco Eiriz, José António Figueiredo, (2005) “Quality evaluation in health care services based on customer‐provider relationships”, International Journal of Health Care Quality Assurance, Vol. 18 Iss: 6, pp.404 – 412
18. Thompson A A, Strickland A J and Gamble, J E (2008) Crafting an executing strategy, 17th Edition, McGraw-hill, ph 4 -24
19. HEALTH SERVICE JOURNAL (HSJ) (2012) ‘HOW A ‘BOTTOM-UP’ APPROACH TO INNOVATION IS MAKING SERVICE IMPROVEMENTS EASIER’
20. http://www.hsj.co.uk/resource-centre/best-practice/qipp-resources/how-a-bottom-up-approach-to-innovation-is-making-service-improvements-easier/5040805.article#.VcTbEflViko
21. (APICS, 2013)http://www.apics.org/industry-content-research/publications/apics-magazine-home/apics-magazine—landing-page—everyone/2013/01/28/achieving-greater-operational-efficiency-in-hospitals
22. Office of Government Commerce (2002) Successful Projects with Prince3. Crown. Pg 9 -23
23. James W. Dean Jr. and David E. Bowen
24. MANAGEMENT THEORY AND TOTAL QUALITY: IMPROVING RESEARCH AND PRACTICE THROUGH THEORY DEVELOPMENTACAD MANAGE REV July 1, 1994 19:3392-418; http://amr.aom.org/content/19/3/392.full.pdf+html
25. Prosci (2015) Understanding Resistance: Prosci’s Flight and Risk Model http://www.change-management.com/
26. Kotler, P & Keller, K. L. (2006). Marketing management. (12th ed.). Prentice-Hall: Upper Saddle River, New Jersey.

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