Llandod is a small 80 bed rehabilitation hospital in Mid-Wales. It holds a strong position within its health trust since its services are deemed to be of high quality but still cost effective as it serves a large geographical population. In order to meet the increasing demand for its services the trust which operates the hospital has asked its three key managers to analyse and evaluate the capability of the hospital increasing the services it offers and operational capability.
The proposals the trust have put forward to the managers at Llandod are:
Proposal 1
The hospital should move to a 24 hour operational capability to allow initial Accident and Emergency procedures to take place. This would see the lose of one of the wards currently being used by rehabilitation patients. These patients would be moved to a local hotel which closed during the ‘Covid’ period. The hotel would be staffed by hospitality workers and agency medical staff would visit once a day for medical assessments and medication delivery. One of the managers would be assigned to this new role which would carry a ‘director’ title.
Proposal 2
The hospital should just work to its current operational capability but review and evaluate possible internal changes to become more efficient and effective in the discharge of patients. At present patients that are deemed ‘fit ‘to leave are staying at the hospital for six weeks longer than required. The trust recently undertook an audit of all the current wards and found that two managed by one of the managers had a much longer discharge time than the other wards.
Proposal 3
The hospital should have a temporary extension built in the current grounds – this would be sourced from the field hospitals used during Covid. One of the current managers would be assigned as the ‘director’ of this field hospital. The rehabilitation patients would be transferred to the field hospital and the wards used for general medical patients. Current medical staff would stay on the wards and agency staff would be utilised for the field hospital. All other non- medical staff would be required to work on the wards and in the field hospital. The field hospital would also take away all the gardens and outside space currently used for some rehabilitation patients.
The trust has instructed the three managers at Llandod to review each proposal and report back on their evaluation and decision on which area they will change.
Given the current ‘crisis’ the trust has indicated its preference is proposal 1 which from their analysis resolves some pressing health issues in the area/sector and is in their view ‘budget’ friendly.
The three key managers at Llandod who have to make this change decision are:
Dr. Richards a long term employee at Llandod who worked for many years as a local GP and who knows many of the patients at the rehabilitation hospital. He is due to retire in the next 2 years and has campaigned in the past for the survival of the rehabilitation hospital to remain open.
Dr. Brown (this title not a medical one but from their work on a Phd thesis). This manager was employed by the trust having completed their study on ‘ bed blocking- how do we deal with the older generation’. Dr. Brown has been at Llandod for 6 months and has already indicated to the trust there is a need for someone to ‘take control’ at the hospital.
Sister Ellis has worked at Llandod for the past 5 years having moved from the main trust hospital having returned to work after a period of leave which was due to ‘workplace stress’. Sister Ellis has previously always engaged in ‘change’ within the hospital and has commented in staff meetings that the rehabilitation hospital must ‘change’ or will face closure.
Note
Please read the case study and in preparation for the tutorial consider what the main SWOT/PESTLE influences/drivers maybe for the managers in deciding their preferred change to the operation at Llandod.
