Four Incarnations Of The Present Ncrha Management Essay

An analysis of the impact of leading on motive and organizational alteration at the North Central Regional Health Authority ( NCRHA )


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To measure the relevancy and importance of administration construction on the public presentation, morale and job-satisfaction of the work force

To find the consequence of organizational leading on the motive of employees and the alteration direction procedure

To urge the necessary alterations utilizing relevant theories and research to explicate these issues.

Need for the Study

The Health Services Employee Survey was conducted in 2007 by the Market Opinion Research International ( MORI ) using a questionnaire designed in concurrence with the Ministry of Public Administration and Information and the Ministry of Health.


To obtain baseline information on employee attitudes and behaviours to track advancement in the hereafter

Compare wellness service with against other public sector organisations

The NCRHA response rate from its over three 1000s employees to the study was a 33 % staff engagement in the exercising.


Job satisfaction and morale

Pride and protagonism

Working for the wellness service

Positions on alteration

Engagement and committedness

Work life balance

Line direction

Senior Management

Internal communications

Learning and development

Vision 2020

Introduction of Case Company:

The North Central Regional Health Authority ( NCRHA ) was established in August 2004 by an act of Parliament No. 5 of 1994.The first board was established in December 2004 but direction duty remained with the North West Regional Health Authority ( NWRHA ) until July 1st 2005. The main executive officer was appointed in October 2005and a board of managers was appointed in August 2006.

The present NCRHA has gone through four reincarnations

The NCRHA is a regional supplier of wellness attention services supplying attention to persons, households and communities through its five ( 5 ) wellness establishments and 16 ( 16 ) Health Centres in the counties of St. George East and County Caroni East. The catchment country of about three hundred and 50 1000 ( 350,000 ) individuals is served by a staff of three 1000s plus members.

The strategic program of the NCRHA sought to set up greater alliance with the incorporate program of the Ministry of Health placed accent on the undermentioned concern jussive moods ; cost direction, integrating and rationalisation of services across the part and infection bar.

The NCRHA planning procedure led to the preparation of a vision, mission statement of nucleus values with cardinal strategic enterprises for the period 2008 to 2010. The cardinal strategic enterprises outlined in the program are high public presentation civilization, operational excellence, quality focal point and cost productiveness.


The North Central Regional Health Authority will go on to better the quality of life of our clients through the publicity of health and efficient collaborative wellness services direction focused on the demands of the population.


To advance health through effectual partnership with the community and relevant interest holders. We strive to supply a safe cost effectual, choice wellness service to the population through extremely motivated and trained human resource.

Core Valuess

NCRHA Company Policy

2NCRHA Company Policy

3 NCRHA Company Policy

Insert a Org chart

Literature Review & A ; Analysis

Harmonizing to Bryans and Cronin ( 1983 p.p 9 ) , Theories about organisation behaviour began to develop during the early and center of the 20th century. Organization theory seeks to understand, explicate and foretell human behaviour in the organisation Theory should ne’er be divorced from pattern, it forms the footing of direction determinations on how to move in certain state of affairss,

Mullins ( 2005 p.p 26 ) provinces that organisational Behavior ( OB ) is a survey and apprehension of how persons and groups behave in an organisation, the impact of forms and constructions of direction on these behaviors and how enlightened direction actions can act upon these behaviors to better organizational public presentation and effectivity.

In ether, OB could be by and large defined as the survey and apprehension of single and group behavior and forms of construction in order to assist better organizational public presentation and effectivity ( Robbins and Judge 2007 p.p 9 ) .

The NCRHA has been impacted by several alterations in organizational leading. Harmonizing to Edinburgh School ( Organisational Behaviour 2003 ) , Organizational leading and organizational construction are two factors, if non managed good, could take to emphasize at the workplace and therefore de-motivated employees. The construction of an administration affects non merely productiveness and economic efficiency but besides morale and occupation satisfaction of the work force. Geting the construction right is the first measure in organizational alteration ( Macmillan Business 1999 ) . Leadership is related to motive, interpersonal behavior and the procedure of communicating ( McMillan Business 1999 ) . Leadership is of import in trying to cut down employee dissatisfaction ( May 19197 p.p 7 ) . This was demonstrated in the survey conducted by MORI ( 2007 ) where the part scored low in countries such as occupation satisfaction, morale, and positions of alteration, committedness, communicating and senior direction.

Organisational theory has influenced the design and development of constructions to a pronounced grade, and even where it is hard to set up positive cause and consequence relationships, the nature of such influence is permeant ( Bryans and Cronin 1983 p.p19 ) . Mullins ( 2005 p.p530 ) states organizational construction is the form of relationships among places in the administration. It defines undertakings and duties, work functions and relationships and channels of communicating.

The NCRHA is a statutory organic structure which incorporates the thought of division of labor, the hierarchy of authorization and formal regulation and processs. Harmonizing to classical theory these features are congruous to a bureaucratic administration based on the work of sociologist Weber who depicted the bureaucratic theoretical account as the most appropriate signifier of organisation for large-scale, complex concerns ( Bryans and Cronin 1980 p.p 11 ) . . Although bureaucratisms are going less and less the popular pick for form amongst most administrations today, it is still present within the public sector administrations such as local governments and universities ( Mullins 2008 ) .

William jennings bryans and Cronin ( 1983 p.p 19 ) provinces specialization of occupation and map or the grouping of similar activities provided a footing which enables the administration to set up construction. The NCRHA organizational construction is functional in nature with its employees runing in silos. This is farther compounded when there is a high grade of centralization may make a state of affairs where top direction is trying to cover with the jobs formed by engagement in both strategic and operational decision-making countries, peculiarly where the former is neglected in favor of the latter ( Bryans and Cronin 1983p.p23 ) . However the matrix administration offers the advantages of flexibleness, greater security and control of undertaking information and chances for staff development ( Mullins 2005 p.p 552 ) . The NCRHA has centralization properties since determination devising is concentrated at top direction with small engagement of low degree forces. These factors could ensue in the de-motivation and disempowerment of staff in the administration as revealed in MORI ( 2007 ) study.

Mullins ( 2005 p.p 542 ) recommends that accent on engagement and authorization suggest a focal point attending on the rules of decentralization, yet senior direction still needs to keep effectual co-ordination and overall control of the activities of the administration as a whole. Structure provides the model of an administration and makes possible the application of the procedure of direction. Ideally concern administration should try to intermix the benefits of decentralization for client orientation and increased reactivity ( Mullins 2005 p.p 556 ) .

The NCRHA showed less than positive consequences in the MORI ( 2007 ) with respects to employee engagement and committedness. Employees with a high degree of occupation involvement strongly place with and truly care about the sort of work they do. A closely related construct is psychological authorization, which is employees beliefs in the grade to which they impact their work environments, their competency the meaningfulness of their occupation and the sensed liberty in their work ( Robbins and Judge 2007 p.p80 ) . Mullins provinces ( 2005 p.p593 ) Authorization makes greater usage of the cognition, accomplishments and abilities of the work force, it encourages squad working and if there is meaningful engagement, it can help in the successful execution of alteration programmes. High degree of occupation engagement and psychological authorization are positively related to organizational citizenship and occupation public presentation. In add-on high occupation engagement has been found to be related to fewer absence and lower surrender rates ( Robbins and Judge 2007 p.p 80 ) .

Judge and Robbins ( 2007 p.p80 ) postulates Organisational Commitment which is defined as a province in which employees identifies with a peculiar administration and its ends and wants to keep rank in the administration.

There are three separate dimensions to organizational committedness.

Affectional commitment- an emotional fond regard to the administration and a belief in its values.

Continuance commitment- the sensed economic value of staying with an administration compared to go forthing it.

commitment- an duty to stay with the administration for moral and ethical grounds.

The affectional committedness dimension can be the attack that direction initiates since it can be related to the administration concern of wellness attention and lovingness for patients. In general, it seems that affectional committedness is more strongly related to organizational results like public presentation and turnover than the other two commitment dimensions ( Judge and Robbins 2007 p.p 81 ) .

Middle and senior directors need to pay attending to things which will really actuate their employees. Earlier author such F.W Taylor believed in economic demands motive. Workers would be motivated by obtaining the hugest possible rewards through working in the most efficient and productive manner ( Mullins 2005 p.p 423 ) . The Human Relations school which is synonymous to the Hawthorne experiments carried out by Elton Mayo conducted experiments and came up with a theory which states that non-financial wages as a incentive is the key to higher productiveness was increased employee satisfaction. The Hawthorne experiments demonstrated that group influences affected human behavior that group criterions established worker end product, and money was far less a factor in finding end product ( Bernard Burnes 2004 ) .

Maslow ‘s Hierarchy of demands theoretical account, Herzberg ‘s two factor theory, Alderfer ‘s modified demands hierarchy theoretical account and Mc Clelland ‘s achievement motive theory are all attacks put frontward to assist in placing what really motivates. These theories are concerned with placing people ‘s demands, strengths and ends pursued in fulfilling these demands.

Employees are non wholly motivated by the same factors. Some are motivated by intrinsic factors and some by extrinsic factors. Employees at NCRHA are faced with the job of hapless on the job conditions. The edifices in which they perform their day-to-day activities are non to the full OSH compliant and some even have serious fire safety concerns. There are besides the issues of sections being short staffed, small room for calling promotion, directors do non mix with lower degree staff, and most of import, employees are non sufficiently rewarded for the occupation in which they perform every bit compared to other statutory organic structures.

The motive of staff can be multifaceted in an administration such as the NCRHA where the work force is professionally diverse. Mullins ( 2005 p.p424 ) said it is because of the complexness of motive and the fact that there is no ready made solution or individual reply that motivates people to work good, that different theories are of import to the director. This is farther confirmed by Butter Heinemann ( 1999 ) who states that all directors have a responsibility to actuate their squads. Motivated people take more pride in their work occupations and work better.

It is of import that leaders recognise this complexness and cognize that what motivates one individual will non needfully actuate another. The leading of an administration can act upon their employee ‘s behavior through effectual communicating, squad working, preparation, wagess and subject. Leadership and motive are closely interrelated. The NCRHA has gone through several alterations which have impacted on leading of the administration and unwittingly on the motive of its employees. The leading manner and attack to alter direction has left employees alienated and dissatisfied.

Leadership as defined by Johns and Saks ( 2005 ) is the influence that peculiar persons exert on the end accomplishment of others in an organizational content. Through effectual leading, directors affect the behavior of people in concern. Bryan and Cronin ( 1983 p.p86 ) refers that leading forms the span between administration ends and single ends and is a important component in finding the success of the administration. Good direction leading helps to develop teamwork and integrating of single and group ends. It aids intrinsic motive by underscoring the importance of the work that people do ( Mullins 2005 p.p 254 ) .

Leadership manner is the manner in which the maps of leading are carried out, the manner in which the directors typically behave towards members of the group ( Mullins 2005 p.p 266 ) . Leadership is a dynamic signifier of behavior. There are a figure of variables that affect the leading relationship. Four major variables as outlined by Mc Gregor are:

The features of the leader

The attitude, demands and other personal features of the followings

The nature of the administration, as such its intent, construction and undertakings to be performed

The external environment

There are many alternate ways of analyzing leading due to its complex and variable nature. The attacks to understanding leading ranges form the traditional position that leaders are born and non made, to the comparatively recent position that leading has more to make with the state of affairs than to any universally desirable set of properties ( Hannagan 2005 ) .

Analysis of leading could be categorised as follows:

The qualities or traits approach- assumes that leaders are born and non made. Leadership consists of certain built-in features or personality traits. This attack focuses attending on the individual in the occupation and non the occupation itself.

The functional or group approach- attending is focused on the maps and duties of leading, what the leader really does and the nature of the group. This attack assumes that leading accomplishments can be learned and developed.

Leadership as a behavioral category- the sorts of behavior of people in leading places and the influence on the group public presentation. The behavioral class draws attending to scope of possible managerial behavior and importance of leading manner.

Manners of leadership- the manner in which the maps of leading are carried out and the behavior adopted by directors towards low-level staff. Concerned with the effects of leading and those being led.

Contingency theories- this attack is concerned with the importance of state of affairs. Interactions between the variables involved in the leading state of affairs and forms of behavior. This attack believes that there is no individual manner of leading appropriate to all state of affairss.

Transformational leadership- this attack is a procedure of digesting motive and committedness, making a vision for transforming the public presentation of the administration and appealing to the higher ideals and values of followings.

-Inspirational leadership- this attack is based on the personal qualities or personal appeal of the leader and the mode in which the leading influence is exercised.

The manner of managerial leading towards low-level staff and focal point of power can be classified in three leading manners ( Mullins 2008mp.p266 ) :

-Autocratic -use of power, bid control, reward penalty

-Democratic- leading map and shared with group and director portion of squad

-Laissez faire ( echt ) – deputation liberty of group members, authorization

The leading manner at NCRHA being a bureaucratic administration is bossy in nature. This type of leading does non further participatory determination devising and inhibits employee buy in to alter enterprises and de-motivates. The engagement of leading in the alteration procedure is critical to an administration. The NCRHA employees showed less than favorable positions towards alteration and this can be diagnostic of hapless leading during administration alteration.

Harmonizing to Mullins ( 2005 ) the effectual direction of alteration must be based on a clear apprehension of the nature of human behavior at work. In most instances, the debut of alteration is more likely to be effectual with a participatory manner of managerial behaviour. The American Society for Quality ( ASQ ) defines that alteration direction is a procedure for guaranting that the people affected by alteration understand the nature of the alteration and the ground for it, with the outlook that new methods of operating will be internalized without making undue opposition, struggle and fright.

Change can be triggered by the demand to react to new challenges or chances presented by the external environment such as intended authorities statute law, which is the instance for a statutory organic structure such as the NCRHA but the organisation must besides be after for improve alteration in it concern of wellness since client outlook are altering.

The lewin theoretical account of alteration describes three stairss that must happen:

Unfreezing: acquiring people to acknowledge the demand for alteration and being willing to seek.

Traveling: really seeking the behavior, procedure, attitudes, or other coveted alterations.

Refreezing: the alteration has been implemented and is now the norm

Although this theoretical account is utile as a model for the thought about alteration, the demand for continual betterment allows small clip for stableness. This means that all directors in fact, all employees need to go knowing of alteration direction ( ASQ Quality Handbook, 2005 p.p 32 ) .

Mullins ( 2005 p.p 825 ) farther argues that pull offing alteration topographic points accent on employee ( client ) needs as the highest precedence. To be successful, organisations need a dedicated work force and this involves the effectual direction of alteration. Change impacts each individual otherwise and direction must accept the single nature of alteration.

It may sometimes go necessary follow other manners of managerial behaviours to impact alteration. Mullin ( 2005p.p825 ) besides refers to certain state of affairss when there is opposition to alter, it may be necessary for direction to do usage of hierarchal authorization and to try to enforce alteration through coercive, bossy manner of behaviour. Another interesting position to alter is that of Ducker ( 2005 ) who said one can non pull off alteration. One can merely be in front of it. We do non hear much any longer about get the better ofing opposition to alter. Everyone accepts that alteration is ineluctable.

The possible positive results change can frequently hold opposition at both single and organisational degree. Resistance to alter to can take many signifiers and it is non ever easy to nail the exact ground. It is hence for direction to follow a clearly define scheme for the induction of alteration. The successful direction of alteration is a cardinal factor of organisational public presentation and should emanate from the top of the organisation. The demand is for effectual alteration leading ( Mullins 2005 ) .


Based on the old survey ( MORI 2007 ) and literature reviewed, the writer concludes the followers.

The NCRHA is in the concern of supplying wellness attention services to the population and employees involved in this procedure have made a witting chosen to function the population. It is non possible to attach a pecuniary value to the work that wellness attention workers provide on a day-to-day footing but effectual leading and direction would supply an environment for motive and committedness to the organizational ends.

The factors discussed in this literature reappraisal focused on how organizational construction can consequence the morale and occupation satisfaction of its employees. The bureaucratic construction may be the preferable construction for public sector administration but it does mean we should non see the human dealingss facet of the administration.

The motive of employees can be both intrinsic and extrinsic. It is of import that direction recognise that different employees are motivated by different factors. Therefore directors should measure their schemes used to actuate their staff. The use of employee accomplishments, cognition and experience in the development of administration ends would further an environment of authorization and employee engagement.

The NCRHA has clearly suffered the effects of hapless leading and this could be diagnostic of deficiency motive, employee engagement, organizational ends and alteration direction. The manner of leading is a cardinal factor in an administration success. Therefore it must be a focal point point for any administration.

The procedure of alteration in any administration is inevitable. The actions and enterprises taken by direction during the alteration direction procedure predict the successful execution of alteration. The NCRHA has experienced several alteration direction processes over its continuance. This has besides impacted on the motive, committedness and engagement of employees in achieving the administration mission. The leading of an administration during the alteration procedure is critical since it alleviates fear and gives clear vision of where the administration is traveling.


The organizational construction at the NCRHA is bureaucratic in nature and most determination devising is centralised to upper direction. The administration design is besides functional in nature which does non let for effectual communicating through out the administration. The altering environment and turning client outlooks are now necessitating administrations to be more antiphonal. The NCRHA should travel to a more decentralized determination devising procedure which would do the administration more antiphonal to client demand. The restructuring of the organizational construction to a more matrix type administration would let for addition flexibleness and employee engagement. There should besides be periodic reappraisals of the administration construction to guarantee chances for employee development and growing taken into consideration.

The direction squad at the NCRHA should critically reexamine its schemes utilised to actuate its employees. The wellness services have such a diverse work population and wellness professional employed motivational factors would necessitate to be varied fitting employee demands. However it could be said that all employees do value good working conditions, occupation security, acknowledgment, calling development, inclusion in determination devising processes along with other intrinsic and extrinsic factors.

The NCRHA should implement wages system that recognises exceeding employee behaviors and public presentation. These schemes do necessitate to be fiscal in nature but should breed the values that the administration should further since employees are motivated by otherwise hence several wagess mechanism should be formulated. The development of a strategic public presentation direction system for the NCRHA would besides supply a foundation for employee development and feedback.

The authorization and engagement of employees in achieving the organizational ends is overriding to it success. The NCRHA should further some affectional committedness dimension into the administration so that employees could place with the cardinal values of the administration such as population good being and compassion.

Herzberg believed that by bettering the nature and content of the existent occupation, employees would be more motivated. He suggested that this could be done through:

Job expansion where workers are being given a greater assortment of undertakings to execute which should do the work more interesting.

Job enrichment that involves workers being given a wider scope of more complex, interesting and ambitious undertakings environing a complete unit of work. This should give a greater sense of accomplishment.

Authorization, which is deputing more power to employees to do their ain determinations over countries of their on the job life.

The NCRHA leading should accommodate a more participatory manner of leading. This would prosecute more employee engagement in the determination devising procedure and buy-in to new enterprises. Employee ‘s engagement would increase motive and engagement in the administration. Administration leaders must exhibit properties such as accomplishment, cognition, support and authorization towards their employees. Directors should ease acquisition and communicating. There should besides be an adaptation of a situational type of leading which would let flexibleness and reactivity. The accomplishments required by leaders are multidimensional therefore directors need to be suitably trained and equipped to react to their changing environment.

The NCRHA direction squad should besides set about a comprehensive SWOT analysis of the administration this would concentrate the administration on the strengths, failings, menaces and chances confronting the administration in its of all time altering environment. This would help in the development of a strategic alteration direction program.

The procedure of alteration direction is dynamic in nature and employee reactions to alter can be different. However cardinal stairss should be observed when implementing alteration in an administration such as the NCRHA. There should a clear demand for the alteration program communicated to all employees and this should be highlighted by leading. The vision and schemes for accomplishing alteration should be defined to stakeholders. Communication and personal committedness by leading through the alteration procedure is critical to the success of the administration.


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