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ORGANISATION AND HR MANAGEMENT

WORD COUNT
TASK 1
3,868 words

DATE: MAY 2015

DECLARATION
‘I confirm that in forwarding this assignment for marking, I understand and have applied the policies relating to word count, plagiarisms and collusion for all tasks. This assessment is the result of my own independent work except where otherwise stated. Other sources are acknowledged in the body of the text, a bibliography has been appended and Harvard referencing has been used.

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TABLE OF CONTENT
1.0

HRM STRAEGIES AND PRACTICES RELATED TO MMC ………………………………………………………. 3

2.0

EXPLANATION ON THE FACTORS AND PRACTICES RESPONSIBLE FOR THE FAILURES OF MMC
FROM A HRM PESPECTIVE …………………………………………………………………………………………………5

3.0

HRM STRATEGIES RECOMMNEDED FOR INCORPORATION BY NHS…………………………………….7

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RECOMMENDED HRM POLICIES AND PRACTICES FOR IMPROVING THE FUNCTION AND
PUBLICITY OF MMC………………………………………………………………………………………………………….10

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HRM STRAEGIES AND PRACTICES RELATED TO MODERNISING MEDICAL CAREERS (MMC)

Human Resource Strategies set out what the organisations intend to do about its human resource management policies and practises and how they should be integrated with the business strategy and with each other. (Armstrong, 2006).
The purpose of HRM strategies is to;
 Guide development and implementation programmes
 Provide a means of communicating to all concern the intentions of the organisation about how its human resource will be managed
 Enable the organisation measure progress and evaluate outcomes against objectives.
(Armstrong, 2006)
Modernising Medical Careers, MMC, was designed by the National Health Service, NHS, to reform postgraduate medical education and training to speed up the production of competent specialist. Its aim was to improve the quality and safety of patient care by the introduction of a more structured, competency-based training, focused on both clinical and generic skills designed to meet the needs of the service (Tooke 2007).
a) Learning and Development Strategy
The NHS in implementing MMC had clearly mapped out a specific HR strategy to tackle the learning and development areas of the medical profession in the UK. By adopting the resource base approach which aims at developing human resources to be more effective and efficient, giving the organization a level of competitive advantage, NHS develop a step by step training & development frame work within the MMC.
Aside from establishing the framework, NHS also established specific principles that were supposed to guide the implementation of this strategy. These principles were called the 7 (seven) pillars of the MMC and they are;


“Trainee-centred; - As it aims to provide trainees with a basic grounding in clinical practice

and with a broader perspective of the career opportunities available to them. It will also act as a platform on which to build their later careers.
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Competency-assessed;- A s the competency of the trainee doctors in regards to their behaviour, skills and attributes, as assessed at the work place will be a continuous part of the programme (Great Britain. Department of Health, 2004)

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Service-based;

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Quality-assured; - As curriculum based programmes will be developed which will deliver an agreed set of competencies and a greater number of experiences and consequently a better knowledge of general practice. (Great Britain. Department of Health , 2004)

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Flexible;
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Coached; - Ensuring that trainee doctors had constant access to career advise via regular meetings with educational supervisors

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Structured and streamlined. – As there is a clear and well detailed framework to which the modernized medical career will follow.

b) Recruitment and Selection Strategy
Part of the execution criteria for MMC, required that a recruitment and a selection process be put in place and thus NHS developed the MTAS system , an online application system used for the selection of Foundation House Officers and Specialty Registrars, and allocating jobs to them in the UK (Great Britain. Department of Health, 2004)
c) Stakeholder Management:
The development of the MMC and its guiding principles was not solely carried out by the NHS.
It ensured it sought the input from other key stakeholders in the medical profession. Through a clear communication platform (regular key stakeholder meeting), NHS and its stakeholders were able to review and agree on the MMC guiding principles and policies, draft the overall programme framework as well as developed the learning curriculum that was incorporated into the system. It also put sessions in place to inform stakeholders about the policy decisions
(Tooke, 2007)
d) Legal Framework
Medical education and training need to conform to clear standards and reflect the needs of patients and the health service (Tooke, 2007). NHS in its design of the MMC programme ensured that it incorporated the set standards for the knowledge, skills, attitudes and behaviours that medical students should acquire in line with laws of Postgraduate Medical
Education Training Board (PMETB) and General Medical Council (GMC).
e) Workforce Planning
In implementing MMC, NHS had to also carry out some form of work force planning. The main emphasis of workforce planning for MMC was to look at the initial implementation issues and then to try to predict the likely future staffing requirement and the steps needed to meet that staffing need. By defining the plan, visioning the future, accessing demand, accessing supply, developing an action plan, Implementing and reviewing, NHS was able to able to develop the framework today call MMC. (Great Britain. National Health Service, 2005)

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f) Talent Management Strategy
One of the key objectives the NHS is to be able to have a pool of skillful doctors to meet the need of the society, a cogent reason as to why the MMC was established; a platform to manage talent. Armstrong (2006) define talent management as ‘ Ensuring that the organization has the talented people it requires to provide for management succession and meet present and future business needs’. For NHS, it was an opportunity to connect specialist doctors who may have the aspirations to develop new skills ‘on the job’ and to progress to the specialist registrar with very willing employers. (Great Britain. National Health Service, 2008)

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EXPLANATION ON THE FACTORS AND PRACTICES RESPONSIBLE FOR THE FAILURES OF MMC
FROM A HRM PESPECTIVE

The introduction of MMC was welcome idea by the medical profession UK as it was believed that the program will bring the much needed reform required in postgraduate medical education. Working together the NHS alongside other key stakeholders developed the system frame work and also policies that should guide the working of the system. However, despite putting all these in place, certain factors and practices by the body jeopardized the success of entire programme.
a) Unclear Project Objectives:
While the framework and polices guiding the framework were established and clearly communicated during the development of the MMC programme, the overall definitive description of MMC and what it embraced was never stated or made clear neither was it ever with key stakeholders. In the development of strategy, particularly those around human resource management, it is important that the objective of the strategy be clearly crafted with actions/steps to executing the strategy clearly communicated to key stakeholders. This reduces ambiguity surrounding expectations and ensures all are aligned on expected outcomes. This was clearly lacking in the implementation of MMC as a wide range of educational and workforce objectives were being ascribed to MMC by both stakeholders and MMC’s own management (Tooke, 2007).
b) Unclear Roles for the Doctors
In the development of the frame, the roles of the doctors was not clearly spelt out, thus they were not clear as to what to do at each career stages (Tooke, 2007). In the management of
Human Resource, it is important that roles and responsibility be clearly spelt out, communicated and well understood by all concerned. This reduces confusion and drives for efficiency, and also forms bases for all future performance evaluations and reviews.

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c) One too many Regulatory Body
Regulating the existence of MMC as a continuum of medical education platform involved two bodies; GMC and the Postgraduate Medical Education and Training Board (PMETB) which created some of diseconomies both in terms of finance expertise. (Tooke, 2007)
d) Failure to Incorporate Key Stakeholder Feedback
While key stakeholders were fully consulted and incorporated into the policy and framework design of MMC, but reports show that various concerns were raised as regard some aspect of the programmes frame work but these concerns where never address nor were they considered while final plan execution plans were being put together. For example, a review of one of the MMC minutes reveals evidence of concerns over the implications of policy implementation but there is little or no evidence that these concerns influence in any form the decisions made by the UK Strategy Group (UKSG) when setting up the strategies and policies
(Tooke, 2007).
Feedbacks are meant to help add value to a process and not eliminate it. It drives for processes to be reviewed, re-evaluated and made better. Failure of UKSG to adopt this impacted negatively on the programme such that the credibility of the entire process was undermined and the programme discredited (Marron, 2007)
e) Faulty Selection and Recruitment System
The Medical Training Application System (MTAS) was an online selection and recruitment system set up under the umbrella of MMC. Its main aim was to select Foundation House
Officers and Specialty Registrars for job roles within the UK. However, the implementation of this system showed a considerable level of weakness in the planning as it was characterized by a lot of criticism from key stakeholders seeing it was not achieving the said objectives for which it was developed.
First and foremost, the time frame between the development and implementation of the system was considered to be too short as there was no time to validate the system. Also roll out was done on a national level as against a regional pilot which would have been easier to manage with the arising problems.
Also certain processes within the system were highly flawed and a good example is the shortlisting process adopted. It relied heavily on white space questions, answers of which could be easily plagiarized, and gave undue scoring weight to these said questions during application.
Supporting documents such as CVs’ to help assessors make better judgment of applicants were unavailable, assessors lacked information, training and time to carry out shortlisting effectively
(Great Britain. Health Committee, House of Commons, 2008)
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Report from the Health Committee, House of Commons (2008) highlighted the fact that the same application design and scoring method were used for candidates at all levels, this was particularly unsuited for distinguishing between more experienced candidates, and thus many seemingly, excellent quality and potentially fit candidates were sidelined by the process.
Also eligibility to apply for training posts via the MTAS were not clearly spelt out to candidates and thus there was a surge in the number of eligible candidates causing a mismatch between the number of applicants and the number of available training posts, this introduced a new level of competition into the system. (Great Britain. Health Committee, House of Commons,
2008)
By adopting a centralized application process which meant that candidates could only make one application per year, this made the system look particularly like a high ‘high stakes’ process, a ‘one strike and you are out’ kind of set up, a staking contrasted with the previous system where applicants could apply to many different jobs as many points during the year (Great
Britain. Health Committee House of Commons, 2008)
These among many other flaws of the MTAS process gave room to key stakeholders losing confidence in the process and calling for an urgent review of the entire process.
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HRM STRATEGIES RECOMMNEDED FOR INCORPORATION BY NHS
A human resources management strategy is the overall plan that leads the implementation of

specific HRM functional areas (Moore et al, 2015). Having an HRM strategy is particularly important as it helps to; satisfy business needs, can be turned into actionable programmes and drives for coherent and integration of systems. For NHS, this is very important as a review of the play out of the implementation of the MMC highlighted great flaws in the execution of various HR policies and practices which impacted negatively on a process with a supposed good merit. Thus for NHS adopting the right HRM Strategies, incorporating the right policies and practices, will help ensure that similar past experiences are mitigated.
On that note, the below HRM strategies are being recommended for adoption by NHS;
a) Strategy for Improving Organisational Effectiveness
An effective organization is one that achieves its purpose by meeting the needs of its stakeholders, matching its resources to opportunities, adapting flexibly to environmental changes and creating a culture that promotes commitment, creativity, shared values and mutual trust. (Armstrong, 2006)

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Achieving this lot would mean that strategies focusing on developing processes that support the achievement of business goals and a positive culture will need to be developed. For NHS, improving organization effectiveness as it applies to the management of MMC will involve it implementing the below actions;


Develop a clear policy objective for Postgraduate Medical Training (PMT)
The Inquiry has revealed that the development and implementation of MMC has been hampered by a lack of clarity regarding the policy objectives and guiding principles that are shared by all stakeholders (Tooke, 2007) and in that regards, different assumptions where made as to what it is the MMC is to be addressing. To drive effectiveness, it is therefore recommended that NHS seats with all its key stakeholders in the medical profession to clearly define what the objectives of PMT should be. In doing this, it must seek to ensure that the interdependency of educational, workforce and service policies are recognized and incorporated into the policy objective (Tooke, 2007).
Adopting this strategy is recommended as it will help NHS clarify the intentions and desires of the Postgraduate Medical Training process to all involved thereby streamlining stakeholders’ expectations from the process.



Develop of a proper Job Design for Doctors at all Career Levels
There were clear indications that Doctors in the MMC programme were not clear on what their roles were at all career levels and as such service offers were not optimal. Service needs cannot be met now or in the future unless there is a clear understanding of what part each healthcare professional plays. This is particularly true for doctors and needs to be articulated for each career phase, including doctors in training and certificated specialists.
Without such definitions it is impracticable to pursue outcome focused medical education or attempt to plan the workforce. (Tooke, 2007).
NHS will therefore need to carry out a proper job design exercise that will help capture clearly the roles of both the doctors and trainees within the framework of MMC. According to Armstrong (2006), "Job Design is the process of deciding on the contents of a job in terms of its duties and responsibilities, on the methods to be used in carrying out the job, in terms of techniques, systems and procedures, and on the relationships that should exist between the job holder and his superior subordinates and colleagues."
Implementing this exercise is recommended as it ensures that both doctors and trainees are clear on their required roles and service expectations should be. This will likely facilitate greater clinical engagement and help engineer maximum return in regards the benefit the society will derive from investment in medical education.

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Also greater acknowledgement of the service contribution of trainees will help reverse the emerging trend wherein some young doctors in training seem to see themselves as trainees first and doctors second (Tooke, 2007).
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Establish Clear Leadership from the Top
Even though the Department of Health played a fundamental role as the instigator and leader of MMC reform programme, the absence of an overall leader to head the MMC was one critical factor that negatively impacted on the system. (Great Britain. Health
Committee, House of Commons, 2008). Stakeholders expected that the Chief Medical
Officer of the DH to take overall charge of the programme, but however, Tooke’s inquiry report revealed that a split accountability structured was what was adopted and no overall head was inducted. Thus no one person gave clear direction to the reform programme.
Clear leadership means taking responsibility for who you are and what you stand for, for decisions made individually and as a team, for how those decisions impact others and for their overall results. It’ about being willing to make decisions and commit to a direction, consider new data, make adjustments and communicate honestly about positive and negative results. It reflects setting the best direction and communicating accurately
(Haggins & Kreischer, 2005)
Having a strong and clear leadership structure from the top is recommended for the NHS as this will help boost the lost stakeholder confidence in the programme and afford it the ability to take speedy actions and make required changes in alignment with operating principles when such need arises.

b) Continuous Improvement Strategy
A continuous improvement strategy aims to improve the quality and reliability of products and services and their customer appeal, enhance operational systems, improve service levels and delivery reliability, and reduce costs and lead times (Armstrong, 2006).
The Postgraduate Medical Training system was design to provide a much need service to the medical profession and the UK society by securing quality workforce for the future and giving doctors in training a chance to a fulfilling career to their own and patients’ benefit.
Deploying the programme has however meet with a lot of challenges ranging from system to process issues such that need which gave birth to the programme where no longer being addressed as the program implementation rather fuelled the introduction of fresh complexities into the system leading complete loss of stakeholder confidence in the entire programme. 9

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Thus there is need a total overhaul of the entire system and process with the aim of improving it so it can generate the expected value for which it was initially designed.
NHS can adopt the below continuous improvement actions; o Strategic Planning: Seek to develop clear strategic objectives and action plans, mapping out how this plan will be communicated, measured, integrated and aligned within the NHS. o Effective Stakeholder Management: Seek to continually understand stakeholder needs and their evaluate satisfaction levels via tools such as surveys, focus group discussions, outreach activities and 360 degree feedback. Defining what the acceptable service standard is and also tracking complaints and compliments. o Efficient Information, Analysis and Knowledge Management: Ensure that performance data and information (both external and internal) are regularly gathered, analyzed and used for continuous programme improvement o Proper Process Management: Use systematic approaches to achieve cycles of improvement across key process areas. ( www.delawarepersonnel.com, 2010)
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RECOMMENDED HRM POLICIES AND PRACTICES FOR IMPROVING THE FUNCTION AND
PUBLICITY OF MMC
After reviewing the all available resource material, the below HRM policies and practices are proposed for adoption by the NHS to help improve the function and publicity of MMC.


Stakeholder Management Policy
The NHS needs to develop a stakeholder management policy that will seek commit to excellence service to all the key stakeholders involved the MMC programme. The below suggested practices would be adopted in executing the contents of the stakeholder policy o Formal consultation with the medical profession and the NHS on all significant shifts in government policy which affect postgraduate medical education and training, workforce considerations, and service delivery, ensuring that concerns are properly considered by those responsible for policy and its implementation
(Tooke, 2007). o Doctors in training to be better represented in the management structures of
Trusts to ensure that they better understand service pressures and priorities and
Trusts better appreciates their service role and training needs (Tooke, 2007). o Members of the Programme Board to be selected in equal numbers by the
Department of Health and bodies representing the medical profession; a similar process will be used to select Chairs for the Programme Board (Great Britain.
Health Committee, House of Commons, 2008). o All future policy development decisions to be approved by the MMC Programme
Board (Great Britain. Health Committee, House of Commons, 2008).
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o Meetings and decisions of the Programme Board to be properly minuted and attendance at the Programme Board must be consistent (Great Britain. Health
Committee, House of Commons Committee, 2008). o Communication with junior doctors to be improved and a single source of authoritative information established (Great Britain. Health Committee, House of
Commons, 2008). o Colleges to be encouraged to work together with the Regulator and service to devise modularized curricula for
Specialist
Training to aid flexibility/transferability (Great Britain. Health Committee, House of Commons,
2008).
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Change and Process Management Policy
A policy that will seek to manage change and continuous process improvement will be useful in driving added value within the system. To improve the function of MMC, NHS should adopt the below practices; o Changes to the structure of postgraduate medical education and training to be consistent with the policy objectives and conform to agreed guiding principles
(Tooke, 2007). o Developed and implement a change process within the system to manage the transitional ‘bulge’, caused by the integration of eligible doctors into the new scheme, with appropriate credit for prior competency assessed experience
(Tooke, 2007). o Ensure that all future process changes are piloted and evaluated before a national rollout is commissioned (Great Britain. Health Committee, House of
Commons, 2008). o A “big bang” approach to reform should is avoided wherever possible in future; o Ensures that the Department produces, and published where appropriate, formal business cases to support major change projects. The expected costs and benefits of reforms would be clearly stated and, if possible, quantified (Great
Britain. Health Committee, House of Commons, 2008). o Formal mechanisms for reviewing progress and risks across the whole of projects would be introduced and regular reviews would inform decisions about whether timetables for the implementation of change are realistic (Great Britain. Health
Committee, House of Commons, 2008). o Working together, College and Regulator to devise a common short-listing and selection processes that have been standardised across the country to allow sharing of assessments between Deaneries (Great Britain. Health Committee,
House of Commons, 2008).

o
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o The Permanent Secretary to monitor all substantial change programmes being conducted by the Department and ensure that other senior officials are informed about the progress of key projects (Great Britain. Health Committee,
House of Commons, 2008). o The Department to ensure that project management is adequately resourced and proper training provided. Managing major change projects would not be regarded as a task that can be tacked on to existing job roles (Great Britain.
Health Committee, House of Commons, 2008). o Ministers and officials to be encouraged to set more realistic timescales for introducing major changes, and to be prepared to delay implementation if necessary (Great Britain. Health Committee, House of Commons, 2008). o The relevant Royal Colleges and Specialist Associations to be more closely involved in the quality assurance of the training system, drawing on their knowledge and experience in this area. Royal Colleges should work with PMETB, and subsequently the GMC, at a national level, and with Postgraduate Deaneries at a local level (Great Britain. Health Committee, House of Commons Committee,
2008).
o A single body will hence regulate the activities of the MMC, thus the
Postgraduate Medical Education and Training Board (PMETB), will be amalgamated with the GMC. (Great Britain. Health Committee, House of
Commons, 2008).
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Work Design Policy

Stating clearly in a policy document the roles and responsibility of all involved in the management of MMC will help give clear focus to stakeholders. And as thus the below practices are being recommended; o Complete clarity is required regarding the roles of the CMO and the NHS
Medical Director in the delivery of MMC. The Department would make clear how the CMO’s role as professional lead for doctors in England can be carried out effectively given his distant relationship with MMC (Tooke, 2007). o Training implications relating to revisions in postgraduate medical education and training need to be reflected in appropriate staff development as well as job plans and related resources. Compliance with these requirements should form part of the Core Standards (Great Britain. Health Committee, House of
Commons, 2008).

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REFERENCES
Books Sources


ARMSTRONG, M. (2006) Strategic Human Resource Management: A guide to action. 3rd
Edition. Philadelphia USA: Kogan Page.

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TOOKE, JOHN. (2007).
Aspiring to Excellence: Findings and Recommendations of the independent inquiry into Modernising Medical Careers. [Online] London: Aldridge Press.
Available from - http://www.asgbi.org.uk/mmc-consensus/pdfs/MMC_InquiryReport.pdf
[Accessed: April 16th 2015]



GREAT BRITAIN. Health Committee, House of Commons (2008) Modernising Medical Careers:
Third Report of Session 2007-08 London: The Stationery Office (HG 25-I).

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GREAT BRITAIN. Department of Health, (2004) Modernising Medical Careers: The next step
[Online] Available from http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publ ications/PublicationsPolicyAndGuidance/DH_4079530?PageOperation=email [Accessed: April
16th 2015]

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Marron, C. (2007) RE: Medical Training Application Service (MTAS) Failures. [Letter]. Message to: Hewitt, P. 5th March 2007



GREAT BRITAIN. National Health Service (2005) Modernising Medical Careers: Workforce
Planning Resource Pack [Online] Available from http://www.gloshospitals.nhs.uk/PGME/Post%20Grad%20Medical%20Education%20Web%20D ocuments/WorkforcePlanning.pdf [Accessed: April 16th 2015]

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GREAT BRITAIN. National Health Service (2008) Employing and Supporting Speciality Doctors : A
Guide to Good Practice [Online] Available from http://www.rcpsych.ac.uk/pdf/Employing%20and%20Supporting%20Specialty%20Doctors%20%20Guide%20to%20Good%20Practice.pdf [Accessed: April 16th 2015]

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MOORE, M. MSSW & MEDIS, D. (2015) What are HRM Strategies [Online] Available from http://smallbusiness.chron.com/hrm-strategies-59260.html [Accessed: May 3rd 2015]

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HIGGINS, C & KREISCHER, D (2005) Clear Leadership: Accountability in Action. Vol 3, Issue 3.
[Online] Available from - http://www.srosenstein.com/pdf/hkv3i3.pdf [Accessed: May 3rd
2015]

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www.delawarepersonnel.com (2010) Guidelines for Implementing Continuous Quality
Improvement in State Government[Online] Available from http://www.delawarepersonnel.com/orgdev/documents/cqi_circle_2010.pdf [Accessed: May
3rd 2015]

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