Midshires College of Midwifery and nursing (case study)

Background This case study describes the attempt to merge five col-leges of midwifery and nursing to form the new Midshires College of Midwifery and Nursing. The existing colleges, between them, serviced hospitals in a large area of northern England. The NHS appointed a Steering Group to oversee the merger, comprising 24 senior managers drawn from the hospitals serviced by the existing colleges. The remit of the Steering Group was fairly straightforward: To oversee the amalgama-tion of the five colleges. In the past, such mergers had been relatively straightforward with everyone keeping their jobs and, for managers at least, an increase in pay to reflect the increased size of the new college. However, there were three issues which made this process significantly dif-ferent and potentially more complicated than past amalgamations. First, there was uncertainty over the demand for nurse education in the future (both in terms of 532 numbers and function). Therefore, there was a threat to jobs.

Second, a potential conflict of interest existed

between the General Managers on the Steering Group on the one hand and the new college on the other. This was owing to the fact that in the past, NHS policy had tied hospitals to a particular college of nursing, whether they liked it or not. This policy had changed and, in future, the General Managers would be able to choose which college of nursing would educate their trainee nurses. They could, if they so wished, put their requirements for training new nurses out to open ten-der to any college in the country, as one Trust else-where in the UK had already done. In addition, and in the short term more probably, they could seek alterna-tive suppliers for post-experience courses (i.e. courses for already trained nurses who needed to upgrade their skills), or even provide these courses themselves in competition with the new college. Indeed, two of the Health Authorities had already established their wn organisation for delivering post-experience nurse education in competition with the new college. This is perhaps why some members of the Steering Group suggested that the new college should not have in its remit the provision of post-experience courses (with implications for the jobs of some 30 per cent of existing staff in the five colleges to be amalgamated). Therefore, key players in establishing the college found them-selves placed in a somewhat ambiguous position with regard to its purpose and remit. Lastly, it was expected that qualifications gained at the new college would be validated by a higher educa-tion institution and that eventually, as similar colleges were doing, it would actually merge into the university sector. There was no formal or explicit acknowledgment of these potential problems or that this amalgamation was in any way different from previous ones. It might have been expected that the Steering Group would seek to clarify these key issues before proceeding to resolve the structure and organisation of the new col-lege. After all, how could decisions regarding its struc-ture and functioning be resolved in advance of key decisions on student numbers, course content, areas of operation, and whether or not it would merge with a higher education institution? Nevertheless, the Steering Group avoided consciously tackling these issues prior to commencing the merger process.

developing the strategy The Steering Group decided that merging the five col-leges could and should be managed as a straightfor-ward and uncomplicated, almost mechanical, process. They established a 24-month timetable for merging the colleges and appointed a Project Leader, on a fixed-term contract of 24 months, to accomplish the task. The appointee was the principal of one of the col-leges being merged. He had no direct experience of merging colleges but had only two years’ service left prior to retirement. This meant that, unlike the other four college principals, he would not be a potential candidate for the principal’s post in the new college. Surprisingly, the Project Leader was given no budget or administrative or specialist support. He could, though, call on the resources of the five colleges, pro-viding that the principals agreed. Within 48 hours of his appointment, the Project Leader contacted the principals of the other colleges, by text, and announced both the formation of a Project Board and its membership. The membership included the Project Leader and the principals of the five colleges,

including the acting principal from his own college. There were also three external members brought in as advisors to the project group. These were a Finance Manager and a Personnel Manager from the Regional Health Authority and the Education Officer from the Nursing and Midwifery Council. By the time of the Project Board’s first meeting, the

Project Leader had produced a plan which, among other objectives, proposed the immediate integration of some administrative processes and the centralisa-tion of student recruitment. The core of the plan was the establishment of four sub-projects aimed at inte-grating the major functions of the five colleges: pre-registration courses for nursing; post-registration courses for nursing; midwifery education; and educa-tion support services. The first meeting of the Project Board discussed its

own membership, the Project Leader’s project plan, the roles of the Project Board members, communica-tions, the development of new courses, and the accountability of the Project Board to the Steering Group. The Project Leader stated that he had been given clear instructions by the Steering Group, and that the task of the Project Board was to get on with the job of integrating the five colleges as laid down in his project plan. This first meeting set the pattern for the future; the Project Leader would act as the only conduit between the Steering Group and the Project Board, and questions relating to the pace, purpose and form of the proposed merger were not part of the Board’s remit. Within these constraints, scope for questions and initiatives existed, but the Project Leader had the final say on all matters.

time for a rethink

In month 5 of the merger timetable, a one-day staff conference was organised for everyone employed at the five colleges. The purpose of the day was to brief staff on developments and get feedback from them. It was apparent as the day progressed that, although staff in the colleges were enthusiastic about the change, and indeed appeared to have more enthusi-asm and ideas than the Project Board itself, there were key issues which were not being addressed and which were causing increasing concern. The main concern for staff was that no one seemed to have a clue as to how many staff would retain their posts in the new college, or what mix of skills would be required. However, staff were just as concerned, if not more so, by the lack of any clear direction for the new college: What was its mission? What products and services

would it provide? How would it be structured? Who would make these decisions, when and on what basis? What seemed to shock and dismay many of the staff was that the Project Leader seemed as uncertain and powerless as they were regarding these issues. The conference brought home to the Project Leader

the lack of progress made towards amalgamation. The sub-groups had met frequently and produced extremely detailed plans; but the ability to turn these plans into actions seemed to elude them, partly because key issues had still not been resolved. For the Project Leader, the conference had crystal-lised a number of his concerns regarding both the pace of the amalgamation and the effectiveness of the Project Board system. He also, privately, expressed the view that he had become a ‘piggy in the middle’ between the Project Board and the Steering Group, having critics in both camps but supporters in neither. In addition, some members of the Project Board were meeting informally but regularly to discuss and promote alternative ideas to those of the Project Leader, though whether he was aware of this was unclear. Similarly, Project Board members were seeing members of the Steering Group informally as well. So a great deal of behind-the-scenes lobbying and jockeying for position was taking place. This was hardly surprising, given the uncertainty – par-ticularly over jobs – which was present. Shortly after the staff conference, the Project Leader called a one-day Project Board meeting to dis-cuss progress, and he invited the Chair of the Steering Group to part of the meeting. Though members were told that the meeting was to examine the situation and discuss options, they were in effect presented with a fait accompli by the Project Leader. He made a number of major announcements at this meeting which in effect tore up the previous four months’ work:

? The Project Board was to be disbanded and replaced by an interim Management Committee for the new college.

? The four existing principals would become part of the Management Committee with specific areas of responsibility.

? The role of the existing principals in the five individual colleges would be replaced by the appointment of heads of sites.

? The sub-projects were to be abandoned; in their place, the Project Leader announced a structure for

the new college which would, he stated, be fully operational by month 12 of the merger timetable.

Despite these changes, decisions had still not been

taken regarding the number of students the new col-lege would have in the future, whether it would be allowed to offer post-registration courses, or whether it would be moving into higher education. Without this information, it was almost impossible to deter-mine staffing levels and the skill mix for the new col-lege, or judge the appropriateness of the proposed structure. In such a situation, inevitably, staff morale continued to decline, especially among staff on short-term contracts. One example of this was the high number of staff, especially in managerial positions, who were on long-term sick leave with stress-related illnesses.

time for another rethink

The creation of the Management Committee appeared to have had little positive impact upon the new college. The new structure still existed only on paper. The reports from the Management Committee were vague, irregular and fragmented. However, in month 9 of the merger timetable, a new Chair of the Steering Group was appointed. The new Chair came in with a sense of urgency to resolve staffing issues because it had been decided by the NHS that his Hospital Trust would take over formal responsibility for the college by month 18 of the merger timetable. This meant that any redun-dancies that might arise, and any associated costs, would be borne by his Trust.

1. Using Figure 14.3, analyze the Project Leader’s leadership style and approach to change, and the degree to which these were appropriate to the situation he faced.

Key points:

• In using Figure 14.3 to understand the challenges facing the Project Leader, students should firstly focus on quadrant Q2, which addresses issues to do with large-scale structural change. This would suggest that the approach necessary for Midshires’ situation would be the sort of ‘Bold Stroke’ transformational change advocated by Kanter et al – see Chapter 10. Kanter et al also advocate that such an approach would need to be followed by a ‘Long March’ in order to be successful in the longer term.
• Students should, therefore, compare the Project Leader’s leadership style and approach to change with Kanter et al’s recommendations. They should then use the outcome of this comparison as the basis for determining the appropriateness of the Project Leader’s approach to change.