This dissertation will aim to understand commitment and non-cooperation in a public funded healthcare organisation. This research study will be carried out in the National Health Service (NHS) in the United Kingdom, which is mainly funded through collecting taxes from the public. It does not need insurance payments from its patients unlike healthcare facilities in other countries. This is a very comprehensively networked healthcare facility and it provides a wide range of free health services to the residents of the UK.
The literature available on public funded healthcare organisations suggests that workers are committed to their profession as well as to the cause that NHS works towards achieving, i.e. working with other so as to ensure faultless service to its patients, keeping its patients healthy, reducing inequalities in the provision of healthcare services, prevention and treatment of diseases, etc. In addition, according to the literature non-cooperation in organisations is linked to frustration in workers, etc. Together with the proposed research questions, the relationship between commitment and non-cooperation in a public funded healthcare organisation is aimed at being explored by means of this dissertation.
The National Health Service (NHS) is the vast health care unit spread in the UK. It controls the health sector in UK. The National Health Service was established by the Health Minister Anreuin Bevan in the year 1948. This service is available for the whole population of the United Kingdom. NHS also works towards providing social services to the needy and helpless people. It provides residence and free home care to them.
NHS can be bifurcated into the part, which deals with the strategy, policy and managerial issues and the other, which works on all the medical facets. The one dealing with the medical facet can be further categorized into, Primary care (which involve GPs, dentists, pharmacists, etc), Secondary care (which is based in hospital and can be accessed on GP reference) and Tertiary care (in this highly specialized doctors are involved who deal with particular critical conditions).
However, with the structural changes taking place in NHS, the division between the different care units is less distinctive. The system gives the right to express their views about the service to all service users in all the four countries; England, Scotland, Wales and Northern Ireland. The NHS is the world’s largest public asset to the health services. The main reason for the establishment of the NHS was that the government aim to provide better health care service to all citizens in spite of their less income. Although some sectors like optical, dental and prescriptions are paid services. NHS is financially supported by the tax paid by the employees from their income. NHS is itself governed by DH (Department of Health, 2012).
The History of NHS
In the fifth decade, it became difficult to operate for NHS. There was a kind of agitation in people. Everybody became skeptical about the performance of NHS. The youth thought that whether they should trust on NHS and older ones felt that things were better in the past. Hospital throughput had risen and new radical treatments demanded great stamina of patients. Prior to 1990 Act, a massive bureaucracy administered all the sectors of the NHS.
When the internal market established and the purchaser-provider came apart, the ‘purchasers’ (i.e. health authorities and family doctors) had to buy the health care within a limited budget from the ‘providers’ (i.e. hospitals, organization providing treatment for the mentally ill, and people having learning disabilities and the elderly, and ambulance services). In order to become a ‘provider’ in the internal market, health organizations became NHS trusts, which were independent organizations having their own management. Initially it was a collection of 57 NHS Trusts, which came into existence in 1991. By 1995, it was NHS who provided all health care
There were some changes in the arrangement and the working pattern of the NHS trust. 10 Downing Street became integral part of the NHS. The decade was specialized by the Organisational chaos that involves the configuration, termination and reshuffle of the structure and responsibilities of NHS authorities and trusts, and the NHS Foundation Trust. The workforce in the NHS decided that if the NHS is a service without payment, the infrastructure should also be not publically owned. Then the private sector associations came for the construction of the hospitals under PFI, and run their clinical services as Independent Treatment Centers and some NHS Walk-in Centers.
The Performance of the National Health Service in the UK While making a policy it’s very important to note that how it is executed. The NHS implies with the focus in health policy in UK. After it’s inception since 1948, NHS has become the world’s largest health service unit. Here the question clearly arises that “Does NHS truly is the most competent, most. The question that obviously arises is: is it truly one of the most efficient, most unrestricted unit?” If we review the performance of NHS, the findings are as below: The NHS is managed by the Department of Health (DoH). If we watch the data of NHS’s official website, it shows a huge scale; more than 1.7 million people employed in NHS, of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners (GPs), 400,000 nurses and 25,000 ambulance staff.
It works on following core principles: The NHS provides a worldwide service for all needy persons who are not able to pay, it also provides wide-ranging services to its patients, it forms its services as per the needs and inclination of the individuals, their families, and their cares, it takes action to different requirements of diverse populations, it works continuously in order to improve quality services and to reduce errors, it supports and values its staff, its patients are treated by the monetary support provided by the public for the purpose of health care, it works together with others to provide an ideal service to the patients, it strives as far as possible to keep people healthy and it respects the privacy of individual and provide open access to information about services, treatment and performance.
Commitment in Organisations
There is a considerable amount of research material available on commitment in the healthcare sector (Allen and Meyer, 1993; Buerhaus, 1999). It has been seen that in the case of health care organisations employees are more committed to the cause that the organisation stands for rather than the organisation itself (Paton and Cornforth, 1992). According to Rebecca Smith, a leaked document reveals a startling fact that the managers at the National Health Service are forcing its workers to accept a pay cut of around five percent. They are also ending overtime payments for night shifts, weekend, bank holidays, etc.
They are reducing holidays and are introducing long working hours for each shift (Smith, 2012). Similar research shows that the workers in this sector are paid much less as compared to what they might receive if they were working for an organisation in the private sector for the same work (Hems and Passey, 1998). A large number of researchers state that organisational commitment is related to the commitment of workers to the cause of the organisation rather than the organisation itself. This is another reason why they are willing to accept lesser pay for the work they do and yet be committed to the work they are doing for patients.
Workers may also be committed to the organisation they work for because when they decide to work for a particular organisation they pick one that has causes, aims, goals, etc. that are in sync with the workers own values, goals and aims. The workers are interested in what the organisation does and stands for and they feel that by being a part of the organisation they are making a successful contribution to the society and at the same time are fulfilling their own aims and goals. The underlying reason why a worker would choose to work for such organisations still remains unexplored. Hence, by means of this research study I aim to delve deeper in order to answer such questions in terms of a public funded healthcare organisation in the UK.
If we look at it from one perspective, organisations in the healthcare sector seem to provide its workers with numerous conditions for being very committed to the organisation they are working for in the form of shared goals, values and aims. However, if we look at it from another perspective, such organisations have several problems that their employees are faced with such as low pay, unpaid overtime, long working hours, etc. (Alatrista and Arrowsmith, 2003).
According to Legge, commitment in organisations is extremely significant as only with the help of committed employees can an organisation achieve its goals and aims fruitfully (1989). Same is the case for organisations in the healthcare sector as well because these are public funded healthcare organisations and they have to ensure that the aims and the goals that the organisation stands for are fulfilled because for such organisations that run primarily on public funds, high levels of commitment in employees is of utmost importance so as to ensure that these organisation run smoothly.
According to Alatrista and Arrowsmith, commitment in workers is not one-dimensional. It is quite complicated to explain or define (2003). It may be seen that a worker is deeply committed to one particular cause that the organisation supports but not the others. There are a large number of internal as well as external factors that have an effect of commitment in healthcare organisations. A union, the profession they are in, national institutions, etc., anything can be related to organisational commitment (Baruch, et. al, 2002). If it is assumed that only internal and external factors impact organisational commitment in workers, it will not be correct. Therefore, this will need to be researched further to understand it better.
Here, it must be known that commitment in workers is not the only reason that results in workers performing better for their organisation. Hence, in the healthcare sector if a worker is performing very well, it might not only be related to increased commitment, it could be owing to any other factor such as the cause that the organisation stands for, the colleagues that the employee works with and so on. (Newell, 2002). Other than organisational commitment, it is necessary here to understand what commitment really is. This literature review will now discusses and explores the different types of commitments.