MSc SPECIALIST COMMUNITY PUBLIC HEALTH NURSING (HEALTH VISITING)
LEADERSHIP & MANAGEMENT
‘A CRITICAL ANALYSIS AND EVALUATION OF A CHANGE MANAGED IN PRACTICE’
Health and Safety Legislation in practice.
Lewin’s model for planned change in practice.
Force Field Analysis conducted at ‘Unfreezing’ stage
Ideas for lone worker risk reduction strategies from the team
Hersey and Blanchard’s model of situational leadership
Reporting in by phone safety plan
Further evaluation strategies
The Government has clearly outlined the need for nurses to develop leadership skills at all levels within the workforce in order to deliver the NHS modernisation programme (DH1 1998; DH 1999). The leadership role expected of community practitioners is evident in ‘Shifting the Balance of Power’ (DH 2001a) and ‘Liberating the Talents’ (DH 2002) with the expectation that health visitors will lead teams which will deliver family-centred public health within the communities they work (DH 2001b). The change I was to lead however was not initiated primarily to support clients, but instead to protect staff working in the community to ensure they were safe and supported in their public health work as a large proportion of the time is spent working alone. The issue of lone worker safety is particularly topical after the recent murder of a mental health support worker during a home visit (BBC News 2006). To support this proposal, Baulcomb (2003) asserts that any change management initiative should not only yield benefits for patients but also for staff and the wider organisation.
The Health and Safety Executive (HSE 2005) reports that nurses and other health care workers are 2.8 times more at risk of an injury2 than clerical workers and the vulnerability of health care workers increases significantly if they are working alone3 (Chappell and Di Martino 2000). It was a particularly pertinent time to examine mechanisms for risk reduction as they had still not been reviewed despite a member of staff being off sick4 due to an adverse incident involving lone work. As health visiting frequently requires lone work, it was clear that lone working practices needed reviewing to reduce the likelihood of a similar or more serious incident recurring.
Further drivers for change were identified as a result of observations of workers in practice. I noted the following areas of concern: up-to-date whereabouts of staff not always provided (or out of date) and a lack of a reporting-in system which would identify whether staff had finished work safely for the day. I discussed these issues with the community nursing manager who wholly supported any attempts to introduce mechanisms that would improve lone worker safety. A further driver for change was the obligation to implement health and safety legislation. Due to limitations in report length, this information has been provided in Appendix One.
If changes are to be implemented which lead to increased worker safety, this will have a positive (although indirect) effect on clients because if staff feel safer and more supported in their roles, they will be less likely to be off sick with stress or injuries (Mahony 2006) which would impact on the team’s ability to deliver the public health agenda. As workers who contribute to the implementation of health and safety measures are known to be healthier and safer than those who do not (HSE 2005), it was felt that this would be an appropriate area for the team to examine and implement change.
It was after consideration of these anteceding factors that the need for change was established and a vision created:
To improve the...
References: Bass, B. M. (1985) Leadership and Performance Beyond Expectation. New York, Free Press.
Baulcomb, J. (2003) Management of change through force field analysis. Journal of Nursing Management. 11. pp. 275-80.
BBC News (2006) Man held as charity worker killed. News item [Internet], BBC. Available from: [Accessed 20th May 2006].
Bennis, W. (1994) On becoming a leader. NY, Perseus Press.
Burns, J.M. (1978) Leadership. New York, Harper Row.
Cameron, E. and Green, M. (2005) Making sense of change management: a complete guide to the models, tools and techniques or organisational change. London, Kogan Page.
Chappell, D. and Di Martino, V. (2000) Violence at work. 2nd ed. Geneva, ILO.
Davidhizar, R. (1993) Leading with charisma. Journal of Advanced Nursing. 18. pp. 675-9.
Deegan, C., Watson, A., Nestor, G., Conlon, C. and Connaughton, F. (2004) Managing change initiatives in clinical areas. Nursing Management. 12 (4), pp. 24-29.
Department of Health (1999) Making a Difference: strengthening the contribution of nursing, midwifery and health visiting. London, HMSO.
Department of Health (2001a) Shifting the balance of power: securing delivery. London, HMSO.
Department of Health (2001b) Health visitor practice development resource pack. London, DH.
Department of Health (2002) Liberating the talents: helping PCTs and nurses deliver the NHS Plan. London, HMSO.
Garvin, J. (1996) Leadership and nursing: traditional attitudes and socialisation. Nursing Management. 3 (3). pp. 20-22.
Greaves, C. (1999) Patient’s perceptions of bedside handover. Nursing Standard. 14 (12). pp. 32-5.
Health and Safety Executive (1974) The Health and Safety at Work Act. London, HMSO.
Health and Safety Executive (2005) Work related violence: lone workers. [Internet], HSE. Available from: [Accessed 26th April 2006].
Hersey, P. and Blanchard, K. H. (1977) The Management of Organizational Behaviour. 3rd ed. New Jersey, Prentice Hall.
Hussey, D. (1998) How to be better at managing change. London, Kogan Page.
Karash, R. (1994) Learning-Org Dialog on Learning Organizations. [Internet]. Available from [Accessed 22nd May 2006]
Kotter, J. (1999) John P. Kotter on what leaders really do. Boston, Harvard Business School.
Lewin, K. (1951) Field Theory in Social Science. New York, Harper Row.
Mahony, C. (2006) Risk reduction. [Internet], Nursing Times. Available from: [Accessed 14th May 2006].
Marquis, B. and Huston, C. (2000) Leadership roles and management functions in nursing: theory and application. 3rd ed. Philadelphia, Lippincott.
McGregor, D. (1960) The human side of enterprise. New York, McGraw-Hill.
McIntosh, N.D. (2000) Implementing clinical education for phlebotomists.Nursing Standard. 15 (1). pp. 43-6
National Audit Office (2003) A safer place to work: Improving the management of health and safety risks to staff in NHS Trusts
NHS Institute for Innovation and Improvement (2005) Working with groups: improvement leaders’ guide. Coventry, NHS.
Northouse, P.G. (2004) Leadership theory and practice. 3rd ed. London, Sage.
Robson, C. (2003) Real world research. 2nd ed. Oxford, Blackwell.
Selby & York Primary Care Trust. (2004) Lone worker policy. York, SYPCT.
Sheldon, L and Parker, P. (1997) Leadership and team building. Nursing Management. 4 (2). pp. 24-5
Stewart, R. (1996) Leading in the NHS: a practical guide. 2nd ed
The Suzy Lamplugh Trust. (2005) Personal safety at work: guidance for all employees in the workplace, working off-site and travelling for work. UK, SLT.
Wright, M and Doyle, M (2005) Classical leadership. [Internet]. Available from: < http://www.infed.org/leadership/traditional_leadership.htm> [Accessed 26th April 2006].
Alexis, O. (2005) Managing change: cultural diversity in the NHS workforce
Handy, C. (1999) Understanding organizations. 4th ed. London, Penguin.
Home Office. (2005) Research development statistics: violence at work. [Internet], Home Office. Available from: [Accessed 26th April 2006].
Maslow, A.H. (1954) Motivation and personality. New York, Harper Row.
Mayhew, C. (2003) Occupational violence: a neglected occupational safety and health issue? Policy and Practice in Health and Safety. 1 (1) pp. 31-58.
NMC (2004) Standards of Proficiency for Specialist Community Public Health Nurses. London, NMC.
Percival, J. (2005) Inspire the team. Nursing Standard. 19 (34), p. 71.
Please join StudyMode to read the full document