Deborah Jamieson and the University College London Hospitals

Julie Battilana, Anne-Marie Cagna, Thomas D'Aunno and Mattia Gilmartin, INSEAD, on Deborah Jamieson and the University College London Hospitals.

Many healthcare systems around the world face major reform. We felt there was a need for a case that would highlight the challenges change agents face when they try to transform their organisations. The case originated in 2003-2004 at INSEAD, when we ran the Clinical Strategists Programme for the UK National Health Service (NHS) National Leadership Centre, focused on teaching clinicians working in management roles, to be more effective strategic leaders. Each participant had to implement an organisational change project. Deborah Jamieson sought to develop nurse-led, pre-operative assessment. Based on her experience in the American healthcare system, Deborah wanted to empower nurses and had clear ideas about implementing this at her NHS Trust. Empowering nurses was a challenge. The dominant model in the NHS has physicians as the key clinical and administrative decision makers.

Teaching objectives

We immediately found this project very interesting and saw an opportunity to examine the process of leading organisational change and highlight current activities in the NHS. We developed a teaching case project and research study to track how clinical strategists went about leading the process of organisational change, aiming to address learning needs for both general and healthcare-specific management audiences. This case shows that alignment between managers and leaders at different organisational levels is an important ingredient in managing innovative service changes such as the nurse-led pre-admission clinics at UCLH. Second, it provides a great example of the interaction between initiatives advocated by the profession, in this case, expanding the professional role and scope of accountability of nurses, and the challenges that change leaders, like Deborah Jamieson, face in implementing new roles. The nurse-led admission clinics are particularly interesting because they change the balance of power between physicians and nurses.

How was contact managed?

Deborah immediately agreed with our idea to write a case about her change project and was very supportive. She arranged everything so that we could spend three days at her organisation. We interviewed most of the people involved in the change project and followed up over a two-year period with regular interaction with her. Implementation was very challenging because Deborah had to convince all the stakeholders, including physicians, about the benefits of nurse-led pre-admission. Battling against organisational inertia in one of the largest NHS trusts was not an easy task. Thanks to Deborah, we were able to have access to all the information we needed to ensure we did not miss anything important. The make-up of our team helped to ensure that we did not encounter major difficulties. Each member bought a different set of skills and perspectives to the project and we worked well together. Julie Battilana developed a close working relationship with Deborah. Mattia Gilmartin, the lead author of the teaching note, an American like Deborah with a background in nursing and management, was able to enhance how we framed the key lessons for management practice. Her knowledge of the US and UK healthcare systems and differences in nursing practice between the two countries was valuable.

Any modifications or advice? 

Mattia taught the case first in the Masters of Health Management Programme at City University, London. Three young physicians in the class reacted strongly against the idea that nurses could competently conduct pre-admission assessments. We have not modified the text but intend to spend more teaching time laying the groundwork to discuss role changes and work design in order to emphasise that this is a positive change for nurses, physicians, clients and the organisation. We are curious to see what colleagues think about the case as they use it with MBAs and executives. At some point, we may revisit the text and make some adjustments. Our experience so far leads us to encourage colleagues to write more cases about such major change initiatives in the healthcare sector.

Case details

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Deborah Jamieson and the University College London Hospitals
Julie Battilana, Anne-Marie Cagna, Thomas D'Aunno and Mattia Gilmartin
Ref 406-039-1

Teaching note
Ref 406-039-8

About the authors

Dr Julie Battilana is Assistant Professor of Business Administration at Harvard Business School, USA.

Anne-Marie Cagna is a Research Associate at INSEAD, France.

Professor Thomas D'Aunno is the Novartis Chaired Professor of Healthcare Management, Professor of Organisational Behaviour and Director of the Healthcare Management Initiative, INSEAD, France.

Dr Mattia Gilmartin is a Senior Research Fellow at the Healthcare Management Initiative, INSEAD, France and President of Gilmartin Worldwide Consulting Inc.

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