Name: https://www.linkedin.com/in/dr-dananai-d-mutandwa-6232542a

Assignment: Organization and Human Resource Management 2

Title: SHRM formulation, implementation and challenges faced with ‘Modernizing Medical Careers’ (MMC)

Tables of contents

MMC HRM strategy and practices……………………………………………………………………………....2

SHRM Factors and practices that resulted in failure of MMC……………………………………….6

HRM strategy I would recommended………………………………………………………………………….9

HRM policies and practices that will improve the function and publicity of MMC………12

Bibliography…………………………………………………………………………………………………………………16

1. MMC HRM strategy and practices

Modernizing Medical Careers (MMC) is career development program that was introduced in 2005 for postgraduate medical training in United Kingdom on the bases of advice from unfinished business report headed by Sir Liam Donaldson. It was introduced to address medical postgraduate training needs of senior house officer (SHO) that were refereed by Sir Liam Donaldson as “the lost tribe” (Donaldson, S. L., 2002). According to Sir Liam Donaldson’s report (2002) MMC was to achieve the following training goals:

1. “be program-based; 2. be broadly-based to begin with for all trainees; 3. Provide individually-tailored programs to meet specific needs; 4. be time-capped; 5. Support movement of doctors into and out of training and between training

programs

6. Trainee-centered; 7. Competency-assessed; 8. Service-based; 9. Quality-assured; 10. Flexible; 11. Coached; 12. Structured and streamlined” (Donaldson, S. L., 2002).

Donaldson, S. L. (2002). Unfinished Business, Proposals for Reform of the Senior House Officer Grade. EDINBURGH: Great Britain, Department of Health.

“The report proposed that reforms should ensure that as many doctors as practicable wishing to enter higher specialist or general practice training can do so” (Donaldson, S. L., 2002). “The programs will enable doctors in SHO training to gain the right knowledge, skills, attitudes and experience in the minimum time and will:

a) Poor job structure: half of all SHO appointments are short-term and do not form part of any training rotation or program;

b) Poorly planned training: there is no defined end-point to SHO training. Time spent in the grade varies and is often independent of training requirements;

c) Weak selection and appointment procedures: these are not standardized and are frequently not informed by core competencies;

d) Increasing workload;e) Inadequate supervision, assessment, appraisal and career advice;f) Insufficient opportunities for flexible training;g) Unsatisfactory arrangements for meeting the training needs of non-UK graduates;h) The relationship between Royal College examinations and their relevance to training

programs varies greatly” (Donaldson, S. L., 2002).

This was mainly after the success of Calman reforms on specialist training for middle level medical doctors. The reforms did not take into consideration of SHO who become the workhorse of National Health Service (NHS). As a result the SHO were left out. The ministry of health embarked on nationwide consultation in response Sir Liam Donaldson “unfinished business report”, to address the plight of SHO doctors (Donaldson, S. L., 2002).

“Sir Liam Donaldson proposed that a single training grade encompassing: foundation; basic specialist; general practice; higher specialist; and individual training programs should be urgently explored” (Donaldson, S. L., 2002). “The report further eluded that in such an arrangement doctors in training would move seamlessly through the grade subject to satisfactory performance and assessment” (Donaldson, S. L., 2002). Sir Liam Donaldson’s report warned that “implementation could not be immediately and some element of application and competition may still need to be retained to meet the needs of the service and availability of training places” (Donaldson, S. L., 2002). Sir Liam Donaldson report advised that it should be

“explored specialty by specialty” (Donaldson, S. L., 2002). The report advocated for “earlier and regular career guidance” for junior doctors and SHO (Donaldson, S. L., 2002).

The report proposed that “postgraduate medical deans should be responsible for the overall management of program-based training, using program directors accountable to them; postgraduate deans would also be responsible for ensuring that trainers were adequately supported and trained, and for ensuring the quality of training placements; it was also proposed that postgraduate deans should be responsible for the appointment arrangements to all programs (foundation, basic and higher specialist and individual)” (Donaldson, S. L., 2002).

Sir Liam Donaldson’s report also proposed the “provisions for basic specialist training should ensure that the needs of non-UK qualified doctors are fairly and properly taken into account and that they have equal access to high quality training programs” (Donaldson, S. L., 2002). Insight of the reforms of SHO grade, the report proposed that doctors in higher specialist training should be awarded a “Certificate of Completion of Specialist Training (CCST) earlier than at before and that would make them eligible for appointment to a ‘generalist’ consultant post in their chosen specialty” (Donaldson, S. L., 2002).

Sir Liam Donaldson’s report proposed that “the non-consultant career grade should be restructured so that some of the stigma associated with that grade be removed, and its prestige be enhanced that the opportunities to enter (or re-enter) higher specialist training from it be simplified and feasible than what was the practice” (Donaldson, S. L., 2002). This was the backbone of MMC which gave birth to MMC.

Different HRM strategies we used during formulation, implementation and reviewing. The committee formulated a program that was to address the above challenges. Pre-registration house officer (PRHO), often known as a houseman or house officer was replaced by a two year foundation program which was divided into:

1. Foundation 1, upon which on completion, the doctor is awarded General Medical Council (GMC) certificate.

2. Foundation 2 where by doctor had limited supervision

In doing so the MMC had a job design for doctors and SHO training. After foundation training, “doctors were to proceed to do a run-through program which was supposed to be flexible and seamless specialist training process leading directly the award of a CCT (Certificate of Completion of Training)” (Donaldson, S. L., 2002). This new job design was done to improve job satisfaction, quality of patient care, make the whole process smooth and as form of Career development among the SHOs. However, in reality it did not meet the expected output. This was because performance management for the whole process was no done properly as evidence by lack of pilot project during implementation stages. The goals which were set in unfinished business by Sir Liam Donaldson were totally ignored during the implementation process. The actual results were opposite to the initial goals. During the implementation no rectification of the flaws were done even though they were apparent.

The MMC used training as a means of motivating SHOs to take specialist training. However, “the selection of this training was highly flawed” as evidenced The House of Commons volume 1 report (2008) (Committe, 2008). “During the selection period, the MMC used an internet based application system called Medical Training Application Service (MTAS) whereby eligible doctors were to fill in on line application forms selecting four different programs from the 59 programs available” (Committe, 2008). The selection process was to done in two phases. In this process MMC was using E-HRM strategy. The selection process used E- HRM strategy and potential candidates filled in a programmed application form which was then down loaded by the assessors for evaluation and short listing. MMC did not prepare for high turnout which was the case in the 2007 crises. The selection process was not fair in the sense that the MTAS was not secure enough as some candidates had their application forms altered and curriculum vita (CV) were not used during assessment. Entry to the pathway was competitive in selection where candidates had to compete for few placements. The selection was centralized in implementation and was to be implemented at the same time in the whole country. This process brought insecurity and anxiety among the candidates as they were not assured of placement. The selection process did not restrict foreign trained doctor applying into the training pathways, which resulted in high turnout. This disadvantaged United Kingdom trained doctors in securing few placements available. The selection process defeated the purpose of reforms which it wanted to achieve in many ways. It was rigid not flexible and many people were not assured of placements. The selection process was not accepted by the employers and candidates. “This caused public unrest as evidenced by demonstrations in London and Glasgow by junior doctors and resignations by senior administrators of MMC” (Committe, 2008)

In implementation of MMC non European doctors who were eligible for selection increased the number of candidates who applied. The MMC tried to bar them for selection, but it was contested in the courts. The implementation of MMC lacked leadership as there was no one who wanted to be accountable of the crisis. It was implemented without piloting the process. SWOT analysis was not done properly during the implantation period. MMC did not rectify the weakness in MTAS, and did not respond appropriately the threat posed to the MTAS and MMC program.

MMC innovation was the main HRM strategy used to improve patient care and differentiate British health care delivery. This innovation was to be achieved through training and human capacity development. SHOs were to be trained in a flexible, time based program. The aim of MMC was to create diversity and job satisfaction among the SHO doctors.

MMC program was also introduced to retain highly skill doctors in NHS to maintain an edge in health services. During foundation period there was job rotation which enhances junior doctor’s skills as they were exposed to different challenges. These innovative changes were meant to motivate doctors and results in job satisfaction. They also attracted doctors to join the NHS. From unfinished business point of view, “international trained doctors were to be given a chance to enter into training pathways easily”(Donaldson, S. L., 2002).This was a strategy to deal with key skill gaps and retain them in the system. MMC process did not ensure that

fairness and respect of people from all section of society properly. This was against the founding principles of MMC.

In conclusion the HRM strategies used in MMC program were not effective. The program lacked leadership and direction leading to 2007 medical crisis of all times in United Kingdom and its collapse. The implementation of the program was poorly done by people who could not take responsibilities of the outcome. It was not piloted, inflexible and was rushed with many flaws. It results in uncertainty among doctors. There was no proper co-ordination “between home affairs and ministry of health for foreign trained doctors’ recruitment and permits” (Committee 2008).

During implementation phase inadequate consultations were done to the medical personal and stakeholders. The original goals “such as professionally led, flexibility”, excellence in medicine and sensitive to service requirements were lost during the way and the outcome was parallel to the intended results (Donaldson, S. L., 2002). This could have been cause by implementers who were not evaluating their progress. In a way MMC was not money down the drain but a learning curve.

2. SHRM Factors and practices that resulted in failure of MMC

The MMC lacked integrity in a number of ways and was bound to fail. SHRM practices used were not feasible, realist, achievable and practical. The policy formulators’ were out of touch with reality. Important recommendations were ignored by the policy makers. It appears as if there was lack of understanding of the reforms from the policy markers. The failure of MMC could have been brought by a number of factors that include:

• Lack of leadership

• Inadequate preparation and poor SWOT analysis

• Lack of involvement of stakeholders in the formulation of MMC

• Poor selection and recruitment process: Centralization, online application forms

• Poor performance management

• Poor implementation

• Employee relations and legal requirements

The implementation of MMC lacked appropriate leadership. “The chief medical officer distance himself from the MMC” in the Third Report of Session (2007–08 Volume I) yet he was active involved in writing the unfinished business which was used as the bases of MMC (Committee 2008). The implementers diverted from the original goals when they were implement MMC. There was not leadership to guide the whole process. The whole process went on unchecked and no rectification was done to align with the original goal. In unfinished business, Sir Liam Donaldson report proposed that postgraduate “medical deans should be responsible for the overall management of program-based training, using program directors accountable to them; postgraduate deans would also be responsible for ensuring that trainers were adequately supported and trained, and for ensuring the quality of training placements”(Donaldson, S. L., 2002). That was not the case in implementation of MMC.

Sir Liam Donaldson warned that “implementation could not be immediately done and some element of application and competition may still need to be retained to meet the needs of the service and availability of training places” (Donaldson, S. L., 2002). This was not the case the process was rushed without piloting it first. Sir Liam Donaldson advised that it should be “explored specialty by specialty” (Donaldson, S. L., 2002). The MMC was broadly applied without evidence based success. There was lack of preparation in the implementation process. SWOT analysis was not done. The NHS was impresses with unfinished business report and hurriedly enforced the implementation of MMC without exploring possible weakness as advised by Sir Liam Donaldson. These weaknesses were to cause the downfall of MMC. The committee responsible did not take opportunities presented by the stakeholders to postpone implementation by one year. MMC showed that the people who were implementing were inadequately prepared to face the threat posed by the medical training reforms. The implementers did not consult the brain child of MMC in its implementation, thus they seem to divert from the purpose of the reforms.

The whole process was done with no involvement of the stakeholders namely the postgraduate deans and SHO. They ignored most of the ideas present to them in the formulation process. The

postgraduate deans were not actively involved yet they were supposed to oversee the whole process. This resulted in some assessor refusing to take part in the process because their voices were not put it consideration. Doctors on the other hand were not happy, “resulting in demonstration in London and Glasgow” (Committe, 2008). The stakeholders felt that they were not involved and the whole process was unfair and not representing the interest of British medical health system.

The selection process was flawed. The MMC introduced a new online Medical Training Application Service (MTAS) which had a lot of gaps. They anticipated that few people will apply and created less post than demanded. The demand was almost tenfold than the supply. There were many non-UK qualified doctors who applied for placements. There criteria of having one person applying for four post overwhelmed the whole process as some individuals had more than two interviews while others had none. Centralization of the process caused many problems as candidates had only one chance in a year to enter into the program. The fact that MTAS was centralized resulted in overwhelming application which was then improperly managed resulting in frustration among candidates. The candidates could not apply to many colleges as was in the past, this means any slight mistake, and they will be out of training. This was against the founding principle of making the whole process “flexible” (Committe, 2008). “The MTAS system was not secure enough because the public had access to it” (Committee 2008). This proved that MTAS was not reliable as anyone can edit or alter candidate information resulting in bias. The employers and candidates were not impressed with way MTAS operated. During the selection process the criteria of matching candidates to available placements were not fair. Curriculum vitas (CV) which gives a better reflection of candidates were not used. The application form was not adequately prepared to reflect candidates, experience, strength, capabilities, attributes and skills. No stimulation program was used to select and match candidates. The selection timeline was long and result in anxiety among applicants.

Affirmative action was not employed as they tried to segregate non-UK qualified doctors from entering into the program. This was against the founding principle proposed by Sir Liam Donaldson that “there be provisions for basic specialist training should ensure that the needs of non-UK qualified doctors are fairly and properly taken into account and that they have equal access to high quality training programs” (Committe, 2008).

There was no evidence to show that proper performance management was done during the implementation process. The whole purposes of reforms were to improve health service delivery in UK. The aim of reforms was to achieve the goals prescribed by Sir Liam Donaldson. However, during formulation and implementation of MMC references to the original goals was not done. This resulted in an opposite outcome as was expected mainly because no evaluation

of progress was done. Implementers were in a hurry to reform the health service delivery system without taking necessary precautions to ensure smooth progress. No proper analysis or feedback of progress was done or given. In addition to that, no rectification of MMC system was done to align to the goal or address loophole in MMC as they arise. As a result of all these, the MMC system was not efficient enough to bring the required change. As a result, MMC disintegrated.

Legal aspect also contributed to the collapse of MMC initiatives. The MMC tried to segregate non-UK qualified doctors from applying for postgraduates places. This was contested by the affected groups and delays in the court resulted in overwhelming turnout. Employee relation resulted in pressure group and union contesting MMC decisions resulting in delays and failure. Due to these reasons some of MMC performance management measures were unenforceable.

In conclusion MMC failed mainly because it was poorly implemented by the think tank at the central policy offices of the NHS without adequate stakeholder involvement, lack of accountability, leadership and lack of piloting. The whole process was done by people who were out of touch with reality mainly not involved in postgraduate training such as deans and SHO. The selection process was flawed in the sense that it was not secure, dependable, reliable and reflective of candidates’ capabilities. The policy makers ignored most of the recommendation by Sir Liam Donaldson which were supposed to be the backbone of it. As a result, MMC suffered a stillbirth.

3. HRM strategy I would recommended

The organizational strategy must fit to functional strategy and individual specialist program. All ingredients of the strategies should be reciprocally and supportive. NHS should formulate strategies that meet its need, based on detailed analysis, can be converted into actionable programs, meets the needs of all stakeholders and are coherent and integrated.

I would recommend them to come up with good HRM strategies that result in fit between policies and programs. I will also emphasize that the success of a strategy greatly depends on execution not necessarily the strategy itself. Therefore success of a strategy depends on implementation.

I would recommend them to do an environment scan and a SWORT analysis. During that period they should hold consultative forums and workshops with the stakeholders of the programs namely SHOs, consultants and many others. After gathering enough evidence, they should engage SHMR specialist to define an achievable vision, mission, and strategic goals. The NHS should clearly state there strategic objectives. These strategic goals and plans should be formulated in such a way that capabilities and resources fit with the environment and atmosphere of the business.

When the mission and goals are clearly defined, they can then formulate strategic plans at a national level. They have to task regional health leaders to formulate strategic plans at regional level that fit with the national levels plans. The management in turn will task the respective collages to formulate their plans which are in keeping with both the national and regional level plans. By so doing, they are involving line managers in the formulation process and the program will likely be successful. When the formulation is finished, they should start implementation of the strategic plan in stages. The action plan should be designed in such a way as to give NHS competitive advantage in service delivery. The first stage would be pilot projects were small populations are targeted to see if the plan is feasible and actionable. The NHS should have started with one count for example and see the effects of the new project. During piloting, weaknesses of the program could be picked and rectified without causing much damage. The pilot project will be evaluated in due course and adjustments would have been made for strategic fit. In that time the online application could be perfected without affecting many people.

NHS was supposed to recruit managers of the MMC who are highly skilled, motivated and flexible. Those managers should fit into the organizational strategy. The policy makers should have involved medical expertise in the form of Sir Liam Donaldson, SHOs, postgraduates’ deans and representatives of junior doctors in the formulation MMC programs. The policy makers should have elected responsible leaders with help of respective deans and head of all 59 programs to oversee the effective implementation of MMC. The managers were supposed to oversee the whole implementation process.

The NHS was supposed to delegate the implementation to the MMC managers and postgraduates’ dean who in turn, were supposed to report to the NHS police makers. This was mainly because the deans were the line managers for the proposed reforms and were in a position to identify any problem that may arise. These were to provide the needed leadership.

The selection process of postgraduates was supposed to be decentralized to individual university or collages. This was going to decongest a central application process. The respective

deans were to spearhead the selection process. The requirements for selection were supposed to be completion of the foundation program and registration with General Medical Council (GMC). Non-UK qualified doctors were supposed to have a valid permit that allows them to study. The applicants are supposed to upload a detailed CV, supporting qualification and two academic references for consideration. The selection process was supposed to have a deadline. All the postgraduate schools were supposed to be strategically connected in such a way that students are not offered the same placement twice. There was supposed to be a central system that connects all school. With this central system, candidates will be able to transfer from one school or program without problems. The central system was supposed to have all postgraduate programs and be accessible to all registered doctors. Respective deans were supposed to conduct interviews for placement with the help of specialist consultants. The deans should use candidates’ talent and capabilities in placing them in specific programs. The candidates should have had an option to take a flexible run through course or go straight into a well structured specialty. The run through specialist course were not supposed to be time capped but performance, capability and competent based. The run through based was supposed to have clinical and written evaluations throughout the year at different location for those who are ready to take at any time. These evaluations were supposed to be structured for different stage such as year 1, 2, 3, 4 and 5. Upon completion a doctor can be awarded a masters degree in medicine for their respective programs. This strategy will bring flexibility for students, those who are faster can finish earlier and those who are slow have all the time to finish. The curriculum should also involve internet and online distance education for suitable programs. This will enhance flexibility.

The postgraduates’ students should be paid a salary which is determined by their progress in the program this will motivate them to progress fast. During training candidates should be award study leave during examination time. Necessary academic materials should be made available for student’s access. In so doing, people are encouraged to specialize and hence bring about human capacity building within NHS.

The training schools are supposed to institute a training appraisal system whereby students are supposed to criticize any shortfall within the system. The training system should then be realigned from time to time to meet the ever changing organizational expectations. The system should stimulate high involvement of postgraduates, lecturers, public and NHS. All stake holders should be treated as partners of the reforms. This will bring high commitment and make the implementation a self regulated process which will likely be successful.

The NHS should embrace principles of corporate social responsibility among the lecturers and students. This will motivate stakeholders to acquire necessary skill, attributes, distinctive capabilities and experience needed for it to have competitive advantages. The NHS should also

encourage students to do strategic research that will increase knowledge and innovation in health department. The discoveries and knew knowledge gained from these researches should be managed well so that other students can beneficially use it.

NHS should embrace worker relation when formulating new policies. They should have had consultative meetings with the junior doctors. When making decision, NHS should consider the legal requirements first because if their decisions are challenged in court, they will pay dearly. NHS should make decision and policies which are not political motivated but gives the competitive advantage through people. The strategies and action plan should be in response to the need of the organization and are consistent with their goals.

The postgraduate program should be structured in such a way that it is flexible, allows innovation, efficient and comprehensive. The program should accommodate candidates with different learning styles such as Kinesthetic, visual, auditory and reading. The program should be closely monitored by the respective deans to institute discipline and ethics among candidates. The program should be flexible allowing student to voluntarily leave and come back.

In conclusion the NHS should motivate SHOs to enter into postgraduate, making the program more flexible, individually oriented and tailor made for specific specialties. The NHS should delegate day to day running of postgraduates to respective deans and the take a regulatory function. They should monitor postgraduate school to ensure that they are sticking to the national training standards. This can be achieved through the use of external examiners during evaluations. These examiners will in turn give feedback to both the collages and national board.

4. HRM policies and practices that will improve the function and publicity of MMC

I will suggest that MMC should implement several innovative HRM Practices strategic policies. HRM practices are statutes or tools used to manage the human resources effectively ensuring that optimal utilization of resources is achieved to give uttermost advantage to an organization.SHRM policies are formulation, process, statutes or procedures that need to be followed to achieve certain goals. They describe how something can be done. These procedures should be clearly written and made available for all stakeholders to use. They need to be reviewed from time to time to give an organization an urge in the market. The policy should be realistic, reciprocal and reproducible in many situations.

I would recommend that they put in place a recruitment and selection policy. This policy should state precisely what should be done during application period. The policy should specify the required qualification, skills, experience and expertise. The policy should clearly state the minimum requirement for the job and addition qualification which may be considered. The policy should clearly describe the role and responsibilities of the candidate and how the candidates can apply. The policy should clearly describe the application process such as adverts and minimum time for adverts. The advertising could be internal or externally. The adverts must be done without discrimination and in a fair manner. The policy should clearly outline the procedures to be followed during the recruitment period. The panelist of interview should be strategically selected to ensure that the candidates who will be selected will meet the needs of an organization. The policy should put in place tools and statutes that makes the process cost effective for the organization and candidates such as having interviews online, at one venue for many candidates or selecting candidates using information from the application form and references. The aim of this policy is to make recruitment process effective and efficient. It should ensure that the best person for the job is recruited and that other equally good candidates are shortlisted for possible engagement.

In a big organization, dismissal of employees may be an evil necessity. For example an individual may be fired from work for misconduct. Type of misconduct in health facility includes the following:

StealingUnprofessional or unethical conductPlagiarism Violating organizational policy or practices Repeated absenteeism from work and lateness

These problems which are common for a large organization such as NHS requires for tangible effective disciplinary and dismissal policy. I will therefore recommend them to formulate an effective dismissal policy. In the policy, there should be a disciplinary committee comprised of different departments for diversity. The policy should clear state the procedures to be followed when firing individuals. These may include written and oral warning given to the individual affected. The policy should ensure that legal requirements for dismissing an individual are meet. The policy should clearly state the degree of misconduct such serious misconduct and gross misconduct. The policy should also state the punishment that will negate each and misconduct. This policy should be made available to every member of the organization for reading or use during a disciplinary hearing.

The NHS is embarking on a career development which is supposed to be flexible allowing students to discontinue and renter a program. This will necessitate a discontinuation and

resuming policy. This policy should be put in place explaining the minimum standards needed to discontinue and resume studies. It should also states necessary steps that need to be taken when discontinuing and when re-entering. This policy should be standard for each and every program. The policy should not be discriminatory but should ensure high quality of the program.

NHS should institute a reward policy to reward exceptional employees. I will recommend them to put in place a reward and recognition policy. This policy should reward individuals who have excelled in their capacity or departments. These extraordinary contributions could be invention of a new drug, improving health standards or even high pass mark. NHS should reward them in the form of money, salary increment, awards and nominations for awards. They can even be knighted by the queen. The policy should stipulate procedures to be followed for awards. Nomination could be done by lecturers or panelist of expertise. This policy will motivate individual to aspire excellence and hence improve the organizational performance.

NHS should put in place training and career development policy in place. This policy should define the priorities of NHS in career development. The aim of this policy is to identify areas of needs and then put in place tools to encourage people to take those careers. The incentives could be scholarships, bursaries or even higher salaries.

Other polices include retention policy, job design and analysis policy, involvement policy, promotion policy, Communication policy, performance appraisal policy and performance management policy. These are just to mention a few policies that can rebrand and improve the function and publicity of MMC.

MMC should adapt new practices that are flexible, dependable, reliable and tangible. These practices should be done to enhance the appearance and performance. The practices include performance appraisals, career development, training, rewards, communication flow, knowledge management and so many others.

Performance appraisal practices should be used in an organization to assess the contribution done by an individual. It can be done by a manger or a consultant. The employee can put contribution in their own appraisals. These appraisals will be used to award recognition or reward and to identify gaps in ones competence which needs to be addressed to improve organizational performance. The disadvantages of this practice are that they are not reproducible; they are biased and can create confusion on what to appraise.

Career development or capacity building is a practice that can be used to potentiate organizational performance through motivation, innovation and skill increment in an individual.

Individuals are motivated by new challenges which are present in trainings and career development. This practices increase talent base and distinctive capabilities of an organization resulting in competitive advantage. Proper training results in efficient and effectiveness utilization of organizational resources resulting in high output.

Reward is the most effective practices used to retain talented workers. This practice can give reward in the form of salary, bonuses, recognitions, incentives or even awards. Incentives can be car allowance, medical aid, housing allowance, holidays, transport allowance; and so on depending on the seniority and relevance of the employee to the organization. People can be given a minimum target to reach for them to get a performance based reward. This will motivates worker to outperform previous target and enhance organizational success. Effective performance based reward will aspire workers to distinction in their work. It will results in team building and reduces wastage resulting in high output.

Communication flow is a practice that potentiates an organization. The communication between departments, fellow workers should be effective to give a company any urge in the market. It can be done through memorandums, website bulletin release, press release, letter or even meetings. This enables an organization to share and process information which is vital for its survival.

Knowledge management is the best practice for innovation and survival of an organization. MMC should have practices to manage distinctive capabilities and discoveries from the postgraduates in a way that it can be easily accessed by future students and making sure that it not leaked to rival organization.

The MMC can regain people’s confidence through innovative strategic HRM policies that are sensitive to the needs of the stakeholders. They should engage best HRM practices that retain highly skilled, talented and performing workers with distinctive capabilities to improve its publicity. These policies and practices should motivate stakeholders to improve the functionality and appearance of MMC.

In conclusion the MMC and its 2007 crisis may appear as failed HRM, but in reality it is not. The MMC gave bases for formulation of sound policies and practiced that will give NHS competitive advantages in the near future. The crisis should be taken as a learning process for future references. The success of an organization is not only dependent on a sound HRM strategy but also on the implementation of the strategy. Thus formulation of a strategic should be all-encompassing to ensure that the line managers and all critical stakeholders are on board for its success.

BibliographyCommitte, H.o.C.H. (2008) 'Modernising Medical CareersThird Report of Session 2007–08,Volume I..', London: The Stationery Office Limited, April.

Donaldson, S. L. (2002) 'Unfinished Business, Proposals for Reform of the Senior House Officer Grade.'.