A new approach to people management for a new NHS
For NHS organisations these are challenging times. The call for transformation, coupled with continuing financial pressures, is forcing our country’s largest employer to take a long hard look at the way it recruits, manages and leads its teams.
Since we started operation we have worked with a number of NHS organisations, all of whom we’ve challenged to take a fresh look at how they recruit, who they recruit and how they look after, develop and support their staff.
So what are the changes needed to support the drive for a transformed NHS?
The challenge ahead
In the 2014 NHS Five Year Forward View, the NHS was for the first time given a clear sense of direction – guidelines setting out how services need to change and improve.
This shared vision of the future is an ambitious plan, in which its leaders describe how the NHS needs to change if it is to close the widening gaps in the health of the population, quality of care and the funding of services.
Delivering a sustainable and transformational plan involves engaging and working with a multitude of partners and suppliers as well as the public. Great communication and relationship building from the outset are key – and this all has to happen within the austere limitations of ever tightening purse strings.
To improve performance but do so with less money demands a fundamental transformation and an accompanying cultural shift in terms of talent management, recruitment and collaboration.
Reflect on how you can do things differently
What’s clear is that continuing to do ‘what we’ve always done’ and continuing to work in silos is not an option. That kind of culture was the key problem identified by both Robert Francis and Don Berwick in their reports resulting from the appalling failures at Mid Staffordshire NHS Trust.
We recently published a series of posts about diversity of thought and how bringing in people, or supporting those you already have, who challenge the status quo is the secret to avoiding groupthink, or over deference to a single opinion leader. Instead the NHS needs to challenge the familiar, question existing process and welcome contributions, ideas and innovative suggestions from staff at all levels, and across different divisions.
Research from across the NHS and other industries has shown that strong collaboration across professional groups can improve organisational performance in terms of both efficiency and quality.
To ensure the quality of patient care organisations need to look across the system at how services can be provided in a efficient and effective way.
Technology, communication, supply chain, relationship management, data analysis, impact analysis and financial acumen are disciplines that all need to work together to ensure the system is run as efficiently and effectively as possible.
“NHS organisations that are enthusiastic about co-operation and team working, both within and across boundaries, are more likely to deliver compassionate, high-quality care.”
The King’s Fund
Here are five steps you could take to kick-start the transformation process:
- Conduct a skills audit. Assess the skills, qualities and values your organisation already has, who your key talent is, and where the gaps are. This means identifying the number of leaders needed in each area of the organisation over the next five years, and pinning down the skills, competencies and knowledge you need to recruit for to achieve the vision set out by the Five Year Forward View.
- Manage your talent to retain your talent. If you’re not fostering personal growth for your key people they will quickly jump ship to somewhere that does. Foster a culture where your employees are valued for their contribution and invest time in engaging your people all the way through the life at your organisation. This means ensuring personal development plans and performance reviews actually happen and that staff are measured on results achieved and key values exhibited.
- Recruit for difference. To diversify your approach you need people who provide a fresh perspective. You won’t get that by recruiting from the same pool of talent as before. The organisations we work with have found it effective to look beyond the health sector and bring in individuals from banking, commerce and not-for-profits, who bring with them new skills, new experiences as well as a fresh ideas. These individuals create change from within, improving processes and driving innovation.
- Encourage inter-disciplinary collaboration. It can be hard for teams with different cultures, priorities and perceptions to find common ground. While your finance team are focussed on value for money your clinicians are all about quality care. So it feels easier to work in silos. However, this silo’d way of working doesn’t breed success, it only deepens the divide.
Michael West, head of thought leadership at The King’s Fund, who have created a toolkit to improve team collaboration, says: ‘The breadth of perspective offered by cross-functional teams produces the questioning and integration of diverse views that enable teams to challenge basic assumptions and make radical changes to improve their products, services and ways of working’.
- Foster a collective leadership approach. This means moving away from the hierarchical style of many NHS leaders to a very different culture. One that requires a change in the way you and your team think about leadership.
- Work with like-minded partners. Bring in a consultant who understands the challenges your organisation is facing, and can help you attract the right people – and keep them.
Case study – Salford Royal NHS Foundation Trust
In 2001, Salford Royal received zero stars in the Healthcare Commission’s rating system. By 2012 they were one of the country’s best hospitals – in the top 10 per cent of NHS organisations on risk adjusted mortality, and for three consecutive years received the highest staff satisfaction rating of any acute trust.
How did they do it? By putting a relentless focus on safety and quality that started with changing the culture of the organisation.
- Clinical leaders were replaced with people recruited not for their reputation or length of service but for their record of high performance and aligning values. These new leaders were give greater autonomy but with it came greater accountability for performance and results.
- The organisation borrowed a performance management system from the commercial world – the GE nine box system that assesses both performance and the values that staff are expected to exhibit. With it came rewards and a system of consequences for anyone who could not do the job. For instance the often automatic NHS pay increases are only awarded if a certain level of performance is achieved.
- Underpinning all of this, the CEO, David Dalton, shifted his role to one that focussed on engaging with and supporting staff, deferring to their expertise, rather than leading from the front.
If you’d like to discuss how we can help you build the strong foundation needed to deliver both sustainability and transformation in your NHS organisation email firstname.lastname@example.org or call 01883 722008 to arrange a free initial consultation.
Case study 6: Salford Royal NHS Foundation Trust – The Kings Fund http://www.kingsfund.org.uk/time-to-think-differently/publications/reforming-nhs-within/case-study-6-salford-royal-nhs-foundation-trust
Transforming culture in failing hospitals is possible – The Guardian http://www.theguardian.com/public-leaders-network/2012/sep/05/transforming-culture-change-nhs-hospitals
Collective leadership: fundamental to creating the cultures we need in the NHS – The Kings Fund http://www.kingsfund.org.uk/blog/2014/05/collective-leadership-fundamental-creating-cultures-we-need-nhs
NHS England – Five Year Forward View https://www.england.nhs.uk/ourwork/futurenhs/