Blair Mcpherson's Comments
Comment on: Tackling the cultural challenges of leadership
In order to change the organisational culture you need to change the management culture!
A disappointing response from those responsible. This isn't about complex staffing formulas or smart staffing rotors. This isn't about a response for all wards. A series of critical reports highlighted that elderly patients were being neglected, receiving poor care blade ring on abuse due to inadequate staffing levels and an over reliance on health care assistants. There were simply not enough staff on duty to ensure elderly people who might need help and encouragement to eat and drink revived it. That there were enough staff to respond promptly when an elderly patient needed the toilet and if the person soiled the bed there were sufficient staff to change the bedding promptly not leaving a patient lying in there own feces till a horrified relative arrives and complains. I think most board members would understand this.
Too much emphasis on leadership. Too much admiration for private sector management.
Intergreated health and social care is the goal because it is more efficient as it removes duplication of services and is more customer focused as services are better coordinated with information being freely exchanged between professionals so the customer does not have to repeat their story. In a prlonged period of austerity the focus is on efficecy as a way to save money. But there isn't much duplication now because it is so hard to qualify for help from social services. As for information exchange there appears to be a lack of will to invest in getting a shared IT system at local levels whether because of the costs, past failed projects or continued professional " confidentiality" issues. In Facebook terminology the relationship between health and social care would be described as "complicated" . And we all know that is code for going no where.
It's always a bad sign if players in a partnership have to go to the lawyers to clarify responsibilities.
Comment on: Equal access to the NHS: the next step
For me it is obvious get equality and diversity right and all else follows. If equality and diversity in recruitment is right you will have a workforce that reflects the diverse population you serve. If you recruit people who do not all come from the same background, hold the same beliefs and think in the same way you are more likely to have the creativity and insight to respond to the challenges of providing services to a diverse population. You are more likely to be customer focused if your staff recognise different sections of the community want their needs met in different ways and you are more likely to have people who can think of different ways of meeting needs. Of course this will only be realised if you have managers skilled in managing a diverse workforce. This requires focusing on developing managers' people management skills. It also requires developing a safe working environment - one where staff feel able to challenge and be challenged. If you get equality and diversity right you will have developed your listening skills as an organisation and so you will have the right approach to engaging communities and working in partnership with the voluntary, community and faith sectors. How will you know if you have got equality and diversity right? By monitoring recruitment and service take up, by setting targets based on local population profiles and by service user and citizen satisfaction surveys. Such an approach to equality and diversity promotes a performance management culture. Meeting the really big challenges means radically changing the way people behave in the organisation. It means engaging staff at every level in doing things differently and it requires people to be inspired. Leagues tables have limited motivational appeal, so does saving money. Claiming the customer is king is hard to maintain in the face of hospital closures, cuts in services, removing children from their parents or admitting someone into a psychiatric ward against their wishes. And despite the traditional emphasis on charismatic leadership front line staff don't do it for the chief executive. In fact in the public sector staff tell us in staff surveys they don't trust senior managers, they don't do it for the money, they do it for the people they serve and they do it because they want to make a difference. The challenge is to maintain this public sector ethos when services are contracted out to the private sector or to the “third sector “a cross between the private and voluntary sectors. The challenge is to maintain this sense of commitment to the general good rather than the bottom line. The challenge is to do this at the same time as the public sector is adopting many of the methods and much of the language of business. What better/clearer way of doing this than focussing on fairness because that's what equality and diversity is all about. Fairness in how we recruit people, fairness in how we select people for promotion, fairness in how we treat people at work, fairness in how we allocate scarce resources and fairness in how we provide services. Fairness is relevant, fairness inspires. Of course fairness is a principle and the tricky bit is applying it in the real world but that is the challenge for the organisation; that's what everyone should be working on. For a case study in a large organisation see An Elephant in the room www.blairmcpherson.co.uk
Comment on: Context is everything in health leadership
Three quarters of senior managers on the Top Leaders program were assessed as over confident, lacking insight into their own limitations and despite their above average verbal reasoning skills were poor at providing colleagues /staff with clarity. I think this description is not limited to those who are being fast tracked but highlights the management characteristics which get people promoted and not just in the NHS. The problem is that these skills may get you the job but if you are to succeed in the job they do need to be supplement. To transform the service you need to be able to innovate, to develop partnerships and establish a harmonious working environment. To achieve this you will require insight into your own behavior and how it affects others. Senior managers rarely get this sort of direct feedback. Who is going to tell the chief executive that they are unclear about what they are telling them to do, that the way they response to requests for clarification is seen as abrasive or that any attempt to debate is seen as disloyal. Much easier to help managers gain these insights on their way up when hopefully they will be more receptive. For a case study in a large organisation see Equipping Managers for an uncertain future www.blairmcpherson.co.uk
So who is the stupid in " keep it simple, stupid". Is it any one who thinks that the "transformation " of the NHS is financially driven not practise led?
Comment on: Contract planning, or last minute scramble?
Is commissioning to be demand led or finance driven?
Comment on: Why the NHS is bucking the low morale trend
I am afraid a more persuasive explanation is that local Governmet employees have had longer to lose their faith, the cuts have been deeper and started earlier, the redundancies have been more widspread, the restructurings more painful and the use of the private sector more extensive. Give it a few more years and I am sure the NHS will have caught up.