The People Manager
As I approached the desk at the health centre, the busy receptionist asked, “Is it a repeat prescription?” I nodded and she searched through the shoe-box file. “Its Mr McPherson,” she said with out checking whether that was with an “a” or “small c”. Without asking my first name she produced the prescription.
The box was full of prescriptions, hundreds of patients at this busy health centre are on repeat prescriptions, there must be half a dozen or more part-time receptionists and I didn’t recognise this one.
So how did she recognise me? Was this by any chance connected to my blog earlier this week when I referred to my difficulty getting an appointment and having to repeat myself to receptionists, GPs and nurses?
Yesterday afternoon the health centre was closed as GPs, nurses and receptionists were all on a half-day training session. You don’t think they were discussing my blog on hsj.co.uk, do you? It is accompanied by my photo, after all.
The government’s requirement for the integration of health and social care services is not about improving care or the patient’s experience. It is instead a concern about inappropriate hospital admissions and delayed discharges; money and performance masquerading as care and compassion.
‘I repeated my story three times to three different members of the same integrated community health team’
Hospitals think community health services made up of GP’s and district nurses could do more to prevent hospital admissions and they think social services are responsible for people staying in hospital longer than is medically necessary while care arrangements are made. The evidence does not support either of these claims but hospitals find them convenient excuses for exceeding budgets and failing to hit waiting list targets.
As to the claim that enforced integration is justified on the grounds of improving service coordination and communication so individuals don’t have to repeat their story, well that implies these problems don’t exist in an integrated service.
A matter of urgency
Feeling unwell and having got worse over the weekend I rang my GP surgery as soon as it opened to ask to see a doctor. When I got through the receptionist told me all the appointments for that day were taken. Was it urgent? I knew from experience that if I failed to convince her I would be offered something next week by which time I would be better or in A&E.
I played my trump card: my quadruple heart bypass. The receptionist said she would arrange for a GP to ring me to decide if I needed to see a doctor. She asked for my details name, address, telephone number and symptoms “to brief the doctor”.
An hour later a GP rang and asked how he could help. I gave a brief medical history and my symptoms he asked if I smoked, what type of work I did and what exercise I took. He made an appointment for me to see a nurse that afternoon at their other health centre. The nurse asked me what seemed to be the problem, I gave her a brief medical history and described my symptoms she listened to my chest and issued a prescription for antibiotics.
Aside from the superficial nature of my medical assessment, I had repeated my story three times to three different members of the same integrated community health team.
“I’m not here just to kick your tyres.” I had never heard this expression before. The context in which it was used was a US college scout doing a home visit with a view to offering a scholarship.
‘My experience of inspections of health and care services is they are superficial’
The expression was used towards the end of the interview to indicate it wasn’t just about the college deciding whether to make an offer, it was also about the student deciding whether this was the college for them. The image of someone inspecting a second-hand car by going around and kicking the tyres reminded me of inspections the department had be subjected to.
Inspecting hospitals, schools, care homes and a whole range of public services has been newsworthy recently, either because of scandals’ in the quality of services or claims by professionals about the unfair nature and intolerable pressure inspections can create.
Judging a car by walking around it and kicking the tyres would seem rather superficial and ineffective, made only marginally less so by checking the documentation, current MOT certificate of road worthiness and service history as an indication of how well it’s been looked after. Yet my experience of inspections of health and care services is they are superficial, overreliant on documentation provided and are not much more than a walk around with optional tyre kicking.
Potential for improvement
This has not always been the case. At one time inspectors spent far more time on site but, as resources have been cut, staffing reduced and more demanding targets introduced, two weeks on site has become 2-3 days.
‘Don’t make the mistake of being overly candid in your attempts to win the sympathy or understanding of the inspector’
The inspectors require a detailed but succinct positional statement in advance of their arrival, backed up with reference to supporting documentation and performance statistics. This is a crucial document since it is your opportunity to describe your services strengths and weaknesses. It would be a big mistake to gloss over the weaknesses as this will be reflected back as lacking insight and awareness and therefore reducing the potential for improvement!
Whatever the assessment of your service, your future probably depends on the verdict for the “potential for improvement”.
Early on in the inspection there is an interview with the person with overall responsibility for the service which will be followed up with interviews of a cross-section of managers, staff and service users. Despite the informality of this one-to-one, the head is expected to impress and show they are in touch with the issues, even though this may only be a small area of their responsibilities, and to be convincing as an effective leader.
Of course, it is tempting to see this as a charm offensive to get the inspector on side. They may talk about the difficult budget position, starting from a low base but there has been tremendous improvement over the last 18 months with very encouraging feedback from patients. Is this reflected in the evidence submitted?
Too much information
Don’t make the mistake of being overly candid in your attempts to win the sympathy or understanding of the inspector. A former boss got carried away in listing the challenges that a director faced in the current climate and concluded by saying: “To be frank this service isn’t in my top three, probably even my top 10 priorities.” Big mistake. What they meant was they didn’t have any worries about this service but that’s not how they came across.
The draft report slammed the department. We were allowed to ask for “factual errors” to be corrected but there was no scope for changing the tone of the report, the comments or conclusions. The report started from the view point that the organisation did not see the service area as a priority and this was reflected in the leadership provided by the senior management team. Despite our additional evidence, assurances from partner agencies that they had been positive and repeated reassurance from senior managers that the service was a priority, the report stood.
What was most damaging was the assessment that our prospects for improvement were poor. Why? Because the senior management team did not view the service as a priority.
We had out tyres well and truly kicked.
There is a saying that the truth is the first casualty of war. Well, when it comes to bad news the first casualty seems to be the English language.
‘Managers and politicians need to be reminded of the impact such decisions have on people’s lives’
It seems some organisations no longer make people redundant, they “demise” them or, more accurately, they “demise their posts”. Did the HR managers at HSBC advise that this sounded better than announcing 3,000 redundancies last week?
What should we understand from Barclays’ use of the expression “right-size” in preference to downsizing for describing a reorganisation that will cut 3,700 jobs? Did senior management hope to convince people that this was a positive move as opposed to an enforced reaction to the organisation’s financial position?
Mindful of your language
During a prolonged period of austerity, how long will it be before public sector organisations start using these expressions? Will some hospital trusts in future adjust staffing to “the right size”? Will local authorities be forced to “demise” more posts and will there be further exercises in “synergy related management head count adjustment” (or: reduction in management posts)?
Does it matter if HR departments create new management speak; it’s not as if it fools anyone? George Orwell explored the idea in 1984 that if you wanted to control they way people thought then first you controlled their language. Demising posts sounds less painful than cutting posts. Making organisations the right size sounds positive, whereas downsizing sounds negative. Reducing the headcount sounds detached and impersonal, while making people redundant sounds very personal.
Cutting services, losing posts and making people redundant is personal and painful. Managers and politicians need to be reminded of the impact such decisions have on people’s lives − not be given expressions to disguise it or words they feel more comfortable with.
In football, the “Rooney rule” doesn’t say if Wayne Rooney scores England will win; in fact, it is nothing to do with the Manchester United footballer. The “Rooney rule” is being transferred from American football to English soccer to require football clubs with a management vacancy to include suitably qualified black candidates on their short list.
‘Some organisations have extended the balanced interview panel to include race. Why not adopt the “Rooney rule” in the public sector?’
In effect it is an interview guarantee scheme. And it works. Ten years ago there were no black coaches managing NFL teams in the US despite the high proportion of black players. By 2007, the Super Bowl was contested between two teams with black head coaches.
On the 20th anniversary of the racist murder of Stephen Lawrence it seems appropriate to review if anything has changed. While there is evidence of general progress and change in attitudes it is still the case that black people are underrepresented in senior positions in many industries. Whether we are talking about football managers or public sector senior managers, black people continue to be underrepresented.
Clearly there is still a problem. If we want to ensure that we are not in the same position in another 20 years then radical solutions need to be tried. No public sector organisation would in have an all-male interview panel now, when 70 per cent of the staff working in the public sector are female, would they?
The concept of a balanced interview panel in terms of gender is established. Many organisations operate a guaranteed interview scheme for suitably qualified people with a disability. Some organisations have extended the balanced interview panel to include race. Why not adopt the “Rooney rule” in the public sector and have a balance short list; a guaranteed interview scheme for suitably qualified and experience black managers?
One way to mark this sad anniversary would be to show thinking has changed in the way we recruit people in the public sector.
This week’s featured publication is The Greengrocer. You know why.
Milo Minderbinder buys eggs for seven cents and sells them for five cents. Clearly this is good for the customer and good for the producer. It’s a mystery how he manages to do this and make a profit but who cares, we are all winners.
Those of you familiar with Joseph Heller’s Catch 22 will know how this commercial venture between the private sector and the public sector in the form of the US army works. Needless to say it makes Milo Minderbinder a lot of money.
So when the supermarket chain offers to build you a new library or the next time your organisation is offered this really good deal to run all your back-office services at a lot less than its costing you now, remember there is always a catch.
Mid Staffordshire is the first foundation trust to be declared bankrupt. The hospital that made national headlines when hundreds of patients died due to poor care over a four-year period from 2005 to 2009 has called in the administrators.
‘Does this mean that, however well managed, some hospitals are just not viable?’
The Francis report identified an obsession with gaining foundation status and a focus on finance at the expense of care as a reason behind the poor care at Mid Staffs.
Now it would appear that as the emphasis has shifted to ensure best care practise, the trust has followed a path of overspending. Last year the government was forced to bail it out with a £20m one-off payment and it is going to have to do it again this year. Does this mean that some trusts either stay within budget and people die or provide excellent care and go bust?
Merge or bust?
In which case does this mean that, however well managed, some hospitals are just not viable? The administrators at Mid Staffordshire appear to think that the population it serves can’t support this size of trust and that specialist services and patients needing serious care will have to be sent to Wolverhampton or Walsall.
This would appear to mean that foundation trusts need to merge or risk going bust. If you go bust then your high-status specialist services, the ones that bring in the big money and the prestige, are transferred and local people have to travel further to access these services.
So the business model is one of completive takeovers. You can see why Leeds is fighting so hard to retain its specialist children’s heart unit.
They don’t sleep. It’s not because they can’t, they just claim not to need to. I’m talking about “top bosses”. They all get up early 6-ish and work out. They do a 12-hour day, come home, read the kids a bedtime story and have a civilised dinner. On a weekend they do sports and walk the dog. They read a few emails on Sunday evening when everyone else has gone to bed.
‘From my experience of senior managers in the public sector, long hours is the norm’
They also lie. Do we really believe they don’t watch TV or eat takeaways? That they never fall asleep in front of the TV after a bottle of wine? What about the big trip to the supermarket? What about the washing of all that sports kit? Who does the cleaning and the gardening? And what about clothes shopping for the kids, for the holidays, for work? No lie-in on a Sunday?
If we are to believe the top business people interviewed in The Guardian they organise their time outside of work with the same discipline that they apply in the office, operating a rigid and punishing timetable. They build in quality time with their children and partner, but the impression is of rather selfish people who fit family and friends in around the demands of work, who see their daily workout to be as important as time with family and are rather glad when everyone else is a sleep and they can catch up with their emails.
Taking work home
These are highly effective people, very focused and very successful but surely not typical of senior managers? Well, yes and no. From my experience of senior managers in the public sector, long hours is the norm. Routinely taking work home – whether reports to read for the next day’s meetings or reading emails in the evening – is common place. Being somewhat preoccupied with work and finding your thoughts drifting to a work issue when you’re with the family or lying awake at night happens a lot.
I would take my son to school in the morning on my way to work. I frequently drove past the school, my mind already in work, only for my son to say: “Are you going to drop me off?”
Being too tired to do much on an evening except watch TV. Falling asleep on the sofa on a Friday night after a bottle of wine. Having every intention of going to the gym at least three times a week to justify the membership but mostly lacking the energy and certainly not able to go before work. Needing that lie-in on a Sunday morning. And yes, selfishly putting the job first but being totally unaware of this because most of the time you like work, you enjoy the status and you have the trapping of success.
Just because performance is good does not mean management is. A hard-hitting report by the parliamentary commission on banking standards (An Accident Waiting to Happen) pulls no punches. One of our major banks had to be rescued due to incompetence and recklessness by senior management. The report makes clear that an organisation can be making lots of money and earning big bonuses for bosses yet be very badly run. Does this only happen in the private sector? Is the opposite also true? Can an organisation be struggling to hit performance targets, suffering from low morale and experience high staff turnover yet still be well run? Does this mean poor leadership and bad management can ruin an organisation but good management does not guarantee success? So how should we judge managers?
‘Your boss gets a big bonus because performance targets were not just achieved but what did they actually do that contributed to this success?’
If your salary is linked to your annual appraisal you will be familiar with this debate. Your boss gets a big bonus because performance targets were not just achieved but exceeded but what did they actually do that contributed to this success? You on the other hand struggled to cover for absent colleagues, had to deal with the fallout from a big restructuring and spent a massive amount of time on a major investigation and subsequent disciplinary. In short a horrendous 12 months, for which you get no bonus or thanks.
What senior management contribute is the strategy. According to the parliamentary report, the bank’s strategy was flawed from the start, warnings from the former finance director were ignored and the regulator failed to act on their own concerns. There are parallels here with the public sector in the push by hospitals to obtain foundation status, the strategy of merging trusts and local authorities’ enthusiasm for outsourcing services. Don’t tell me that the financial directors of some of these organisations have not expressed concern about unproven benefits and increased financial risks or that the enthusiasm of the chairman and chief executive is shared by all. And the regulators/inspectors while they may have their concerns consider this area outside their remit.
The criticism is of boards, and in particular chairman/leaders, who with their chief executives adopt high risk, short-term strategies, who dismiss the concerns of their financial directors as being over cautious, who cut short discussion and debate as simply postponing the inevitable and consider any dissent to be personal disloyalty. These individuals are arrogant and over confident, lacking insight into how their behaviour affects others within the organisation and creating a “brash” culture.
The most telling quote from the parliamentary commission was that from the deputy chairman of the bank Sir Ronald Garrick: “I have no doubt that the HBOS board was by far the best board I have ever sat on.” Good for him. But not good for the rest of us.
Your performance in a large organisation gets you noticed and you’re head-hunted for a high-profile post. Four years on and you are again head hunted for a top job.
‘Once you were a rising star, now you are battling to keep your job. So what changed?’
Then a year into the new job you are taken to task over your performance in your previous role. You are accused of not revealing the true extent of the problems you encountered, of persistently presenting too positive a view of progress and of giving reassurances that were not warranted by the reality on the ground.
Suddenly there are questions about your integrity and doubts about your leadership. Once you were a rising star, now you are battling to keep your job. So what changed?
Internal power struggle
Was it the person who took over your old job who found the skeletons in the closet, or did they just have a vested interest in overstating the problems they inherited? Was it the aggrieved former colleague who blew the whistle on an undeserved reputation? Was it a critical inspection report that caused a reassessment of your period in charge?
Are the people who now accuse you of too much spin the same ones who were unduly concerned with protecting the image of the organisation? After all, wasn’t it part of your job to talk up performance and show the organisation in the best possible light? Were the reassurances you gave in good faith the same reassurances that your managers were giving you?
Now you face the charge of having lost the confidence of those you report to: how are you supposed to answer? Did you misjudge the situation and back the wrong person in the internal power struggle, or is it just another example of a manager being given too much credit for success and too much blame for failure.