NHS Leadership Spring Debates: Patient and staff experience

Readers' comments (17)

What do you think?

• Anonymous | 9-Feb-2010 9:55 am

  Leaders responsible for low staff experience scores should be enabled to develop improved behaviours and skills. A learning organisation is one that learns from the things it doesn't do well - and improves. The culture should support that same learning in its leaders (and indeed, in all staff).
  Anne Axford, from Linkedin

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• Anonymous | 9-Feb-2010 11:03 am

  Sanctioning people is a recipe for disengagement, which is massively expensive and detrimental to the organisation as a whole for many reasons. If someone isn't performing sufficiently well there will be a reason, assuming that the original recruitment and CPD assessments are conducted properly. Finding out the reason is the first step; addressing the reason is the second step, and offering continuing support through development is the third step.
  Derek Mowbray, from Linkedin

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  Sarah FRASER | 9-Feb-2010 5:50 pm

  Is this question more of an "and" than an "or". There is significant research that demonstrates the link between staff experience and patient outcome. I am not sure how you can have one without the other?

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• Fai Lee | 10-Feb-2010 9:10 am

  Leadership is about taking responsibility by the scruff of its neck. It is also about the duty of care to one's staff. I have worked with very good NHS managers that show clear leadership potential. I also bear the misfortune of having to work with senior people who do not support staff and have blatant disregard for their subordinates. NHS leaders in a position of command must be accountable otherwise they will not earn the respect of their staff.

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• Anonymous | 12-Feb-2010 2:46 pm

  I would (in part because of my HR background) want to give weight to a leader's success in nurturing the talents of their team. This is as much about culture as numbers attending essential or other training programmes. I would be wary of using single year numbers in staff surveys to sanction people in formal leadership position - but they might well be part of reward and sanction systems if uncorrected and sustained across several surveys or build into a picture from other sources - grievances, leaver surveys, root cause analysis of untoward incidents and the like.
  
  Eric Galvin, from Linkedin

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• Paul Flecknoe | 15-Feb-2010 5:34 pm

  I agree that this is not a question of either/or, but also think that motivating and valuing the workforce is a critical management skill in any organisation with proven links between staff well-being and outcomes in many different organisational settings. As Foundation Trust and bsuiness models proliferate, with fewer clinicans in senior management, I think the danger is that performance targets mean that staff well-being is increasingly forgotten about. In organisations that provide different kinds of care for people, I think it is vital that staff feel enagaged with and cared for to enable them to engage with and care people in their job roles. Providing care and dealing with people in severe physical and psychological distress is a different kind of 'business', and staff engagement and support is critical to the success of this kind of work.

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• Anonymous | 17-Feb-2010 1:06 pm

  I think sanctioning is a bit harsh but giving the leader practical support/ mentoring/coaching (especially from a successful leader in a similar Trust) to address staff concerns and issues to produce a positive outcome could be a better way forward.
  
  Elizabeth Solaru, from Linkedin

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• Anonymous | 17-Feb-2010 1:06 pm

  I think sanctioning is a bit harsh but giving the leader practical support/ mentoring/coaching (especially from a successful leader in a similar Trust) to address staff concerns and issues to produce a positive outcome could be a better way forward.
  
  Elizabeth Solaru, from Linkedin

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• Anonymous | 17-Feb-2010 4:12 pm

  The next time you are in a queue at the supermarket and the surly teenager serving you snarles at you or makes a mistake then demand to see the boss of tesco or asda and hold them personally responsible. Sounds silly doesn't it
  Good managers and leaders can get the best out of people and often do but to suggest that all of their staff will be great 100% of the time is ridiculous, especially as dismissing people for their attitude is notoriously difficult. That is not to say that leaders should be accountable and yes they should, i'm a little concerned though that once such an idea has permeated the corridors of people who think of such things there will be a lack of common sense and 'target's set that will develop the wrong sort of behaviours

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  annetofts | 18-Feb-2010 2:58 pm

  Too frequently both organisations and individuals are unclear about the connection between leadership development and performance; so, learning may happen but may not change individual behaviour or culture. Defining outcomes that relate to personal & team performance; the organisation & its partners & to patients & carers can provide a clear focus for the design, delivery and evaluation of effective leadership development. Defining outcomes helps everyone 'start with the end in mind' and so keeps the focus on achieving benefits for the leader, their colleagues and so vitally those they serve (patients, service users and carers).
  
  Anne Tofts
  Healthskills

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  Derek Mowbray | 18-Feb-2010 3:26 pm

  Improving staff experience (whatever that means) will improve the outcomes for patients. Assuming it means staff engagement, the evidence is clear - engaged staff are characterised by 'vigour, dedication and absorbtion..manifested in high levels of energy and mental resilience, and willingness to invest energy in one's work'. If this energy is directed towards patient care, this will have a positive impact on outcomes for patients.
  Looking at the argument another way, if staff are disengaged it will be for a reason. If the reason has anything to do with ill health, either physical or mental, and if disengaged staff continue to work they become part of the massive costs of presenteeism (estimated cost about £15billion pa) - these resources are effectively denied to patients, resulted in poorer outcomes for patients. If disengaged staff go off sick, there is another massive cost that are resources denied to patients. Essentially, all managers need to be clear that managing their staff effectively is central to the production of high quality healthcare, and this means adopting the behaviours that promotes commitment and trust. However, as we all behave according to the context we are in, the cultural foundations of the NHS need to be aligned to a Positive Work Culture that encourages and expects managers to manage their staff effectively in terms of promoting commitment and trust leading to engagement leading to positive outcomes for patients.
  The Manager's Code, now out for consultation, is in three parts - managing the organisation (to build a Positive Work Culture), managing people (to build commitment, trust and engagement) and managing the service (to build, sustain and deliver high quality services). There is no short cut or quick fix.

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• Anonymous | 22-Feb-2010 11:32 am

  For me there are two really key skills for great leaders - one is courage and the other is creating trust. The problem in the health service is that there is precious little trust (in the true meaning of the word). As Stephen Covey says - trust is the one thing that changes everything - lack of trust can bring down Governments, the most successful business, the most thriving economy, the most influential leadership and so on. Lack of trust slows everything down - increases paperwork, generates more policies and procedures, more supervision, more internal and external verification - all of which detracts from the real work of the health service. The job of a great leader is to inspire and increase trust. With trust we can move faster and achieve greater satisfaction.
  
  Staff tend to see the leaf or maybe leaves on a branch - managers will see a number of branches on the tree - the senior managers job is to see the whole tree - but the leaders job is to see the forest. Sometimes it may be difficult to reconcile the leaf to the forest and in that instance the leader needs courage and both the staff and leader need trust.
  
  I guess low staff experience may be an indicator of poor leadership but I am not sure that punitive measures inspire trust - on either side - all it will do is inspire suspicion, fear, and anxiety.
  
  Dawn Hillier, from Linkedin

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• Anonymous | 23-Feb-2010 10:57 am

  As for sanctioning leaders, if staff experience scores are low, there is a need to work on group dynamics of the Trust. This was brought home to me at my recent day at the Assessment Centre. Group norms and group think can hinder creative thinking and taking a stand. The other two thoughts I would like to put forward are: Firstly, should leaders be encouraged to digest mega mass of information and think quickly or be allowed to mull over things? Turtle MInd is more effective than Hare Brains for thinking through complex issues. Secondly, more focus should be on doing the right thing as opposed to doing things right.
  
  Mary Shek, from Linkedin

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• Fai Lee | 25-Feb-2010 2:33 am

  I very much agree with Dawn Hillier (post 22-Feb-2010 11:32am) about trust and leadership.
  
  I have further to add by saying that there are fundamental differences between a leader and a manager.
  
  Leaders inspire and direct staff to achieve a task, all the while maintaining a high standard of conduct and duty of care.
  
  Managers control an organisation's resources and time.
  
  Leaders must have strong management attributes but managers are not necessarily leaders and this distinction is core to the debate.
  
  Leadership means accountability, so that stories like this do not become common place:
  
  'Stafford Hospital caused "unimaginable suffering"' - The Times (-> http://bit.ly/9XNRTZ)
  
  'Mr Burnham said it was a “longstanding anomaly” that the NHS did not have a robust way of regulating managers or banning them from working, as it does with doctors or nurses.'

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• mary holmes | 26-Feb-2010 3:52 pm

  Learning and leadership are closely related & moving towwards a learning culture needs clarity of what is meant - what are the desired outcomes? The outcomes need to relate strongly to the patient and staff experience - patients, service users & staff need to be engaged in defining the outcomes and achieveing the shift. In this way leaderhsip encourages learning, engagement and has an shared focus.

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• David O'Regan | 1-Mar-2010 5:25 pm

  We are in a service industry - it is paramount that our staff are encouraged to 'delight'. Happy staff make for happy patients. Richard Branson in Business laid bare goes further to say that staff should have fun!. Do your staff have fun? How do you know? Do you walk the floor?
  
  All leaders clinical ,nursing and mangerial need to be accountable to their staff - as a consulant I have to do a 360 but not as a CD (I have designed a quiestionnaire to ask for such feedback!). This is wrong - I would make it compulsory for all leaders to ask for 360 from the all the staff they lead - they are morally resposible for the welfare and devepment of the staff they lead.
  
  Perhaps not only should the people who do the work design and inspect the work but also elect their leaders rather than have them imposed!

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• Fai Lee | 16-Mar-2010 9:09 am

  @DAVID O'REGAN (post 1-MAR-2010)
  
  Quite right on all aspects.
  
  I couldn't agree with your sentiments more.
  
  Regards.

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