Upping overall performance is a shared task, say Peter Noble and colleagues

What enables institutions to transform their performance? A study of more than 30 leading academic/health centres in four continents has identified practical measures that are transferable to the NHS.

There needs to be enough dissatisfaction with the current climate for people to accept the pain of changing

Despite the real terms growth of the UK health system over the past decade, in health outcomes we have fallen behind many of our international competitors.

Led by a team from Leeds University, the study found a challenging financial climate can act as either a deterrent or a catalyst for organisations in need of turnaround.

Four themes emerged, revealing the importance of organisational conditions that facilitate creativity, innovation and behavioural change to produce sustainable improvements in performance.

These relate to:

  • ensuring the workforce has congruity of goals and expectations;
  • matching ambition with potential for how realistically individual career aspirations are aligned to organisational goals;
  • looking at effective models of collaboration with partner institutions;
  • interventions that transform performance over time.

The study examined each theme in depth and identified consistent characteristics of high performing institutions.

We would suggest NHS institutions consider practical measures to support sustained performance:

Creating urgency for change The challenge for leaders is communicating the case for change in ways that inspire staff to change within the cultures where they traditionally operate.

The report suggests: “There needs to be enough dissatisfaction with the current climate for people to accept the pain of changing. Articulate what the dissatisfaction is and develop a shared vision of the future”.

Engaging staff in the search for practical solutions was the starting point for this in many institutions.

Brand identity and strengths As institutions compete in an increasing global environment, they need to embrace a performance management framework that resonates with the specific context, vision and values of each organisation.

Through the NHS climate of competition and contestability, institutions will only be able to sustain their performance by building critical mass around their niche activities.

The report recommends: “Concentrate your resources on areas of strength and consider strategic partnerships to increase capacity and capability.”

Sharing and reflection In high performing institutions we found a willingness to share and learn from best practice elsewhere and to engage regular external review. In one high performing public sector institution HR staff spent time in private sector organisations such as John Lewis to learn about different approaches to managing and developing staff.

Effective leaders A factor in determining overall NHS performance is the knowledge gap on many boards, particularly on issues such as public health. It is perhaps surprising that many leadership roles, particularly for clinicians, still have little formal development input. Successful institutions displayed the characteristic of humble leaders, with an emphasis on staff engagement and empowerment, not command and control.

HR interventions Centralised HR structures were commonly seen as a barrier to performance management. Use of the levers available to HR, by changing workforce behaviours and providing the incentives, is seen as a powerful tool to shape organisational development.

Transforming practices within learning organisations include coaching, mentoring, and developing specific skills and competencies.

These are all interventions where HR professionals can make a difference.

Some institutions will struggle to survive in the current economic downturn. The real winners will be leaders and managers who can give prominence to behaviours which form a bridge between the vision of an organisation and the day to day practice of staff.