Healthcare managers should never forget that good performance requires morale-boosting not ego-bashing, advises Paul Beal

The Department of Health investigation into NHS East Midlands highlights the issues of alleged bullying at the highest level in the NHS.

Given the current climate and the prospect for the future, pressure is likely to increase, with productivity initiatives and savings programmes. If staff continue to be managed in a challenging way, many may perceive it as bullying and harassment

Strategic health authority performance meetings should be challenging and supportive to organisations, not “kicking sessions” as executives around the country sometimes call them, with behaviour at times verging on what could be perceived as bullying. That kind of behaviour can transfer to the whole organisation.

The outcome of the DH investigation should create an opportunity to develop a new approach to performance management, making senior managers more aware of the impact of their behaviours.

In recent years I have seen people return from NHS leadership programmes with what they believe are the skills to challenge. My observation has been that they have gained little insight into how their challenging behaviour affects their colleagues.

Staff on the front line are constantly under the pressure of budget constraints, targets and managing the care of patients. Given the current climate and the prospect for the future, the pressure is likely to increase, with productivity initiatives and savings programmes. If staff continue to be managed in a challenging way, many may perceive it as bullying and harassment.

Having worked in the NHS for many years as a director, I have been involved in dealing with alleged cases of bullying and harassment. In many cases this is about behaviours and attitudes of individuals which become part of the culture of the organisation.

Some organisations tolerate bad and negative behaviours and do not routinely tackle them at every level.

By addressing performance from the top down and communicating effectively with a supportive and developmental approach, an organisation can benefit from a healthy approach to management while achieving the tangible returns of increased productivity and a motivated workforce.

The change cycle does not happen overnight; it takes time and does require leadership by example. I recall an NHS organisation where I introduced a new performance management policy, with a training programme to support this. The approach was to get managers to manage the performance rather than use formal disciplinary procedures and to deal with issues through regular one to ones and feedback.

Initially, there were some sceptics. Even the trade unions were wary of this approach. However, with the support of the HR team and working with managers and trade unions we started to change the culture. In time everyone understood “the deal” and was supportive of the cultural shift.

Developing an effective performance management culture in the organisation benefits both management and staff and this has a positive impact on patient care. The initiative needs to come from the board and the executive team, role modelling leadership behaviours and holding people to account.

Getting the basics right is crucial. This involves regular feedback and rewarding good performance, not tolerating poor performance or bad behaviours. Communicating an expectation of this throughout the organisation is fundamental.

The HR function has a central role in supporting this cultural shift through coaching, having strong policies, training and developing managers in good practice and supporting them when cases need to be dealt with through formal processes.

We owe this to our staff, patients and the public to get the best out of the workforce. We should not shy away from this at any level in the NHS, whether as a manager or a clinician.

10 tips to develop an effective performance culture

  • Build the relationship with staff
  • Lead by example
  • Be self aware about the impact of your behaviour
  • Use regular two-way feedback
  • Deal with issues as they arise
  • Have regular 1:1 meetings
  • Ensure appraisals have clear objectives and provide personal development plans
  • Use your HR managers as a sounding board
  • Have clear and robust HR policies understood by all
  • Be clear about consequences of continued underperformance