Published: 01/09/2005, Volume II5, No. 5971 Page 20

There are two basic propositions that currently dominate policy thinking in healthcare. These are enshrined in the Healthcare Commission's Standards for Better Health and form the basis for management values to be used in implementing the standards.

The first is that consumers need to have control over their treatment if they are to maximise the benefits to be gained from health and social care. The second is that staff need to have control over their work and their environments if they are to deliver the best care.

The benefits of care are realised when consumers have contact with the NHS, and in most cases this is when staff and consumers have direct contact.

Managers need to find ways of ensuring that consumers and staff can both maximise what they get out of the relationship. Many management theories have suggested that organisations need to recognise the motivations of staff. Maslow's pyramid of needs (individual people are motivated by basic needs which, when satisfied, give rise to higher and higher needs) suggests that selfactualisation is the highest need that individuals strive to meet.

Based on an analysis of the work of Drucker and McGregor, Maslow concluded that the happiest workers are those whose work is recognised as an integral part of their lives. But even more so, how, where and by whom patients are treated will be integral to their lives, as will their expectations of healthcare.

Maslow (based on the work of McGregor) identified 36 propositions about how people wish to be treated.

He applied these to organisations, but analysis of a selection of these propositions demonstrates how they are equally applicable to patients/ clients and can form the basis for a universal set of management values.

For example, the proposition that everyone dislikes fearing anyone means patients should be free from fear and anxiety caused by healthcare staff's decision-making, and equally staff should be free from fear and anxiety caused by their superiors' decisions.

Managers could use these approaches in implementing the Standards for Better Health framework of values, which focuses on benefits to staff and patients/ clients and is intended to create an environment in which the needs of both are met at many levels, from safety through to self-actualisation.

Professor Ellie Scrivens is professor of health policy at Keele University and director of its Health Care Standards Unit, which is funded by the Department of Health. The views expressed here are those of the author and not necessarily those of the DoH.

e. e. j. scrivens@keele. ac. uk