One of the ills plaguing the NHS that seem to be overlooked by senior managers is middle managers that stay in one job, one position, same department for years. This includes ward sisters in acute hospitals, managers in community and primary care and those in primary care trusts.
I worked in a ward at one local hospital (west London), where the ward sister (now modern matron) had worked in the same place in the same position for over 20 years! While this is a good sign of retaining staff, this practice may not be so good for business.
People who stay in any job for too long tend to 'be set in their ways'. They build empires. They hinder progress. This may be one of the reasons why the government and the Department of Health have so much difficulty with introducing change in the NHS. Change can be difficult to effect when some of the managers and leaders who have the responsibility for championing these reforms have become stagnant in their roles and may even have difficulty understanding the rationale for some of the reforms.
Employees turn first to their immediate superiors for advice, support, direction and help with problem solving. If their line managers are ill equipped to deliver, NHS organisations are at far greater risk for both higher (undesirable) turnover and increased disengagement of staff.
Another sad factor of this practice is that when highly talented people join the organisation, department or ward, they usually have great ideas of how things may be improved. Unfortunately, they soon become disillusioned as those ideas are thwarted by these veterans, leading to either the individuals leaving, or becoming entrenched in the old way of doing things.
According to Towers Perrin, a global professional services firm, to create a high-performance culture that helps retain key talent and fully engage the right people, organisations need to create visible, accessible and inspirational leaders. The NHS management may want to look at structures and profiles of middle managers who have leadership responsibility.
Some of the most successful organisations tend to 'reshuffle' or rotate their staff every few years to prevent people becoming desensitised to their environment. Even government leaders tend to reshuffle Cabinet ministers every so often. Staff rotation wards off stagnation, promotes career enhancement and helps to build expertise and experience in large organisations, among other things. The big question is why does this not happen at the operational level in the NHS, bearing in mind that human resources is one of the NHS's biggest assets?
Towers Perrin says that the key for organisations to remain successful in changing market conditions is to act quickly, to move people and operations across boundaries and ensure a supply of critical talent. These organisations tend to build a comprehensive approach to workforce management that is closely aligned with their strategic business needs.
The World Consulting Group (2006) believes that an optimal organization is simply adaptable: in today's flexible and ever changing global environment, no organisation can have a long term structure. If the final goal of an organization is its longevity, it is vital to be elastic and even more importantly adaptable. Thus, a well-structured organisation, is an organisation which can reshuffle it selves in order to adjust to its market and more importantly adjust to its competitors.
If the government is serious about reforming the NHS, then, it needs to examine the issue of staff rotation to encourage creativity, flexibility and to ensure that valuable skills do not go to waste.
Alice Chingwaru, nurse lead, Ealing PCT