A chief executive who laid himself bare to staff questioning online believes webchats could be a effective way to communicate with staff. Is he right, asks Ann McGauran

Published: 07/03/2002, Volume II2, No. 5795 Page 14 15

When was the last time a hospital chief executive had to grapple with the cost of sex-change operations, performance-related pay, reform fatigue and the loss of drinkingwater taps all in the course of half an hour and in front of a large audience? During a webcast believed to be the first of its kind in the NHS.

The live event lasted half an hour, with Hammersmith Hospitals trust chief executive Derek Smith dealing with a wide range of questions sent in by staff on anything from strategy to service development and health politics.Many issues were controversial, but he tackled them with a high level of openness. He says staff were 'prepared to ask questions - no matter how awkward' (see box).

The approach grew from a desire to add to the ways of communicating with staff 'to get a two-way dialogue' and he believes the idea could easily be picked up by other trusts. 'The technology is there for people to do it. It is a mine of information, albeit from a selective group. But we need to analyse this stuff.'

Before and during the chatroom session he was bombarded by about 70 questions, with around 200 staff contributing during the time slot. Four similar webcasts involving a range of senior staff, including the chief executive, have been arranged.

Mr Smith came to the trust last year from London Underground but has worked in the health service for 26 years - most recently as chief executive of King's Healthcare trust. He believes that in a 'fundamentally undermanaged' NHS, such an immediate method of communication as the chatroom works well - but 'people should still use staff meetings, circulars and newsletters and walk their patch'.

Those taking part in the webcast are able to remain anonymous.

The ideal position, Mr Smith says, is that staff would feel would feel 'entirely open and comfortable' about what they are asking and 'this is new and creating that opportunity'. Staff need to see that they will get 'honest answers in a frank dialogue'.

Keith Stone is the clinical information development manager who worked on the project. He says that with PCs in every ward area and clinician's office and in the hospital's cyber cafés, the webcasts 'allow every person in the trust the ability to ask questions of the chief executive'. He mentions two main reasons for setting up the scheme.

The first was as a 'hook' to 'allow clinicians to see the usefulness of the intranet and all the services we provide' - including information on evidence-based medicine and clinical guidelines. Second, it is a vehicle for 'asking questions in a safe manner, with the information 'not going through any sort of spin'. It is also an ideal way to get a measure of the issues staff have strong feelings on - 'like dipping a thermometer in a bath'.

Future webchats will include a further session with the chief executive and ones with acting nurse director David Foster, director of human resources Ian Young and the trust's professor of fertility studies, Lord Winston.

It would be useful for staff to be able to 'fire off questions to the prime minister, the health secretary or a health minister', Mr Stone adds. Trust communications head Nuala O'Brien agrees: 'If you look at the agenda about improving communications and using technology, they would be mad if they did not take the chance.'

In future sessions she expects 'testing questions' on the results of the staff attitude survey, due out shortly. The process of the live questioning is 'very open, and I am up for that - and Derek is, too'. She describes the chief executive as 'very clear in his communication', even though 'we might not like what he is saying'. She adds: 'It is groundbreaking and is signalling that openness is not just tokenism.'

The only trade-off with staff being able to opt for anonymity is that 'we might take out inappropriate questions', but that has not been necessary so far. That is perhaps a sign of the importance staff attach to the project.

Jason Foster is a specialist commissioning manager with the trust, dealing with high-cost treatments such as gender reassignment. He says that since the webcast, 'people have been coming to me and picking up questions about commissioning'. The event has helped to 'get a lot of people thinking'.

Has it helped him learn more about his chief executive? 'He seems an honest bloke who says what he thinks.'

If you ask me. . .

QWill any of our patients need an operation in France or Greece?

AThe NHS is to offer patients choice if they are waiting more than six months for treatment, but I would hope that they would not need to go abroad. In fact, I believe that the publicity around the 'Lille Nine'has damaged the reputation of the NHS.

QWhat are your opinions about performance-related pay?

AIt only works when the individual or group really can be incentivised.This requires two conditions not usually present in the public service.One - that the objectives to be achieved, and the pay, can be directly aligned (as in sales) and two - that the extent of the award is sufficient to incentivise the required behaviour.

QHow are you going to go about implementing yet more NHS reforms?

AI detect a little reform fatigue in this question. . I do think the NHS has gone target mad and there are far too many centrally driven initiatives.We need to be clear about those things to which the trust really can commit and achieve, and then do them well.