When St Mary's trust and Isle of Wight Community Healthcare trusts merged on 1 April 1997, 2,800 staff were involved - and there were 21 redundancies, including some boardlevel jobs. Research suggests that in the process of merger, too much attention is often given to economic and legal issues at the expense of people issues. But understanding the culture of the organisations concerned can facilitate change.
We undertook research to explore perceptions of management in the two trusts. A total of 34 members of staff from the two organisations, including the chief executives, non-executives, consultants and senior managers, were interviewed.
Questions designed to elicit the nature of the two organisations included: 'If this trust was an animal what would it be?' 'If this trust was a family who would play what role?' and 'If a friend of yours was coming for a job here and asked you what it was like, what would you say?'
Other questions dealt with performance and whether staff felt they could rely on support from others. The results indicated, among other things, that those in the acute trust saw the community trust as a somewhat cuddly, domestic organisation - a cat or a dog - while the community trust perceived the acute trust as more aggressive, characterising it as an adder, tiger and hyena.
Key themes emerging from the research on the two organisations are shown in the box.
The project report showed there were similarities but also differences in management styles, how people were treated and where the power lay. It provided a valuable framework for moving forward, a catalyst for change and stimulated the board to develop a more open, supportive and proactive culture.
The trust developed an organisational development strategy, influenced by Peter Senge's model of core learning capabilities.
3Its aims were:
to ensure that agreed values underpin all aspects of behaviour;
to create an environment and culture of life-long learning;
to devolve decision-making and encourage leadership at all levels;
to develop the concept of self-managing teams and multi-professional working;
to establish a clear link to service planning.
A fundamental pillar of the strategy was developing the trust's core values. These emerged from a series of workshops involving a crosssection of staff and representatives of all professions and centred on valuing, encouraging, supporting and sharing.
The strategy reinforced the importance of investing in and caring for staff if tough performance objectives were to be achieved and sustained. The financial and service planning cycle was reviewed to include hard targets on personnelrelated issues.
It was felt necessary to undertake a number of 'quick-fix' changes to show the trust was starting to live its values. These included:
a week's induction programme for all new staff;
monthly forum meetings chaired by the chief executive and open to all staff;
a system of team briefing;
an annual awards ceremony to reward high performance and innovation;
more comprehensive selection procedures for senior staff;
zero tolerance of bullying policy and mandatory training for all managers;
a new incident-reporting system which allowed the reporting of inappropriate behaviour.
The trust considered appraisal and leadership as key issues in developing the organisation and improving performance management. The existing system was found to be slow and inconsistently applied.
Annual appraisals are now mandatory for all staff and senior managers, and clinicians have 360infinity feedback. This entails a feedback interview, a personal learning plan and one-to-one coaching as appropriate. Those undergoing 360infinity feedback have to give a questionnaire to 10 colleagues, including at least four of those who report to them. The results are then sent to an external agency for collation before the manager is interviewed by two senior personnel and training managers.
Over a period of three months, facilitated mixed groups were set the task of describing behaviour which they felt supported the trust values. This led to a behaviour framework which is now written into job descriptions and the appraisal system.
The appraisal system is recognised as a key vehicle for bringing about culture change as well as a crucial strand of performance management.
Early feedback from the new appraisal scheme reinforced the view that the behaviour and approach of managers, particularly at a senior level, is of paramount importance to culture change.
The trust used the management charter initiative standards to help clarify the expectations of managers at each level. A competency-based development programme was put in place to achieve the expected performance standards.
The trust is rethinking its approach to developing leadership skills. It decided to invest£40,000 in sending eight senior managers to undertake the learning empowered organisations (LEO) threeday leadership programme, based at Leeds University. Our aim is for all people who manage or influence others to attend the LEO programme. We hope this will create a critical mass of individuals who will lead the organisation in line with the trust's philosophy and development strategy.
Our final focus was how to review and reinforce the changed culture. Measuring cultural change is a complicated process and the trust continually seeks evidence wherever it is available.
Initial indicators have shown that a more open and transparent approach has enhanced the working environment. The most recent employee survey, in which 1,400 staff members took part, showed more than half (53 per cent) thought they were kept informed of what was going on and 69 per cent found the team-briefing system useful.
Incident reporting has increased, and staff feel able to report what they consider inappropriate behaviour. We believe the previous blame culture has been addressed and serious issues can now be approached in a positive rather than confrontational way.
4Feedback is sought through yearly staff-attitude surveys, regular care group/support functions, performance review meetings and the monitoring of appraisal paperwork. A repeat of the research work on management cultures was also carried out 14 months into the new trust, the results of which showed some improvements in communication and identified some areas that needed further work, such as style of management.
We intend to repeat this research later this year to provide an ongoing benchmark. Achieving cultural change is a complex journey requiring constant revival and review. It also demands unyielding commitment from the trust board. The work within the organisation on values-performance management and behaviour provides an invaluable reference point for strategic decision-making, particularly in times of turbulent change.
Four years on from the merger there is a perception in the trust that things are slowly changing. But the big test for the organisation will be whether all functions can work together as equal partners when the going gets tougher.