Delivering change is difficult, and the NHS has a lot to deliver. One thing that could make the difference would be to help staff understand how their day-to-day work fits with the wider strategy of their hospital.
To run a sustainable hospital is increasingly challenging
Hospitals are large and busy. The NHS employs thousands of staff seeking to deliver clinical services to nationally set standards, and within constrained financial envelopes. Services are under constant pressure to change and evolve, causing additional and competing pressures on staff time. Many initiatives are launched without full consideration of the long term impact, meaning that they can change mid-way through delivery and there is often a risk that benefits are not realised. With these changing priorities it is hard for staff to see how it all “adds up” and why they are doing what they are doing.
Operating as one team is harder than it looks
In addition, pressures are compounded by the tensions that can exist between front-line staff and managerial staff. These staff groups are often located in different buildings, have different career paths, and can encounter very different day-to-day experiences.
There is also high turnover of executive teams with, for example, the average tenure of a hospital Chief Executive being less than two years. This can affect motivation for all staff, irrespective of role; if change is perceived to be overseen by an inconsistent, ever-changing corporate team, it is harder to go the extra mile. This may also lead to further feelings of resentment between staff.
Greater transparency across hospital staff is crucial to successfully tackling the challenges
So, how can hospitals better overcome the barrier between managerial and front-line staff? The answer is driving a transparency agenda. This can be achieved through:
- Clarity of direction: a vision must be clear, and all change initiatives should be able to draw a direct line to it. The vision must be in frequent use, and made accessible to all. The management team should work with clinical departments to ensure their local plans are aligned to the longer term strategy. The vision and long-term goals should be displayed visually in the workplace.
- Clarity of role: a greater transparency between managerial and front-line staff about what they are doing and why, will help these groups to understand each other’s perspectives. This could include a communications and education exercise on what each department is doing to help the hospital to succeed.
- Clarity of value: a hospital depends on all of its people. This needs to be recognised to form a more collaborative culture from ‘ward to board’, moving away from “do this” to “how can we solve this / achieve this together?” This clarity must be fostered through spending time together, for example through ward visits.
It is important to recognise that, whilst it is critical to ensure there is transparency and understanding between managerial and front-line staff, the tension will always exist to some extent. Transparency, when it works well and is consistently applied, fosters high levels of trust, collaboration and efficiency across all staff groups. This, in turn, will help a hospital to meet the significant challenges it faces in delivering high quality services within the financial envelope available.
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