In this weeks Health Service Journal there is a report of a survey amongst NHS managers about their opinions about the processes of achieving the financial savings that have been requested by Government. Although the size of the survey is small (244 respondents) the responses are of interest for several reasons. One is whether the responses show that the NHS is a healthy organisation.

What is a healthy organisation?

A healthy organisation is one that propels performance.

A healthy organisation produces strong corporate resilient against the risks and threats to their survival.

A healthy organisation is one that responds well to internal and external pressures for change, adapts itself readily and easily to changing circumstances, and restores itself faster than any competition.

The ingredients that are essential to organisation health include :

• a culture based on commitment, trust and engagement;
• clear and unambiguous purpose;
• an architecture that is designed to ensure involvement of staff in decision making;
• a workforce that is flexible and adaptable to change;
• and a leadership approach that is adaptive and based on shared corporate responsibility.

Introducing these ingredients into any organisation is dependent on the top managers having a passion for success through stimulating high performance from staff.

The essential element is stimulus. The right cultural context of any organisation stimulates the thinking, feeling and, therefore, attitudes and behaviours of the employees in the organisation.

Relevance of this to the survey?

The following is a brief summary of the survey findings as published in the HSJ:

Ability to capture ideas: 55% said yes (what do the other 45% think?)

Engagement and ownership: 42% said yes to engagement in financial improvement schemes, but 36% said no

Financial schemes with clear owner: 50% said yes (what about the other 50%?)

Timetable for delivering the schemes clear?: 48% said yes (what about the other 52%?)

Financial challenge owned by the organisation?: 59% said yes (what about the other 41%?)

Inter-dependency between schemes – well managed?: 50% said no

Role of the Board:Decisions that reduce the benefit of schemes? 20% said yes.

the conclusion from the representative of the surveying company was ‘There is a disconnect here and it points towards a leadership gap’.

Two things strike me – one, the financial challenge is massive and is a stated corporate objective and two, the NHS isn’t a healthy organisation, therefore has little prospect of adapting quickly to the pressures for change that are being demanded.

If the NHS was a healthy organisation and had embraced adaptive leadership principles, then we would find that the financial challenge would have engaged everyone, and that staff would feel a strong commitment to ensuring the demands for change were being met. There would be no disconnect; all the ideas, innovations, re-thinks would be sifted, challenged, and where feasible, implemented. The leaders would be demonstrating one of the attributes and behaviours that leads to engagement – giving direction with committed ambition – an attribute and consequential behaviour that is very attractive to others, so attractive that they follow and become engaged in the project.

Another headline in this weeks HSJ shows the symptoms of an unhealthy NHS:

Getting clinicians to speak up is the real key to fighting poor care – they should be anyway, and not just them. If the NHS was healthy and adaptive principles involved everyone would share corporate responsibility for everything, and that ‘ownership’ would ensure that standards are consistently high, and if not, someone would immediately raise the alarm without any fear of humiliation, threats to their future or anything of that nature, but supported, encouraged and congratulated on his/her corporate responsibility for ensuring high standards.

Government spending cuts are fuelling workplace bullying and “silencing” people worried about losing their jobs, a union claimed today.

One in three have been reported as being bullied as the threat to jobs increases.

In an economy that isn’t growing at the rate required to restore stability, the increase in bullying is a symptom which underlines the lowering of performance at work. The combination of lower performance with economic restraint  has the hallmark of a ‘storm’.

Managers urgently need help to manage staff who now fall into five categories of risk of under performance

a) those staff who have been asked to continue to work as normal (no doubt after periods of uncertainty)

b) staff who have been asked to remain but change their circumstances – changed job, changed location etc.

c) staff who continue to be unsure what is going to happen to them

d) staff who have been asked to remain but expect to be told to leave in the future

e) staff who have been told to leave.

People will move from one category to another over time. Each category of staff require exceptionally capable management to maintain performance.

Corporate, workforce and individual resilience training is essential for all managers to acquire an understanding of how to manage their staff, and for staff to equip themselves with the approaches to strengthen their personal resilience. See our programmes and book on them now.

We provide detailed analysis of what resilience is and why our exercises are appropriate in strengthening corporate, workforce and personal resilience.

Derek

In February Dame Carol Black was invited by the Government to investigate sickness absence at work.

To use the language of illness, the incubation period for psychological distress manifests itself in psychological presenteeism – those who remain at work but unable to perform effectively because of events that divert attention and concentration on the job. Examining how to eliminate and reduce presenteeism will have the bigger impact on absence due to distress, because of the larger numbers involved, the cost and the position presenteeism plays in the process of decline leading to absence.

One of major challenges is that much of psychological presenteeism is undiagnosable or below the diagnostic threshold. Such a threshold exists for medical purposes. From a psychological perspective, anything that diverts attention and concentration away from the main focus (work) will have an impact on performance.

People can be diverted away from their main focus in any number of ways. The challenge is to reduce the impact of all known triggers that divert concentration, and to create the environment that fosters concentration. This isn’t straight forward, but the starting point is individual interactions with others, which, if conducted with courtesy, smiles and encouragement will have the effect of heightening intensity of the interaction and enabling stronger concentration. The stronger the seductive power in interaction the less significant is the environment. As most people will have limited seductive strength, the more important  is the environment in aiding concentration. This is why in our evaluation of training programmes we always ask about the environment as an aid to learning, and this section is nearly always scored lower than all the other sections of evaluation. We have quite a strong seductive power as facilitators.

I hope the review of sickness absence will go beyond processes, and dig deeper into the real issues of relationships, roles, wellbeing and performance.

Derek Mowbray

Presenteeism is a serious phenomenon, and likely to get worse as the economic climate becomes even more challenging. The Sainsbury Centre report on the mental health aspects of presenteeism suggest that there is an  annual cost of £15bn due to psychological presenteeism at work. Addressing this has the potential of saving £8bn per annum, a nice contribution to the national debt relief. read more »

The worst leader is one that lies and is despised; not much better is one that leads using oppression and fear; a little better is the leader who is visible, loved and respected; however, the best leader is one whom the people hardly know exists, leaving them happy to say, once the aim is achieved, ‘We did it ourselves’ - Lau Tzu around C5thBC read more »

This question was posed recently on a forum:

“The organisation I work for is going through a radical restructure . As a result, it will experience enormous cuts over three years, be in a state of transition until the new body is formed in 2013, see redundancy on a large scale and possibly see either mergers or acquisitions. This change will no doubt affect all aspects of the business and also the employees within the organisation. ”

“What innovative things would you do to help manage such radical change????”

Since this is such a pertinent issue, I thought I would share my suggestions with you.

• The first and most fundamental change for everyone involved (throughout the whole workforce) is to start thinking in terms of creating a ‘new’ organisation, even though it’s migrating from an existing one.
• Apply the Mowbray Model of Oganisational design and development – and help the organisation to be clear about purpose;
• Identify the beliefs and values that the new organisation wishes to apply into practice, and this will become the cultural foundations within which managers and staff will be expected to behave;
• Identify the architecture that will help promote the values and beliefs (let’s hope they include commitment, trust and engagement),
• Take a look at the 13 specific aspects of the organisation that form the ‘rules’ of how the organisation is meant to work (ensure the ‘rules’ promote commitment and trust),
• Identify the levels of skill needed to implement the ‘rules’ and embark on training programmes.

The focus needs to be on creating and sustaining commitment and trust, as this will take the organisation through the current challenges towards a new environment.  In addition, you might want to consider the implementation of a set of management codes like my own Manager’s Code which is also designed to promote commitment and trust and links wellbeing with performance and productivity.

Whilst the scenario described involves the complete organisation, the same principles can be applied by individual line managers faced with making change within their own area of control.

By far the biggest problem for the NHS is why does it exist? The ambiguity surrounding the health services clearly fails to generate the degrees of commitment and emotional engagement needed to ensure that everyone who works in it concentrates on their work and not on other things, like new structures, bullying and other symptoms of presenteeism. It doesn’t really matter iF its GPs or Jo Bloggs who does the commissioning; what matters is their deep commitment to purpose and their understanding of how to achieve it – if the purpose is ambiguous then achieving it will fail. Therefore it doesn’t matter if we respond to consultation or not as those in control of the NHS bask in its ambiguity to enable wriggle room when things don’t work out quite the way some people imagine. What is happening will merely ensure the NHS slips further down the effective health services chain to a point when insurance companies will step in and identify clear purposes for health care and organise their own delivery of services. I wish they’d step in now and do something to support initiatives relating to psychological wellbeing, performance and productivity – as this is so crucial to the economy as a whole, yet hardly pings on the radar.

It was the treatment of Dr David Kelly that is unforgiveable combined with subsequent events that are out of pattern. Sure, he may have broken some kind of Civil Servant’s ‘rule’ about disclosure, but this was in the public interest and he was a public servant. The subsequent difficulty in believing what happened is that it all adds up to something that has little face validity. The medics are saying one thing; the top judge said something else; the inquest hasn’t been held, and the medical records have been frozen for years; what the guy said appears to be true; what the reporter reported appears to be true, and he got the sack from the BBC but subsequently exonerated.  What is a normal, sensible human being supposed to think?

The representation of these events provide the opposite of what is normally needed to create commitment and trust leading to engagement. There is enough ambiguity for the public to be on the alert, to become inquisitive, and to question everything about this unfortunate episode. If ‘sleeping dogs’ continue to lie the degree of disengagement of the public with government will continue until it’s reversed by some fantastic demonstration of face validity that we all think is extremely positive and to our benefit.