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.