Key elements include:
- inspirational vision and narrative focused on quality of care, frequently articulated.
- commitment to effective, efficient performance based on goals and objectives.
- good people management and employee engagement – compassionate leadership.
- continuous learning and quality improvement.
- enthusiastic team-working, cooperation, partnership and integration.
- staff understanding of why some decisions have to be taken centrally and when they can be made locally.
Some thoughts about possible tools:
- A formal series of commitments around behaviours can be useful; if in place it should be used at the point of recruitment onwards.
- Remuneration is important to recruitment and retention; differences between inner and outer city weighting can undermine retention in some areas.
- Results of the annual NHS staff survey should be analysed by site where possible to differentiate areas of excellence and difficulty.
“Some roles are quite mechanical and people may think they are not as valued as much as those with more complex skills, yet these roles are crucial to the patient pathway.”
“Newer staff who come into the organisation have some really good ideas and it is important to support them so that they can be shared with the wider network.”
“Some staff find it hard to make decisions without consent from everyone. I warn people not to include too many colleagues in their emails to avoid wasting time with unnecessary discussion.”
“Nurse managers who allow matrons to approve bank shifts avoid delayed payments and retain the goodwill of bank staff.”
“Traditional hierarchies need to adapt to the pace and amount of change coming from the front line.”
A values-led culture
If an organisation is thinking of opening a new site, it is a great opportunity to embed the right culture so that everyone knows not only what the organisational values are but also how to live them. It is important that after a site mobilisation the values are continually reinforced and embedded.
- People can care for others well only if their own basic needs have been met. If we want staff to be caring towards patients, the staff have first to feel cared for – by the organisation and each other.
- Many issues dealt with through mediation, the disciplinary process and even employment tribunals could be dealt with much more quickly and locally.
- Once embedded into the leadership at all levels, many issues will be resolved locally, freeing senior leadership time.
Defining the values – these should reflect the status quo as well as the organisation’s aspirations so that staff can see they are rooted in reality.
Living the values – Although many trusts have identified the standards of behaviour they expect staff (and patients) to abide by, and there may be widespread awareness of them across an organisation, the extent to which they actually affect behaviour can vary. This is likely to be because people need to know:
- what, specifically, they need to do to meet the standard, such as say hello and introduce themselves, answer the phone within five rings, check everyone’s had a chance to contribute at a meeting.
- what to do if they are on the receiving end of inappropriate behaviours. This can be particularly challenging for more junior members of staff when a senior colleague behaves inappropriately.
Communication – staff must be able to see how the values affect them personally, how they benefit the team and help the organisation. Workshops are helpful to tease out what the desired behaviours look like in practice.
Leading by example – the most cited reason by those in the public sector for lack of engagement is that there is one rule for senior managers and one rule for everyone else. So if respect is one of the values, the leadership team must demonstrate this at all times; if another is excellence, quality should always be held in as high regard as financial considerations.
Embed them from the start – setting expectations at the beginning of the recruitment journey is crucial to how staff see the values. If you are clear at the outset about the culture and nature of your business, it is more likely you will attract and retain like-minded colleagues.
Consequences – staff must see the consequences of going against the values. Leaders must be prepared to deal with infringements whether through training or the disciplinary process. If values are to be given the priority they deserve, they need to be regarded in the same light as policies and contracts – it is, after all, the organisation’s reputation at stake. Similarly, those who excel at embodying them should be rewarded.
Reinforcement – values are for life. Make sure they are brought to life at regular intervals to ensure they stay an integral part of everything you do.
Techniques which could be used include:
- auditing current practice across the organisation to ‘pulse check’ the level of awareness and adherence.
- creation of safe places for staff to role-play difficult situations and learn how to handle them in line with the values.
- creation of widely-understood tools to help staff recognise where the values are not being lived and help them challenge the situation, for instance a ‘yellow card’ when someone steps over the line and a process for follow-up.
“Action follows thought, and if our thinking is changed we will find the ways to create a culture that inspires caregivers and reshapes the patient’s experience towards a more trusting and compassionate environment for healing to take place.”
Lee, F (2004) “If Disney Ran Your Hospital: 9½ things you would do differently” Second River Healthcare Press Bozeman, MT USA