Leadership ConneXions - Issue 9
Welcome to Leadership ConneXions Issue 9 and welcome to all our new subscribers. Leadership ConneXions currently reaches out to almost 2000 subscribers.
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Health issues remain high on the media and political agenda at the moment. It was therefore considered timely to offer a Leadership ConneXions dedicated to a couple of articles on health. The first highlights a study that demonstrated that the quality of the HR director in a hospital impacts on the number of lives saved. We know from local experience that the quality of doctors has an impact on patient mortality but HR directors? Read on to find out how!
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Work together, save lives
'Training, appraisals, teamwork' may be a modern management mantra but can it actually save lives? A recent study of 61 hospitals in England concludes that modern human resource practices can be a matter of life and death. Angela Spencer reports.
League tables for consultants may be one way of helping patients choose the safest hospital for treatment, but what about league tables for human resource (HR) directors?
Could the success or failure of an HR director be any indication of a hospital's medical performance? And would it make any difference to patient outcomes if the same director was or was not a voting member of the hospital board?
The man behind a recent research project at Aston University, Birmingham, is convinced the answer to three questions is a decisive 'yes'. Good HR management is key to improving the quality of care in the NHS, says Professor Mike West.
What's more it's no longer a choice for individual hospitals to make, but an imperative. The new performance 'star-ratings' assessments measure management competence in staff involvement and partnership working, and part of that measurement will be based on the opinions of staff.
The first ever national staff opinion survey has already been carried out by the Department of Health and from 2003 will be conducted annually.
West's report, A Matter of Life and Death, People Management, makes a direct link between progressive HR practices and patient mortality. Put another way, it shows effective staff appraisals can be lifesavers. West said: "Without invalidating the need for more and better doctors, the focus on medical staff alone may be missing a crucial point.
"It is the effective management of all the staff within the hospital community that really makes a difference to health.
"If you have in place HR practices that focus effort and skill; if you develop people's skills; if you encourage co-operation, collaboration, innovation and synergy in teams; and you do this for most if not all employees in the organisation, the whole system functions more effectively and performs better as a result.
"Staff need to be properly trained and given responsibility, they need to feel respected and valued as though they 'belong'. All these things reflect directly on standards of patient care. And the effects show across the board, even in measures of performance as fundamental as patient deaths in hospitals."
West has previously conducted research into the effects of teamwork and into stress and its causes in the NHS.
This latest study involved chief executives and HR directors from 61 unidentified hospitals who were interviewed and asked to fill in a questionnaire survey detailing HR policies.
West said: "We came across a number of hospitals which were doing wonderful things in terms of training and employment. One hospital, for example, had introduced team-based working across the entire hospital and had taken out whole layers of management, giving budget control to nursing teams along with the power to change rotas or bring in flexi-time.
"The proviso was that the staff were accountable for the changes they made. The results were more motivated staff who felt they had a voice and far more flexibility in patient care."
The Department of Health's initiatives on Improving Working Lives and Shifting the Balance of Power, both recognise the value of the 'virtuous circle'. That is, by giving staff on the front line increased power and responsibility in decision making, they become more motivated and involved, take up training to increase their skills and deliver better quality care to patients.
On the flip side, however, West found hospitals that were following NHS policy for implementing appraisal systems and sending down orders that appraisals should be instituted. But they were not training people to carry them out properly or checking that they had been done.
"Bad appraisal can be worse than no appraisal at all because it can turn into an opportunity to 'beat up' staff and result in increased anxiety and de-motivation. Appraisals should make staff feel valued and be of benefit to their development and to the people at the receiving end of care."
One of the biggest indictments for some hospitals was in the area of teamwork. Twelve of the 61 hospitals claimed all their staff worked in teams, while 23 said between 80 and 99 per cent did. But a staggering 24 trusts failed to provide any information at all.
West said: "Very often HR directors were not clear about what was happening on the ground. HR directors do need to know what's happening because they are the ones who can make the difference.
"It comes down to the culture of leadership. Some in people management think looking at technological advancements and broad strategy changes are priority but by far and away the most important aspect is how you manage staff."
Information was gathered on deaths following emergency surgery, non-emergency surgery, admission for hip fractures, admission for heart attacks and re-admission rates.
Also included was the mortality index developed by Sir Brian Jarman at Imperial College, London, which measures the ratio of actual deaths to expected deaths, taking into account the patients' age, sex, diagnosis, length of stay and whether they were an emergency admission or not.
All results were weighted with information about the size and wealth of the hospital plus details about local health needs and the number of doctors per 100 patients.
West said: "When we performed the final analyses they showed a strong relationship between HR management practices overall and patient mortality. We found that appraisal has the strongest relationship with lower patient mortality, followed by teamwork and, thirdly, the sophistication of training policies.
"Another striking result was that where the HR director was a member of the hospital board (just over half those surveyed), the association between HR practices and patient mortality was even stronger."
And while the resource implications for hospitals can be considerable, the returns are worthwhile.
West estimates that if 25 per cent more staff receive appraisals, 25 per cent more staff who give appraisals receive appraisal training and 10 per cent more staff have a personal development plan, there would be, for example, 1,090 fewer deaths following hip fractures per 100,000 admissions - that is more than one per cent of all admissions. In other words, it could save 12.3 per cent of hospital deaths.
"Even with the weaker relationship between teamwork and deaths following emergency surgery, if hospitals were to increase the percentage of their staff working in teams by just 25 per cent, they would see a seven per cent reduction in deaths," he said.
"Any intervention that holds out the possibility of reducing patient mortality in hospitals by the levels suggested should command immediate and widespread attention amongst policy makers and practitioners.
"We need to take this research further," he said. "It's a life or death issue."
Source: http://www.nhs.uk/nhsmagazine/archive/june02/feat13.asp
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Lesson Cards from the British National Health Service Clinical Governance Support Team
The following is just a few of the cards from Collection No.1 from the British National Health Service Clinical Governance Support Team. These cards, while directly related to health services in Britain will generally have wider application in many different types of government business. Just read them with your own work place in mind and look for the learning in your area.
Just a few of the cards are supplied here. If you want to read more, follow this link to a collection of 18 lesson cards at http://mux2000.mutronics.biz/03847212/KBase/Lesson Cards from the NHS Governance Team.htm
Alternatively, you can subscribe to the Gurteen Knowledge Website to be sent lesson cards at regular intervals. This site is dedicated to knowledge management, learning, creativity, innovation & personal development and has lots of great information. It is definitely worth exploring.
The home page is: http://www.gurteen.com/
The direct link to the lesson cards is: http://www.gurteen.com/gurteen/gurteen.nsf/id/email-courses
Card 1. - where you stand affects what you see
A team involved in a review of stroke services needed to make time for their work and understand why staff morale was low. One of the team (the lead nurse) decided to go 'back to the floor' as a staff nurse for three months, wearing a staff nurse uniform. An acting G grade nurse took management responsibility for the nursing on the ward, even when the lead nurse was present. It was a real eye-opener: seeing the service from the frontline and learning how junior nurses are treated by medical and other nursing colleagues. Patients assumed that as a junior nurse she had no authority. The knowledge gained by the team ensured that their recommendations for action 'hit the spot'.
- Lessons -
- Don't rely on recollection: make sure that you get to the bottom of the problem.
- Don't judge others if you are not close enough to what they are doing.
- Remember, where you stand affects what you see.
Eureka: Going back to the floor - to get a frontline view.
Card 2. - many individuals have hidden talents
A review of maternity services spotted the opportunity to extend the role of healthcare assistants. Previously they were seen only in a 'cleaning' role and not valued as members of the clinical team. They were leaving for other jobs, turnover was high. A new training programme was devised to give them new skills and a role in 'hands on' midwifery care. A certificate is awarded at the end of the programme. Healthcare assistants now provide care for women in the department - assisting midwives during and after delivery. They also assist women with baby care. Healthcare assistants have a new pride in their work. Midwifery staff say that team working has improved.
- Lessons -
- Be alert to the opportunity to enhance the roles. Don't see people in rigid boxes.
- Make it easy to attend training sessions: pay staff to encourage attendance for those off duty.
- Remember, many individuals have hidden talents.
Eureka: Creating a new role for healthcare assistants..
Card 3. - it is not only clinicians who impact on the efficiency of services
When a hospital's A&E team was looking at ways to improve their 'door to needle time' they made sure that their work was truly multi-disciplinary. They involved all the main clinical disciplines - as well as receptionists and other administrative staff. In the event it was the receptionists that made the breakthrough. They suggested that they could direct patients presenting at reception with chest pain straight to chest pain area within A&E. This would circumvent the triage system and perhaps inevitable delays as they waited their turn. This change enabled the Department to improve from 30% of patients receiving thrombolytic drugs within 30 minutes to 88% - the best in the region.
- Lessons -
- everyone needs to be involved in looking at way to improve services, and make sure they all contribute.
- You can't afford to have anyone sitting on the sidelines.
- Remember, it is not only clinicians who impact on the efficiency of services.
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