“There’s been a lot of debate recently about bringing back compassion into nursing, and new training being offered for staff. But is this treating the symptoms rather than the underlying disease?” Sally – Quality Director in the NHS
For an industry whose sole purpose is health and well-being, the National Health Service is actually dominated by process, rather than people. When lives and £billions are at stake, it’s no surprise that the management response is one of control, standard-setting and continuous process redefinition to prevent waste, negligence and mistakes. Imagine then, being a senior manager, responsible for Quality at an NHS Trust hospital. This is Sally’s job – responsible for patient safety, H&S, clinical audit, risk management, complaints, serious incidents, litigation, inquests and (when there’s time) quality improvement.
Sally’s hospital is not large and is just on the cusp of being clinically viable, providing in-patient and out-patient services, maternity care and 24hour A&E services. With financial challenges, several recent high profile serious incidents and the never-ending search for cost-savings, the hospital leadership is under pressure and subject to political and media scrutiny like never before: a picture depressingly familiar to many other public service providers.
Sally’s position gives her a unique insight into how crisis management, continuous change and new initiatives impact on the people on the front line:
People who want to care for others and want to be valued for the difference they make, but who don’t have the time to listen, empathise and understand because they’re too busy coping with the latest changes,….
…learning the new guidelines, and introducing new systems, on top of running existing ones. And all this while dealing with people at their worst – in pain, in grief and in fear. Bureaucratic controls and scrutiny look a lot like mistrust and can result in people losing (or perhaps abdicating) autonomy, responsibility and job-satisfaction. People become ground down and protect themselves with ‘gallows humour’ and focusing on the process and not the patient, and so earn the reputation for being uncaring.
There is a grudging acceptance of the need to tick boxes and fill in forms, but that’s not what gets them up in the morning. There’s a long-hours culture, where the most conscientious and capable are given more and more to do, and managers are ‘too busy’ to be available to their teams – and with their inevitable focus on the latest Government initiative, KPIs and budgets, they can appear as uncaring too.
There’s been a lot of debate recently about bringing back compassion into nursing, and new training being offered for staff. But is this treating the symptoms rather than the underlying disease? If it’s unrealistic to expect to fundamentally change the risk- averse, financially constrained and rule-based character of the NHS, are there ways to enable the people who work in it to cope with these pressures, to build their resilience and nurture their caring and people skills?
Sally knows that the occasional “thank you” from a patient goes a long way, as does being recognised by your boss for doing a good job. She believes that it is crucial to job satisfaction and the quality of care for patients, to create time and space for personal interaction – between staff and patients of course, but also between teams and their managers.
There has to be a dialogue for there to be a relationship, through which you can build trust, openness, understanding, acceptance and self-awareness which enable people to cope with conflicting expectations and restrictions, to be more interested and engaged, have self- confidence, to delegate and to take personal responsibility.
Working as a team is vital – to support and learn from each other, and it is here that the NHS has something to share with other public sector organisations – how to learn from when things go wrong. Incident-reporting, clinical audit and investigations are just part of ‘the way we do things round here’. Perhaps counter- intuitively in a world where lives and lawsuits are at stake, it is common practice to openly review cases with peers, in a non-judgmental way, without attributing blame, but with the aim of sharing views and finding ways to do better next time.