Fag paper…


I’ve visited two Trusts recently. People have been good enough to give me their time, show me what they are doing.

They are proud, they are innovative, pushing the boundaries, trying new things. The amount of effort and energy they bring to work each day is astounding.

What makes some organisations work and some not?

There are five things I look for.

The first is an emphasis on purpose.

What’s the purpose of a hospital? Fixing the sick… easy answer. But we complicate it.

The sick have to be fixed in a budget. The sick have to be fixed to the satisfaction of regulators.

The sick must be fixed within time-scales and targets that are not decided by them.

The sick have to be fixed within guidelines, rules and regulation.

Purpose is something different.

It is a determination to get as good as you can and then do that bit more.

One of the hosptials has a hairdressing and manicure service for mum’s keeping weeks of vigil at the cot-side of sick-kids. The small things are the big things.

The other focussed on loneliness. A small thing that can erupt into a very big, ugly thing.

These changes come about though people really understanding that their purpose is about so much more than fixing the sick.

How does it happen? That’s the second thing I look for. The leadership style.

Despite the efforts of development courses to homogenise leadership and trainers to groom the hopefuls… you can’t.

There are a number of leadership styles. Highly personal, through to authoritarian. They all get results and they all have their problems.

The successful ones, that keep being successful, are the ones that all do one thing…

They create the time and space for their good people to do great things.

One of the Trusts has an enthusiast for safer drug-delivery and worked with a manufacturer to develop a fail-safe delivery system.

The other created the time and space for their sonographers to develop a remote service and a training programme.

Both of the initiatives are really top-drawer-good and respond to a changing environment.

That’s the third thing, I look for; adaptability.

Being able to adapt to a changing environment.

One Trusts has moved health and social care into the same building, onto the same floor and into the same offices. The results have been stunning.

The other Trust had changed work flows and reduced patients nursed in corridors to near-enough zero and has an accelerated rehab programme, reducing elective stays to a pit-stop!

Both Trusts have seen the problems, turned them into opportunities and dealt with the unexpected.

And that is the forth thing. Realism.

Organisations that are not afraid to hold up a mirror and look at themselves. Say, this is not good enough, what shall we do?

If I took you, blindfold, to either of the Trusts and asked you to tell me which is which… I’ll bet the farm, you couldn’t.

You will see people who think it is OK to be proud of what they do.

That’s the fifth thing.

You’ll see it on the faces of the people working the hardest. They are happy.

They are happy when they are not working in the shadow of a ‘superior-organisation-culture’.

Where everyone understands that what happens between the patient and the Trust is captured when someone says; ‘Hello, my name is…’

… it goes right, or wrong, from that nanosecond.

The Trusts showed me thirty or more initiatives, ideas, innovations and improvements. All home grown. Each of them replicable in other Trusts.

Yet, the Trusts couldn’t be more different, one on the east coast, one on the west. One of the Trusts is tangled up with the regulators, the other isn’t. One Trust has a lot to lose. The other has everything to gain.

Two Trusts; high morale, training opportunities, teamwork, the right kind of leaders, flexible and adaptable. Space and time and a relentless focus on purpose, patients, relatives, carers and friends.

Who are they? I wasn’t going to tell you but they are so proud of what they do… I can’t do that and it’s a reaffirmation that it’s all about the people!

They are Newcastle upon Tyne FT and Southport and Ormskirk Trust.

A hundred and sixty miles a part, but on the ground, the people doing the job… you couldn’t separate them with a fag paper.

Contact Roy – please use this e-address – roy.lilley@nhsmanagers.net
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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.