The health and care workforce is currently grappling against a tide of remarkable adversity and pressure, and the cracks in morale are beginning to show. At the Nuffield Trust’s recent Summit, I chaired a session which aimed to explore how leaders might re-energise the weary doctors, managers, nurses, care staff and other professionals in the sector.
In some areas, and most notably in social care, there simply are not enough resources, the people who do the work are very poorly rewarded for their labour and there are just not enough of them.
But taking that on board, the panel was asked to address what can be done – even in spite of the enormous challenges in the sector – to make a positive difference to the workforce?
For all the differences in perspective, there was a remarkable degree of consensus. In the end, a clear set of lessons emerged from the panellists and audience. These recommendations are compiled with national policy-makers, leaders of national bodies (NHS England, NHS Improvement and Health Education England and so on) and senior leaders (clinical and non-clinical) in local health and social care organisations in mind.
1. Build values into absolutely everything
This includes recruitment, selection, training, management, promotion, appraisal and pay progression. Stop placing so much weight and value on competencies and skills and start placing more on values. Competencies and skills are important but they are easier to inculcate, easier to assure and easier to maintain in the face of adversity than values, which take concerted effort, constant renewal and consistent practice.
2. Make your values explicit and model them yourself
At every level of operation – whether as a system, an organisation, a service or a practice – make the values clear and model them in your own behaviour. Do the work of translating what the values mean into clear expectations of how employees and colleagues should behave towards patients, peers, colleagues and those working in the other parts of the care system.
Try not to pass the stress and anxiety that comes with being a leader down the line. Be observant, pay attention to the detail of your peers' and colleagues’ behaviour and talk to them about it: do they act supportively across team, professional and organisational boundaries? Do staff talk about patients as real people or as things – bed numbers, administrative categories, diagnoses and conditions? Do they run colleagues down when they are not in the room? Do senior clinicians pay attention to trainees and to their needs?
3. Practise civility
Expect yourself and others to honour normal standards of polite behaviour. This means behaviour as simple as addressing colleagues and subordinates by their name (and not for example as “the new FY2”) and introducing yourself by name to your patients/residents/colleagues.
4. Put an end to bullying
Stop bullying and tolerating behaviours that don’t fit with the values. Treat them as unacceptable and call them out when you see them. Challenge them no matter where they occur, including at the top of the system/organisation/service.
5. Endorse and validate good practice when you see it
Praise people when they have done a good job. Personal recognition goes a very long way towards making people feel valued. Do it more.
6. Bring people together
At a system level, use national resources to train people to work together better. Merge Skills for Health and Skills for Care. Make experience in health and social care mandatory in graduate management training schemes; include multi-professional working in the curriculum for undergraduates in all the health professions. Avoid incentive and reward schemes that divide rather than bring people together.
7. Help colleagues understand one another
At organisational level, encourage and reward multidisciplinary working and find ways of helping staff to understand each other (and each other's roles) better. The Schwartz Rounds are an example of one such opportunity: a forum for reflective practice, open to all the staff who want to attend. They offer a time and space (one hour, once a month) in which people from any discipline and all levels of the hierarchy sit together as equals to reflect on their work and the impact it has on them as people. The Rounds are confidential, voluntary and expertly facilitated to make them a psychologically safe space. In the context of organisations with steep hierarchies and departmental silos, they are deeply counter-cultural. Chief executives sit alongside nurses, porters, care assistants and consultants. People listen to each other, respect each other and for that one hour are treated and behave as equals.
The Rounds have spread in the UK largely by word of mouth and by pull from people who want to do them. Significantly, people who participate in them say they feel less isolated, better able to understand their colleagues and more in touch with their original motivation to care for others. Indeed, at the Summit there was talk whether Schwartz Rounds could be adapted for chief executives to talk about the strains they face.
Having read the list you might be forgiven for thinking, as Martin Green wryly put it, “talk about stating the bleeding obvious!” or as Clare Marx said, “what needs doing is small, cheap and doable.”
It’s true the tips are obvious, small and affordable, but that does not make them doable easily. Talking to colleagues about what they do is one thing, talking about how they do it, and how their behaviour affects others is quite another and it takes courage.
Ultimately, change will not come down to just our skills or competencies, but to what we value in a work culture. And if we’re going to tackle the crisis in morale in the NHS, our values are a good place to start.
Jocelyn Cornwell is a Trustee at the Nuffield Trust and Chief Executive of the Point of Care Foundation, an organisation that implements Schwartz Rounds in the UK. She chaired a session on workforce at our recent Health Policy Summit, which you can watch below.
Cornwell J (2017) 'The time to value our staff is now'. Nuffield Trust comment, 24 March 2017. https://www.nuffieldtrust.org.uk/news-item/the-time-to-value-our-staff-is-now