Subscribe
Share
Share
Embed
The National Health Executive Podcast is the perfect place to garner insights from across all aspects of healthcare, as we get into the crucial ‘whys’ behind the stories and how they can impact all of us to improve our work, our lives and the care and services we provide as an industry.
Tune in, discover more about our diverse and talented health sector and it may well spark the solution to help you see a problem or challenge in a new light.
NHE Ep 39 What makes a good NHS Manager?
Presenter: So firstly, uh, I'd just like to clarify and, I guess, set the ground rules for management, because to me it's quite a self explanatory term, but at the same time it's quite ambiguous. So, just to be clear, how would you define management in the NHS? What positions would you deem as management?
Anthony Painter: I would define it more by what people do than what their job title is. And I think this is really important. There'll be lots of people across the HS who have, um, the word manager, uh, in their job title, and they will be managers. But there are also lots of people, whether they're, uh, nurses, consultants, um, GPS right across the system, who have management responsibilities. And what that involves is managing other people, managing their performance, their well being, their development, managing processes and systems, um, to improve diagnostics or treatment, uh, of pain, um, or treatment pathways. And, um, there will be people, um, who manage, um, major complex organizations such as, uh, IC UBS, uh, NHS Trusts, all of whom have management, um, responsibilities and skills within their job descriptions. And I would define all those different people as being managers, whether they have the word manager, uh, in their job title or not.
Presenter: It's more than just a title, it's more what you do in the role and how you help.
Anthony Painter: Yes. And what that starts to do is it starts to define management in the NHS as a particular set of standards and skills. Now, the NHS is very reliant on highly qualified people at all levels, um, and as the Charter Management Institute, we are very keen to see people in management with managerial responsibility, having particular sets of skills and capabilities demonstrated, um, trained, uh, and recognized. So when you start to talk about management as a set of skills and capabilities, that takes you into a very different conversation around what you do with respect to just a certain category of roles within the NHS and the wider care system.
Presenter: You mentioned these type of skills. So I guess for the non believers amongst our listeners, how does management help in the NHS? Why is it so important? Does it help patients? Does it help staff? Does it help senior leaders, even?
Anthony Painter: There is an association, um, between, uh, good, uh, management and organizational outcomes in the NHS, just as there is elsewhere. In fact, we worked with the Social Market Foundation on a report into the state of, uh, management and leadership in the NHS. And what should be done about that? One thing that was found, by the way, is that 27%, um, of managers in the NHS think that leadership in their organization is not effective. Which obviously is very worrying in and of itself. Not least because the research shows, um, that if you have above, um, average leadership and management in your organization, you're far more likely, or three times more likely to be a, uh, highly performing NHS organization than if you have a lesser average, um, level of the quality of management and leadership in your organization. So this really matters. Um, and it matters across a number of different dimensions. It matters for healthcare outcomes, it matters for patients, it matters for staff and their, uh, well being. Um, and it matters for those in positions of management, in management and leadership themselves, because you want to be part of uh, a burgeoning and successful organization that is delivering um, on its mission. So I would say, actually, the importance of managing for leadership. It is recognized, um, within government and across the NHS. There's no doubt about that. Um, but maybe isn't given quite the attention and focus that it maybe should be, given how important it is.
Presenter: You mentioned some of your research. Would you be able to share any, I guess, practical examples of, I guess, good management in action, where it has helped and how it has helped really drive patient outcomes?
Anthony Painter: Maybe, yeah, I can give a number of different examples. In fact, there are a number of different case studies in the report at an organizational and an individual sort of, uh, um, uh, treatment or clinical area level as well. We had PAinside and glossop, integrated care trust. And part of their journey from, uh, inadequate to good in the CQC rating was setting clear priorities, setting clear goals to, um, develop their sort of middle management, um, to get the right people in place, to manage change, to build trust and ensure that managers and leaders across the organization, whether in clinical or non clinical roles, were visible and engaged. And that was a critical part of their transition to, um, a good CQC rating. Uh, we also had a look at Leeds Teaching Hospitals trust. Again, um, massive improvement, um, and the trust went from the bottom 20% of NHS employers to the top 20% in terms of staff, um, engagement and well being, good outcomes, again, on CQC. And part of that was implementing a different style of management that was more visible, flatter structure, there was greater autonomy, individual teams, training at every level, and ensuring there was a range of different experiences available to the trust. And again, that was transformational over a period of time. So we see constant example, and the thing that's really notable about these examples is how quick the change can be. So for example, the NHS obviously had its workforce development plan agreed by government recently. That is uh, a change that will take place over a decade, decade and a half. The examples that I've just, um, given you, actually, we see change in two, three, four years. So it can be a rapid way of improving organizational outcomes, patient outcomes, um, care quality. There's an example, actually. We provide something called the Chartered Manager Award, which, um, recognizes those managers which apply, um, the critical skills of high quality management in their workplace. Not just in the NHS, but across, um, sectors and indeed, industries. We have awards for those who have made transformational change on the back of their Chartered Manager knowledge and application. So professor, uh, Godwin Simon from the Medway NHS Trust, um, basically accounted for the change that he's seen in his team. I've improved the quality of care by reducing avoidable cardiac arrests by 90%, improved clinical governance by reducing the response time for complaints and serious incidents. I've expanding consultants and the Junior Doctor workforce with improvements in working environment, better staff morale and improvements in staff feedback. So what you're seeing here is the sort of critical practices of high quality management. Engaging your staff, getting the right people in place, developing them, um, um, getting better processes in place, uh, implementing it over time, building trust. And then he goes on to say, with improved clinical engagement, job planning and deployment of workforce, there's a reduction in referral to treatment weight with 33% reduction in, um, gastroenterology, 55% reduction in cardiology and 90% reduction in, uh, neurology. So it's not just about sort of having an improved working environment and that's critically important. It's about seeing massively improved outcomes in NHS and care settings. That means improvements in health outcomes and.
Presenter: For our listeners that are NHS managers or perhaps fall into that bracket of some descript. You may have answered this already just then because I was going to ask what are the hallmarks, key hallmarks of effective management? But I might change it slightly to what would you say are the things in management that they should avoid? People should avoid what is poor management?
Anthony Painter: Poor management is not doing the right things. And doing the right things are being there for your staff, knowing your organization, knowing your team, knowing your area. Um, listening, engaging, challenging where necessary, setting clear goals and targets, and, um, ensuring there are mechanisms in place to help people deliver and ensure that they are delivered. It means managing, um, yourself, um, and so you can manage your emotions, you can gauge with others effectively. You can improve yourself and your skill set, uh, over time. It means collaborating, thinking beyond team or departmental or organizational boundaries. It means being aware of the things that can really improve outcomes and performance in your area, the technologies that might make a difference, how they might be implemented effectively, thinking creatively, problem solving, being there at critical moments. All of these things are the characteristics of good management. And the corollary is bad management doesn't give any attention or importance to those things. And so recently we actually launched a major piece of national research on, uh, the difference that good managers can make. And, um, it's quite striking. Um, this was a survey of two and a half thousand workers and two and a half thousand managers, again, across all sectors. But, uh, if you've got an ineffective manager, you are likely 15% of those ineffective manager, uh, feel valued and appreciated versus 72% with an effective manager. 77% of those ineffective manager feel motivated to do a good job. Only 34% with an ineffective manager feel motivated to do a good job. 60, um, 8% with an effective manager recommend their organization is a good place to work. Only 21% with an ineffective, uh, manager 67% would agree that the organization has a good company culture if they have an effective manager. And those that have an ineffective manager, only 22% would agree that their organization has a good organizational culture. So you can see across the board the difference this makes. And you put that in the context of a hospital GP, surgery, a care home, and anybody who knows anything about those sorts of organizations will understand that that sort of boost to morale. And, um, the difference that can make on a day to day basis to everybody involved staff, patients, wider stakeholders it's really important.
Presenter: I mean, based on the figure you just quoted there, it does really seem incredibly important. So how would you say the NHS should go about recruiting? I guess, good managers? Is it about cherry picking good leaders from elsewhere or fostering for them from within? How would you say the NHS should go about that? Uh, because NHS recruitment is a huge topic at the moment.
Anthony Painter: Yes, it is. Management is a set of, um, general skills. You can identify what makes good management that cuts across all sectors and that might lead you to think, OK, well, you could just find good managers from other sectors and just bring them in and then everything would be OK. But actually you need to have the contextual, knowledge and understanding too. So I think my inclination would be for the NHS to try and identify those with interests in developing managerial skills and expertise and give them that support and training to do so. By the way, across the country, 82% of people become managers, haven't had no formal training or skills, uh, in being a manager. And hopefully I've, um, articulated that it is a set of definable skills and behaviors that are absolutely critical and a set of values underpinning that. You've got to have an inclusive mindset, you've got to be ethical. And obviously that's a very important part of the discussion in the NHS and I'm sure we'll come on to that. But I think I would look within the workforce where those who, um, have expressed an interest, whether they're in a clinical or non, uh, clinical setting, to give them the tools, the knowledge, the skills, the capabilities and application that they need. The vast majority of the future managers in ANHS workforce are going to emerge through, um, the NHS, um, itself. So that's where I would concentrate. And I think, in fact, that was the main sort of approach of the Messenger Review, which obviously, um, was published, uh, just over a year or so ago, was thinking about how to develop the quality of the management workforce within the NHS and management within the, uh, NHS. And that seems like the sensible starting point overall.
Presenter: Now, NHS managers are quite topical at the moment. I believe there's been, um, some recent calls for higher or more regulation of NHS managers. I think the Labour Party wrote to the NHS confederation last month asking them to contribute it to its review of frameworks and regulations. So I guess my question is one do you support that there should be more regulation for managers? And if so, how do you think that should look?
Anthony Painter: I think obviously we had the, um, awful situation with, um, Lucy, uh, let be and I don't want to preempt anything within, uh, the, uh, inquiry, um, but obviously it did raise a number of issues. Professional regulation and validation is a very important part of, uh, the health and care system with a whole series of regulatory bodies involved with that. That tends to focus, in the main, on, um, clinical staff. So obviously there have been wider calls for should managers, uh, have similar sort of accreditation or regulation. I think that makes some sense. Um, at the end of the day, for the reasons that I've expressed, managers are deeply and intimately involved, whether clinical or non clinical, in healthcare outcomes. And the decisions they make are critical. If they're not listening to whistleblowers, for example, if they're not listening to and, um, feedback within the organization, if they're not investigating properly, um, where there may, um, on occasionally be malpractice, then that is deeply, deeply, deeply problematic. And those managers don't fulfill their duties and responsibilities to patients. And the wider public, as well as to organizational self interest are not encompassing the whole range of those characteristics of a good manager or what it means to be an ethical manager in the context of health and care. And so I think it's entirely understandable that there are calls for regulation, uh, of managers within uh, the NHS system. I think it should be explored further. Uh, now, I don't think it stopped there. And I think in your question, you reference the frameworks and regulation. I think frameworks are also important. I think we need to raise the overall level of training and knowledge across managers of all different types and leaders, um, within the NHS, and even greater focus on that. I think a sort of national framework of management quality, a curriculum that flows from that, and an expectation that those in management positions will have engaged with that curriculum and proven their proficiency in context, um, uh, in relation to that curriculum is important. I think it's important that, uh, those that oversee the NHS in different forms, whether it's on a local, regional basis in the case of, uh, ICBS or NHS England, and obviously the Care Quality Commission itself ensure that there's follow through on that upskilling and uptraining of the NHS, uh, management, uh, workforce. I know not just the messenger Review. I know there's a lot of focus on that in the NHS at the moment, so it's not like I'm suggesting something that isn't in motion. It is in motion, and we can get a good sense of that. But I think it's important to think through this comprehensively across the piece. So that sort of professional regulation piece, um, is entirely understandable and no doubt welcome. But beyond that, there's much more that needs to be done to ensure that we see good quality management and leadership in living and breathing form, not just in technical and regulatory form, across all NHS organizations.
Presenter: Now, of course, your role at the Chartered Management Institute has, of course, shaped your views on all things management within NHS. You've mentioned some of the national research you've been in recently already, but could you tell us a little bit more about the work you've been doing at the CMI?
Anthony Painter: We're the Charter Pressure body for management and leadership. So that's why we exist. We're a charity that's been around for about 75, uh, years. We define a set of professional standards that relate to modern high quality management and leadership. We provide qualifications in that, uh, and we provide membership, um, and a whole series of accredited awards from Charter management degree apprenticeships, which, by the way, have been deployed quite extensively in the NHS charter Management Award itself. So that's basically, we exist to promote high quality in management and leadership within, um, public services and the wider economy. So, of course, that's how we come at this. We're not naive about that. We don't think that management and leadership alone is a magic bullet to all the problems that are faced within the NHS and elsewhere. In fact, there was a great report that I read this morning from the Institute for Government that maps out the current state of public services, including health and social care, and points to some very deep fractures and structures and foundational challenges in terms of investment resources, access to quality technology, the right workforce, as well as high quality staff and leadership. And it's a whole panoply of different challenges that public services currently face. They identify management leadership in the NHS, by the way, as something, uh, which needs critical further development as well, in the same way, um, that we do. So we're not alone in focusing on this, and we don't focus on management and leadership alone. It's part of a bigger piece. We need sufficient resources in our health and care system, and we need high quality, innovative, increasingly productive people and resources, um, in our, uh, health and care, um, system. So that's how we approach this. And we do deep research. We, um, come up with policy ideas, we engage with policymakers, media, uh, and sectoral leadership, including in the NHS, um, itself, in order to work with others to see that high quality and management leadership can make a difference alongside lots of other things so that's how we approach things. We see ourselves very much part of a wide public conversation, but we just like to ensure that there is the right focus on this particular but critical element, um, that we need to really zero in on. Um, as we think about the next five and ten years of the future of the UK. Its health, its well being, its economic welfare.
Presenter: Now, throwing back to everything that's been said already today, and perhaps things that haven't been said. If I asked you to give one piece of advice to an NHS manager listening, who wants to improve the service delivery, prove patient outcomes, all that sort of stuff, what would you say and what would you say, actually as a second part to that question, to a senior leader looking to recruit an effective manager?
Anthony Painter: I would say really focus in on your people. That's the element that's going to, uh, determine the outcomes that your patients face and ensure that they have the knowledge, skills and to deliver and that they are cared for and supported as well as challenged in the right ways. In doing that, you will discover talent you didn't know, that you had, capabilities you didn't know existed. And by focusing and zeroing in on that, you will see change that happens far more rapidly than you dared hope for. And the second part of your question.
Presenter: What would your key piece of advice would be to a senior leader looking to recruit or foster a good, effective manager?
Anthony Painter: Look inside first. See where you've got people that have the aptitude, the mouse, the desire to manage and lead effectively support them in their, um, development, uh, and where there's still gaps. Make sure that when you recruit people into management positions, or positions that require management capability, they have those capabilities, um, test them. There's always a tendency in any job interview to, um, ask around the sort of technical aspects of a work. Uh, do they know the job? Do they know the area? Have they got the knowledge base that enable them to succeed and thrive? And of course, all that's massively important and a bit around how do you manage people, processes, systems, tends to be a sort of bolt on question at the end. Give that a bit more importance because the two things matters together, technical capability and management expertise. And when you combine those, that's when you see real change, um, and improvement.
Presenter: I mean they do say it is a typical saying that I hear, that NHS and the healthcare in general is a people facing it's people's business. Obviously there's more to the NHS than just people treating the patients, but fundamentally it is a patient facing job. The more I talk to people about NHS, it seems that works both for staff as well as the patients. They have to, I guess, think about them too.
Anthony Painter: I think that's an exceptionally shrewd observation. Staff have to feel a sense of belonging, a sense you care about them, a sense that their voice matters, a sense that they are supported to improve, um, and develop. And if you do all those things in the right ways, they then will provide better care for patients. And you know what, you constantly hear refrain around sort of red tape and management being sort of uh, almost identified as exactly the same thing within, AHS, it's the managers with the clipboard and ticking boxes, whatever, and that's a burden on everyone. Managers experience that sense of um, red tape and bureaucratic overload, uh, as well. In fact, the survey that um, we did with SMF found about 60% of managers feel that there are organizational obstructions to them doing their best job possible, including red um, tape. So I think we need to start to separate this notion that red tape and management are exactly the same thing. There is red tape and bureaucracy, but the best management doesn't approach change in that sort of very bureaucratic way. It approaches it in a more agile, problem solving, people focused way. That's what the best of modern management does, underpinned by ethics and the sense of a need to include as many as possible. And as long as we think about management in those ways, then we can see real change. And those examples that I gave you all approach in those ways. Lead teaching, Hospital Trust we've seen it actually in North Staffordshire NHS Trust, half of whom the leadership team actually uh, are charter managers. Royal Berkshire, uh, NHS Trust and others you care to mention when they see management as a dynamic, problem solving, people focused, um, discipline that requires deep knowledge of the area it operates in, that works in collaboration with others, and is focused on outcomes relentlessly over time. That's uh, when you see real um, service improvements.
Presenter: Now, if some of our listeners would like to carry this conversation on, where should they find you? Where can they find you? What should they do?
Anthony Painter: Come to our website. Managers.org UK. All the resources I've discussed that we've published are there, so have a look there if you want to find me, um, individually. Um, I'm on LinkedIn and um, Twitter. Ah, is Anthony, um, painter, and always love hearing from people and either infuriate agreement or constructive disagreement. So please do get in touch.