Workforce is probably the single biggest expenditure of any healthcare organisation, and especially so in NHS (after all, all care is delivered by humans - it works better that way).
Because of this, when efficiencies need to be made, workforce expenditure comes under the spotlight.
Techniques such as Lean, and programmes such as NHS Institute's Productive Series look at ways to shave pennies off each activity. But what about activities that aren't actually necessary, but that organisations hold on to because the individuals fear for their continued employment?
We already know that under Payment by Results, a secondary provider (hospital) can increase their income by increasing their throughput (eg improving quality to the point where length of stay is reduced, which frees up beds, which allows more people to come in for operations). But is this value for money? Does the extra income generated cover the additional cost of driving up quality?
We looked at this with the boards and front-line (clinical and support) staff of an acute teaching hospital, and a care trust. We generated profiles of the staffing currently in place, and the staffing models that the staff themselves thought would deliver best care. We examined cost per unit of activity and quality outcomes, and compared this with the avowed aims of the Trust.
Most importantly, we compared the profiles for similar departments and functions, which generated passionate discussion and soul-searching.
The staff themselves agreed potential new staffing profiles, taking into account resources (cash) available and the tariff under payment by results.
Managers, workforce planners and clinicians used the profiles generated to plan and implement projects to deliver the changes and realise the benefits.
In a busy and turbulent world, it's almost impossible for the Directors to mandate every change and every conclusion, and it leads to resentment and de-motivation. The above process engages people, helps them to feel part of the organisation in which they work, to see the bigger picture, to work for the greater good. That's when quality improves at the same time as unit costs reducing.
The SfH Career Framework team are building a database of roles and people so that staff and potential recruits can understand
what their local role or title is equivalent to
what they need to do in order to progress to the next career level
what career paths others have followed
what the opportunities are with their skill set
and so that organisations and workforce planners can
understand the different local titles used and how they relate to competence, experience and autonomy
have access to a range of standard job descriptions and person specifications, to greatly simplify recruitment and appraisal
and developing and planning teams to deliver care
In order to achieve this efficiently, the team developed standardised questions that would allow a role to be assigned to a Career Framework level in each of 8 dimensions of the role.
I developed a tool to capture this information and combine it into a database, which allowed rapid capture of over 400 roles so that the Career Framework level, competencies and Job Descriptions could be compared across professional groups and points of commonality and difference recorded.
I reported on the success of this development and on the results, which make interesting reading
The differences between practice for the same task performed in different hospital trusts is striking. Healthcare scientists decided to examine this issue in more detail, and my part was to use competences to determine what were the minimum competences required to perform a particular step on a science pathway (in this case, Pathology Laboratories), the minimum level of scientist with these competences, and compare this with actual staff performing the task in different Trusts.
The results are fascinating: staff profiles vary between core hours and extended hours in those Trusts which run extended hours labs, and between teaching, large and community hospitals providing lab services (big, medium and small labs).
In some cases a significantly better qualified and experienced person performs a task than the minimum needed; in most cases this is justified because the experienced person is required for some stages and using another person would duplicate headcount, or because a senior person is needed during extended hours; in a few pathways there may be opportunities to make significant cost savings through more appropriate team profiling.
The full report (in which my contribution plays a small part) can be downloaded from the Skills for Health web site, on page http://www.skillsforhealth.org.uk/page/career-frameworks/pathology-profiling-project
Wouldn't it be nice to do what the US Government does, and condemn someone to death because they do something you don't like (New Charges Filed Against WikiLeaks Suspect)
However, US Government and the military are the laughing stock of any thinking person - how was this information leaked in the first place? Thinking people are concerned that nobody is being hauled over the coals for the security policy (or lack of it) in the first place, nor for making sure that US government information is even moderately secure.
At the root of it, this is the problem.
Private First Class Manning was authorised (as an intelligence officer) to see Top Secret information. Not restricted to just Iraq. Not restricted to just military. Just Top Secret. And since just about everything the government does is classified as Top Secret (so the voters can't find out about it), that means that the sheer volume of "stuff" classified as Top Secret makes it very difficult to keep tabs and impose any sort of order.
What's your IT policy? Do you have protection in place, so your company secrets can't be copied off onto a flash drive or CD? Do you have your confidential documents as web pages, so they can't be downloaded en masse, but only read one at a time?
US Government doesn't. Bradley managed to bulk copy 250,000 documents (you don't do that, one document at a time!) onto a CD-ROM and nobody knew he'd done it without going back to the logs. He was then able to mail the CD to Wikileaks with no restriction.
You and I can't (usually) jail someone or condemn them to death for leaking confidential information.
But we can get everyone committed to each other, a bit like Edward III did when he created the "Modern Round Table" at the end of the 11th Century. We can get people to understand the consequences, not to themselves (Private Manning probably knew the risk he was running) but (far more important to most people) the impact to friends and colleagues of their actions. If you don't share the organisation's ideals, can you adopt them? And if not, can you be detected?
Actually, we may look back on this incident and thank Private Manning for sparking off the demands for democracy across the whole Arab world - but that's another story.
When we all pull together, we can move mountains.
People might not share the ideals when they join a company, and selection processes that put this as top priority may end up recruiting only the talentless. But they can commit to the ideals as they settle in to the organisation, provided you know what you are doing and make an effort to help them. That's what Benefits Management is really about.
Benefits Management isn't just about new projects and initiatives. It's about aligning people, inspiring people to want to achieve the same outcomes, getting people to work together.
It applies just as much to your security policy, your remuneration and reward policy, to your expenses policy, to your recruitment and reward scheme as it does to the new projects and initiatives.
Don't leave it to chance and to the heavy (and expensive) hand of the law. Take the opportunity and talk to us about how you can use Benefits Management to transform your organisation, from petty office politics and people running in different directions, to an inspired team of people proud to work for the organisation and proud to support the customer base.
I went to a benefits workshop on implementing a new IT service within a big organisation. We looked at the features of the solution offered, and were asked to identify benefits for each stakeholder. Over 4 hours we brainstormed, and focussed, and documented, and planned how to measure.
Then it struck me – this is all the wrong way around! Granted, I usually examine benefits in front-line (health and care) environments not in back office functions, but many of the enablers are back office.
Nobody at the event asked “didn’t we already know why we wanted this, before we designed it?”. Instead of starting with the need and creating the solution to solve it, we appear to take the solution as the fixed item and look for ways to justify it after the event. If we knew why it was wanted, the benefits design, planning, management and realisation would be simple: does it do what we want it to do?
So start with the need. What is the problem that needs solving (insufficient resources to meet demand, waiting lists too long, costs too high, demand for different services, administration ineffective, people’s safety privacy and respect threatened)? What is the whole of the solution that IT is only a part? What about the IT solution proposed (or mandated) actually solves the original problem, in conjunction with other (workforce, service transformation, facilities change) components?
Build a benefits profile around this. IT solutions can’t deliver benefits in isolation, and nor can most of the other components of the solution. The solution is in response to a need, so the benefit is resolving the need. Monitor progress towards resolving the need, and you have your benefits realisation. Measure something specific to the IT project, and you run the risk of becoming divorced from the whole solution and benefits not realised.
(also known as Bring your child's teacher to work day)
I've just spent two days at the New Types of Worker conference in Glasgow "Excellent Out Of Adversity". The keynote speakers were excellent – in fact everyone was excellent!
The Health and Care Sector Skills Councils had invited the head of one of the other sector skills councils: Jack Matthews of the Improve Food & Drink Skills Council. Not only was he very passionate, not only was he very funny, but he made a lot of very important points, entirely relevant to the enormous combined workforce in health and social care (over 2 million).
Jack shared with us that the Food & Drink industry has an image problem. Schoolchildren just don't want to come and work in the sector, they don't want to "work in a canning factory". Gone are the days when young adults would look starry eyed towards careers in Nestlé, Mars, Kellogg's; the Food & Drink sector is seen in a very different light at the moment.
That’s funny – another keynote speaker pointed out that schoolchildren didn't want to work in social care – it was no longer seen as a profession providing the care of people who desperately needed it, now the job was seen as emptying bedpans. Same job (if anything, even more professional, and certainly better paid relative to other work), but the perceptions have changed.
I suppose the starting point is to work out where these low perceptions come from. Unfortunately, the finger of blame seems to point towards schools and school teachers(!) Children and young adults are brought up with the idea that many of these jobs are somehow less than they appeared to previous generations. Dads and Mums still work in their careers proudly, and many sectors remain so specialised that the children's parents will stay in one sector for life. But schools that used to churn out eager members of society ready to be molded to one or other industrial or commercial sector, now turn out adolescents who want a big salary for only doing the interesting bits, and prepared to stay at home rather than take on a job with unfulfilling parts. Whatever is going on, it needs to be put right.
At one time, companies wanted to give children an early taste of what their industry consisted of, and invited them in to see what was going on. It gave a parent the chance to introduce their children to the reality of the day-to-day work so vital for Britain's success. Perhaps because the "job for life" doesn't exist any more, this has become less common. And with parents working longer and longer hours and spending less and less time with children at those formative times when they think about study options and future careers, teachers become the main arbiters of children's attitudes. The teaching environment is very different (children tend to need controlling – employees tend to need empowering, and so on) and the sad reality is that schools and universities fail to turn out people suitable for commerce, for industry, and for public sector and third sector jobs (as predicted by Lyotard 1984). So perhaps we now need teachers with experience of the attitudes, of the pride, and of the hurly-burly and ups and downs of the kinds of jobs that their pupils will find usually themselves in.
How many companies are ready to invite teachers at local schools into the organisation for a week or a month, to shape these attitudes? How many proud parents, instead of taking their child to work, would take their child's teacher to work? Is this the answer, or am I unnecessarily maligning teachers and schools?
Success in business, and outside the workplace, frequently depends on the nature of the relationship. And the nature of that relationship is entirely within the control of – YOU.
Cialdini describes six weapons of influence, of which three relate directly to the relationship between people:
these are important to your success: nobody can do it on their own, we succeed when we can persuade/encourage others to join with us, whether through leadership, coercion, or some other form of persuasion. We "infect" others with our enthusiasm, to work together as a team, else we become part of someone else's plan. If you tend to work on your own, or with an organisation from your last autonomous, then they are just as important to help you get your point of view across, to negotiate well, to win the argument. Unless you are entirely self-sufficient, and on an island then you will always affect or be affected by the people around you.
The key to consistency (one of the three weapons of influence which relates to the relationship between people) is in being pretty well. Extraordinary leaders have made some of their success on being unpredictable, but let's be frank, it doesn't work for the ordinary person in the street. Being consistent, being predictable, fitting the mould – this is what makes people comfortable with you, this not only makes you trustworthy, but it can also help people to like you (other key weapon).
Consistency, fitting the stereotype, will raise people's perception of your competence, and often your authority.>
The difficulty is that in a wonderful egalitarian society, we have different stereotypes of men and women.
Men are expected to be:
woe betide the person who crosses the gender divide.
then you will always affect or be affected by the people around you.
Of course the same applies between the races, between ages, between people of different sexual orientation (if this is even within the workplace), and it is a challenge – it's difficult to have true equality, when people have preconceived ideas of what they expect, and punish those that do not comply with the proper stereotype. Alysia Morga picks up on this in her blog "Why Women Should Flirt at Work"