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Tackling performance concerns in hospitals requires hands-on leadership

14-February-2013 0:00
in General
by Dr. Jenny King

Edgecumbe welcomes the Francis Report on the catastrophic failings at Mid Staffordshire and more widely, the recommendations for NHS Leadership. We note that Robert Francis points out (Executive Summary, Page 18) that “The experience of many previous inquiries is that, following the initial courtesy of a welcome and an indication that its recommendations will be accepted or viewed favourably, progress in implementation becomes slow or non-existent”. This mirrors exactly our experience in the last 10 years of working with many NHS Trusts to support their management teams in handling concerns about performance.  In particular we have been concerned about the following:


  • Timely follow-through after the initial intervention is crucial. All too often, once our report has been submitted to the commissioning team, weeks if not months pass before any further actions are taken. Valuable momentum is lost and cynicism is re-kindled. It becomes increasingly difficult to effect improvement. The strongest effects of our interventions happen when the senior leadership team is fully engaged and “on the case” from start to finish.


• There must be full engagement with any recommendations. The report provided after the intervention should be a living document – frequently referred to, to ensure the team is on track; not treated as a one-off exercise that ticks a box saying “ we’ve done as we were asked – we commissioned a review”.  


• Medical Directors must stay engaged in the frontline of the process, and resist the temptation to delegate the review to a more junior manager who has neither the experience, nor the clout – especially with senior doctors – to drive the process through to a sustainable conclusion


• Trusts have frequently commissioned review after review after review, from a variety of different organisations – leading to interview fatigue, cynicism and a spiral of learned helplessness. With each new review that is commissioned, credibility is reduced.


• The time lag between interviewing people and disseminating the review findings may be many weeks or months – causing a build up of anxiety, fear and diminished morale so that when the feedback is finally delivered, the audience is in too much turmoil to respond constructively.


Visible sponsorship for tackling difficulties in a hospital must come from the highest level – the CEO and the Board. Handling performance concerns is a marathon not a sprint – and requires leaders to stay in the race for the long haul and not simply shelve the report once it has been commissioned.

Addressing compassion fatigue needs a different style of leadership Jenny King IMG fatigue


David Cameron urges Trusts to “recruit for compassion”.  But what about tackling compassion fatigue? What made the nurses at Mid Staffordshire – or indeed any other hospital – change from being caring individuals with a vocation to help patients, to individuals who showed such an utter lack of compassion? Could it be that the relentless demands, the complete lack of appreciation for their efforts, the intolerable push for process, procedure, cost-savings; the desperate lack of staff and support, simply drained the capacity of those nurses to respond with care and humanity? We can – and we must - recruit for compassion at the outset– but that compassion needs to be nurtured and retained, or it will very soon wither on the vine.

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