The other week in one of the #nhssm chats one participant wondered why all Trust’s weren’t approaching a particular topic in the same way. Forgive me, I can’t remember what we were exactly discussing, but my reaction was along the lines of “but each NHS Trust has its own unique culture, which limits the ability of each Trust adopting a “one-size fits all” approach to x”.
I often forget how much or how little the general public know about how the NHS works. It’s perhaps because I’ve worked in and alongside the NHS for so long that it’s wonderful, strange and bizarre ways are almost second nature to me.
For example, I’m used to the fact that the monthly timesheets which are manually completed and sent to payroll have a different name in each Trust. And yes, unless a Trust is very progressive - or has been working with the excellent @Vincelammas – and have fully implemented the costly Electronic Staff Record and thereby using it to its full potential, the monthly timesheets are still completed manually costing millions of pounds in employing payroll staff to input each timesheet, audit it etc etc. But I digress.
One Trust I have recently started working with has an interesting deadline culture. Every conversation ends with
“What deadline would you like [me] to work to?”.
I like this approach, and deadlines are strictly adhered to. But it’s unique – and that’s why it has a struck a chord with me.
Although I like to think that I’m consistent in how I practice my profession, I realised the other day that the way I approach issues depends on the local culture of an NHS Trust.
The HRD of one Trust called me as an issue had arisen regarding a particular topic. He knew I had knowledge of the subject and would be able to give some sound advice. I helped prepare a response which used evidence from NHS Employer documents, emails and minutes of meetings. It was factual and contained timescales. The HRD was happy with the proposed response and kept me in the loop as the internal discussions continued and the issue was successfully resolved.
Afterwards I sat and reflected – if another HRD from a different Trust I know well had called me with the same question, my response would have been very different. In this second Trust the politics are subtle. My response would be designed around managing the audience and focusing on the outcomes rather than look at the detail. A different approach, but appropriate for a successful resolution for that Trust.
So it isn’t easy, despite central control and guidance, to ensure that there is consistency in approach across the country, across every NHS provider. The challenge is to find way to work with the nuances of each different culture when trying to embed a nation-wide initiative. It also explains why some initiatives or innovative ways of working work in some areas, but not in others.
I think that’s why I enjoy working with the NHS – the local culture is a challenge and brings added complexity to the projects I work on. Who would want easy or simple?
That views rings true for me in my local government days – when dealing with headteachers and politicians. Its certainly added a richness to the giving of advice.