The impact of #N30: a day of action

Maximum disruption.  That’s the purpose of going on strike.    You will  have read the global figures on the impact of the Strike Action on November 30th but I felt it was important to write about the local impact.  Let’s begin with some basics

1.In an average District General Hospital (DGH) they will undertake about 2,000 outpatient appointments per day and 180 elective operations.

2. On an average week day, a DGH will admit about 80 patients through A&E.  On the weekend this will drop to 65.

Based on the above, the staffing levels are determined and bed moves are managed.  The Trust will run its operations tightly.  Any  significant increase in A&E attendances & admissions will be felt across the Trust.  Naturally, weekends have lower staffing levels because of the lower number of potential admissions.   On top of this, every Trust has sophisticated admission prediction tools, and they will increase / decrease elective activity in response to these predictions.   But like the weather, these predictions are sometimes wrong.

Turning to elective operations, the theatre list will be determined by the consultant who is recommending the surgery.   Each surgeon has different views on how their patients should be treated, and consultants do not “swop” or operate on another consultant’s patient except in exceptional circumstances.  The list is drawn up by specialty.  Eg a respiratory consultant will operate on all patients with lung conditions, including those with Cancer.

The same applies for outpatient appointments.  The key difference with outpatient appointments is that a patient may present with a persistent breathing issue [for example] and in the course of the appointment the potential diagnosis of cancer may present.

There were two strike exemptions on November 30th: one was emergencies, the other was cancer.  But as you can see above, it is incredibly difficult to pull out and determine who is a cancer patient on any given day without considerable effort.

Some Trusts treated November 30th November as a Bank Holiday.  Whilst it might be a sensible approach, I’m not sure how they pulled that off. Not withstanding the fact that it was [otherwise] a normal working day in terms of predicted admissions, but also the fact that usually, with planned cancellations, six week’s notice needs to be given.   Six weeks is deemed as the appropriate length of time to arrange cover / re-arrange appointments in a way that is not disruptive to the Trust.

Since the legislation states that strikers do not need to notify their employer before the day that they intend to go on strike, many Trusts had no idea of the true extent of the disruption.  They faced two choices:

1. Continue as normal, assess the situation at 8am on the day, and cancel as appropriate

2. Make cancellations at short-notice.  However, the Trust may find itself in a position where many staff arrive for work, only to find that there is no work to do.

The  impact on patients should not forgotten.  The exemptions were around cancer or emergencies.  But what abut the patient who’s been suffering for years with their leg?  Their routine operation scheduled for the 30th November is going to change their life.  And then it’s cancelled.  Or the patient who didn’t know she had cancer, until she attended an  outpatient appointment and through discussions with her doctor the diagnosis is made?

Other Trusts took the brave [but in my view the only] option to continue as normal.   What was not seen on Wednesday was the considerable work that was done behind the scenes by managers in Trusts to ensure that the hospital continued to run on November 30th.  The same managers who are in the unions that were out to strike.  And this work continues, as Trusts attempt to recover from the Day of Action.  As I said, maximum disruption.


Senior Leadership Teams: : What it takes to make them great. (Book Review)

I was asked to review this book by the Health Service Journal and my review was published last month.

As a leader, have you ever considered whether you really need a leadership team? This question is often ignored or the leader assumes that they’ve answered it, until they realise that their leadership team has become dysfunctional. 

This book commences by asking this question, followed by five further questions about the purpose and membership of a top-team and how this has an impact on the organisation’s performance.   The answers to these questions can provide valuable insight into a team’s understanding of how well they are working together. 

The authors provide a template which, in their view, is the foundation of a successful team.  In order to establish a high-performing team, six necessary conditions are required:  three essential (real team, right players and compelling direction) and three enabling (solid structure, supportive environment, team coaching).  The authors suggest that all six conditions do not have to be in place when a team is formed, but evidence of the team’s potential to obtain them is a pre-requisite. 

The last section of the book offers four key competencies which the authors believe are essential for a top team to possess. The book also describes four different types of leadership teams (information, consultative, co-ordinating, or decision-making) and how they should be deployed in an organisation.  The authors provide numerous case studies, although the majority are American and only two relate to healthcare.

I would recommend this book to newly-appointed Chief Executives and their top teams.  Organisational Development professionals will find the book useful when developing staff engagement or communication strategies within an organisation. 

This book is realistic:  it recognises that the journey from a collection of senior managers to a high performing top-team can be hard and painful, but ultimately rewarding.  There is nothing new in this book, but it stops and makes you think.

Overall rating: 4.5 stars


Authors:  Wageman, Ruth, Nunes, Debra, A., Burruss, James, A., Hackman, J. Richard

Publisher:  Harvard Business School Press

 You can purchase this book from Amazon

Does Your Relationship With The TUs Represent Good Staff Engagement?

The local TU representative (staff side representative) carries the enormous responsibility of being an advocate of the local members of his department or professional group.  In an ideal scenario, your staff side rep should be able to reliably inform the Trust on what the local members think of proposals and service developments.   It is not uncommon to “test the temperature” around a new idea by running it past (informally) the local staff side rep first.

In organisations (and I mainly refer to NHS Trusts) where there is a sense of trust between management and staff side, this relationship can be dynamic, collaborative and very constructive.  Where there is little trust, the organisation can find itself with a dysfunctional and disruptive workforce.  I have been struck this week by how important staff side relationships are.

Let’s take Job Evaluation:  The NHS has a national, bespoke system called Agenda for Change.  Implemented in 2005, thousands of managers, HR staff and staff side reps were trained in this system.  It’s not a perfect system, but it has helped to reduce the potential of pay inequity and attempts to bring transparency to a creative art form.

Although there is national guidance, I find that with each Trust I work with there is local interpretation: this ranges from how each factor is scored to how the process is carried out.    For example:

  • The Trusts where there is poor staff side relationship, the process is long and drawn-out. 
  • In other Trusts, management have worked with staff side to streamline the process. 

In one Trust, the time it takes to evaluate a set of 10 posts is 8 times longer than another one!  This has an obvious impact on productivity and carries a significant cost to the organisation.

The key to driving efficiences lies with the local staff side.  There needs to be an element of trust between all parties with any radical changes to an established system. 

The Trust that has significantly stream-lined its process has high staff engagement.  The staff trust the process and their local representatives to ensure that the right outcome is reached.

On the other hand, the Trust who has a long, labourious process has poor staff engagement.  The local staff side are fighting to protect the status quo as they fear that the staff may be disadvantaged if any efficiences are built into the system.

Job evaluaton may seem a dry topic to reflect upon in relation to staff engagement, but the underlying outcome is money.  And money matters to staff.  If staff are engaged  they will allow their local staff side reps to work collaboratively with managers.  This can only result in a win-win for everybody.

I’ve written about Staff Engagement before, and my views haven’t changed.  It’s important to recognise that staff engagement permeates through-out all elements of the organisation, and it all starts with the Trade Unions.

Flexible working & Staff Surveys

Every year in the NHS, we undertake a staff survey.  It seeks to measure a range of different topics and the results can be analysed on a national level.   One of these topics is flexible working. 

Flexible working is incredibly important in the NHS and is a key element of any staff engagement strategy.  

Last week I triggered a discussion with an HRD around the uptake of flexible working within their Trust (they had not performed well in this area on their most recent staff survey).  I shared the findings from an assignment I undertook last year with another NHS Trust.   I had been asked to explore the reasons why the uptake of flexible working was so poor within this organisation.   The outcome was that staff were working flexibly;  they just didn’t realise it, and they hadn’t formalised any flexible working agreements.  As a result, the staff hadn’t ticked the “I work flexibly” box on the survey. 

In response to these findings, this Trust invested in promotional materials and raised awareness of the different types of flexible working that are available to staff.  In this year’s staff survey, the Trust scored higher than last year on flexible working.

I’ve been asked to explore this issue with another Trust this year – who are expecting similar results: they believe they do have a significant number of staff working flexibly, it’s just not reflected in their survey.   

I like to be an optimist, and think that flexible working is embedded in the NHS; that in it’s natural form it’s a working arrangement that arises out of an informal chat between a member of staff and their manager.   But the realist in me is asking: is it really that simple?

How To…….Write A Reference

“I have a member of staff who’s applied for another job.  Their new company has approached me for a reference.  The only problem is….I have nothing good to say about them.  What do I write?”

A reference request for a highly performing employee is never a problem to write.  It’s this opposite situation where managers often come unstuck.   Sometimes, you’ll just want to put your head in your hands and wonder “Where do I start?”

In fact, references do not have to be lengthy.  All you need to confirm are the employee’s basic employment details. (It’s worth checking to see if this is your company policy).  However, should you be in the position whereby you’re asked to provide a fuller reference, these are my tips:

1.  Start by confirming their post title and length of service.  It is always useful to confirm your relationship with the member of staff, particularly if it has changed during the period that you have known them (eg I was a colleague of x from June 2005 until January 2009, when I became his/ her line manager).

2.   Outline the key duties of their role.

3. Stick to the facts, or if you need to write a subject comment, qualify it with evidence.

4.  If you have been actively managing this member of staff and have been giving them regular feedback on their work, they will be aware of the areas where they still need to develop.*

5.  Ask the employee if there are any achievements of note that they would like to you include in the reference.

*Although all references are confidential, in the spirit of transparency I always share the reference I have written with my member of staff.  Even the poorly performing ones. 

Writing references can be, and should be, easy.  The key is your relationship with this member of staff.   References are never a problem if you have been actively performance managing your staff.  

To avoid any sticky reference requst moments in the future, invest the time in your staff now!

What’s the point of Exit Interviews?

A recent post by the Evil HR lady was about Exit Interviews the different options available and getting valid reasons for leaving from departing staff.  There were some excellent suggestions for gathering real data, but I want to take it one step further…..

My view is there is little point in undertaking Exit Interviews.  I don’t believe they represent value for money.   Whether they are outsourced (ie through on-line exit interview packages) or done in house (face to face or via paper surveys), they take up considerable resources.  I commented on the Evil HR Lady’s post saying that I had recently recommended the implementation of on-line exit interviews to an organisation I was working with.  I’m not be contradictory here.  I’ll explain my position:

As an HR professional, I strive to deliver best practice in whatever project I’m working on.   Last year I was engaged to deliver a Staff Engagement Strategy within limit resources.   All the research on staff engagement states that undertaking exit interviews is one small, but crucial, element of such a strategy.  I therefore considered the various options and decided that going on-line was the most cost efficient option with the best potential for gathering significant data that could be reported to the Board. 

In the background is a whole raft of research out there including:

  • the majority of people leave their jobs is because of their manager / management;
  • a third of employees leave within a year following a bad appraisal;
  • Induction crisis (ie a poorly managed induction or poor recruitment, or both) is one of the main reasons why employees leave their jobs within the first year;

Therefore, exit interviews are seen as a way of gathering data to prevent the departure of valued staff.   A good exit interview should have an appropriate balance of data and anecdote – similar to that you would find in a good staff survey.   You need the data to be able to tangible measure against any pre-determined metrics.  The anecdotes provide context to the data.   And as the Evil HR Lady says, organisations need to act on this data.  And in my experience, many don’t and give excuses such as “The data isn’t meaningful enough for us to take action”.  

Therefore, a year older and a year wiser, I think I would now try and argue the fact that where resources are scarce (as they are in the NHS), exit interviews are not cost-effective.  Instead, I would support two surveys:

  1. An annual staff survey which would include staff’s intention to leave within the next twelve months and the reasons for this;
  2. An “Induction Crisis” survey, to be undertaken by staff who were within three to six months of starting with an organisation. 

The whole point is about keeping valued staff;  with exit interviews  we trying to close the stable door after the stallion has bolted.  So what’s the point?

Moving difficult staff isn’t the answer

This weekend, I had lunch with a good friend.  Duncan is the Head of a Learning & Development department for a business in the City, and his team sit within the HR Department.  We don’t normally talk shop, but Duncan’s currently managing a “difficult employee”, and is receiving absolutely no help from his HR colleagues.

I’ve come across such difficult individuals before: One member of staff that I had the luxury of managing, many moons ago, had the misfortune of loosing a close relative every six months.  In between she would also experienced a range of terrible personal tragedies.  And when she ran out of ideas, she put in a grievance.    I was lucky enough to have a solid line-manager who decided to look into her situation more carefully: the death certificates did not seem to exist and the counter-fraud team were unable to unearth any police incident numbers. Finally my boss “called her bluff”.   At that point, the employee gracefully handed in her notice.

Duncan described to his “difficult employee’s” antics to me, and she is demonstating similar behaviour.   Her negative behaviour is becoming destructive for both Duncan and the other members of his team.   But their HR department are not prepared to support Duncan in taking a tough line with this member of staff.  With a significant sickness absence record (not really a surprise), the “difficult employee” has little chance of being successful in finding another job.   However, light is at the end of the tunnel:  she has just applied for a transfer to another part of the organisation.  The Head of HR is endorsing the application and so it is likely that soon she will move from Duncan’s team, only to be a burden for another part of the organisation.

Duncan is incensed by what is happening:  with an HR team who are advising a “hands-off” management approach,  he feels paralysed by the situation.  He is also angry that the HR team aren’t demonstrating best practice by actively support him in managing this difficult member of staff.  For me, I feel that the HR team in this organisation is letting  our profession down.  And whilst City institutions continue to handsomely reward their Executives (which I have no issue with, but then I don’t always agree with the Daily News) they are also continuing to waste money and resources by not appropriately managing their staff.  Surely it is cheaper to dismiss this individual and then fight any claims via an Employment Tribunal than to retain them and their difficult behaviour in employment indefinitely?

I have been lucky in my career to have worked with strong and professional HR and Occupational Health practitioners who have supported me when I’ve been working on cases concerning difficult employees.  It’s our responsibility as HR practitioners to consider all the options, the risks and benefits of each, as well as the cost implications when we work with line-managers who are trying to manage “difficult employees”.  And let’s face it, moving staff is the easy solution.   The one thing that I truly believe is that in such situations moving the difficult employee isn’t the answer.  Whilst it might seem to solve today’s problem, it does not help anybody (the manager, the employee, the team or the organisation)  in the long-term.   So why do it?