Thursday 30 April 2009

If we’d known the start point, we wouldn’t have ended up here!

If we’d known the start point, we wouldn’t have ended up here!

A tricky situation

A few years ago, my team and I were asked into a major teaching hospital to ‘run service improvement workshops’ in three directorates.

They were at very different stages of development. One directorate ran seminars every year, and enjoyed brainstorming their possibilities, selecting the best options, working up action plans and benefit reporting, and assigning the tasks. Talk in the room was about opportunity and possibility, and how much had been achieved from previous years.

One directorate failed to set a date for the workshops. The senior clinician was acting medical director and never had time to call his top team together, and the top team didn’t want to make a decision without him. Our best efforts to get them to talk about opportunities were met with talk of targets and indicators that they had to meet now.

The third was different. On the surface all seemed normal – fairly high levels of sick leave and busy shifts that nobody wanted to work; give and take and banter.

Preparation is the key

As we interviewed each of the senior team in private, in preparation for the workshop, it became apparent to us that they weren’t on speaking terms with each other beyond the minimum required to keep up the façade. To try to run a service improvement workshop with this lot would be to try to teach a hungry tiger how to perform first aid – the end might be worthy but they just weren’t ready for it.

A disaster waiting to happen – averted by careful planning

In our case, we spotted the situation and were able to change the nature of the workshops so they became much more personal, directly tackling the communication issues and the very real resentment. We got the 6 top team members to discuss (in a protected environment) how working in that situation made them feel, what they thought could be done to put it right, and their own personal responsibility for both the problem and the solution. With the top team united, many of the problems of sickness and understaffed shifts resolved themselves with substantial improvements in patient safety and patient experience.

Cost-Benefit Analysis

The key is to use facilitators who are skilled and experienced enough to identify the situation they face, and to prepare a plan to resolve it.

Can you imagine the ‘successful’ workshop that failed to address the real issue, and that perhaps resulted in humiliation for senior staff with the inevitable litigation and claims for unfair dismissal. I often meet people with the title “service improvement facilitator”, and there’s an enormously wide range of skills and experience. Some have 20 years’ of managing teams and delivering workshops, whereas others are just out of training grades (“no experience needed”).

It will pay for itself many times over to get the right outside organisation to tackle those difficult situations, and give your staff facilitators a chance to learn from example.

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