Last week I donned my NHS governance hat and visited 2 hospital wards. They belonged to the same organisation, were in the same building, yet the difference between the 2 was so prominent they could have been in 2 different organisations.
Whilst both were clean, tidy, patients cared for, looked after….it was their style, attitude and effectiveness of the leaders that were poles apart.
The Matron here was articulate, passionate and seem to continually strive to do better for both patients and staff. She had a vitality and energy about her which showed up in her conversation. The language that she used was positive, empowering and had a worldview perspective to it.
She had an up to date knowledge and overview of the ward, was a visible presence and seem to have ‘voice’. She articulated her concerns about nurse training, their lack of patient contact and practical knowledge and how they addressed and overcome this on the ward…
She talked about the positive changes that were made since the arrival of a new ward sister a year ago. Of how they worked together to instigate change, of how the number of complaints had significantly fallen and how they achieved this – by listening to patients, anticipating their needs, changing their attitudes, showing more empathy, adopting a team approach ….
The patients described, ‘a team ethic’, ‘that someone has set the standard’, ‘that they are individuals but even the cleaners may do things slightly differently, but they don’t miss the corners’
Was noticeably different
During the walk around, ward B’s Matron did not have the answers for some of the questions posed. For example ‘what was the average length of stay for patients?’ She waited until the ward sister had joined us and asked her to respond.
On looking around the toilets, which were clean and tidy, I noted that there was a tissue on the floor. Neither of the 2 nurses seem to notice it nor did they pick it up. This was in contrast to a visit to another ward in the previous week, where the Sister on finding some paper on the toilet floor, got a tissue, picked it up, put it in the bin and them washed her hands. A small but significant act and coincidentally she was more like the Matron in ward A.
I observed that both the ward sister and the matron seem to share a similar disposition and perspective. There wasn’t that sense of drive and passion and willingness to tackle challenges. For example, the sister mentioned that the day room was small, cramped and cold and not a suitable place for patients to wait (sometimes patients who are ready for discharge are placed here as the bed is needed for another patient). Yet she seemed resigned that nothing could be done or that there may be different options that could be explored.
When asked how she influenced and facilitated change, the ward sister replied that her ‘main priority is to look after the patients’ and that this ‘comes first’, that she hasn’t got the ‘time to come into the office to do the other stuff’.
She seemed ‘rushed’ in demeanour and the image of a hamster going around a wheel popped into my head. The language that she used was negative and powerless.
There wasn’t time to speak with the patients though was aware that some complaints were made around staff attitude and communication.
How can 2 wards be so different?
Does the vastness and complexity of the organisation contribute to this?
Can culture permeate through to everyone?
How do organisations get consistency in approach, values, behaviour, attitudes, outcomes… across all of its departments and people?
In posing these questions, some of the thoughts that wandered into my head include:
– Leadership starts from within –it requires holding up a mirror for scrutiny, feedback, self awareness, emotional intelligence… Organisations need to encourage leadership at all levels and make it the business of everyone
– Individual development and coaching will only progress an organisation to a certain point. It is not sufficient. Learning needs to be collective so does leadership capabilities
– Organisations are socially constructed through a dynamic network of conversations. Shifting the conversations to what you want people to talk about and to pay greater attention to, can influence positive systemic change
– Intangible tacit knowledge carried by individuals has more value when it moves from the individual and becomes organisational knowledge. Organisations need to provide the time, space and opportunities for this to happen
– Organisational learning is emergent and surfaces through the interaction of individuals in groups and teams. Dialogue is the key to transformation and organisational change . Use group and team coaching, action learning, world café…type of methodologies to foster learning, ‘unlearning’ and dialogue
How do you think organisations can seek consistency in its approach, values, behaviour, attitudes, outcomes… across all of its departments and people?
Would love to hear your perspective
I am skilled in using a range of methodologies to foster organisational learning and dialogue and my research dissertation was on teams and team working. Get in touch if you would like to know more.