Search results

Management of the NHS is necessary and vital to effective delivery of health services. It is not a process that can be avoided, whoever does it. New Labour needs effective managers in the NHS if they are to bring about the changes they want to see. Manager bashing, which New Labour is showing signs of continuing, is counter productive and encourages a climate of threat for managers which subsequently translates into bad management practice with its inevitable consequences for service quality and productivity. The NHS badly needs a positive long‐term strategy of serious investment in individual and organizational development. It is a question of balanced investment between the long‐term management capability of the NHS and immediate patient care. The major issues of rationing, priorities and the balance between health and health services will always be part of the difficult national and local management task. Some move by politicians in the direction of open recognition of these difficulties and the burden they place on the skill, will and courage of managers could go a long way to building a caring management culture.

Achieving high performance in an organization is a complex business. Most approaches are too piecemeal, unidimensional or iatrogenic. Healthy working is an approach to managing performance that attempts to overcome these problems by aiming, in a holistic manner, to harmonize those factors which affect, either separately or jointly, individual physical, mental and emotional health and individual and organizational performance. The approach is based on a set of values and a series of steps. The first step has to be establishing an information base‐line – the four key indicators. A survey was undertaken by PBS to establish the availability and usefulness of data in NHS organizations; summarizes some of the issues raised. Although a worryingly small number keep useful data or produce useful information, much can be done in making critical links if available data is fully used.

While the need for leadership in health care is well recognised, there is still the need to better understand how leadership contributes to improving healthcare services. The body of knowledge concerning improvement has grown significantly in recent years, but evidence about links between leadership and health services improvement remains poor, especially within the UK National Health Service. It remains unclear how and why leadership is important to service improvement, and how leadership development can optimise service improvement.This paper describes a study commissioned by The Health Foundation, exploring the links between leadership behaviours reported by clinicians and managers in NHS organisations and their service improvement work. The study highlights leadership behaviours that appear to be positively associated with NHS improvement work. This paper provides insights into which aspects of leadership are used for different types of improvement work and considers lessons for leadership development.

Proposes that there are sound commercial as well as ethical reasons for health organizations to create “healthful” jobs and working conditions. Describes specific actions for health organizations to take to design jobs and work to benefit the organization in terms of efficiency, effectiveness and health promotion.

Describes a distinctive model of managerial leadership which proposes an integrated framework of ideas and skills of potential application to any leadership situation – and has been devised from literature sources and tested in a number of national and international workshops. Discusses the concepts of transformational leadership and transactional management. Relevant macro factors consist of a number of components from which a range of capabilities, or skill sets, may be derived. Concludes with an outline programme format which suggests how these capabilities may be acquired and developed by managers who aspire to leadership.

Argues that, for the National Health Service to be effective and efficient and give a good quality service, the personnel function is crucial and must therefore receive adequate investment. Suggests that the NHS can learn a lot from “leading edge” organizations, which give priority to husbanding their human resources.

Discusses an exploratory study of the impact of NHS reforms on the management of staff. Argues that “management” has moved from a view that staff should be provided with a secure and comfortable working environment to “labour” being viewed simply as a factor of production. The result seems to be an unprecedented sense of alienation among significant numbers of NHS staff. Proposes possible ways forward. The first focuses on the “means”, accepting that the “ends” of the NHS will, for the foreseeable future, be dominated by the market. The second examines more closely the market‐driven, business “end” or purpose and challenges the unitary view of the NHS Trust as a coherent business entity. Beyond these short‐ to medium‐term responses, concludes that a return to a somewhat more flexible and less hard‐edged human resources philosophy is a longer‐term investment as the labour market tightens and skilled staff become scarcer in the later 1990s.

Explores the introduction and development of Service Level Agreements (SLAs) in relation to Human Resource Departments. Considers approaches to SLAs and highlights four dimensions necessary for the completion of an SLA. Stresses that Human Resource Specialists should have a thorough understanding of how directorates and other departments relate to one another to provide added value in terms of contribution to the organizational outcomes. Suggests the idea of adding value is an integral part of the SLA process which ensures that it operates as a means to an end and does not become an end in itself. Examines the degree of devolved freedom given to a department to seek work or sell its products outside its Trust/Unit. Scrutinizes the format of SLAs and concludes that the benefits of SLAs for users of Human Resource Departments and the benefits to the Human Resource Departments are similar.

Acknowledges that business planning in the NHS frequently disappoints. Reasons for this are found in the tendency for managers to view the production of a plan as an end rather than a means. A further difficulty resides in the perception managers have of their world. Argues that marketing is the most appropriate paradigm for understanding and structuring this world at present. However, an adaptive cognitive style is necessary to allow constant reframing within the dominant paradigm or even reframing of the paradigm itself. In adopting these approaches, the probability of achieving competitive advantage is heightened. If they are ignored, however, it is likely that training and development techniques, however sophisticated, will have little lasting impact.

Proposes the MILTON model of health care policy and management as a framework within which debates about the future reform of the UK National Health Service may be conducted. Reviews the economic, political, social and technological forces which have shaped health care policy and management. Suggests that, at the macrolevel, the paradigm has changed from one based on assessment of needs to one based on securing value for money. At the microlevel, there have been equally profound changes in the nature and availability of work. A theme common to both levels is that of rapid and continuous change. Claims the MILTON model offers a way for the protagonists in the health care debate to locate their arguments about policies of health care provision and the implications for the management of work in a changing world in four planes of the model. The benefits are that the differing positions may be seen more clearly and, arguably more important, that a wider range of options is appreciated when, all too often in the past, arguments have become polarized on a single plane.