Too much stick, not enough carrot?

Image courtesy of BBC News

Health Secretary Wes Streeting has introduced new NHS league tables, but they have not been universally welcomed within Healthcare.

We must improve efficiency and accountability in the NHS, but a ‘name and shame’ approach could have a negative impact on the health and wellbeing of healthcare staff, and therefore on the delivery of care.

What is proposed?

There will be new league tables for NHS trusts, with:

• Trusts Publicly ranked (‘named and shamed’)

• Failing managers being sacked

• Leaders of underperforming trusts having their pay cut

• ‘High-performing’ providers being given extra support and freedom

Nobody wants to reward failure, and initiatives to improve performance and reduce waiting times are needed. But in the cash strapped NHS we have to ask:

What constitutes real Value for Money?

We all want the best value from the Public Services we pay for. But it is hard to measure value in a healthcare system already stretched to the limit and starved of resources. The government wants to ensure that ‘every penny of extra investment is well spent’, but in many areas investment is required simply to shore up services that are already less than adequate.

Inadequate resources are the root cause of poor performance. Staff work beyond their hours, and pay, to provide a level of service. Even then many feel their services have deteriorated. Staff are often frustrated that their best no longer seems good enough.

We need to plan targeted investment in services that are struggling rather than planning to punish staff working in those services. Lessons from the past demonstrate that we must avoid concentrating on targets and metrics at the expense of patient care and staff engagement.

How will league tables impact Staff and Patient Care?

It is never nice to be working in an organisation which is at the bottom of a league table. League tables have a huge potential for unintended consequences - Public naming and shaming of the organisation where you work reflects negatively on the work performed by staff, who are usually doing their best in difficult circumstances. This inevitably lowers morale, increases pressure, decreases job satisfaction, raises stress levels and magnifies the risk of burnout.

Many Staff in organisations labelled as ‘failing’ will seek jobs in Trusts considered ‘better’ in the league tables, and ‘struggling’ Trusts will find it difficult to recruit to the existing and resulting vacancies. This will become a negative downward spiral, where poor rankings increase the challenges to improve care. League tables may lead to deterioration rather than improvement. They are potentially a recipe for disaster.

How could we care for Caregivers?

Instead of a ‘name and shame’ approach, we need to address the root causes of poor performance. Over the last decade, the NHS has suffered from chronic understaffing, escalating staff stress, and starvation of investment.

We need to provide support and resources to struggling trusts, and their staff, rather than ‘naming and shaming’. We must, of course, recognise and reward efforts to improve, but we also need to develop a learning and development culture. We need a more constructive approach than ‘name and shame’; an approach which values and supports NHS staff, which are its greatest resource.

What is the Role of Coaching?

In my blog posts I have consistently argued that Executive Coaching is an essential tool for NHS Staff. Its value is undisputed and enables staff to deal with stress, avoid burnout, plan their careers and rekindle a sense of personal direction in their roles.

Coaching equips staff in leadership roles with the skills to navigate challenges and inspire their teams. Personal growth improves personal performance, as a new career focus increases engagement and job satisfaction. Coping mechanisms reduce the effects of stress and prevent burnout. Coaching promotes Team building leading to improvements in care through better communication and collaboration.

Coaching will play a vital strategic role in supporting staff, improving team working and enhancing care delivery.

Conclusion

Whilst Wes Streeting’s intention to improve the NHS performance is commendable, league tables will have a negative impact on staff and therefore on patient care. An approach that addresses systemic issues, supports struggling trusts, and invests in staff development through Coaching will be more effective in achieving long-term improvements in healthcare.

It is important to have the right staff, with the right skills, in the right jobs, where they are able to develop their skills and are happy that they are functioning well. Coaching has undeniable proven benefit for NHS Staff and is absolutely part of the solution. League tables are not.

Many trained and accredited Executive Coaches are available to work with NHS staff. Most of us offer a free no-obligation conversation so that you can determine if Coaching is what you need. If you think I might be able to help, please use the link here to book a free discovery call. And if I am not the right coach for you, we can discuss who else might be a good fit.