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What Can Managers Learn From the Mid Staffordshire Hospital Scandal?

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The long awaited Francis Inquiry Report exposed the true scale of the catastrophic management failings at the Mid Staffordshire NHS Trust. The scandal highlighted the lack of competent governance, poor working culture and ineffective management across the Trust and the wider NHS.

The report makes it clear that too many health sector managers felt pressured to put financial performance targets ahead of patient safety. There was a dangerous separation between senior management teams and those providing frontline clinical care, creating a blame culture where staff worked in fear of reprisals if issues were brought to light. In addition, it meant that the board became disengaged from its core responsibilities for standards of patient care.

If we're going to learn from this, line managers and senior management in the sector need to reconnect with both patients and staff in the following ways:

Walk the floor
For starters, we need to see managers - including those at board level - walking the floor in hospitals, inviting collective feedback from patients and staff, and using this to rebuild trust and create a better working culture. 'Management by walking around', as it's known, can really help managers to get a sense first-hand of conditions on wards and spot where things could be done better.

It is important to have regular catch up sessions involving NHS managers, clinical staff and representatives from patients' groups. This will help to gain a realistic understanding of what is happening across the organisation and what needs to be improved swiftly or monitored more closely. This immediate and detailed feedback should highlight both good and bad examples of activity, to enable more effective management.

Escalate bad news
Managers must make it clear what is expected of all staff members, what good and bad behaviour looks like and the impact of both. Part of this has to be an expectation that problems or difficulties are immediately brought to managers' attention. Front-line staff need to feel comfortable coming forward and providing feedback, both positive and negative, in the confidence that their concerns will be dealt with professionally and effectively. 'Shooting the messenger' or brushing their concerns under the carpet is simply not good enough when patients' health is at stake.

Competent and confident managers
As with the Inquiry's proposals to evaluate nurses on the quality of care they provide, managers should be evaluated on the quality of their leadership and effective management. As part of this managers need to receive regular feedback on their personal strengths and weaknesses - and those of their teams. This will ensure that gaps in knowledge and skills are identified and filled, with adequate support provided.

Training from day one
Management training should begin early and be maintained throughout careers in the NHS. Training should be a condition of being appointed to a management position within the NHS and continued professional development should be encouraged with accessible resources readily available to managers, alongside formal qualifications.

Professional managers are those who have signed up to a Code of Conduct
The reputation and integrity of managers needs to be rebuilt to counter current mistrust. To do this, better alignment is needed between organisational and personal principles.

CMI members must sign up to a code of conduct, demonstrating their competence, professionalism, honesty and integrity at work. Frameworks such as this are essential towards rebuilding trust and moving forwards in the NHS.

It is essential that managers have the training and support needed to meet the standards expected. The need to meet targets should not continue to cloud that which matters above all else - staff wellbeing and patient care.

It is vital that the report recognises the importance of building skills and performance against professional management standards and ensures that all staff, whether clinicians or managers, are encouraged to get qualified and recognised for their management skills.

Further information on the Chartered Management Institute is available here - http://www.managers.org.uk/

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