Leadership Lessons
What can be learned from the DH Staff Survey?
Written by: Andrew Vincent, Medicology Ltd. Published: 3rd June 2010
Annually, over quarter of a million staff(289,000 in 2008) are invited to participatein the NHS staff Survey, resulting in some160,000 respondents and eliciting a wealthof data on the experiences of staff workingacross all manner of NHS organisations.Used intelligently, the insight containedwithin could hold the key to resolving someof our greatest human-related challenges,as well as providing a stark wake-up call insome topic areas. We’d like to focus on whatleadership lessons can be drawn from thesurvey results.
Strengths and limitations
Besides the insight gained, it needs to beappreciated that all surveys have limitationstoo and the staff survey is no exception.It asks an intelligent set of questions,comprehensive even, but then suffers fromthe manner in which the data is interpreted,resulting in sometimes misleadingperceptions. For instance, to establish thekey findings (e.g. KF1 % staff feeling satisfiedwith the quality of work and patient carethey are able to deliver) the interpretationconsists of the amalgamation of results from3 different questions, rather than a straightforward, singular question. This runs therisk of potentially important findings beingmasked by better results in concurrentlyanalysed questions.
As soon as you pool data to obtain anaggregate result, you need to considerweighting. Consider the question “thequality of leadership in my organisation isexcellent ” with a 5 point scale running fromstrongly disagree to strongly agree with aneutral midpoint. On its own, the questionelicits comparatively little informationbecause leadership is a broad area withmany components. So, to improve thequality of insight gained, leadership isexplored by its components, breaking thisinto say three questions such as:
- I received clear, unambiguous direction
- Communication is active and focused
- Shared ownership & accountability is encouraged
Let’s say that the results return as 24%,51% and 74% strongly agreeing with thestatements respectively. The aggregateresult of ‘leadership’ is an acceptable 50% butit masks the underlying and serious problemthat direction is poor. That’s serious enoughbut clear, unambiguous direction is knownto be one of the most significant influencersof performance there is and therefore carriesmore weight than the other statements.
If you married the strongest result andthe weakest result into a statement, youcould almost say that “almost everybody iscommitted to the organisation but almostnobody really knows what to do” – whichdoesn’t sound like a high performanceenvironment or even a well led one. Thishighlights both the danger of aggregatesand the absence of weighting, both of whichare inherent in the results of the staff survey.
That said, the data obtained focuses on keyareas know to contribute to performance andaffect morale and therefore gives rise to a rangeof interesting findings only some of which wewill focus on, from the leadership perspective.
Teams & teamworking
Over 90% of respondents indicated theyworked in teams but only a worryinglylow 39% felt that they worked in wellstructuredteams in which staff have clearobjectives, work closely together to meetthese objectives, and regularly review andreflect on performance. In effect, the resultssuggest that although staff are gatheredand expected to work together, this is notcoordinated, organised or led in an effectivemanner. This is a poor finding for leadershipacross the NHS and if the staff survey istruly representative, then the tax payer isfunding 90% of 1.3 million people to worktogether to deliver a high quality, efficient‘result’ and yet only 0.5 million receive thesort of leadership that is likely to deliver theexpected performance.
The leadership lesson is simple – theleadership of teams needs attention.Fortunately, around 60% of staff reportedmeeting to discuss how to improveteamwork, although the survey doesn’taddress just what kind of team building ordevelopment teams undertake. Our personalexperience is that comparatively few teamsundergo formal team development, which isoften seen as an overly soft ‘skill’ to invest in.However, the issue here is more of a leadershipone than a team one and highlightsthe urgent need to address leadershipdevelopment in those leading teams.
Line management
More worrying results appear whenconsidering the leadership skills of linemanagers in general. The survey highlightsthat line managers are clearly committedto their staff, with 67% of participantsreporting that their manager helped themwith difficult tasks and 70% reported feelingsupported in a personal crisis. However, onlyjust over half (53%) felt that their managergave them feedback or asked for theiropinion (51%) before making decisions thataffected their work. This highlights morefailings from a leadership perspective.
Healthcare staff, particularly on the front line,have a strong motivation to be helpful andsupportive and this shows through stronglyin the results. However, good leadershippractice involves staff having regular feedback on performance and thisis known to impact morale, not to mentionbeing an important part of a performancemanagement feedback loop – it is difficultfor staff to improve if they don’t actuallyknow how they are doing! Furthermore,transformational leadership involvesdeveloping ownership and accountabilityin team members and this is highly unlikelyto occur if managers simply take decisionswithout consulting or sharing the processwith the team members those decisionsaffect. It is dangerous to over-interpret theresults but we can probably conclude one oftwo things, or both:
- Those in leadership positions have nothad sufficient leadership development
- That transformational leadership is notcommonplace in the NHS, which couldbe due to the first point or possiblya more transactional approach ispreferred
We refrain from concluding that those inleadership posts are just not up to the jobbecause our experience is that with properdevelopment, good leadership practice canbe encouraged, developed and embeddedin most.
Appraisal
In 2008, 64% of respondents hadundertaken an appraisal (or a knowledgeand skills development review). Givena historical disdain for appraisals in thepublic sector this is a welcome findingthat suggests a stronger commitment byorganisations to actively performancemanage their staff. However, only 27%of all staff felt that their review was ‘wellstructured’ in that it improved how theyworked, set clear objectives and leftthem feeling that their work was valued.
Consistent with previously highlightedfindings, only a third (34%) said that theyreceived clear feedback on how they weredoing. At a practical level, the findings couldsimply be down to a lack of experienceor training in delivering appraisals butthe trends towards no clear direction,poor feedback, lack of recognition etc arefrighteningly consistent throughout thesurvey results as a whole, suggesting a morelikely issue with the leadership developmentprocess rather than the skills training.
Feeling valued
One of the strongest predictors of moralein staff is whether or not they feel valuedfor the contribution they make. Ensuringthat contribution is recognised is not onlyconsistent with delivering against thefundamental human needs but also falls intoa category of leadership 101. It is sad to findthat less than a third are satisfied with theextent to which their Trust values their work.The survey report strives to highlight thepositives by identifying that in some trusts,over half (56%) of staff are satisfied withthe extent to which the Trust values theirwork but in the interests of balance, whichwe applaud, lets on that in some Trusts isonly 11%. If 56% is the highpoint in a caringprofession where staff have traditionallygiven their all and more, this finding shouldencourage shame in the leadership ranks.From our perspective, it is one more notchon the post of conclusion that leadershipneeds addressing and addressing fast.
So what can we conclude?
Our first conclusion is somewhatfrightening. Although we spend over £100billion annually on health, employing 1.3million people and expecting those 1.3billion to perform well, deliver value andimprove continuously, the survey highlightsa stark lack of proven leadership behaviours.Our long experience of front line clinicalstaff and managers alike is that they arecommitted, hard working and with positiveintention in almost everything they do.They are also capable people that managesometimes to achieve amazing things withcomparative little resource. However, theyare enormously disadvantaged by notadopting good quality leadership practice.Our experience is that healthcare staff arehighly motivated to adopt good practicein all that they do and so our secondconclusion is that the lack of leadershipbehaviour is a corporate failure to developleadership that has persisted for a very longtime.
As we enter and era where much is going tobe expected of our healthcare workers, someof it very uncomfortable too, organisationsneed to take on board the absoluteimperative of ensuring they have the rightcalibre of leader in place by identifyingthem, training them and nurturing theirleadership journey. When dealing with thisdearth of existing leadership expertise, itwould be easy to adopt an almost freneticapproach to instilling leadership skill. Weurge caution. A competitive market, copingwith a demanding environment in an era offinancial famine and massive reconfigurationrequires something a bit different – theimperative of context-specific leadership.Imagine increasing your leaders’ ability toachieve and muster the support of peoplewhilst they still disagree with the direction totravel. Now that’s an interesting challenge!
Author:
Andrew Vincent
Managing Director, Medicology Ltd
