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Why workforce compliance metrics are ignored

Changing culture is tough - in comparison, it’s far easier to write compliance management software!

The metrics we share with Trusts are drivers for positive transformation, but if we want maximum success, we’re going to need buy in from managers and staff.

We had a deep think about how staff can react to the “imposition” of new insight – and (inspired by “The Seven Stages of Grief”) we noted a definite flow to proceedings. For us, empathy with staff is key to reducing any difficulties and always front of mind.

Much has been written on change management and acceptance - now it is our turn to put things in an NHS workforce compliance context.

If you are a staff member dealing with change and reading this post, perhaps try to work out where you place yourself. You may find this weirdly reassuring, and be able to identify coming issues to stay ahead of the game.

As we deploy our solutions, we’ve had to design supportive strategies to address of the issues noted below (perhaps the subject for another post).

Yet another transient initiative

The NHS is choc-full of uncooperative systems. Nurses and Managers find it hard to respond with enthusiasm to another new solution. Perhaps thinking, “After, all Trust management will be moving on to the next problem in a few weeks. If I sit still and avoid engagement, the problem will therefore go away.” It’s an understandable response to a lack of historical follow through.

Treading on my toes

The delivery of new insight can trigger a defensive reaction from staff. What? It’s that bad? In a way, using out of range metrics to trigger corrective processes is a very logical step, but it’s one that can seem to diminish a manager’s sphere of control and apportion blame. Where is the room for professional judgement, if the Trust is run on numbers?

Compliance can be painful

So we’ve identified some behaviours and processes ripe for improvement. Excellent work all round, but for Mangers to action the issues they previously didn’t have the evidence to confront, can be:

  1. More work

  2. More grief

For instance, let’s consider taking issue with staff over shift working patterns. Of course, a Manager may already have an idea that all was not quite cricket, but now, they have to do something unpopular about it. And the staff are already working pretty hard. Is it worth rocking the boat for?

The apprehension in challenging staff is understandable. The reality is that many Ward Managers (although experienced nurses) are undertrained in how to handle human-management issues.

Leading nicely onto…

Where’s the support?

If change projects aren’t well understood at all levels in a Trust, a brave Manager may take on some of the change processes and stick their neck out - only to find a discouraging lack of support from senior Trust executives. If staff complain and a complaint is upheld, the Manager may feel like giving up.

Not invented here

It’s a very good idea to ask staff how their day could be made better. How would they like to work? And then to contrast this with what usually happens. In a change management forum, we then need to tease out how to get from A to B.

Change processes birthed in this way are more likely to stick.

Change imposed on staff is likely to be differently received. You want me to do what? How? How much spare time do you think I have?

That’s not my responsibility anyway

A new process is by definition, err, new. It may not be part of existing job descriptions or may not have an obvious escalation structure. So who’s picking this up? No motivating force, no consequences (aka “the carrot and stick”)

The question really is, who benefits from a changed process. And transitional pain is likely to some degree for any change, but who absorbs it?

“Some pain no gain” is a hard message to sell. Staff higher in the organisation’s hierarchy may be better able to think “on behalf of the Trust”, but other staff may perceive no benefit and believe the Trust is big/ugly enough to take care of itself.

In compliance management, there’s a saying, “Who guards the guards” (from Juvenal). Where does the buck stop? Will Wards make changes? Will Matrons contribute? Will Heads of Nursing chase Matrons? Will the Chief Exec even be here next month?

Ultimately, if there is no consequence where staff ignore new processes, staff will quickly revert to the status quo and a promising transition will break down.

My head is just 1mm above water

It takes time to consider and action new processes - for instance, there could be product training involved. In a pressured Ward context, where will the Ward Manager find the space to change? Is it fair to expect a transition to be simply accommodated without additional support?

Oh I see…

Eventually, when the light bulb moment arrives, when the benefits of a transition have become evident there’s a timely opportunity to really groove new processes on that back of a honeymoon period. Champions can be selected to virally introduce this change to other parts of the Trust with increased velocity (by this time, many lessons re: deployment smoothification will have been learned).

All you can eat

We find this is also a good time to show what else we can do. Change is usually introduced in (hopefully) palatable mouthfuls, often which build on success from previous projects, so now to capitalise on enthusiasm and wow the Trust with what’s coming next!

We’d appreciate your thoughts and comments, as ever. And you can find out more about our work here

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