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Staff Sub-Cultures & Perceptions of the Organisation: An Historical Perspective. North Tees & Hartlepool Foundation Trust. Service Line Management. Transparent accountability. Resource interconnections. SERVICE LINE MANAGEMENT. Multidisciplinary based care.
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Staff Sub-Cultures & Perceptions of the Organisation: An Historical Perspective North Tees & Hartlepool Foundation Trust
Service Line Management Transparent accountability Resource interconnections SERVICE LINE MANAGEMENT Multidisciplinary based care Systemisatised care processes
Staff Views on Organisational Practices Views on: • Management models appropriate for improving the overall performance of clinical units • The management style of Trust • Trust’s organisational goals • Staff affiliation with their Trust
Styles of Management • Collegial (inclusion, freedom, belief, satisfaction) • Meritocratic (encouragement, degree of freedom, individual achievement, competition) • Unit based paternalistic leadership (loyalty, belonging, team solidarity and achievement) • Hierarchy (direction, compliance, rules, discipline, surveillance)
Sub-Culture/KnowledgeMapping Views on : • Health care issues • Strategies for addressing hospital resource issues • Autonomy and accountability • Clinical governance • Clinical and resource interconnections • Causes of clinical practice variation • Basis for setting clinical standards
Stances of Acute Care Trusts and PCT for the Study as a Whole Emphasis on financial realism and transparent accountability Individualistic concepts of clinical work Systematised concepts of clinical work Emphasis on clinical purism and opaque accountability
Professional Subcultures in NTHFT; 1995 & 2002 Emphasis on financial realism and transparent accountability GM 1.5 MM GM 1.0 MM 0.5 Systematised concepts of clinical work Individualistic concepts of clinical work AHM -1.0 -1.5 -0..5 0.5 1.0 1.5 NM MC MC -0.5 AHC -1.0 1995 NC 2002 NM NC -1.5 Emphasis on clinical purism and opaque accountability
Professional Subcultures of Acute Trusts in an International Sample Emphasis on financial realism and transparent accountability Individualistic concepts of clinical work Systematised concepts of clinical work Emphasis on clinical purism and opaque accountability
Medical Clinicians’ Views on Performance Improvement, 2002 • Emphasised • Improvement of the internal organisation of clinical work • Increased resources and improved decision-making about their use • More effective organisational management • Tended to believe that • Decision making processes within the Trust were ineffective • Past amalgamations and policy implementation had been poorly handled • Doubted that • Managers would be able to ensure the Trust functioned decisively and effectively in the (then) new health economy environment
Medical Managers’ Views on Performance Improvement, 2002 • Emphasised • Improvements in the internal organisation of clinical work within the Trust • Making better use of resources the Trust already had • Would have appreciated • More time for both clinical work and management activities • Better access to clinical information to guide service design and inform service delivery • Greater emphasis in team working • Greater skills development in team development and management
General Managers’ Views on Performance Improvement, 2002 • Emphasised • Reorganisation of clinical work internally • Concerned to • Rein in the power of the consultants • Wanted • More effective team working within the organisation • Partnership and joint organisational working within health economy, including subsuming aspects of primary care into the Trust • Characterised at times by • Some blame shifting to DoH and clinicians • Apparent lack of ideas to resolve difficulties
Nurse Managers’ Views on Performance Improvement, 2002 • Emphasised • The belief that clinical performance outcomes were related to virtually all aspects of organisational life • A concern that clinical work should be better organised and managed • Concerned about • Time pressures • Lack of experience in working in and leading teams • Lack of forums for cross-disciplinary and cross-directorate meetings • Wanted • Leadership development • Reshaping of Trust management structures • Concrete suggestions the new service developments (not just abstract ideas)
Nurse Clinicians’ Views on Performance Improvement, 2002 • Emphasis upon • Pay and conditions • Concerned about • Accessing more training opportunities • Sorting out anomalies in working conditions • Poor management-staff relationships • Characterised by • Extremely low response rates • Appeared disengaged with the organisation • Focused upon personal development and personal needs
Allied Health Managers’ Views on Performance Improvement, 2002 • Emphasis upon • The organisation’s relationships with external bodies • Organisational requirements for improved clinical organisation (on which they had many and wide ranging opinions) • Believed that • Resources, especially time, were critical for achieving the reorganisation of clinical work • Concerned about • The role of AHP within the Trust • In effective voice in clinical decision making (though having a wider understanding of how care were structured) • Pay and conditions, poor access to training, poor accommodation • Characterised by • Disenchantment with work and the way the Trust was managed
Allied Health Clinicians’ Views on Performance Improvement, 2002 • Emphasis upon • Better access to training • Improvements to the organisation of clinical work and to organisational management practices • More resources • Concerned about • Difficulties in working in ‘integrated’ teams (though supportive of these) • Poor management both within the profession within the Trust and the wider Trust management • Better care planning especially in regards to discharge • Characterised by • Unhappiness with their line managers
Traditional Service Delivery Model Medicine AHP GM Nursing
“Clinical Product Line” Model IntermediateProducts Final Products
Previous Improvement Efforts IntermediateProducts Final Products
