‘It comes from the top' is a phrase often used to describe how a workplace culture feels. Thomas (2017) stated that if the heads of an organisation are committed to building the right culture, then it will cascade like a waterfall and, if the senior managers' levels of engagement are high, then their ability to engage others in the organisation is strong.
Last November saw the publication of a report commissioned by the Department of Health and Social Care (DHSC) by Sir Ron Kerr (2018). Empowering NHS Leaders to Lead was the result of a review into how the executive leadership of the NHS could be better supported and empowered to ensure the best possible service is delivered for patients.
One of the report's findings stated:
‘The conditions in which leaders operate are stressful and difficult, with great responsibility and the highest stakes. Over time, this has led to a negative working culture in which both bullying and discrimination are prevalent and accepted.’
On reflection, I believe there are some real lessons for us to consider in our professional leadership roles. As a senior nurse leader, it would reasonable to suggest that it is highly likely that one would frequently feel under pressure. Whether as a ward leader, through to the role of a chief nurse, the current level of scrutiny regarding our approach to caring for patients, how effective we are, and how productive we are, feels constant.
The Kerr review was asked to focus on three issues:
In the case of expectations and support, Kerr noted that the NHS struggles to recruit to leadership positions in its most challenged organisations. This struck a chord with me because all the trusts in which I have worked have had a ‘worry ward’ or department where, over time, a reputation has built that the area is ‘difficult’. Fieldwork from the review indicated that executives (including chief executives) of trusts in special measures for quality are likely to be more inexperienced than those of high-performing trusts. Indeed, I have worked in trusts in which junior nurses are offered leadership opportunities to turn around a struggling ward.
The report cites evidence from interviews suggesting that leaders often feel that they are seen as the solution ‘in and of itself’, as opposed to the leader of a team and organisation responsible for delivering an improvement plan. The level of professional risk served as a disincentive to individuals in taking up such positions. Concerns were raised during the review that there did not seem to be a clear pathway to develop the next generation of leaders and suggested that more could be done to invest in local talent management. It could be suggested that the NHS has focused heavily on the development of new recruits and less on aspiring ward leaders.
On the second issue, Kerr (2018) stated that the NHS needs to get much better at learning from both successes and failures, moving to a more open learning culture that encourages transparency and honesty. Understanding our workplace cultures has become a real focus for senior nurses. The report stated that there is much more that can be done to nurture and support NHS leaders to thrive, so that they in turn can support their staff to deliver high-quality care for patients.
The third issue for Kerr was the heavy burden of bureaucracy on NHS leaders. While work on reducing the level of administrative burden placed upon leaders is under way, the review accepted that, while there must be assurances that certain standards are met, the sheer volume of requests, many of which are identical, can distract from much of the good work leaders do.
Leaders should be fulfilling their vision to transform cultures and improve working practices for their staff and the care delivered to patients by clinical teams, rather than signing off information requests. This truly chimes with me and I am pleased that this issue is being reviewed, as the pressure from regulatory bodies ultimately has an impact on the senior ward leaders who are then required to support these requests.
The review recommends a number of actions to build a modern working culture in which all staff feel supported, valued and respected for what they do and can challenge without fear. These include:
These national plans can be easily translated to local application.