Staff Sub-Cultures & Perceptions of the Organisation: An Historical Perspective
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Transcript of Staff Sub-Cultures & Perceptions of the Organisation: An Historical Perspective
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Staff Sub-Cultures & Perceptions of the Organisation:
An Historical Perspective
North Tees & Hartlepool Foundation Trust
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Service Line Management
Resource interconnection
s
Systemisatised care processes
Multidisciplinary based care
Transparent accountability
SERVICE LINE MANAGEMENT
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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
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Abbreviations
MC Medical Clinician
MM Medical Manager
GM General Manager
NM Nurse Manager
NC Nurse Clinician
AHM Allied Health Manager
AHC Allied Health Clinician
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1995 (111 staff) 2002 (102 staff)
1 Financial viability Financial viability
2 Service quality Service quality
3Productivity improvement
Equal access
4Organisational
stabilityProductivity improvement
5 Service innovation Service innovation
6 Equal accessOrganisational stability
7Teaching and
researchStaff welfare
8 Staff welfare Teaching and research
Ranking of Organisational Goals for Whole Trust
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Trust Goals 1995(Ranked by Mean Score)
Total MC MM GM NM NC
Financial viability 1
1.881
1.931
1.781
1.761
1.911
2.00
Service quality 2
3.424
3.782
3.003
3.292
3.173
3.86
Productivity improvement 3
3.562
3.043
3.782
3.003
3.7823.679
Organisational stability 4
4.6583
3.777
6.115
4.954
4.394
4.07
Service innovation 5
4.716
5.734
4.564
4.335
4.565
4.39
Equal access 64.87
54.73
44.56
65.38
65.00
64.68
Teaching and research 7
6.167
6.236
5.448
6.807
6.097
6.25
Staff welfare 86.86
86.80
86.78
76.58
87.07
87.07
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Trust Goals 2002(Ranked by Mean Score)
Total MC MM GM NM NCAHM
AHC
Financial viability
12.96
12.78
12.20
12.29
54.44
34.17
12.44
12.38
Quality 23.22
33.78
43.40
44.21
22.88
12.72
12.44
23.13
Equal access 33.96
23.43
33.20
54.64
12.81
23.89
54.89
54.88
Productivity 44.18
44.04
22.80
34.00
76.44
54.22
34.00
43.75
Service innovation
54.68
64.96
55.40
23.29
64.81
65.11
35.56 3
3.63
Organisational stability
64.70
44.04
76.40
65.00
33.81
44.06
44.30
65.31
Staff welfare 76.00
86.57
65.6
86.29
44.38
86.17
76.00
87.00
Teaching and research
86.22
76.39
87.00
75.93
76.44
75.67
86.33
75.75
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Trust Work Values, 2002
MC MM GM NM NC AHM AHC Sig.
Conformity to rules and risk avoidance
-.207-.22
6-.096
-.044
.654 .202 .464 .000
Inequalities of power are natural and beneficial
.523 .474 .362-.10
4-.33
0-.203
-.070
.000
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• 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)
Styles of Management
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Perceptions of Management Structures and Style, 2002
Styles Identified
Style 1 Style 2
Collegial .724 -.421
Meritocratic .689 .067
Unit based paternalistic leadership
.010 .961
Hierarchy -.924 -.014
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Staff Perceptions of Received Management, 2002
MC MM GM NM NC AHM AHC Sig.
Collegial/ meritocracy vs Hierarchy
-.459 .174 -.069 .006 -.544 -.359 -.221 .003
Unit based Paternalistic Leadership
-.164 .197 .215 .295 .204 .431 .295 .006
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Affiliation Modes of Staff, 2002
MC MM GM NM NC AHM AHCSig.
Value Identification
-.559
-.062 .319 .008 -.530 -.252 -.547.000
Cynical .048 -.121 .496 .189 .454 .210 .158.027
Calculative identification
.179 -.231 -.364 -.140 -.023 -.085 -.077.059
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Sub-Culture/KnowledgeMappingViews 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
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Stances of Acute Care Trusts and PCT for the Study as a Whole
Emphasis on financial realism and transparent accountability
Emphasis on clinical purism and opaque accountability
-1.5
-1
-0.5
0
0.5
1
1.5
-1.5 -1 -0.5 0 0.5 1 1.5 2
Acute Care Trusts
Primary Care Trusts
Acute NM
Acute AHM
Acute GMAcute MM
Acute MC
Acute AHC
Acute NC
PCT NM
PCT NC
LC
GP
PCT GM
PN
Individualistic concepts of clinical work
Systematised concepts of clinical work
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0.5 1.01.5
1.5
1.0
-1.0
-1.0 -0..5
0.5
-0.5
-1.5
-1.5
1995
NC
MM
MC
GM
NM
MC
MM
GM
NM
NC
AHC
AHM
2002
Individualistic concepts of clinical work
Systematised concepts of clinical work
Emphasis on financial realism and transparent accountability
Emphasis on clinical purism and opaque accountability
Professional Subcultures in NTHFT; 1995 & 2002
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Summary of NTHFT Professional Cultures, 2002
Acute MC MM GM NM NC AHM
AHC
Recognise the interconnections +/- + + +/- - + -Balance accountability and accountability +/- +/- + +/- - +/- -Systematisation of clinical work - - +/- + +/- +/- -
Multidisciplinary teams - - + + +/- + +/-
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Professional Subcultures of Acute Trusts in an International Sample
-1.5
-1
-0.5
0
0.5
1
1.5
2
-1.5 -1 -0.5 0 0.5 1 1.5
N&Y Region
England
Wales
Australia
New Zealand
MC
MM
NC
NM
GM
Individualistic concepts of clinical work
Emphasis on financial realism and transparent accountability
Emphasis on clinical purism and opaque accountability
Systematised concepts of clinical work
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International Sample
MC MM GM NM NC Total
N&Y Region Project
103 24 63 69 81 340
England 162 51 82 105 115 515
Wales 177 42 79 113 284 695
Australia 343 129 134 181 191 978
New Zealand 190 59 111 94 83 537
Total 975 305 469 562 754 3065
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Medical Clinicians’ Views on Performance Improvement, 2002Emphasised• 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
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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
Medical Managers’ Views on Performance Improvement, 2002
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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
General Managers’ Views on Performance Improvement, 2002
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Nurse Managers’ Views on Performance Improvement, 2002Emphasised• 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)
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Nurse Clinicians’ Views on Performance Improvement, 2002Emphasis 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
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Allied Health Managers’ Views on Performance Improvement, 2002Emphasis 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
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Allied Health Clinicians’ Views on Performance Improvement, 2002Emphasis 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
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Percentage Predicted Group Membership, 2002
MC MM GM NM NC AHM AHC Total
MC 45.1 18.3 2.8 5.6 1.4 7.0 19.7 100
MM 20.0 55.0 20.0 5.0 - - - 100
GM 4.1 14.3 49.0 20.4 4.1 6.1 2.0 100
NM 3.5 5.3 12.3 40.4 15.8 12.3 10.5 100
NC 7.5 1.5 3.0 16.4 43.3 7.5 20.9 100
AHM - 12.2 17.1 19.5 9.8 14.6 26.8 100
AHC 9.8 12.4 5.9 7.8 13.7 3.9 51.0 100
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Traditional Service Delivery Model
Nursing
GM
Medicine
AHP
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“Clinical Product Line” ModelFi
nal Pro
du
cts
Intermediate Products
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Previous Improvement EffortsFi
nal Pro
du
cts
Intermediate Products