Management Challenges from the NHS

This morning a story has broken about ‘Maternity Support Staff’ drafted in to help hard pressed midwives perhaps putting mothers’ and babies’ lives at risk by taking on jobs for which they are not fully trained. The story illustrates a number of common management failings. How many of them are apparent in your team at work?

  • Roles are not clearly defined – the tasks that can only be done by fully qualified midwives and other medically qualified must be clearly defined and communicated – and they are not. Or rather they are defined clearly, but differently, by various players in the system – leading to confusion.

Solution - Staff should be trained to work with line managers in order to identify and resolve any ambiguities in their role. Roles should vary from person to person according to their skills, experience and training. All team members should be clear on what any individual is and is not qualified to do.

  • Processes for managing staff shortages are not in place – when a Maternity Support Staff sees a patient in need of assistance (that should be delivered by medically trained staff but none are available) what should he/she do? What options are available.

Solution - Record and monitor all instances where care was required for which no competent trained member of staff was available. This will help to build awareness of the extent and criticality of the problem. Hold weekly supervision and support sessions with staff in a culture of trust and openness so that these issues can be discussed and affirming or adjusting feedback can be given.

  • Delegation is not working effectively at the local level.

Solution - Trusts are free to set the day to day work of Maternity Support Staff. However this has to be in the context of a relationship of supervision, support and development in which a responsible and competent manager works with the staff member to recognise and develop their skills and experience and delegate to them accordingly. If a Maternity Support Worker can do tasks that would usually be done by a higher paid midwife or consultant, without compromising quality of care, then this is exactly what should happen. This is good management – creating value and reducing cost.

These challenges of basic management good practice are not confined to the NHS. They arise in every organisation. However the NHS is a classic example of a purpose driven organisation. People join it to be part of a team delivering excellent care. However the task driven culture fails to provide the space for staff to talk about the challenges that they face in their day to work and to develop, in partnership with competent managers, the skills, judgement and strategies to provide better care.

  • What problems are caused in your team because roles are not clearly defined?
  • How much do you really know about the risks associated with staff shortages? How does the work still get done when you are a team member down?
  • Do you have a management culture that develops each team member to the maximum of their potential? Or do you just manage to the job description?

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