the swampy ground research project
a resource about partnership working for managers & educators in health & social care
Case Study - 'Settling for the best you can get'
'Settling for the best you can get’ :creating a cross professional management team:
This case is about creating a new management team across specialist professional disciplines, following a major re-structuring in a large acute health trust. The new directorate spans at least 8 different areas of medicine. The re-structuring which created it was key to the feelings among the partners. It seemed generally acknowledged that this process had not been well handled, leaving people resentful and with personal losses.
Limes
The restructuring was also seen to reduce management resources by creating more strategic management posts and so taking operational level posts away. The beginning of the new directorate management team was also hindered by the time it took to get all the people in post, especially all three operations managers. A year or so on, the general manager, members of the management team and managers who work to them can all see some progress.
People in this case:
Alison, Clinical Director, Directorate of Specialist Medicine, a doctor
Michael is the General Manager of the new directorate
Kumba is a Sister managing nurses in 4 outpatient departments in the new directorate
Hilary is an Administrative & Clerical Manager within the Directorate of Specialist Medicine
Marian, operations manager of one of the specialisms in the new directorate, a nurse
researchers' Commentary
This case raises several issues which are echoed in other cases.
On leadership, it shows the power of a direct approach to resistance and tackling 'bad behaviour' especially that displayed in public fora and this links strongly to the joint commissioner's approach in 'We won't ever backbite'. This approach is in contrast to that in 'Actually Getting Together' where one person did block progress and wasn't challenged. Michael's conclusion about just how far you can move people highlights the importance of recognising even small shifts and their cost to individuals. Partnership for him is about what you can achieve, short of outright support [ degrees of agreement continuum].
This story emphasises reputation and credibility in leaders, being both visible, known and accessible. Also that these issues are noticed by staff. ['We won't ever backbite'] The story shows too how the leader is always looking to the next thing, the next change, even in the middle of present changes - boundary scanning and keeping the innovation of the partnership moving.
In common with other stories the trigger to set up the partnership was key here [Webb: reasons for partnership - mandate, altruism or exchange] The mandated 'forced marriage' from the start produced many of the problems that Michael had to deal with. This highlights recurring dilemmas about structures - their advantages and disadvantages, how long re-structuring can take, how partnership has to go beyond a structure to a 'forged' partnership. And how long it may take to see the benefits. Only now are members of the management team seeing any links across their specialisms, such as the commonality of out-patient services, which the leaders saw from the start. It isn't clear from the stories how far staff further down the hierarchy see the links, or if they do. [ Weil's cycle of change, how people will be at different places at different times]
The story emphasises issues of culture and relationships, openness in making this shift to a real team - and that lack of time to look at processes or surface assumptions and stress all get in the way.
It also raises concepts of power : moving towards people to deal with complex issues, both to engage them for real as with the reluctant doctor; and also as a symbol of shifting power, as with the intention to 'go out' to primary care teams. [Chambers ]Here a large acute trust is recognising the need to deal with the power it may be perceived to wield by people in primary care, to turn the usual process over and go to them; They are recognising low profile symbols of culture such as where you meet make all the difference.
It reflects too the shifting boundaries in health and their increasing permeability: between acute and primary care; between doctors and patients; between specialisms and professionals
Differently from 'We won't ever backbite', but like other stories however, it was important here to let people sound off about immediate past problems of restructuring, to deal with resentment before moving on. Perhaps as a mandated change that no-one, even the leaders, really wanted initially meant that these feelings had to be acknowledged rather than passed over. The question remains: what would have made the whole re-structuring a better process ? Did those in more senior positions make their purposes clear and 'market' them? [ Bartlett and Ghoshal (1994)]
The case also raises key aspects of support to different professions and relationships between managers and health professionals. It shows how the levels and specificity of support to individuals must be taken account of and how layers of different kinds of support can interact. The new team recognised and explicitly worked on this support, which has had a positive impact on their staff and on overall culture in the new directorate. On the other hand while clerical and admin staff seem to appreciate new focused arrangements for their function, some clinical staff would still prefer separate site based clerical and admin staff
Read or download a PDF of all the stories in this case study.