In an effort to turnaround what has happened at the Mid-Staffordshire hospital it has been announced that there is to be a change in culture within the organisation.  Apparently the situation arose because bosses were concentrating more on cost-saving than ensuring compassionate care to patients.  Customer care should be at the centre of the new culture, it’s a serious thing to get right, but making the change is no mean feat and is a strategy that needs to be carried out with a variety of coordinated actions.  The planned shift in recruitment focus that was announced is important, but there needs to be joined up thinking in all areas to make things work.  There has to be real commitment by everyone not just management speak.  The Chief Executive has already apologised for the scandal promising to put things right but words are cheap and it is demonstrable actions that will count in the long run. 

At the heart of the strategy for culture change it will be important to develop a framework for all the required activities going forward.  It’s essential to create a new belief system with a mission statement and values that everyone will buy into.  Culture change requires a change in thinking by everyone.  Bringing onboard new employees is crucial so they develop into the new ways of thinking and working.  Developing a robust induction programme based on the framework will help them along with mentoring. 

Develop a Competency Framework

The implementation of a competency framework in which key competencies based on the new  values could provide a platform for recruitment, performance and development.  The framework should be based on promoting the best possible customer service.  There needs to be management buy in with demonstrable actions from the top not just lip service paid to proposals.  Employees observe management and will see how they support any culture change.  If it is not done well then everything will fail. 

The service to the patients (the customers) needs to be scrutinised to understand exactly where things have gone wrong.  The slide in customer service could be due to a number of factors – cost cutting, decreasing standards, outsourcing and a change in attitudes.  

Recognise The Importance of Leaders

Leaders are the key to making the culture change work.  They need to fit the new competencies and exhibit the desired behaviours with profiled roles in a new management structure.  Detailed job descriptions need to be developed and leaders should be interviewed against the competency framework to ensure fit for their new role.  If they don’t fit then someone who does should be recruited.  Ongoing their performance needs to be measured against the framework to ensure their performance is up to scratch. 

With customer service at the heart of the new culture it is important the leaders interact with the customers – the patients.  This behaviour is very rarely seen in the NHS.  Management are usually locked away in their ivory towers and it is only the doctors and nurses that see the patients.  If the leaders interact with the patients they will find out at ground floor level exactly what is going on and if things are not right then hopefully action will be taken.

Change recruitment processes

The recruitment process should be designed to attract the highest quality staff who will stay because they belief in what they see and the job they do.  Job descriptions should be developed against the competency framework and staff recruited in accordance with the desired competencies.  Competency-based interviews should be developed that ensure that employees with excellent customer service skills, compassion and care are recruited.

Develop performance standards

Clear standards of behaviour should be developed as part of an integrated performance management process with a top down approach.  Not just everyone going through the annual appraisal and locking the form away in the drawer for twelve months, but an active commitment to fulfilling the objectives set that will bring about real change. 

Provide training & development

Training and development against the competency framework is essential to develop the key competencies of compassion, care and customer focus.   Integrated learning initiatives should be developed using a whole range of techniques to develop the desired behaviours.  This can include work shadowing, courses as well as the use of literature for example. 

Look at Compensation &  benefits

Reward both financial and non-financial act as huge motivators and need to right to attract and retain high quality staff.  If employees perceive that the existing compensation system is not fair, it will affect their attitudes, and in turn, their behaviours.   People are consistently evaluating what they, and others, are getting in terms of wages, benefits, and work environment attributes against the daily efforts they are making. In many cases, their perceptions are exaggerated. In other cases, their perceptions of inconsistency and inequity are justified. By moving towards a more equitable compensation system that rewards people for supporting the desired work culture, a major roadblock to culture change effort can be removed.  In the cash strapped world of the NHS it’s not just about increasing financial reward but by providing job satisfaction through interesting work, non-financial reward can be a great motivator. 

Improve communication

With many communication systems, communication is infrequent and one way in nature. People don’t get a lot of information or feedback about how they are doing or how the organisation is performing, and when they do, this information is more often than not negative. The net results of this cultural issue is that most employees see the existing meetings, newsletters, and bulletin board postings as a waste of time. It is important to keep the values and beliefs alive with regular meetings and discussions.   It is a good idea to make sure that written correspondence includes references to service. This spreads and reinforces the message.

Implement Customer satisfaction surveys

By carrying out customer satisfaction surveys with the patients key information will be gained on progress along the desired course of action for culture change.  Surveys should be analysed for success and failure, with the latter being addressed to make improvements.  Customer service should be continuously monitored and reviewed.

It is important to maintain continuous improvement.  Culture systems have momentum and can easily spin into a totally different direction if action is not taken.  Desired, or undesired, behaviours and work practices are reinforced on a daily basis by the work systems in place.  Many organisations think that culture change can be brought about by hiring consultants (which the NHS is notorious for), sending people on training courses or forming new teams, but sustainable change can not be brought about in this manner.  Culture is a hard thing to change just like everyday habits, but change is an ongoing event that has to be constantly worked at. 

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