When my mother was ill last year in hospital, it gave me some opportunities to be curious about how the staff were with her and with each other.
Every morning, someone would come around and ask her what she wanted in her meals for the rest of the day. It was always one of two people. One was a little shy, I think. She was not as chatty as some of the other staff but she was caring. When she came to collect trays later in the day, if my mother hadn’t eaten much, she would express concern—maybe ask if it would be better to order something different next day and so on.
The other was churlishness personified—I really thought everyone would benefit if she gave some attention to her attitude. Both these people worked in the same team in the same hospital, reporting to the same line management, doing the same job in the same wards with the same patients.
My point—somewhat against my main argument—is that, to a certain degree, each person was bringing their own baggage to work and allowing it to influence their approach to patients and relatives. It is hard to “blame” the management team for this. But it is also the case that either these people’s manager or supervisor had been unsuccessful in instilling a caring approach in all team members, or they hadn’t even tried.
Learning from a retailer
Rewind to the eighties when I worked in Marks and Spencer’s head office. For a time, I was a project manager on a sensitive IT development. I and two colleagues reported to a senior manager—let’s call him Roger—and each of the three of us had teams, all working in a large open plan office.
From what I learnt in M&S, it appeared that the directors of the company spent more time doing one thing more than anything else. That was visiting stores. The purpose of each visit wasn’t primarily (or at all) to “inspect” the store. It was to talk to the staff and the customers.
Roger used to do something similar. Most days, when he was in (which was most days), he would tour the open plan office, stopping at each group of desks and chatting with the people there. Not about work: if a work topic needed discussing, it deserved a proper meeting. No, we would chat about the weather, or the view out of the window, or the holidays or whatever. The staff really appreciated it. It showed he cared about them and he learnt a lot from the encounters.
Irony of ironies, he used to call this his “ward round”.
Low morale = poor care
Back to the hospital. Sitting by my mother’s bedside, I idly watched the nurses and the other staff who routinely engaged with patients and relatives. Unfortunately, at one point, it was necessary to have a conversation with Matron about some lapses of care, as I saw them. “What you have to understand”, she said, “is that all the nurses here are very demoralised”. This wasn’t exactly news to me.
What you have is an acknowledgment that low morale equates to poor care.
Of course, lack of morale can be caused by overwork. The workload, and the levels of staff needed to do it, are largely outside the control of the hospital management, let alone of the individual nurse and ancillary worker. Clearly, this must be demotivating for everyone.
But people forget a fundamental truth. Viktor Frankl who, by surviving the Holocaust, endured an infinitely worse experience than being in an NHS hospital, famously wrote in Man’s search for meaning :
We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.
The way we are in work is a result of a choice we make.
We are not, and cannot be, made to be a certain way by other people. But people influence how others are by their own attitude, and those in a senior position have a real opportunity to practise—in both senses of the word—positive influence with a view to raising everyone’s morale. Even if it means giving away their last piece of bread.
I wanted to ask Matron how many times the Head of Nursing (a board position) had shown her face on Matron’s wards—ever—and I was sadly confident the answer would have been, never. Unfortunately Matron’s pager went off and I didn’t find out the answer.
The way forward
I don’t believe that the vast majority of health care workers lack compassion. It might have been eroded in some of them by their training but, if a hospital has a problem with a supposed lack compassion, then I suggest the board, and the Head of Nursing in particular, needs to adopt the attitude of the M&S board in the eighties (a time when M&S was splendidly successful) and do some ward rounds.
Directors could usefully see that their jobs are essentially to work on the organisation, not in the organisation (as we say in business). If one of the most pressing problems is the quality of care actually received and felt to be received, then that has to be worked on. Directors should delegate (or ditch) everything they do that could be considered as working in the organisation. I suggest each spends 75% of their time on “ward rounds” (encompassing all places of work, of course).
It is not the role of directors in any organisation to work in the organisation and I am sure those reporting to them would be happy for the increased responsibility provided that they, in turn, could delegate (or ditch) some of their tasks—particularly as I advocate the immediate reports spending 50% of their time on “ward rounds”.
Even after the first visit, morale is likely to raise—just a little bit and maybe only in the team visited. If the board is committed to this (and why wouldn’t they be) a change across the whole hospital will be perceptible after a few months. After a few more months, it will be self-energising and become a virtuous spiral of improvement.
Raising the morale of staff—helping them change their whole approach and attitude—will have a massive impact, not just on the level of compassion experienced by patients, relatives and colleagues, but also on efficiency and attendance. I cannot believe that there would a net cost to this change and the gain would be incalculable.