2 Questions and 6 Indicators of NHS Team Success or Failure
The recent report ‘The NHS Forward View’ tells us that the future of the NHS depends on greater efficiencies. As a large organisation the NHS delivers its services through teamwork. Therefore the efficiencies will have to be made though better teamwork. You already know that some NHS teams are outstanding, and some teams are not quite so good. We’ve devised a new Team Diagnostic Toolkit to help you identify which of your teams are working exceptionally well and where things might be going wrong. When things go wrong the results are clear: lower productivity, staff de-motivation, poor communication, lack of co-operation between departments, or a growing ‘blame culture’. But these are just symptoms, and the symptoms are not the disease. So what are the underlying problems causing these symptoms?
If one of your teams is failing to succeed, or needs to improve its performance, you could ask one simple diagnostic question: “What has changed for that team recently that might be making them less efficient?” in other words you need to find out what is stopping them from being successful. If there is nothing obvious and specific to them, you need to investigate further. As a senior leader in the NHS, a good place to start is by asking some searching questions about your team’s wider success or failure.
This approach advocates positive inquiry into the best of what is, in order to imagine what could be, followed by design of a desired future state that is compelling and thus creates future change towards greater efficiencies. The model is based on the assumption that the questions we ask will tend to focus our attention in a particular direction – in this case a positive direction. Questions are never neutral, they are always value laden and fateful, and social systems (like for example, your NHS Trust, CCG or Service) move in the direction of the questions they most persistently and passionately ask and discuss.
A Positive Question
Using the principles of Appreciative Inquiry, you could start in a positive frame of mind by asking yourself, your top team and senior clinicians and managers:
“Which do you think is our highest performing, or most efficient team, and why?”
OK it’s really several questions in one. The point is to start by diagnosing what success looks like and feels like in your part of the NHS. Really work away at the diagnostic question “Why?” One efficiency model, Six Sigma, suggests that you need to ask 5 Whys to discover the root cause of a problem. We’re suggesting the same approach, asking 5 Whys, to finding the root cause of success.
Then you need to build on the results of your diagnosis. You might ask yourself and other senior people in your organisation what you, and they could or should be doing to create those same positive conditions that improve efficiency or performance in all the teams operating throughout your service. Just asking these questions of your key people and analysing their answers, plus asking for suggestions to apply and improve things across your organisation, will put you well ahead in the efficiency stakes.
Failure to Analyse the Positive
That’s because in our experience, most organisations don’t put much (if any) resource into identifying and analysing what they do exceptionally well or get right. In most organisations success is taken for granted and goes unexamined. They spend most of their diagnostic resources exclusively investigating and analysing faults, problems, failures and complaints. They take a problem solving approach based on a deficiency model. They ask questions such as “What are the problems?” or “What did we get wrong?” or “What needs to be fixed?” Sometimes they phrase the question in terms of challenges, which still focuses on deficiency, on what’s missing or needs to be fixed or solved. Whilst this approach is important, it misses the fundamental lessons to be gained from analysing success. A simple example is to ask: “When we are being more efficient than usual, what exactly are we doing differently that makes us more efficient?”
A Negative Question
For balance then, if you want to try a more familiar, problem focused approach, you could ask yourself, your top team and senior clinicians and managers:
“Which do you think is our poorest performing, or least efficient team, and why?”
OK it’s another example of several questions in one. Your purpose is to diagnose what may be going wrong in your teams or service so that you can put it right – fix it. Now the Six Sigma model comes into its own with the 5 Whys of root cause analysis. This method is designed and intended to tell you what’s going wrong. The problem is that stopping being inefficient is not the same thing as starting to be more efficient. For example, if throwing things away is wasteful, stopping throwing them away is no less wasteful unless and until you start to re-use or re-cycle them.
So an essential stage in this approach is to ask yourself and the other senior clinicians and managers in your organisation what you, or they could or should do to improve things, and create more positive conditions that will actively increase efficiency and productivity in all of the teams throughout your service. Then you can analyse what works using Appreciative Inquiry and take positive steps to build on your success.
6 Indicators of Team Success or Failure.
As a senior leader, there are a number of organisational level indicators you could identify and measure to tell you if things are going well or if you have a problem. As a guide they are usually reducing if things are going well, or increasing if things are going wrong. You should be able to ask your HR Department or Clinical Governance Team for this information.
For example do you have:
1. Decreasing or increasing staff turnover rates?
2. Fewer, or more, or more serious errors or never events?
3. Decreasing or increased levels of patient complaints?
4. Decreasing or increasing levels of internal disputes and grievances?
Two other sources of diagnostic information you could use are:
5. Staff surveys and
6. Exit interviews.
All of these indicators should be continuously monitored for you by your HR Department or Clinical Governance Team. For example, what does your last staff survey tell you? If you don’t already survey your staff, or haven’t done so far a while, we can help you to organise a survey. We can discuss what questions you would like to ask, and more importantly, what you want to do with the answers.
What does the analysis of recent exit interviews tell you? If you don’t usually interview staff when they are leaving (exiting) the service, you could identify one or two recent leavers and ask someone from HR to phone and interview them. We can help you to identify the key questions you want to ask, or we could conduct the exit interviews on your behalf.
What do you do next?
Well that depends on what you want to achieve. If you find that these two questions and 6 indicators give you food for thought, or some useful insights, you might find our free Team Diagnostic Toolkit helpful. It contains 20 questions you can use immediately to diagnose team success or failure to a deeper level. Simply contact us to request your copy. You might also want to test out our Leadership Team Impact Report. It will give you evidence of the impact of a specific team on their people and service. It’s on special offer during March 2015.
You may also want to consider our Clinical Leadership Skills Development Programme and how it will help you to develop more effective clinical leaders in your organisation.
If you have identified some problems, or would like to talk confidentially to someone with the experience and expertise to help you to improve team efficiency and performance in your service, please get in touch. We have a successful 14 year track record of working in the NHS (and 28 years in the private sector) and can show you brilliant testimonials from our clients. We look forward to hearing from you and we’ll be happy to help you in any way we can.