Watching the first two programmes set me thinking about inter-professional working at the hospital and in particular the professional relationship between doctors and nurses, some of whom were also managers. As a nurse who has worked for many years in the NHS in both hospital and primary care settings, I’m aware how these professional relationships and teams work, or don’t work, to bring about change reflected in the wider NHS.
It is self-evident that effective multidisciplinary working is vital if patients are to receive high quality care. It was evident that the staff in the programmes were working hard to provide a very good service to patients but managers were also preoccupied with meeting government targets and managing scarce resources.
"individuals seemed unable to effect change"
There was no shortage of ideas to promote improvements to the service but on the whole individuals (and teams) seemed unable to effect change. Nurses came out well in terms of good ideas but they seemed powerless in relation to the consultants. There were unfavourable comments made about the behaviour of some consultants by a couple of nurses and this seemed to be a strategy they used to deal with the everyday frustrations of one group feeling disempowered in relation to another group.
Consultants too showed their frustration with a system that seemed to control them rather than the other way round. There was a certain amount of acceptance that things took a long time to change in the NHS and that’s the way it always has been.
"When Brian became personally involved things started to happen"
One of the factors inhibiting effective teamwork for change was the lack of communication; it was very difficult for the different staff groups to get together for face-to-face meetings. Pressure of work was the reason most cited for this; there was recognition that everyone was very busy. One of Gerry’s tactics was therefore to get people to sit down together and talk. He acted as facilitator, motivator and change agent and tried to get Brian to do the same.
When Brian became personally involved things started to happen so why couldn’t the various teams do the same? What was preventing them from making the improvements they so obviously wanted? Of course teamwork does happen otherwise the whole system would grind to a halt. But individuals or groups at the coal face do not always have the authority or resources to change the system. Preparation, communication, time, and sometimes courage, are needed to make even relatively small changes and Brian recognised that people needed empowering in order to be able to innovate.
"senior managers cannot be as visible as this all the time"
Gerry was concerned to bring about a cultural shift; a fundamental attitude change across the organisation. One of his strategies to bring this about was to encourage Brian to walk the corridors and meet staff and support them personally and this seemed to work. It made staff seem valued and was appreciated by them. However, senior managers cannot be as visible as this all the time and middle managers need to feel secure in the knowledge that they will be supported in their efforts.
A learning organisation is one in which there is reflection and learning from experience. There is a need to foster a belief that individuals and groups can make a difference. Learning together is one means by which teams can become more effective and interdisciplinary education has long been seen as an important feature of professional education and practice.
The NHS is changing, albeit slowly, and this is evidenced in the programmes through the changing roles of staff and the opening up of professional boundaries. An example is that of the endoscopy service where a nurse consultant runs the service and practices an expanded nursing role. The government has for several years been pushing nurses to take on wider roles and increased responsibilities. Nurses work as expert practitioners, managers of care, provide first contact care for patients and have widened their scope of practice into areas that have hitherto been the domain of others, particularly doctors. The careers opportunities for nurses are wider than ever before and the nursing curriculum nowadays prepares nurses for these expanded roles and educates for leadership and autonomy.
To find out more about nurse education at the Open University, visit the Health & Social Care courses and qualifications website.