Mid Stafford Hospital - Leadership Analysis - Case Study Example

Mid Staff Case Name Class Unit Introduction The release of the Mid Stafford hospital report was a clear indicator of the abuse of the patients within the National Health Service (NHS) in England. The article seeks to address the system by revising it and coming up with ways in which Staffordshire abuses can be curbed and prevented from reoccurring. The board have the main responsibility of ensuring the patients received high quality care and overall performance of the system (NHS, 2013). According to the inquiry, the board failed in this regard. Leadership and organisation culture led to many patients to suffer abuses while others lost their lives. The report indicates that there is need to change leadership and culture in the context of NHS. NHS leadership have been heroic based and have failed to use leadership that is shared, adaptive and distributive. From the report point of view, most important leadership in NHS is between general managers and clinical managers (McMullen & Adobor, 2011). The report also notes that leaders exist in all organisation levels. The report notes that leadership in care settings and other organisation is vital. Stakeholder theory looks at the new non hierarchical conceptualisation of leadership. Stakeholders include those inside the organisation as well as those outside it. There is no assumption of managerial overall authority on the rest of the stakeholders. According to the theory, leaders do not have to be the managers. Leaders are expected to rely on non hierarchical relationships (NHS, 2013). This case study analyses leadership and governance bases on Mid Stafford hospital report in terms of stakeholders’ theory showing how stakeholders’ theory informs leadership and governance and how the theory and practice may be developed. Critical analysis Board management model Up to 1990s, NHS boards’ management used the stakeholders’ model. The boards were large and their membership included the elected local government members, trade unions and health care professional among others. Due to the large sizes of the boards, they were heavily ritualised in their meetings. The decision making was shaped by the senior officer and their team. The model changed in 1991 due to the advent of the internal market (Klein, 2006). NHS boards adopted the private sector unitary board model which was used by the business in US and UK. This led to formation of small unitary boards made up of 11 to 15 members. The members took a collective responsibility in their decision making. The change of the stakeholders’ model by the NHS boards and adoption of the business model was adopted in 1991. Corporate governance in NHS was strengthened by using lessons learnt from the failure of the other corporate in 1990s (Klein, 2006). NHS Foundation Trusts were first established in 2004 and were based on co-operative and mutual traditions. The trusts cover more than half of the acute care hospital and mental care providers. The foundation trust governance structure is made up of two boards which are board of governors and local leadership. The structure thus resembles the Anglo-Saxon unitary model. The role of the board must be based on conformance and performance. Conformance involves being accountable externally and supervision management (Newdick & Danbury, 2013). External accountability is based on being compliance with the legal and regulatory requirements. The board have to be accountable to the shareholders as well as stakeholders involved. In ensuring there is supervision management, the board is supposed to ensure that there is oversight, performance monitoring and appropriate internal controls. On the performance, the firm is supposed to ensure that it achieves it mission and goals through the board (Klein, 2006). For good governance to occur stakeholders must be fully engaged and accountability enhanced. NHS board was supposed to ensure that they create opportunity for people to make their views known. Those in charge should have been asked on their decisions and plans. When there is accountability and stakeholders engagement, it becomes easier to express complain and know where changes should be carried out (NHS, 2013). There are three important components of governance that could have helped NHS to avert the crisis. The components are fiduciary, strategic and generative. The fiduciary duties are related to the organisation legal responsibilities (Newdick & Danbury, 2013). The strategies component is based on the ability of the board to set direction. The generative aspect relates to the board leadership through governance. This is based on the organisational renewal and strategy (NHS, 2013). Leadership analysis at NHS NHS model of leadership was heroic which led to the crisis outlined in the report. The board had failed to recognise the importance of having shared leadership distributed and adaptive. The leaders did not involve other stakeholders when looking for ways to improve the care. When the staffs are engaged in leadership, it becomes possible to improve service delivery. Several reports have proved that when all staffs are engaged, it becomes possible to bring out change (Klein, 2006). Stakeholders’ engagement in NHS should have ensured that there was a better patient experience and outcomes. When the patients are engaged in their own care, it becomes easier to improve the outcomes and provide the care that is deserved by the patients (McMullen & Adobor, 2011). The organisation leadership strength is directly related to the outcomes. The organisations have to look into ways in which the patients needs is put first and outline what needs to be done to bring out the needed change. NHS boards have thus to invest in leadership skills and qualities for the staff in management and board. Patient leaders play a very vital part in ensuring that there s quality improvement in health care (NHS, 2013). Weak leadership and culture Mid Staffordshire NHS foundation culture can be described as unhealthy and dangerous. This was one of the major causes of failure in the system. The culture was evidenced by several negative aspects such as bullying, target driven priorities, lack of engagement, poor staff morale, no feedback from trainees, isolation and denial. It is important to note that organisation culture is determined by the form of leadership in place. There was lack of effective leadership at Mid Staffordshire (Newdick & Danbury, 2013). The board can be described as lacking effective leadership. The level of board inexperience was high and there was overconfidence. The non executives were aloof of the operational concerns despite the fact that that they posed risk to the patient safety. There is high possibility that the clinical leaders did not have voice in the board level. When the board disengaged the doctors from the trust’s management, they neglected concerns especially about the patient care (Klein, 2006). NHS shortcomings in leadership were also aggravated by the negative culture. There was lack of consideration for the patients, defensiveness, secrecy, wrong trust assumptions, poor standards acceptance and failure to put patient first (Newdick & Danbury, 2013). The top down leadership at NHS made it possible for the managers not to own up to mistakes. This makes hard for others to learn from mistakes. The culture did not allow openness and transparency which jeopardised patient safety. This made NHS to be an institution that was not ready for public criticism (Klein, 2006). Leadership at Mid Staffordshire NHS foundation trust can be described as pace-setter. This is evidenced by the management laying out demanding targets, reluctant to delegate tasks and not offering collaboration (Newdick & Danbury, 2013). The leadership was command and control based which led to staff being demoralised and denied authority to make decisions. This was a major cause of poor care at Mid Staffordshire NHS foundation trust. The leadership needed to be complemented by other styles through a reform. Doctors and clinicians needs to be included to bring change and improve services. Leadership that is needed should be engaging. This involves an open and transparent leadership where teamwork is emphasized (NHS, 2013). Detachment between managers, staffs and patients The culture at Mid Staffordshire NHS foundation trust made leaders to be detached from the consequences of what they did. The leaders were not able to look at the impact of their actions on the patients’ health. This led to board leaders to look only at the financial targets while overlooking the patients’ health (Newdick & Danbury, 2013). The culture at Mid Staffordshire NHS foundation trust became more business focused than patient focused. The culture was not based on positive values which led to failures. Strong and stable leadership was needed where mutual support based on teams was carried out (NHS, 2013). The organisation needed to hold open board meetings where the leaders would be able to listen to the complaints from staffs and patients (Newdick & Danbury, 2013). The clinicians are needed to be engaged in the leadership roles. This was not the case at Mid Staffordshire NHS foundation trust. This helps to closer the gap between the managers and the clinicians. The NHS leaders were not active in giving recommendations that would help to enhance the patients well being (NHS, 2013). Staffs at NHS are mostly intrinsically motivated to assist the patients when venerable. When the system lets the staff down, failures occurs (Newdick & Danbury, 2013). The system is composed of the NHS leadership from the national level and leadership at the local level. The actions of staff at Mid Staffordshire NHS foundation trust were influenced by the leadership that was in place (Klein, 2006). Developing stakeholders’ theory at NHS Engagement When there is engagement between the staff, patients and senior management, it becomes possible to enhance the experience and eliminate heroic leadership (Coulter, 2012). The patients and staff feels needed and respected by the organisation which can lead to improved care. Engagement is a key concern for the best performing organisations. When the staffs are not engaged, it can lead to burnout making them cynical, depressed and exhausted. Engaged staff are less likely to make mistakes (Harrison, 2012). Studies have found that higher engagement leads to enhanced care for the patients. Staffs require autonomy which enables them to use their range of skills and become more satisfied with their jobs. The managers are supposed to nurture optimism, resilience and self belief which can enhance engagement. When the health staffs have control on how they perform their jobs, they are able to become more engaged (West & Dawson, 2012). Sharing decisions with the patients helps in improving care. This is only possible if the leadership uses stakeholders’ theory. The healthy staff are able to support the patients in ways which they can manage their long term health conditions. Staff experience and patient experience should be closely related (Newdick & Danbury, 2013). This is due to fact that when the staffs are happy, it increases the possibility of the patient being happy. When the leadership involves engagement, the staffs are able to choose whether to do minimum or maximum. The staffs are free and there is little supervision (Harrison, 2012). Staff engagement When there is engagement, the staffs put more efforts to interact with the clients. The staffs’ works more as they feel involved (Newdick & Danbury, 2013). Engagement has been proved to help in improving health care. When there is engagement, there is improved control in operations. The staffs are able to exert more influence in the procedures that are in use and culture improvement. This helps in enhancing the patient outcome (West & Dawson, 2012). In Mid Staffordshire NHS foundation trust, the staff should have been more involved in decision making. The case study points out that there was no open communication and employees were not involved with management communication (Newdick & Danbury, 2013). The employees when empowered can put forward ways in which better services can be delivered. By engaging the staff, it implies the degree to which they are involved in care, decision making and interacting with others to meet their needs (Harrison, 2012). Patient engagement Patient engagement is a very vital factor in NHS. Patients at Mid Staffordshire NHS foundation trust were not engaged according to the case study (Newdick & Danbury, 2013). This involves giving the patients better information and more control. Patients have right to influence their own care and services. The decision making must involve them with the clinicians but not the clinicians alone. Stakeholders’ theory supports sharing of the decisions (Coulter, 2012). Engaging the patients ensures that the right type of care is given to the patients. The managers and clinicians are able to see services from the patient perspective. This is a method that can help culture that is more responsive to the patients (Harrison, 2012). The patients are able to take control of their own care and the professionals help them to do so. Having a greater involvement of the patients is the most effective way to ensure that Mid Staffordshire NHS foundation trust is sustainable and ensuring that it’s more patient centred (Coulter, 2012). Engaging doctors NHS has the best trained doctors in their services. When the doctors are not empowered, they feel alienated. Doctors who are not empowered underestimate their work in most cases. The powers that the doctors have and the decisions they make are paramount to achieving the organisation goals (Newdick & Danbury, 2013). The organisation reputation lies on decisions made by the doctors. The leadership needs to work together with doctors which will strengthen the medical engagement (NHS, 2013). Engaging nurses Nurse leadership is needed in improving health care. Nurses are vital in improving the health care as they encourage safety, productivity and clinical experience (Schulter et al. 2008). Nurses feel more motivated when they are given the opportunity to participate in planning care (Newdick & Danbury, 2013). The system at Mid Staffordshire NHS foundation trust should make the nurses full partners in designing care pathways. Nurses should be exposed to an environment where they are trained on teamwork. This helps to develop a high sense of responsibility (NHS, 2013). Engaging the board Governance and leadership at the board was a major failure at Mid Staffordshire NHS foundation trust. NHS boards have three main roles which are; coming up with strategies, accountability and shaping the organisation culture. When the boards are able to focus on governance and strategies, they are able to perform better (Newdick & Danbury, 2013). Boards should be able to engage the staff in coming up with decisions which enhances satisfaction. The assertive executives at the board should be eliminated and heroic leadership eliminated. The board is supposed to adopt the recommendations given by the case study (Alimo-Metcalfe, 2012). Engaging across the system Engagement in the NHS should be across the board. Poor coordination has been the main cause of failure. Quality services at Mid Staffordshire NHS foundation trust require co operation across all systems in place (Newdick & Danbury, 2013). This needs the ability to understand the goals and priorities within an organisation. The management have to win people emotionally and have the right people at the right places. Heroic leadership cannot work at Mid Staffordshire NHS foundation trust (NHS, 2013). The leadership at top level have a major responsibility of ensuring they bring the needed change (Newdick & Danbury, 2013). The leaders at the top level have a duty to show that caring and compassion are the vital values within the service. This is through their actions and behaviours. A lot of emphasis on openness and transparency is needed. NHIS leaders and the clinicians’ team are required to work together in a devolved decision making model. This makes sure that leaders and teams have the needed capabilities which can help in improving the health care quality (McMullen & Adobor, 2011). The report acknowledges that senior leadership at NHS is fragmented due to reforms in the sector. The organisations involved in the reforms are many hence they are supposed to work together. This is to avoid an instance where the staffs receive mixed messages. This can lead to repetition of the failures at Mid Staffordshire NHS foundation trust (Ramsay & Fulop, 2010). The leadership in place is not expected to send signal that financial performance is more important than the patient health. This was what lacked as leaders in Mid Staffordshire NHS foundation trust could not put the patients needs first (McMullen & Adobor, 2011). As an organisation owes duty to the investors, they also owe a duty to the stakeholders. NHS was supposed to have a duty to the stakeholders and ensure that they are able to receive a fair treatment. The senior management cannot act against the interest of the shareholders as the repercussions are as evidenced at Mid Staffordshire NHS foundation trust (Klein, 2006). There is need to eliminate status quo as seen in the case study. Ideas should be listened to and valued which can lead to innovation and entrepreneurship (Newdick & Danbury, 2013). This helps to come up with a culture that is open to entrepreneurship. The leader is viewed as a role model for change and learning. Mistakes made are used as a learning opportunity. The heroic individual leadership based on the monopoly of vision in Mid Staffordshire NHS foundation trust should be replaced with visions shared from different shareholders (Spurgeon, Clark & Ham, 2011). Engaging shareholders creates a diversity of perspectives and wealth of experiences. This is the type of leadership where teamwork is supported. To take this form of leadership, it will be challenging for the Mid Staffordshire NHS foundation trust but the possibilities engagement it brings makes it more interesting (Klein, 2006). Conclusion According to the case study, leadership and governance were the main cause of failure at Mid Staffordshire NHS foundation trust. The leadership exercised was heroic where there was monopoly in vision. The top leadership failed to engage those in other positions in their decision making as seen in the case study. For the Mid Staffordshire NHS foundation trust to be effective, they have to engage all stakeholders in leadership. They should be able to demonstrate that they value their staff and engage them in leadership. Heroic leadership should be replaced with an engaging leadership where all stakeholders are involved. Patients, nurses, doctors and board should all be involved in leadership. This is through creation of stakeholder’s model of leadership and governance. According to the stakeholders’ theory, this will enhance innovation and creativity at NHS. References Alimo-Metcalfe, B 2012, Engaging Boards: The relationship between governance and leadership and improving the quality and safety of patient care, Retrieved 6th December 2014 from, www.kingsfund.org.uk/leadershipreview Coulter, A 2012, Leadership for Patient Engagement. Retrieved 6th December 2014 from, www.kingsfund.org.uk/leadershipreview Harrison, D 2012, “The sTIMUL Project: Putting Yourself in the Patient’s Shoes”. British Journal of Healthcare Assistants, Vol. 6, no.2, pp. 546-549. Klein, R 2006, “The Troubled Transformation of Britain’s National Health Service”. The New England Journal of Medicine, Vol.355, no.1, pp. 409-415. McMullen, R.S & Adobor, H 2011. “Bridge leadership: a case study of leadership in a bridging organization”. Leadership & Organization Development Journal, vol 32, no 7, pp 715- 35. National Health Service (NHS) 2013, Commissioning Board. Report of the Mid Staffordshire NHS Foundation Hospital Trust Public Inquiry. Board Paper: NHSCB28021. Newdick, C & Danbury, C 2013, Culture, “Compassion and Clinical Neglect: Probity in the NHS after Mid Staffordshire”. Journal of Medical Ethics, (Online). http://dx.doi.org/10.1136/medethics-2012-101048. Ramsay, A & Fulop, N 2010. The Healthy NHS Board: Principles for good governance. London: National Leadership Council. Schulter, J., Winch, S., Holzhanser, K & Henderson, A 2008, “Nurses’ Moral Sensitivity and Hospital Ethical Climate: A Literature Review”. Nursing Ethics, 15, 304-321. Spurgeon P, Clark J & Ham C 2011, Medical Leadership: From the dark side to centre stage. London: Radcliffe Publishing. West M & Dawson J 2012, Employee Engagement and NHS Performance (online). www.kingsfund.org.uk/leadershipreview Read More