Bad Management

Spot checks at geriatric wards in 100 hospitals have revealed that 35 needed to make improvements and 18 did not meet legal standards. At two of the trusts there were major concerns. So the Care Quality Commission tells us today.

How is it that people end up behaving like this? It is bad management.

It starts at the top

It always starts from the top. It is the responsibility of the people at the top to set the standards and make it clear what they mean.
I have seen relatives in hospital extremely well cared-for and looked after. I also remember, when my grandmother was in hospital before she died, witnessing exactly the problems described in this report. And that was over 30 years ago. The simple act of putting her cup out of her reach caused her great problems.

This was not a case of ‘understaffing’ or ‘lack of resources’. It was someone who was not clear what she was supposed to be doing and why.

The new recruit

Many years ago I took over a production department in a factory. Jane, a new recruit, joined one morning.
At coffee break she was the only person sat at the table in the corner while the supervisors and team members sat at different tables laughing and joking, clearly enjoying themselves.

I was horrified.

I called the supervisors to a meeting. I asked them what they thought they were doing during their break. I was greeted with blank looks of complete mystification. I asked them who was responsible for the new recruit, Jane. Alison said Jane was in her team.

So I asked her how she thought Jane would be feeling sat on her own at a table, ignored by everyone else while they all sat around laughing a joking.

Red faces and a prickling embarrassed silence followed. Things were rather different at lunchtime and we never had the problem again.

They were good people

These supervisors were not monsters; they were good, kind and friendly people. They were just not thinking. They were completely focused on their own needs and had forgotten their responsibilities.

My responsibility as their manager
But also, it was my responsibility to set the standards and make them abundantly clear. I needed to make sure that they knew that, as supervisors, they were not only responsible for the quality of the products, the scheduling of the work and training. They were also responsible for ensuring the people in their teams were happy at work.

Some hospitals

Messages like this seem not to have got through to some (but not all) hospital departments. It’s very easy for this to happen when the focus from the top is on admin and cost saving.

Priorities

When times are tough, people get stressed and it’s much harder to prioritise effectively. You tend to react instead of plan and you also tend to focus on yourself rather than those in your care. And this happens right at the top, where it has the biggest impact.

For more on this see this article on how to avoid mistakes when implementing change which goes through how these situations arise and what to do about them.

The leaders need the right skills

It’s very easy to blame the individual nurses, but this is a leadership and management issue. If these problems are occurring it means the systems are wrong, the priorities are wrong and the objectives are wrong, or have not been cascaded properly.