Health and Social Care Management Essay
Health and Social Care Management
Mary Parker Follett (1868-1933), defined management as “the art of getting things done through people”. This may seem a very narrow angle for some, however, the philosophical concept of management, relies on results being obtained through people. The nature and role of managers has been an emerging concept since the early 19th century, often linked to administration and being the middle ground in organisations allowing to filter objectives to employees and vice versa, filtering employee’s needs to senior staff within the organisation. In my view management is a set of hierarchy working to achieve a common objective.
As a Patient Advise Liaison Service (PALS) and Stakeholder Engagement and Involvement Manger, my role is predominantly to manage the customer service role for the Care Trust. Up until recently the Care trust was specialist in Mental Health and Learning Disabilities. The Trust is now at the stage of applying to become a member of Foundation Trust Status, which involves recruiting members to help shape the future of the organisation (BDCT, 2013)
My role can be viewed in favour of Mintzberg’s headings: Liaison, Monitor, disseminator and spokesperson. I am the Liaison between the organisation and the team, and also the wider service users. I monitor the team’s performance, activities and disseminate information from the organisation to many third sector organisations, such as BAMHAG and ACAS, both of which are advocacy services for Mental Health service users
As cited in Mullins (2010) by Crainer, management is making things happen. My role can also fit in with Crainers model as I am heavily involved in making sure that the team can meet objectives. The difficulty with the statement of making things happen is dependent upon each individual’s motivation and their individual circumstances. I feel that as an individual I am in the infancy stages of my career and have motivation with clear defined, SMART, goals (Mullins, 2010).
The manager’s role and activities have a different number of models and theories which are used to explain what a manager does, or should do. Some of these are explained by the following:
Fayol’s model looks at: Planning, organising, command, co-ordinate and control. My management role does have a certain element of Fayol’s model, but I found this view to be quite restricted, my role involves a lot of motivation, or the fact that is how I manage.
Drucker’s model looks at settings objectives, organising, motivating and communicating. I feel that this is the best fit for my style and role. The limitation of this model is that it has a less authoritarian approach to it, and as I have discovered in my experiences can lead to the team that is being managed almost abusing a level of candour.
Stewart describes the management role as to say the activities and role dependant on demands, constraints, and choices. Again, this can also fit in with my role and management style but is demanding on some of the authority that is needed.
The management style as described by Blake and Moulton in their grid looks at manager effectiveness versus efficiency. These are what I believe to be key qualities, attributes and skills of a successful manager. There is however room for a change in style dependant on circumstances.
My role is to manage the Patient Advice and Liaison Service for the Trust – to ensure the service is visible and accessible to patients, their families and carers through analysis of contact information and evaluation of experience. To develop procedures to ensure effectiveness of core business of service. The implementation of a telephone rota and advertised business hours has been an issue. Service users that are known to the team through historical working practices often end up having adhoc meetings in the office. This is both disruptive to other staff and can also be deemed as unprofessional.
However, the particular service users have a high level of dependency on the PALS officers. My initial reaction to this as a manager was that we needed to have a timetable for appointment, so that PALs officers are not severing a link with the service users but for an element of empowering o take place, as explained by Bandura’s self -efficacy service. If an individual is told they cannot look after themselves, eventually they believe that. However using empowerment can allow for service users to identify their own strengths. As a manager the challenge I face is that PALS officers have different levels of motivation and different triggers for motivation.
Mullins 2010 defines motivation as why people behave in a certain way, why people do what they do. This is explained further to say that the direction and persistence of action. It is concerned when people choose a particular course of action in preference to others, and why they continue with a chosen action, often over a long period of time and in the face of difficulties and problems. This is true of both in a positive and negative light. An example form the team that I manage is that PALS officers are often on the in-patient wards to promote the service of PALS and to ask those people that would otherwise not be able to raise a concern.
My critique of this situation was that a service can only be promoted to a certain level, otherwise it can be over promoted and this is where we find the leaflets that are handed out, just thrown about. My view is that each interaction should make a difference to the PALS officers. They should be able to understand that unless they found a new way of working, they are offering a counselling service, for which they are not qualified to do or paid to do. Again the discussion around empowerment was quite useful in highlighting to PALS officers that they are not there to ‘nanny’ service users.
I provide day to day management for PALS staff including provision of formal supervision; there is also need to provide ad hoc supervision, this may be in order to support staff in dealing with sensitive, upsetting, distressed cases / clients. I also receive and deal with complex cases or where cases require escalation from offices; dealing with sensitive, highly emotive issues and dealing with clients who may be extremely upset and / or distressed.
My role is also that of a Stakeholder engagement and involvement manager, which has a very corporate approach. I am responsible for forging relationships with both internal and external stakeholders. As discussed, the roles of PALS manager and stakeholder engagement and involvement manager does occasionally cause conflict, they are not natural roles that would come together. My understanding is that my predecessor had an interest in this area and so the role became theirs, and as such has been handed over.
Another challenge to the above is that my role is job-shared. My co-colleague also works to manage PALS and stakeholder engagement. The conflict in that situation is that this individual is also a PALS officers, this means balancing three work roles out of which the
Since the Mid Staffordshire Enquiry (2012) a huge push has been taking place to ensure processes and procedures are in place for service users/patients, carers and communities to have their say. The Francis Report (2013) highlights 290 key recommendations for organisations providing care. As part of my role I had to identify the key areas for development which are most relevant to the PALS officers and stakeholder roles.
Prior to my joining of the team, an internal consultation was underway and when I joined the deadline for the consultation period was looming, however, I was able to be a spokesperson for the team ( Mintzberg) by keeping up to date with PALS policy and guidance and develop local procedures for the Trust in relation to PALS. This had to be robust process which could iron out some of the concerns
I also work with the Head of Involvement and Equality to develop the PALS service to ensure the service meets requirements for the transformation agenda. At the moment I do this by having monthly meetings and adhoc regular contact. Again fitting in with Maslow’s hierarchy of needs I need this regular contact to maintain and improve my effectiveness as a manager. One of the challenges that I face is to maintain an overview of the system used to record PALS cases. This is to ensure information related to quality of services including equality data and patient experiences are recorded and effectively used across the organisation. I also develop local and Trust wide reporting mechanisms to do this. The challenge is the operational side of getting staff to actually record. I will need to consider the barriers to this during the one to one supervision sessions.
The involvement function of my role is quite wide but a lot of the work involved looks at developing systems using IT based programmes to support the equality and involvement agendas – including development of effective stakeholder engagement mechanisms to record stakeholders and involvement activities. I also keep up to date with patient experience guidance and to work alongside the Patient Involvement and Experience Manager by ensuring that PALS contacts are recorded accurately and are reported in line with patient experience indicators and commissioning requirements.
The NHS has undergone a huge change in the direction of strategies and financial decisions that are made. (DOH, 2013) The ‘failure’ of previous managing organisations such as the Primary Care Trust, has meant that a lot of the workload from there PCT has now moved over to the Care Trust. The experience of patients is very important in this process as it highlights that poor management can leave patients to have poor experience. (Patients Association, 2013)
I MANAGE A TEAM, BUT ALSO HAVE TO WORK AS PART OF A TEAM. MY MAIN ROLE IS THE LEARNING CURVE FOR MYSELF AND TO OBTAIN THE LOCAL KNOWLEDGE HELD BY THE PALS OFFICERS. I DELIVER REGULAR TEAM BRIEFING SESSIONS, SHARE INFORMATION, SKILLS AND EXPERIENCES WITH COLLEAGUES LISTEN AND ARE OPEN TO THE VIEWS OF OTHERS. I ACTIVELY WORK TO DEVELOP AND MAINTAIN POSITIVE RELATIONSHIPS WITH PEOPLE AT ALL LEVELS. BY DEVELOPING AND MAINTAINING CONSTRUCTIVE WORKING RELATIONSHIPS WITH LOCAL SERVICE USER, CARER AND COMMUNITY LED ORGANISATIONS. (MULLINS, 2010)
An effective team, as stated by Mullins and other literature surrounding management, is a group of people that work together to achieve outcomes. This is a multidisciplinary approach, using a matrix style of working. I am comfortable with this description as I also feel that a team is a group of individuals that work together to use skills and expertise and team working to complete tasks assigned to the group.
The defined role of a team looks at defined roles, skills and expertise. An important part of the team is to maintain regular contact, collaboration, co-ordination. These regular and frequent interactions give the team a more defined purpose. I also feel that a team needs skills and knowledge to carry out capability.
The challenges that I face in my role are that the role is of an evolving nature with and increased demand and support should be given by other colleagues in a matrix style of working. However, due to the lack of clarity from senior management and the fact that the job description is very new can lead to an impact on day to day management of the PALS team.
Another significant challenge is to performance manage the PALS team. The team has been working together for approximately 8 years, with some of the newer members joining around 4 years ago. This has led to a culture of working to ‘our way’. The concern with this approach to team working is that it may not necessarily meet the objectives of the organisation. In the scenario of the PALS team we constantly seem to cover ground rules and not be able to get past that, this can be seen as a level of non- compliance. As a manager my role is to steer the team to meet the team’s objectives, but this can be difficult due to the complex dynamics and individual personalities. To combat this I arranged individual sessions with staff to generate discussion around what each member of staff feels that they have done well, what can they do better and what would help them to get to that stage.
The challenge that I face with the team during this period of consultation is to maintain a positive working environment and culture which actively improves the performance of the department and teams within it in relation to involvement, patient experience and equality. This id due to the motivation levels within the team. As cited in Mullins 2010, ‘Team working is no more than a fashionable term used by management to give workers an exaggerated feeling of importance’ my view on this is that team working has to be used in the right context. There are times as a manager where you can be led by your team however, overall the manager has to set the scene and highlight the core areas for team working and independent work.
My role in terms of the day to day management of PALS Team including objective setting for individuals and team; allocating work to staff, completing monthly sickness returns. I ensure PALS staff are up to date in terms of all mandatory and required training and development is up to date at all times. It is imperative to my role to identify and arrange appropriate training and development for PALS staff, via the appraisal and KSF route, to ensure successful delivery of business and to keep staff motivated and engaged in their roles. This is also as described by Druckers management model, which asks the questions of what do managers do?
The manager’s role according to Drucker:
Sets objectives. The manager sets goals for the group, and decides what work needs to be done to meet those goals.I engage in this process by using supervision and team meetings, to set objectives but also to understand that the objectives are clear and clarified
2) Organizes. The manager divides the work into manageable activities, and selects people to accomplish the tasks that need to be done. I am in a job share situation, where my colleague is also a part time PALS officer. This has meant that I have had to revise the workload, so that both my skills and management tasks required are delegated appropriately between us and also to staff within the team that have the right skills. The challenge that I face in this situation is that I do not have a PALS background; however, it is important for me to be objective and put simple plans in place to have the team working effectively. I aim to pick up a lot of these conversations during the supervisions that I have with staff.
3) Motivates and communicates. The manager creates a team out of his people, through decisions on pay, placement, promotion, and through his communications with the team. Drucker also referred to this as the “integrating” function of the manager. My main style of working and management is to use motivation as a contributing factor, by looking at the motivators and demotivates and allowing staff to make their own decisions, using coaching and facilitation. Once aims and objectives are agreed, this allows me to measure the progress during meetings and one to ones
4) Measures. The manager establishes appropriate targets and yardsticks, and analyzes, appraises and interprets performance. This goes hand in hand with motivation, my main role is to measure the outcomes and also to measure underperformance. I aim to try and do this in a facilitating manner and not punitive. My own experiences of being managed in a punitive manner led me to completely switch off. I believe that the right skills and appreciation is at the heart of trying to get a team or individuals to work together. By using reflective practice I can also measure the performance of the team. I recently asked for team to bring figures of complaints/ concerns and issues to team meetings, so that we can be measurable and auditable.
5) Develops people. With the rise of the knowledge worker, this task has taken on added importance. In a knowledge economy, people are the company’s most important asset, and it is up to the manager to develop that asset. During the one to one sessions, I have designed a template to ask staff what works well, how we can do it better, looking at ways of improving stakeholder work, raise the empowerment level of individuals to take on responsibilities once involved, i.e. chair meetings etc.
Managers born or made, Mullins states a combination of both, my roles both professionally and personally have evolved through needs (Maslow’s Hierarchy of Needs). The need to bring a substantial income into our family home coupled with the determination of having a professional post. I also feel that as described above I am working using Druckers model for my personal development. One of the main aspects being that I am constantly setting measurable targets for myself and constantly reviewing progress and working to timescales.
One of the constant reminders that I have to keep addressing in my role as a manager is that motivation is not linked to ability. As Mullins points that an individual can be motivated but not have the right skill set or resources to carry out their ability. This is quite fundamental to bear in mind as often motivation and ability can be seen as the same, in my view they are co-dependant but need to be addressed individually.
Motivation means doing the best of ability, understanding what you can cope with and enjoy. Motivation is possibly the best way of doing something, taking into account individual characteristics and drivers. What motivates one individual may not motivate another (Mullins 2010)
The definition of motivation is to keep the momentum going, having the drive to achieve objectives, achieving and keeping a check on self-motivation. Motivation is linked to rewards which are individual to different people. Mullins (2010) states motivation is why people behave in a certain way, why people do what they do, the direction and persistence of it is concerned.
Having a sense of achievement is important to all; Organisations are now buying into the fact that staff needs to be kept motivated and engaged. As a result of Staff surveys, (BDCT 2012) organisational aims as well as individual aims are driven by certain motivating factors. These as discussed previously are dependent on individual circumstances. In a team of staff the motivation will be at different levels as people are at different points in life. A lack of motivation has the effect of having a destabilised work environment and an impact on staff morale.
“Motivation is not performance. Performance = motivation and ability levels” (UoB 2013) this phrase sums up for me what motivation means as a manager
Within motivation there are different theories. Buchanan and Huczynski’s theory on goals looks at main motives for our behaviour, wealth status and power trigger. Our behaviour towards attainment is encapsulated as the Content theory. Mullins 2010 looks at content theories as the drive and need of motivation. Decisions: why do we choose to pursue certain goals is termed process theory, the focus is on how choices are made with respect to goals. Job enrichment theory looks at influence and how can we motivate you to work harder.
According to Maslow’s Hierarchy of needs (Buchanan and Huczysnki) an individual, team or manager has the following needs:
1, physiological needs
2, safety needs
3, social needs
4, ego needs
Maslow states that the lower needs have to be satisfied first. My role as PALS Manager came as a result of national changes within the NHS. My previous role was in commissioning and due to move over to the Commissioning Board, however due to geographical challenges; I applied for a local job so that it could fit in with my need of being a carer to my family.
In my role as Stakeholder Manager, I collaborate and facilitate corporate events, raise service user and carer profile both inward facing across the organisation and outward facing. The Care Trust has made a huge effort to recognize and reference to the Francis Report, patient experience is at the heart of patient care. As stakeholder manager I am constantly reviewing, what does this mean?
To take a proactive approach I take the comments from the board to team meetings to raise awareness of issues and concerns that have a potential to take place, based on Mid Staffs Enquiry (Francis Report, 2013) and vice versa from stakeholder groups back to team meetings. It is critical in my role is to keep a balanced view between the organization and the stakeholders. I am able to agree with the rhetoric assumption of we have been here before in terms of making service better for people , but I believe that the catalyst for change is always evolving and by using reflective practice I am able to highlight the positive changes that have taken place.
An example of this is that carers are invited to Board meetings to share their experiences so that the senior management has some idea of the situation at grassroots level. Historically this was not taking place, however due to the feedback received regarding involvement activities from service users and carers, the Trust Board invite Service users and carers on a regularly basis. This allows service users to be an advocate for others but also with regular contact to become almost semi-professional and understand some of the concerns faced by large organisations.
The history of service user movement groups is well documented (Everett 1994, Campbell 1996, Wallcraft J, Bryant M 2003) and awareness of this literature enables an understanding to develop of the gigantic steps that have been made in the area of user involvement. The past quarter of a century has witnessed a dramatic change in the way that those using mental health services are perceived, represented and valued, not least as contributors towards their own care as opposed to purely receivers of it.
The role of service users in the 2007 mental health service is far removed from the role they played just decades previously (Campbell 2005) and the increasingly used term “experts by experience” highlights the value placed on service user contribution in all aspects of their care planning. This patient expertise is also fundamental to service user involvement, which not only takes many forms, but occurs on many varying levels. Involvement ranges from the macro level of service planning and evaluation through to involvement at the micro level of service user participation and decision making regarding their own care (Braye 2000). Recognised by the DoH (Department of Health, 2001b) in their Expert Patient document.
In my role of team management I am faced with conflicting demands upon my time and within the members of staff. Conflict resolution has become an important part of the manager’s role, the questions can be asked as to why there can be conflict. One of the reasons that I have uncovered during my research is that individuals can make organisational objectives, become personal objectives, this may not be fitting to everyone, due to individual circumstances.
Job purpose and job crafting is linked to my personal beliefs and motivation theory.
There are two factors that motivate people in their jobs. These two factors are:
Hygiene – factors affecting job dissatisfaction are qualities of supervision, pay, company, policies, physical working conditions, relations with others, and job security.
Motivator – factors affects motivation are promotional opportunities, opportunities for personal growth, recognition, responsibility, and achievement.
Herzberg argued that Hygiene factors do not contributes towards higher performance instead they are for prevention of dissatisfaction in jobs. True motivators are impacting motivation and hence organisational performance.
In my view hygiene factors are not contributors to motivation is not entirely true. Based on individual factors like responsibility, economic situation, opportunities available, these factors may act as motivators to work.
In evaluating the effectiveness of my role as a manager, I am not able to constructively measure my performance in this role as it too early to measure, however, in other areas of my life and on requesting regular feedback from my peers and previous colleagues, I would say that I am an effective manager in terms of motivation, objective setting and team working. I am able to synthesise and analyse my own development to better inform myself and the team that I manage. This role in particular is a short term contract and because of this I feel that my delivery of results is paramount to my reputation as an effective manager.
Some of the challenges that I have faced include the spontaneous nature of the team. The embedded dynamics means that it was difficult for staff in overcoming the initial authority and assertiveness of my role. Staff were working to their own demands; they were working hard and trying to give all they can in their roles but not working as effectively as they possibly could. I detected certain levels of non-compliance and lack of respect towards me as a manager from colleague and staff.
This may be due to the fact that they consider themselves to be local experts in their respective roles. This became an apparent weakness; due to unclear nature of my role and lack of management support this had a knock on effect in my management role. Staff felt that because I was unclear they could also have become complacent in their roles and resisting much required change. I gained support from my manager to facilitate those discussions with my job-share and focussed on the need to work more effectively and efficiently.
Following on from the Francis Report, the Trust have decided to conduct an external consultation of the department, this will have an impact on the PALS team, both positively and negatively. Positively the recognition and the importance of service user involvement in mental health care are possibly at a higher level now than it ever has been. The Care Trust was up until a couple of years ago a mental health and learning disabilities, specialist trust. Due to the many changes taking place in the NHS this has now changed and the Care Trust has taken on other responsibilities, the challenge that I am facing in my role is that the service users and carers are mostly from the mental health background, therefore the diversity of involvement from a wide range is restricted, however, this is critical to my role and to the wider role of the organisation.
Personal development plan
An analysis of my personal development plan will allow me to face some challenges constructively. One of the main concerns is that I have no clear definition of role and therefore unable to set objectives for my team. I aim to seek clarification from my manager and also from the organisation in terms of what the PALS team should be doing, especially in light of the Francis Report.
I will be arranging staff supervision sessions and also identifying key areas for development of staff. Regular feedback and appraisals will help in setting the teams objectives.
The workload will be reviewed and I will be reviewing time on activities so that a rota can be in place for manning the office and the telephones.
I will be able to manage conflict regarding the workload, once the discussions around caseload management have taken place. This will allow cases to be appropriately handled and in a timely manner.
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WriteWork contributors. “Management, Partnership and User Involvement in Health and Social Care” WriteWork.com. WriteWork.com, 05 June, 2007. Web. 02 Jun. 2013.