Changing the "Old Management" paradigm: Staff Retention in Health Care

By Tony Bradford, Managing Director, Centre for Corporate Health

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The Challenge: The "Old Management" Paradigm

Like many organisations, the San has had its challenges in recent times with increased demands and pressures from its external environment. These include various health fund and resource issues, keeping up to date with the latest technology and medical procedures, competitive pressures from other hospitals, increased customer demands, and balancing often conflicting priorities with the economic reality of maintaining a viable business.

These external demands, plus others, have placed a great deal of pressure on the internal operating environment at the San. The greatest challenge of all according to CEO Dr Leon Clarke is maintaining high morale, excellent performance and quality patient care in an environment where staff are being asked to do more and more with fewer resources.

The pressures that both private and public hospitals are under have been well documented and of greatest concern is nursing turnover. Staff retention, especially within nursing, has been a major strategic imperative at the San. In particular the Executive Management team recognised the need to do whatever it needed to stem the flow of younger nurses leaving the hospital, and sometimes the profession altogether.

Typical problems experienced in junior levels of nursing have been caused largely by the "old management" paradigm based on power and control. This is caused by managers feeling like they have to promote themselves in order to look good and impress others in order to get ahead, maintain their status and position and level of authority. This results in an aggressive/defensive culture. The younger generation entering the workforce today do not take too kindly to such an operating environment. Some choose not to work in that environment and leave, yet others slip into self-protection mode by using passive/defensive behaviours in order to fit in, be liked, not "rock the boat" and stay out of trouble. This results in increased stress and poor morale which in turn leads to more turnover.

The key to handling these demands and pressures is not so much in what people do, but how they do it. In particular, working within their "circle of influence" and focusing on the things that every manager does have control and influence over has been a big shift in thinking throughout the hospital. This means looking at themselves and their own behaviour. Moreover, managers at the San have addressed how they go about their work and interact with each other - their operating culture.

The Intervention

The San engaged the Centre for Corporate Health to assist in the organisational development intervention. The management development initiative targeted three levels of management: Executives, Senior/Middle Management, and Frontline Supervisors. So far over 100 managers from all departments have participated in the programme.

The main focus in the management development programme involved the careful examination of what managerial behaviour contributes to and detracts from effectiveness at the individual, team and organisational level. This was achieved with each manager receiving comprehensive confidential 360-degree feedback using the Life Styles Inventory (LSI) followed by the Management Effectiveness Profile System (MEPS). The LSI was used to address fundamental habits of thinking and behaving and MEPS was then used to assess the impact that this thinking has on specific managerial competency areas vital to success.

Using LSI and MEPS together has been a great way for every manager to examine the cause and effect relationship between how they think and the impact that this thinking then has on specific managerial competencies. For example, it would make sense that a manager high in Approval and Avoidance in the LSI would score lower in the MEPS skill areas of "Providing Feedback" and "Integrating Differences". Being able to recognise the reason why managers were having difficulties in various managerial functions and by addressing the root cause of such difficulties has been instrumental in assisting managers achieve meaningful and lasting change.

The underlying theme throughout the six stage programme was to strengthen Achievement and Humanistic-Encouraging behaviours and decrease Power and Oppositional behaviours. Specifically this focused on developing greater communication competence and covered modules such as:

• Mentoring and coaching

• Managing employee performance

• Managing change

• Managing stress

The focus was on enabling managers to have more constructive conversations with their teams and helping them to realign their own values and needs with the hospital's mission, by focusing on the achievement of goals, and by increasing the level of participation and involvement.

This required a fundamental change in thinking for many managers especially regarding the sharing of power, and for managers to feel like they don't have to do everything themselves.

Next page: The Results

Tony Bradford is the Managing Director of the Centre for Corporate Health, Sydney. For more information on this programme, contact him via tony@cfch.com.au.