Managing performance - time for a change in the NHS

HR managers in the NHS spend 80% of their time dealing with performance, conduct and sickness. A key problem area is that the antiquated disciplinary procedures in the NHS including the use of low level warnings are no longer fit for purpose. Nor are they culturally in synch with the times. The NHS is on the threshold of radical and unprecedented change. Every NHS Trust will be affected and will be expected to transform into efficient, stand alone, solvent organisations. HR professionals within the NHS will be tasked with leading and implementing this transformational change, and supporting line managers to deliver excellent patient care with less resource, no investment and challenging financial targets. A high proportion of HR professionals in the NHS would admit to dedicating the majority of their working week dealing with time consuming transactional problems such as low level performance, conduct and repeated sickness absence issues. Where is the capacity to address the transformational agenda? As a HR Director in the NHS, I have encountered NHS Trusts where members of staff have been on suspension on disciplinary grounds for long periods, where consistent under performance is tolerated and addressed with no sense of urgency through a series of warnings, meetings and hearings that compound the performance issue and create an endemic problem within the service. I have witnessed trusts that deal with consistent sickness absence problems through a maze of interconnecting employment policies that line managers find practically impossible to navigate and do not promote a speedy resolution to the underlying problem. What private sector organisation would tolerate this? Will there be the resource or line management capacity for this out-dated approach in the 'new' NHS? The basic principles of effective performance management are not rocket science. The NHS has many experienced and dedicated clinicians who we promoted into management roles with little or no management experience or training. Managers are tasked with ensuring excellent patient care under extreme circumstances. This leaves many line managers to tackle challenging performance management issues with limited support from their HR service, employment policies which are usually lengthy, complicated and overly employee focused, and a blurred relationship between the HR service and trade unions. In this era of austerity, NHS organisations are under severe pressure to perform financially. Lengthy disciplinary procedures do not support budget reductions. Indefinitely suspending staff on full pay adds no value to patient care or the organisation. In one NHS organisation I experienced an under-performing senior manager suspended on disciplinary grounds for over six months while the trust completed the internal investigatory process. During that time the manager's work had to be covered by a temporary member of staff – and the trust had to bear the additional cost. If the original issue with the senior manager had been dealt with in a timely manner this could have been avoided. How is this an effective use of public money in a cash strapped NHS. It is time for an alternative, results focused approach to performance management in the NHS. Robust, clear, business focused HR policies and processes can support line managers in addressing poor performance within a realistic timescale. Organisational support for the change in practice and giving managers the skills, competence and confidence to deal with performance issues will either result in staff performing effectively in a reasonable time frame or exiting them from the organisation fairly. The approach requires managers and clinicians to work differently and undertake the people management responsibilities of their job. This requires a culture shift as many managers are uncomfortable with this aspect of the role and initially react with 'you are asking me to do HR's job.' However, line managers are best placed to manage their teams and achieve the best outcomes through them. The new role of the HR professional in the NHS will be to add value by guiding, coaching and transforming line management into effective management practitioners. The reputation of HR We worked with one client where the reputation of HR was poor and a perception they were too close to the trade unions. By restructuring the HR service using the principles of HR as a business partner and introducing a new performance management policy with a training package. This intervention increased workforce productivity and started to change the culture to introduce a performance management culture in the organisation in a short period of time. The way forward is to support and develop line management, support the change in culture to outcome focused performance management. To develop HR professionals who are business focused and who will support and coach line management in the approach. To develop robust HR policies which address performance issues quickly and effectively. To support healthy, challenging and engaging relationships with trade unions. And finally, to develop HR Directors and chief executives who are not risk adverse to dismiss staff who are not performing effectively. There has never been a more important time to ensure we get the best from the workforce in the NHS. Many trusts are being asked to do more with less, at least 70% of NHS spend is on workforce, HR leadership at board level is key to transforming the workforce to meet the challenges ahead. It is time for transformational change in the NHS and this is the start of the journey! Paul Beal is managing director of Consulting at 216 . He has worked with many NHS organisations as HR director on both a permanent and interim basis