The old cliché that for a person to change they must really want to change is true – for individuals and organisations alike. However, the initial reason for change is nearly always a change in the external environment, i.e. something, or someone, impacts on us so greatly that we feel a need to respond. Think about why people decide to stop smoking, or lose weight.
The NHS, and the medical profession in particular, are conservative organisations. They have traditionally operated in the comfortable situation of insatiable demand and constantly increasing supply. The type of work is complex and specialised, often performed by arrogant and complacent health professionals. These are the ingredients of the ‘Success Syndrome’, which ultimately, produces declining performance and denial, ‘disabled learning’ and a downward ‘spiral of death’ (Nadler and Shaw, 1995).
In that context, how can change possibly occur? Is there anything we can learn from academic change management? Well, here are my learning points distilled from my MBA module on change management:
- All process models of change involve an initial disturbance, shift and re-consolidation
- If initial momentum is lost the process can become stalled
- Process models can be used to analyse change situations
- When beginning a change the desired end should be kept in mind
- Dramatic changes are often easier to initiate than gradual ones, but the results may be less predictable
- The importance of people issues in change management must not be underestimated
- Leaders must define their vision, garner the necessary resources, (mostly human), and communicate constantly
- Personal transition issues should be anticipated by change managers, who can facilitate progress through stages of adjustment
Ref: Nadler, D., Shaw, R. and Walton, A.E. (1995) Discontinuous Change: Leading Organizational Change. Jossey-Bass, New York.
How do you know if the training you are doing is worth it? Here are four simple tests:
- 1. Reaction – how the participants feel about the training; qualitative
- 2. Learning evaluation – have learning objectives been attained?
- 3. Behaviour evaluation – has behaviour in the work place changed?
- 4. Results evaluation – are outcomes better as a result of the training?
Again, in the NHS, doctors rarely evaluate their study leave in these terms. However, I would suggest that clinical and medical directors are well-placed to control the use of study leave and to intervene by establishing organisational processes that affect training. The human resource (HR) function in most NHS Trusts has virtually no input into doctor training (other than providing the generous funding for it). A wise medical/clinical director should liaise with HR to shape study leave to the organisational requirements! Shock, horror!
Unless training fits with the long-term strategy of the organisation a considerable amount of money can be ‘thrown away’.” (Bernhard and Ingolis, 1988)
There should be a relationship between an individual’s training and the organisation’s strategy. You may think this is self-evident, but most doctors I know never consider their Trust’s strategy when applying for study leave! Rather, they think of it as an instiutional ‘right’. Now, obviously, as professionals, doctors ought to be able (to a certain extent) to decide for themselves what training needs they have, but I think ‘study leave’ is an underutilised lever for aligning the needs of the organisation with those of the individual. For example, we know that multi-disciplinary working is essential for patient safety, yet how often do we use study leave to encourage such team working? Similarly, we know that a common cause of patient complaints is the attitude of staff, yet do we insist on personal development training?
Training can be defined as ‘…learning to do something and, when it is successful, it results in things being done differently.’ (Bramley, 1996).
Planned training is a ‘…deliberate intervention aimed at achieving the learning necessary for improved job performance.’ (Kenney and Reid, 1994).
If we used these criteria for assessing the use of study leave in the NHS, I think we’d often have a tough time justifying it. It’s time for clinical and medical directors to be pro-active with study leave for the benefit of their organisations and, ultimately, patients.
- Bernhard, H.B. and Ingolis, C.A. (1988). ‘Six lessons for the corporate classroom’, Harvard Business Review. 66(5), 40-48.
- Bramley, P. (1996). Evaluating Training. London, Institute of personnel and development.
- Kenney J and Reid M (1994). Training Interventions, 4th Ed, Institute of personnel and development, London.
What sort of training do we give to senior clinicians in the NHS? There is a very generous ‘study leave’ budget for doctors, but there is virtually no supervision of the events doctors attend. Sure, there is the box-ticking of whether or not a given course fulfils ‘Continuing Professional Development’ but it’s hardly a rigorous standard. Even less is any after-the-fact assessment of usefulness or how performance has improved because of attending an event. Study leave is often viewed as a ‘jolly’, evidenced by the increasingly exotic locations for events.
In future posts, I’ll describe what a managed approach to ‘study leave’ might look like.