Empowering staff should be a top priority for health system leaders

Last summer, in partnership with the County Councils Network (CCN), we researched the difference between a council’s adrenaline (the ability to respond to an initial crisis) and its core strength (the ability to keep dealing with ever-changing circumstances). Staff resilience, good willing and flexibility have been key for health and social care systems to respond to the Covid-19 crisis. In healthcare it feels like the adrenaline has now run out.

Prior to the pandemic, big shifts were being made in the intermediate care operating model. These shifts took place over an extended period, and staff were engaged throughout. By contrast, change over the last two years has been directive, incredibly rapid and almost constant. A staff survey IMPOWER conducted with a recent client showed that only 30% of staff across intermediate care thought their role had not changed much in the last two years, with many still in temporary roles. Some staff have lost sight of what they are trying to achieve with only 33% saying they understood the vision for Home First. There are still skills gaps from when social care staff were pulled into the community from hospital wards as part of Discharge to Assess (D2A). Staff are tired of filling gaps with little training, development or even time to reflect. Health system leaders must refocus their efforts on empowering and supporting staff.

Despite this, staff continue to show remarkable flexibility and strive to make their systems better – it only takes a small amount of support to enable staff to make the changes they want to. For example, working with an acute hospital ward to support them to build relationships, clarify roles and responsibilities, and communicate better, led to a reduction in length of stay by 50% and doubled the number of daily discharges.

Similarly, staff working in the Home First team wanted more ownership of decision making. This allowed them to involve patients more in decisions, reduce hand-offs and delays and build communication with wards and other partners. The team were able to improve patient outcomes and reduce discharge decision time by 60% by using project management to map processes, reduce risks and issues, and support stakeholder management.

System leaders should listen to and support their staff. They know what needs to change in the system and how to change it. They want to improve experiences for the people they support and for themselves. Empowering staff can make all the difference, and could be done by:

• Setting a strong, clear vision for the system going forward
• Making the strategic decisions required to regularise staffing, reduce secondments, and provide fixed-term contracts wherever possible
• Providing the project and change resource needed to enable change to be effective
• Making space for staff to tell the leadership team what needs to change – and ask staff what they need to make it happen

Leaders across health and social care are still under immense pressure, and deal with operational crises every day that make it hard to look up. But providing the structure, leadership and support that empowers staff to drive change (ie building core strength) can deliver transformational and sustainable change that ultimately delivers better outcomes.