Over the last 15 years I have coached, mentored and provided Clinical Supervision to hundreds of nurses, doctors and managers in the health and social care sectors. As you might imagine, some of the issues that they discuss in their sessions can be concerning to hear. Whilst it is essential to be mindful that the coach/mentor/supervisor is only getting one side of any story, I have always worked on the basis that my clients’ perceptions are very real to them and my role is not to judge them or anyone else.
Having been an executive director of an NHS Trust, I am well aware how difficult it can be to keep appraised of everything that comes under your remit. You rely on staff to keep you informed. However, some people will tell you only what they want you to hear or think you want to know. It may not cross someone’s mind to keep you appraised. Staff often think that their senior colleagues must know about a given situation, and can then make up their own narrative about why nothing is being done to address the situation. However, directors and senior managers cannot always know everything that is going on around them if things are not brought to their attention.
I am a naturally optimistic person and have said to many clients that it may well be that their manager, their Board Director or the Chief Executive is unaware of the situation of which they have spoken. I have, therefore, always been an advocate of informing senior leaders of issues when it is appropriate. I find it difficult to believe (and am aware that I do not want to believe) that a senior manager or executive director would “turn a blind eye” to issues of a serious nature if they were fully appraised of the issues, particularly in matters that affect patients or the staff working within health and social care. That would surely be not only unethical and unprofessional, but a dereliction of duty and demonstration of poor governance. So, when someone told me recently at a social gathering about a situation in their hospital, I had cause to reflect on my generally optimistic standpoint.
The gentleman, who is a nurse and works in one of our flagship hospitals in the UK, told me that staff in his clinical team regularly work 12-hour shifts that include no breaks (“even taking a loo break can be difficult”). Furthermore, that the Director of Nursing of the organisation is fully aware of the shortage of staff in this department and does not appear to be addressing the situation, which has been going on for over 6 months. The conversation has raised some questions for me, such as:
What would I do if I were the Nurse Director in that organisation and fully appraised of the staffing issues in that clinical department?
In the event of a serious incident, who is more culpable – the Director who is aware of the situation and does nothing, or the Director who is unaware of the staffing situation but should be?
Leaders of our health and social care services face many dilemmas. There are no easy answers and, ultimately, they may have to make difficult decisions. It is easy to think that one would not allow any significantly undesirable situation to continue once being made aware of it. But, what would we actually do? Indeed, is it a case of “There but for the grace of God go I” and breathing a heavy sigh of relief?
What would you do?