Training Blog

In Images of Organisation, Gareth Morgan talks about learning the skill of “reading” situations. This is particularly important for people dealing with business situations. “Skilled readers develop the knack of reading the situations with various scenarios in mind and of forging actions that seem appropriate to the readings thus obtained”. The metaphor “implies a way of thinking and a way of seeing that pervade how we understand the world generally”.

Morgan wasn’t intending to categorise different types of business, rather offer different ways of looking at them. The metaphorical lens can help people understand their experiences with them.
Morgan uses eight metaphors to create “images of organization”:

• A Machine – Businesses are often designed and operated as if they are machines, with highly visible structures and procedures. They offer continuity and security, but tend to fit people into jobs rather than allow much creativity
• An Organism – This means seeing the businesses as behaving in similar ways to our own biological mechanisms. When the environment around us changes, so do our bodies. Successful businesses are often adaptable and open to change. This may mean that its structures and procedures are less fixed.
• A Brain – Seeing a business as a brain means realising it has to be able to respond to change and also capable of rational thinking and intelligent change. Being open to inquiry and self-criticism often produces the ability to innovate: as Morgan puts it, businesses become “learning systems” that are able to self-organise.
• A Culture – When you speak of businesses as cultures, we are referring to the fact that they are made up of sets of values, perspectives and principles, held and sustained by the people who work there.
• A Political System – Businesses are not only about structures, cultures and hierarchies, they are also about politics. Politics in this context is about the social relations between individuals and groups in a business that involves authority or power. Organisational charts that plot the lines of communications between people will reveal some, but not all of the politics.
• A Psychic Prison – This more abstract metaphor suggests that some businesses are constrained by themselves. Conventional or usual, ways of organising work and thinking about it can limit change and the adoption of alternative business strategies. Looking at the business in these terms encourages us to dig beneath the surface in order to see the restrictions real or otherwise that may be affecting the business and its ability to operate successfully.
• Flux and Transformation – Morgan suggests that the secret to understanding businesses from this perspective lies in understanding the constant change shaping our lives. To understand a business we have to appreciate it as an ever changing thing. It grows & regenerates in order to survive.
• A Vehicle for Domination – This metaphor introduces the idea that businesses can be or an attempt to be dominant. They can or try to impose their will on others. Again it encourages us to dig below the surface in order to understand and appreciate how business can exert power and influence.

Morgan’s framework is considered to be useful as one way of understanding business. It’s not intended to suggest fixed types of businesses. Businesses are likely to be a mixture of different metaphors, which can change over time, or according to circumstance. The metaphors can help to highlight the complexities of a business and their potential impact.

Gordon Brown has said overpaid public sector workers will be “named and shamed” in efforts to deliver more value for money in public services. Ahead of the pre-Budget report, the PM said “efficiency savings” would help to save £12bn over four years – £3bn more than planned in the Budget. Crime maps and online school reports will be used to cut overheads as Labour tries to halve the Budget deficit.

The Conservatives say the government is not being straight on the cuts needed. The government has delayed its planned comprehensive spending review until after a general election. In the pre-Budget report, Mr Darling is expected to confirm annual borrowing will top £175bn – which the government has promised to halve within four years. In his speech in central London, Mr Brown said ministers had identified £3bn in additional efficiency savings since the Budget in April.

Of that, £1.3bn over four years would be achieved by streamlining central government, he said, indicating that certain programmes would have to be delayed or abandoned. We need to do what households up and down the country do to prioritise the necessities and postpone the things we can do without

Government spending on consultants would be cut by half and communication spending by a quarter – saving £650m – while more Civil Service staff would be relocated from London to “cheaper” premises. Whitehall departments could set up “common spending policies” and share office space, as part of a “third generation of changes in public services”. In its report, Putting The Frontline First, the government points out there are now 4,300 senior civil servants compared with 3,100 in the mid-1990s.

Mr Brown said public sector workers earning an “over-generous” salary would be “named and shamed”, as many had “lost touch” with normality. In future, all new public sector jobs with salaries above £150,000 will have to be approved by the Treasury while the details of civil servants and other public sector managers under direct ministerial control currently earning that amount will be published.

Mr Brown has ordered a review of senior public sector pay by the Senior Salaries Review Body to report by the Spring. He said: “Money which should be spent on health, on schools, on policing and on social services is, in some cases, going on excessive salaries and unjustified bonuses, far beyond the expectation of the majority of workers. This culture of excess must change and will change.” He added that the government would use technological advances to make services more user-friendly and cheaper.

As an example, sending text messages to remind patients about GP appointments could help save up to £600m a year wasted on missed visits. The public needed more “feedback and interaction” when using services, such as crime maps and giving parents online details of children’s progress at school, he added. Mr Brown promised to bring more such details on to the internet by next year. “The proposals we are setting out in this plan – which is just one element of our efforts to reduce the deficit – will go further than we have ever gone before in streamlining central government,” Mr Brown said.

“We have already promised savings of £35bn a year by 2011 on top of the £26.5bn a year already delivered through the Gershon [spending] review. “But by identifying new ways of working – and being prepared to make the tough choices – we can deliver in excess of another £12bn in efficiency savings over the next four years.
“This includes £3bn of new efficiency savings identified since the Budget – of which over £1.3bn will come from streamlining central government.”

The proposals were laid out in Parliament by Liam Byrne, Chief Secretary to the Treasury, who said that saving money should be “everybody’s business”. Chancellor Alistair Darling told BBC One’s Andrew Marr show that public spending would be “a lot tighter than it was in the past” as a result.

He said parts of the troubled £12bn NHS IT system would be delayed as it “isn’t essential to the front line” – a move Health Secretary Andy Burnham told MPs on Monday would save £600m “over the lifetime of the programme”. Mr Darling said the full details of spending cuts would not be revealed until “the first half of next year at some point”.

Meanwhile, as part of plans to tackle the deficit in public finances, the Treasury is working on a possible windfall tax on what it sees as the exceptional profits of banks or the excessive bonuses of bankers.
But the Conservatives say the government is still not revealing the full extent of cuts needed to tackle Britain’s debts.

They say they would protect NHS and international development spending but the rest of Whitehall would face “very difficult choices” if the Tories won power. The party has also called for a moratorium on all government computer projects, claiming Labour has spent £100bn on IT since 1997 and that contracts worth another £70bn are due to be renewed or commissioned in the next two years.

Shadow Treasury minister Philip Hammond told MPs: “Since 2000 they’ve poured billions of pounds of taxpayers’ money into indifferent public services, borrowing and spending like it’s Monopoly money.”
He called Labour’s savings plans a “mish-mash of announcements and stolen clothes, in the dying months of their rule”.

Liberal Democrat Treasury spokesman Vince Cable said: “If the government knew there was inefficiency, why hasn’t the government already dealt with it?” We have now reached the point where the investment gap which we inherited…in 1997 has been fixed.

He added that more had to be done to improve the level of independence local government has from Whitehall, in an effort to increase accountability. Jonathan Baume, general secretary of the First Division Association, which represents senior civil servants, called the government’s proposals on public sector workers “irresponsible”. He added that “this announcement looks more like crude electioneering than a sober assessment of the implications for central government of the fiscal crisis”.

In businesses where there are groups of people working it is important that they’re able to work together. If they are not able to work together, it results in conflict and low productivity. In some cases it can result in major mistakes being made.

Ideally all members of the group should share the same ideas and goals. However in reality often the goals are shared within the team but the ideas about how to achieve that sometimes differ. This can be a good thing as long as there is good clear communication and the ability to compromise in order to get things done.

The team dynamic usually consists of degree of hierarchy, where each person is assigned a role. In a medical setting you can see this within individual departments which are smaller teams within a larger team, that is the hospital, which is a smaller team with a particular trust and so on until you get to the largest team of all the NHS.

Now we’ve all seen the stories on the news about the NHS failing, this is because their are parts of this team that are not working effectively. If you think about it logically each department is essentially a business if it does not work effectively then it loses customers this can then impact on the hospital as a whole because if you have a bad experience in one department then you are not likely to go back or at the very least reluctant to go to the hospital where you had the bad experience fearing that if you do the same thing may happen again.

There are a number of options that can be applied to rectify the situation:

• Change the Team
• Alter the hierarchy
• Take Courses in team management and effectiveness

If you decided to take the 3rd option then your next question is who/where can i find these courses. Well there is a company called Medicology Ltd. This company offers a diverse range of tools to help you make your team the best it can be.

The definition of business excellence is: a state of organizational performance achieved through the successful integration of a variety of operational and strategic elements that enables an organization to become one of the best in its field. Excellence is initially evident when an organization rises above its competitors, and it is usually measured by the ability to sustain a leading or significant market share. The strategic and operational elements contributing to excellence include the organization’s approach to total quality management, quality assurance, quality awards and quality standards, core competency, benchmarking, customer service, the balanced scorecard, and leadership. Taken altogether, these components should produce an organizational approach to the generation, development, and delivery of products and services that is better, cheaper, and smarter than that of the competition. Attempts at becoming an excellent organization have spawned terms such as best practice, best-in-class, and world class manufacturing and are usually associated with a holistic approach to competitive advantage.

So clinical business excellence takes this definition and applies it to clinical settings. Medicology has a centre of excellence in this area. They are already running courses to help the NHS staff develop on both a professional and a personal level. Now they are holding a conference on, yes you guessed it, Clinical Business Excellence. This conference will be held on the 29th June 2010 at Park Crescent Conference Centre. For more details see clinicalbusiness.co.uk.

A government minister has told bankers “to come back into the real world” after Royal Bank of Scotland directors threatened to resign over bonuses. City Minister Lord Myners said it was unrealistic that bankers should expect to be paid million pound bonuses.

RBS reportedly wants to pay a total of £1.5bn in bonuses to investment banking staff, and the board has threatened to quit if the government blocks the move. The Treasury said it would intervene if it was in the interest of taxpayers.

Meanwhile, Barclays is planning on increasing the non-variable element of staff pay at Barclays Capital, its investment bank, the BBC’s business editor Robert Peston says. The Government is caught between a rock and a hard place. Many voters cannot understand why taxpayer supported banks should pay their staff any extra bonuses.

In January the Chancellor will have to approve the bonus pot at RBS. Any increase could generate a backlash against the government. But the City doesn’t like what’s seen as interference in the boardroom. Looks like this will run and run. Barclays maintains that by pushing up salaries, it is only doing what G20 governments have asked it to do, by shifting the weight of pay from the variable portion – ie bonuses – to fixed.

Lord Myners has estimated that at least 5,000 bankers in the UK will earn more than £1m this year. He told the BBC that the median wage in the UK was just over £20,000 a year, and yet some bankers expected as a matter of course to receive bonuses, in addition to their salaries, of millions of pounds.

He also said banks needed to be mindful of the fact that much of the profit they were now making was due to “the benign conditions” created by the government pumping billions of pounds into the economy to stimulate demand. RBS directors say it is their legal duty to act in the interests of shareholders, and that if they do not pay competitive bonuses, top talent will leave the bank.

This would have an adverse impact on profitability, and therefore the bank’s ability to repay the taxpayer, they argue. Business Secretary Lord Mandelson said: “I understand the point that RBS directors are expressing – they say they have to remain competitive in the market in recruiting senior executives, and this is why it’s important that all the banks are equally restrained, and RBS is not singled out.”

The Conservatives said the government was sending out mixed messages. Shadow financial secretary Mark Hoban said: “The government’s policy on bonuses is a muddle. The city minister claims he will veto big bonuses only to be superseded by the business secretary calling for banks merely to show restraint.

“We have been clear – no significant cash bonuses should be paid out this year and that money should go towards increasing lending to the families and businesses who propped up the banks in the first place.”
Liberal Democrat Treasury spokesman Vince Cable said the government should “call the bluff” of the RBS directors and accept their resignations. “The government has to impose itself and must not be pushed around,” he told the BBC. One banking analyst went a step further, suggesting the directors should be sacked. “Their job is very simple – to fulfil the requirements of the shareholders. If we tell them to paint everything blue, everything has to be blue,” said Ralph Silva at SRN. “They should not be going up against shareholders. I think we should fire them [before they resign].”

But he also argued that the government would be making a mistake if it told the bank not to pay bonuses. The best bankers who brought in the most profit would leave, he said, and for this reason he thought the bonuses would be paid. But others took a more sympathetic line with the RBS directors. Stephen Regan at the Cranfield School of Management said that shareholders could not call the shots and only had the power to call an extraordinary general meeting, at which they could vote on whether to oust the board.

“Ownership is with the shareholders, but control of the business is with the directors,” he said. The government owns 70% of RBS after bailing out the bank during the height of the financial crisis, a stake that is set to rise to 84% following the Treasury’s recent pledge to inject billions more into the bank.

Last month, Chancellor Alistair Darling announced that the Treasury, as the major shareholder in the bank, would have the “right to consent” to how much RBS pays in bonuses and how they are paid. RBS is said to want to pay £2bn in bonuses across the group for its performance in 2009, with £1.5bn going to its investment banking division, which is expected to make £6bn in profits this year.

Most people would not even consider taking an exam without acquiring the relevant knowledge, skills and insight in preparation for it and therefore why would you approach perhaps one of the most important events in your life, getting the right consultant job, with any greater uncertainty than there needs to be? You wouldn’t. In fact, we know that you’d want to absolutely ensure you stood the best possible chance of success and that is why we have developed the Medicology approach to consultant interview success. It’s your future and so we don’t believe you should take any more chances than necessary.

The Medicology approach consists of the following:

• Gold standard, low number, specialty-specific consultant interview course
• Access to consultantinterviews.co.uk, allowing you to see example questions, hot topics, key strategies, CV guidance and more
• Psychological profiling to understand your likely strengths and weaknesses, as well as their match to your specialty
• Back up coaching – fail to get appointed on 4 occasions and we’ll examine the reasons why, as well as coach you to success

CONSULTANT INTERVIEW SKILLS OPEN PROGRAMME

Pre-Interview visits – creating personal presence & deriving benefit
Understanding your consultant interview panel
Building rapport with interviewers
Effective communication skills within interviews
Advanced interview techniques
Psychological techniques for increased rapport, impact & clarity
Understanding the reasoning behind the question
Answering questions within the context of who’s asking – understanding the interviewer
Recognising the effects of your internal wiring on your approach to answering questions
Effectively structuring your answers
Talking about yourself & showing the real you – do & don’t guidance
The answers you must have – knowing what to research
Handling difficult or unexpected questions
Dealing with ethical questions
Dealing with political questions
Developing business or commercial healthcare knowledge
Effective presentation skills
Demonstrating initiative, personality, leadership and political awareness
Understanding your body language
Question practice with a 1:6 instructor-participant ratio

Benefits and objectives

• Get the best jobs by adopting the right strategies for your specific specialty
• Develop appropriate confidence in all interview situations
• Communicate in the right language and with the appropriate degree of confidence for your specialty
• Utilise the full range of interview strategies to influence the result
• Increase awareness of the necessary key topics
• Gain valuable practice and personal feedback

Course type and teaching methods

The course consists of an engaging mixture of delivery styles including lectures, discussions and exercises all designed to ensure you the highest possible success in your future consultant interview. A substantial component of the afternoon is dedicated to interview practice in groups of 6 people with each person having individual mock interview questions in front of the small group. This structure is extremely successful in recreating the pressures of a real interview whilst giving each person the opportunity to rehearse in a safe environment whilst receiving valuable feed back from a trained facilitator and the small group of fellow attendees. All candidates learn from listening to others answers, reflection and tutor feedback. Topics covered include the political agenda, clinical governance, ethical decisions, clinical leadership, dealing with difficult colleagues, conflict, supporting junior doctors and teaching. These sessions are facilitated by senior Medicology coaches and by experienced, trained consultants with direct experience of interviewing for consultant colleagues.

Senior doctors are calling for human tissue to be routinely kept for genetic testing in cases where young people die without explanation. It is thought that the DNA from such samples may reveal an unsuspected inherited condition and save relatives’ lives. One doctor said pathologists should be encouraged to take the tissue and ask for consent later if necessary.

But the Human Tissue Authority said it was “alarmed” about public calls for practitioners to break the law.
The Human Tissue Act requires that appropriate consent is in place before the tissue is removed from a deceased person. During the implementation of the Coroners and Justice Bill we will consider the additional procedures that might be required to enable families’ wishes in this respect to be achievedquote here
Ministry of Justice spolesperson

Dr Mary Sheppard, of the Royal Society of Medicine’s pathology section and a leading expert on Sudden Cardiac Death (SCD), said some coroners did ask relatives already but others felt it was not part of their remit. She said: “If coroners routinely requested consent from the family to retain material for DNA testing at autopsies we would be able to find out far more about how the person died and possibly prevent other deaths in the same family.” She estimates that every year roughly 800 young people under the age of 35, apparently fit and healthy, die suddenly from unsuspected heart disease or without explanation.

The government has recently set up a database operated by the NHS Information Centre to collect reliable data from pathologists on these deaths.

• Inherited heart problems that can cause SCD:
• Long QT syndrome – a disorder of the electrical activity of the heart
• Brugada Syndrome- irregularities of the electrical activity of the heart
• Inherited cardiomyopathies or heart muscle diseases

Coroners are in charge of inquests and post mortem examinations and overseen by the Ministry of Justice.
A spokesperson for the Ministry of Justice said: “We recognise that some families who lose their loved ones tragically early would want a more extensive post mortem than is usually required by a coroner whose duty is to establish the cause of death. “During the implementation of the Coroners and Justice Bill we will consider the additional procedures that might be required to enable families’ wishes in this respect to be achieved. More generally, and in relation to specific research projects, the new Chief Coroner is expected to issue guidance on the handling for all requests relating to research into the causes of deaths which coroners investigate, and to provide advice to coroners on how they may or may not be able to co-operate.”

Alison Cox, founder and chief executive of the charity Cardiac Risk in the Young (CRY) said: “In the past two years we have seen the coroners taking huge steps to support families after the tragedy of a young sudden cardiac death. “DNA testing is clearly a potential resource for further information when it is possible to obtain it.”

Dr Paul Brennan, a clinical geneticist for the Northern Genetics Service, said there should be a change to coroners’ forms to deal specifically with consent for the pathologist to retain tissue for DNA extraction and storage. He said: “Until then, I would urge pathologists who have not had the opportunity to obtain consent, to think about taking these tiny tissue samples – usually a spoonful of blood or a cubic centimetre of spleen tissue – and then ask the relatives for consent. “If consent is not given, the tissue must, by law, be destroyed. But if it is not even taken in the first place, a huge potential benefit is lost.”

Adrian McNeil, chief executive of the Human Tissue Authority (HTA) said: “The HTA is alarmed about any public statement that urges practitioners to consider breaking the law governing consent and the taking of tissue for DNA testing. “We recognise Dr Brennan’s right, as a senior practitioner in the sector, to propose changes to the current law but cannot endorse what would be a clear breach of the legislation.”

Morale is one of the most significant factors affecting organisational performance with clear links to many adverse situations:

• High sickness & absence
• High staff turnover
• Poor performance
• Poor clinical outcome
• Low customer satisfaction ratings
• Reduced team effectiveness
• Conflict & obstruction
• Increased tribunals & grievances

Medicology MTI has been developed to address two specific needs:

a robust and sensitive measure of morale
a differential diagnosis of the factors positively or negatively influencing it

It consists of a series of questions around known influencing factors and takes the average person around 10 minutes to complete.

Robust Measure

Medicology MTI introduces two important processes to ensure that the morale measurement returned is both sensitive and representative.

Firstly, it utilises variance to assess morale, i.e. how far above of below neutral the score for a particular factor is for that person and thus avoids the weakness found in many systems that use an arbitrary scale.

Secondly, it asks the respondent to indicate how important a factor is and this is taken into account in the overall calculation. Coupled with variance, this creates an immensely sensitive measure.

Differential Diagnosis

Medicology MTI is designed to provide detailed analysis, reporting and guidance. Your morale report will include analysis by:

• overall score
• individual questions
• different staffing groups or departments

Furthermore, individual questions contribute to section morale scores, to help you identify problems in the following areas:

• Growth & Development
• Leadership & Management
• Personal Factors
• Relationships
• Work (the work itself)
• Workplace (the work environment)

This level of analysis and reporting allows you to not only assess morale in different staff groups but to diagnose any specific problem areas so that interventions may be applied.

Practical Information

Medicology MTI is designed to make your life easy:

• Run morale testing from a few to thousands swiftly and effortlessly
• Define which staff groups are most appropriate to you
• Re-run the survey at intervals (which can be set up automatically e.g. 3 monthly intervals) to assess how it is changing over time
• Bulk upload your staff from Microsoft Excel® or provide them to us and we’ll do it

For more information or to try out this great product for yourself see medicology mti

medicalperception.com from Medicology Ltd allows Trusts, PCTs, SHAs, Government, Pharmaceutical, Medical Equipment & Biotech companies, health service suppliers and more to access, survey and evaluate the mindset of health service staff, simply and cost-effectively. Medicology Ltd is also the leading provider of leadership, management and personal development for health service professionals, especially clinicians, meaning we spend most of our lives inside the heads of clinical staff, understanding how they think, how they evaluate problems, their similarities and differences from each other, their sources of meaning and more. That’s a very, very good place to be when designing meaningful, high quality research.

What can we do?

• Survey health professionals in every medical specialty
• Access the medical mind nationally and internationally
• Evaluate clinical perceptions around drug therapies
• Gauge perceptions and feelings about important issues
• Develop insight into clinical pathways
• Understand how professionals choose products & services
• Develop greater sales force effectiveness
• Evaluate job satisfaction & morale
• Run a series of evaluations over time

This is just a brief set of suggestions, so if you need something not on the list then simply ask.

Why medicalperception.com?

There are very compelling reasons to use medicalperception.com

• Highly cost-effective for the highest quality research
• Rapid deployment time
• Professional outward appearance
• Ability to retain and re-run research studies, gaining insight into trends over time
• Build in the ability to control for different psychologies
• Highly trusted, competent team
• Enormous degree of medical insight available in study design

Experts are warning that poor communication between hospital staff and with their patients is far too common and deeply damaging. According to the findings of a confidential review patients left out of the loop and staff clocking on and off without a handover was commonplace. Change in the hospital team structure over recent years has seen individual clinicians become “transient acquaintances during a patient’s illness rather than having responsibility for continuity of care”, says the NCEPOD report. It found a co-ordinated handover of patients between night and day staff only occurred in a quarter of the teams. In 13.5% of cases lack of communication compromised continuity of patient care.

In just over half (53%) of cases there was an apparent lack of input from senior doctors “leading to delays in giving patients timely and appropriate care”, report author and surgeon Ian Martin said. And 30% of the patients were not seen by a consultant within the recommended 12 hours after admission. In a fifth of patients who were not expected to survive on admission there was no evidence of any discussion between the health care team and either the patient or relatives on treatment limitation. Many “do not attempt resuscitation” orders were signed by very junior trainee doctors. NCEPOD chairman Professor Tom Treasure said the report vividly revealed the challenge medical teams face in making the transition between saving life and allowing natural death. “It should be ensured that patients achieve the best quality of life until they die. Effective team working and communication with patients, relatives and carers are fundamental to getting this right.”

Director of the Patients Association, Katherine Murphy, said: “These findings run the risk of undermining basic confidence in the NHS. Some of the examples are shocking. “NCEPOD is the nearest the NHS has to airline ‘near miss reporting’. Its findings must be acted upon, or problems will continue to plague vulnerable patients and their families.” John Black, president of the Royal College of Surgeons, said doctors had long been concerned that the loss of team working in hospitals had fuelled the risk of poor communication, and sub-standard patient care. He said the implementation of a 48-hour working week under the European Working Time Directive almost certainly meant that the problem had got worse since the latest study was carried out. Professor Black said the only way to address the problem was to opt out of the directive.

A Department of Health spokesperson said measures had been introduced to improve care – including an end of life strategy – since the report’s survey was carried out. “We are putting in place an extensive programme of health and social care training to support end of life care provision, including pilot projects to support the development of communication skills. He added that evidence from hospitals already implementing a 48-hour week showed a drop in mortality and no evidence of harm to patients. “Working together with the local NHS and the Royal Colleges we have set up a rigorous quality assurance process to give us an accurate picture of how EWTD is being implemented and so we can provide support where it is needed.”