Human Resource Strategy Of The NHS

Tameside Hospital NHS Foundation Trust is located at the Tameside General Hospital in Ashton-Under-Lyne. The organisation was formally authorised as a Foundation Trust on 1 February 2008. The Trust was formerly known as “Tameside & Glossop Acute Services NHS Trust”.

Employing approximately 2,300 staff, the hospital provides the wide array of services one would associate with a general hospital, including Accident and Emergency services, general and specialist medicine, general and specialist surgery and full Consultant led obstetric and paediatric hospital services for women, children and babies. The Trust’s clinical services are provided in a number of different specialties and departments. These are organised into four Divisions.

Situated at the foot of the Pennines, eight miles to the east of Manchester the Trust services a population of over 250,000. The population is concentrated in the largely industrialised areas of the eight townships of Tameside, which comprises Tameside Metropolitan Borough Council.

The Trust’s overarching purpose is to become the local Hospital of Choice for patients, the public and staff. The Trust will continue to play its part in the local community, and to seek to build strong and enduring partnership relations throughout 2010/11 and beyond. The Trust is committed to building on its achievements of 2009/10 and continuing to improve the care the hospital provides and the way we work.

Tameside appears to have a very positive future ahead as we have recently undergone extensive building work under a PFI (private finance initiative) Project where we have had £120 million investment. The Health Investment in Tameside (HIT) Project is the biggest investment and most extensive site improvement Tameside hospital has seen for decades. It will result in new Acute and Mental Health facilities with a construction programme which started in autumn 2006 and will be completed by the end of 2011.

The organisations expenditure consists of around two thirds on its workforce. The approach in the way the hospital manages staff is crucial and is key to delivering the best possible care to patients. Staff have the opportunity to develop their skills, knowledge and attitudes and engaging staff in this way will the lead the organisation through a very difficult economic climate.

Tameside Hospital like other hospitals is dominated by a mainly female workforce and this is impacting on a previously male management culture and there is a competitive edge now between the existing male workforces in similar organisations.

The financial and economic outlook for the coming three years is very challenging and the demands on healthcare services are likely to rise at the same time as available funding becomes more constrained. Improving productivity will be a key focus of the Trust’s work over this period, but this will not be allowed to come at the expense of the quality of healthcare services.

The Trust Board recognises the challenge of maintaining an accessible and comprehensive range of clinical services for the population of Tameside and Glossop in the current economic climate, and acknowledges that this may be more readily achieved through both innovation and scale. The potential to work collaboratively with another organisation in the development of a hospital group to ensure the continued delivery of quality and productivity is being actively explored. The key aim of such collaboration would be to achieve additional efficiency and quality gains, without the need for major structural change (merger).

The Trust already has an active programme for the involvement of patients, the public and staff in its work. Website – http://www.tamesidehospital.nhs.uk/Documents/AnnualPlan201011.pdf – Accessed 30.03.11. However, it remains the view of the Trust that there are additional benefits to be gained from developing wider and deeper involvement. The Trust’s staff also will need to feel empowered to seek out ways to achieve quality gains whilst also delivering productivity improvements, such that the Trust can secure financial and service stability going forwards. As stated above, the Trust’s Stakeholder Engagement and Communications Strategies will set out the Trust’s plans to enhance the involvement and engagement of key stakeholders.

Staff involvement plays a major part in delivering the high quality services expected by such a large community like Tameside and as such the organisation invests heavily in staff development. There is a direct link to the performance of staff and the organisations HR strategy. Unfortunately in the current economic climate this couldn’t be further from the truth as staff morale and motivation is certainly not what it was as “job cuts” is the focus of every member of staff at the Trust.

Current Challenges in Strategic Priorities

The HR function at Tameside Hospital has become the forefront of driving change within the organisation. The workforce strategy (see Appendix 1) links back to the Trust’s Mission Statement (See Appendix 2) for being “the hospital of choice for the people of Tameside and Glossop”. The Trust wants to use this to underpin the strategy and link it to its business performance.

To define human resources and human resourcing strategy

Human Resources

Human Resourcing Strategy

The efforts, skills or capabilities that people contribute to an employing organisation to enable it to continue in existence

The general direction followed by an organisation in how it secures, develops and, from time to time, dispenses with human resources to help it continue in the long term

Leopold et al (1999)

Since the recent change in government and the plans reform the NHS, HRM has become more prevalent to everyone working at the Hospital and what the unknown aims and objectives will be in the coming years. The much criticised Nick Clegg at the Liberal Democrats conference in Sheffield recently has been humiliated by his own party after passing a motion that our family GP’s will be in control of commissioning services. Paul Burstow the Health Minister was quoted saying “There will be no US-style privatisation of the health service on our watch.” Sunday Times 13.03.11. The truth is that nobody really knows what the future holds for the NHS and whether the future reforms will be successful. Mr Burstow also told delegates “stripping out layers of needless management and capping administrative costs (means) we’ll be able to make £5bn of savings over the next four years – all of which we will plough straight back into patient care”. www.bbc.co.uk. The strategic HR priorities of the NHS as a whole will be on how these cuts will affect staff and the services they deliver and also how with a significant number of job losses the business is expected to continue with delivering the adequate patient care required.

The Independent predicts that union leaders have also indicated that a loss of 50,000 jobs could be lost to due to efficiency savings. www.independent.co.uk. Inevitably this type of reform is going to lead to failures on the frontline with the loss of nursing staff delivering the patient care which is so widely criticised.

The focus in our organisation currently is efficiency and effectiveness as there is a significant hole in the purse which funds the whole organisation. We are currently nearly £2 million in deficit and this is predominantly the case for many public sector organisations where cuts are being made within the existing workforce to combat the financial deficit which hospitals, police and local councils are declaring at the current financial year end.

The role of Human Resources is also changing not only as a result of a coalition government but also as a result of globalisation and the expectations of stakeholders and how the rapid development of technology impacts on HRM. Within a change in environment, the HR professional has to evolve to become more strategic and a change mentor within the organisation.

People Management (January 2011) suggests that in many Asian companies the positioning of HR is best placed as a business function with a leadership role and operating at a very transactional level and they tend to think less about HR strategy but focus directly on growth. This indicates that the UK can learn from the way their HR leaders operate.

They have:

Faster implementation cycles – Asian leaders have a much more fluid interpretation of HR structures and that a rigid definition of business partner, specialist and HR services can create silos and slow response times.

Putting insight at the heart of the function – HR leaders are “savvy” and they use this to drive business growth strategy.

Pull the purpose lever – they create a sense of purpose by harnessing the press, the project and the organisation behind a big idea.

True Engagement – they use the three A’s – accountability, authenticity and adaptability.

It could soon mean that the UK is struggling to keep up with the way HR is responding to competition and change.

In order to succeed in the UK, HR must be a business driven function with a thorough understanding of the organisation’s bigger picture and be able to influence key decisions and policies. In general, the focus of today’s HR Manager has to be on strategic personnel retention and talents development. HR professionals will be coaches, mentors and succession planners to help motivate organisation’s members and their loyalty. The HR manager will also promote and fight for values, ethics and beliefs within their organisations, especially in the management of workplace diversity.

Leopold et al (1999) states that strategy makers are seeking to achieve a ‘fit’ between HR Strategy and the broader business strategy and ultimately this should contribute fully to the achievement of business objectives.

Whittington’s (1993) fourfold typology shown below is extremely useful and helps to understand the complexity and the multidimensional ways in which strategy might be conceived. It is based upon outcomes and how they are perceived purely between either profit-maximising or pluralistic and whether the strategy is either deliberate or emergent.

Processes Deliberate

Classical

Systemic

Outcomes

Profit-Maximising

Pluralistic

Evolutionary

Processual

Emergent

Whittington’s typology of strategy Marchington et al (2008)

Mabey et al (1999) suggests that the National Health Service has been exposed to decentralization and division into profit-responsible divisions.

The organisations workforce strategy is also expected to deliver the “employer of choice” and the domains for this method are as follows:

Employee Resourcing

The focus for Tameside is workforce planning and contingency staffing, managing change, modern recruitment and selection practices, new roles and job redesign and developing shared services.

Workforce/HR Planning

This is essential to any organisation in ensuring we get the right caliber of staff, with the right skills. As an integral part of the business planning process it involves recruitment, retention, development strategies and the provision of workforce information to managers.

Effective workforce planning ensures you will have a workforce of the right size, with the right skills, organised in the right way within the budget that you can afford, delivering services to provide the best possible care. www.healthcareworkforce.nhs.uk

There are four categories of staff that are important in human resources planning:

Exisiting staff

New recruits

Potential staff

Leavers

Marchington et al (2008) suggests when the world markets were much more stable and predictable, HR planning was prominent in HRM, personnel management and labour economics. HRM texts have discussed whether HR planning is still worthwhile. In some “new” organisations HR planning conveys images of bureaucracy, rigidity and a failure to comprehend the limitations of planning in an uncertain environment. Tameside’s Workforce Strategy focuses on tactical adjustments to address unknown forces in relation to high demand of services from our commissioners and also the public.

Tameside’s workforce planning is flexible in nature which allows the organisation to respond effectively to the peaks and troughs of activity. This is through the use of agency and temporary staff which relieves some of the pressure associated with peak times of the year like winter.

Skill mix is another focus for the organisation to ensure staff can work across all divisions which gives increased flexibility to the staff we have and which departments they can work.

Changes over the next 5 years are projected in our Workforce Strategy. The reductions in staff are significant and this will be managed through effective strategic planning and the deployment of HR interventions such as stringent vacancy controls, allowing for natural wastage, effective redeployment and a planned approach to contingency staffing.

Beardwell et al suggests that the Markov model is something which should be used by “manpower planners” in addressing internal factors that need to be considered in the development of a manpower plan.

Recruitment & Retention

Staff are the most valuable asset in an organisation. Their performance determines whether the organisation achieves its goals and expected results. As a manager you need to create and maintain an environment in which your staff are motivated to perform well.

The Trust is developing Recruitment & Retention strategies locally, nationally and internationally to help fill vacant positions and hard to fill posts across the Trust. We are seeking to recruit returners back into nursing, midwifery, professions allied to health and medicine. In addition we monitor the reasons for staff leaving and have developed an exit questionnaire to ascertain the main reasons why staff leave.

The NHS as a whole advertises through a centralised internet site http://www.jobs.nhs.uk/ this enables the organisation to attract a wide variety of candidates for any single advertisement. We also use techniques such as talent banking and generic recruitment campaigns.

The trust aims to ensure that the recruitment and selection of employees and volunteers is always carried out in a fair, timely and cost-effective manner.

Poor staff retention has many consequences including cost of staff turnover, loss of company knowledge, and decreased morale. These things can all be detrimental to your business. The retention of key employees is critical to the long-term health and success of any business. Organisations need to try to do what they can to retain their best employees to ensure customer satisfaction, product sales, satisfied co-workers and reporting staff, effective succession planning, and deeply embedded organisational knowledge and learning. www.health4work.nhs.uk

Tameside is considering undertaking the introduction of assessment centres, psychometric testing and competence-based selection methods for all vacancies within the organisation. This approach will underpin our commitment to delivering dignity in care by ensuring a workforce “hard wired” with the requisite behaviours and values. The induction process is also being reviewed and it will be mandatory for staff to be re-inducted every 2 years.

Essentially Tameside is aspiring to be as modern with its recruitment process as possible as well as cost efficient. The Trust marks itself to be able to attract and retain the best possible staff but Torrington et al (2005) suggests that this varies over time as labour markets become successively tighter and looser depending on economic conditions.

Because an organisation may have to bring about a cultural shift within the company in order to improve employee retention, you may be faced with some resistance to change from some members of staff. Resistance can take many forms ranging from the subtle undermining of change initiatives or withholding of information, to active resistance including strikes. Poor communication has been linked to issues surrounding the effectiveness of change management because imposed change can lead to greater employee resistance.

Reward and Recognition

Through communications, pay modernisation-benefits realisation and staff recognition schemes Tameside audits itself to ensure the workforce is fully engaged with the delivery of the corporate objectives. Benefits realisation of the recent new pay systems so we can continuously improve productivity.

There are schemes which recognise staff commitment which reinforces values and behaviours:

Chairman’s Prize for Service Improvement, Teamwork and Innovation

Above and Beyond Award

Caring for Those Who Care Award

Long Service Award

100% Attendance

These schemes motivate staff and contributes to wider organisation performance and links back to Tameside being the “Local Hospital of Choice”.

Succession Planning

Ideally an organisation would not want one talent to replace another but to develop a pool of talent. This is a more dynamic approach to succession planning and gives individuals the chance to put themselves forward to a talent pool. One of the key features of a structured management development system is a succession plan. Cole (2002:390)

Succession planning is typically defined as “a process by which one or more successors are identified for key posts (or groups of similar key posts), and career moves and/or development activities are planned for these successors”. In other words, succession planning is about preparing organisations for likely or inevitable changes now, in order to minimise challenges later. www.idea.gov.uk

Some large organisations develop schedules for their succession planning but Tameside does not have such an elaborate schedule. Succession planning is a very informal discussion between managers identifying potential candidates who would be suitable for roles which are about to become vacant from retirement, voluntary leaving, dismissal or sickness.

Strategically the NHS has a workforce review team (WRT) but at local levels like District General Hospitals it is more difficult to implement workforce planning effectively. With an organisation such as Tameside a more formalised approach to succession planning would be advisable to build a pool of staff rather than assessing staff within your own department.

For workforce planning to be successful it requires accurate data, modelling, continuous and iterative planning, specialist skills, scenario building and stakeholder involvement.

Talent Management

Develop leadership and staff empowerment, talent spotting and succession planning.

Performance Management and Monitoring with HR Metrics, Performance Monitoring and External Benchmarking.

Tameside recognises the importance of a positive approach to the management of unsatisfactory work performance to enable the Trust to deliver quality services. Unsatisfactory performance by individual employees for whatever reason is detrimental to the service and Trust as a whole. As well as reducing standards of patient care and service delivery, poor performance by individual members of staff has a demotivating effect on other employees.

The hospital operates a rigorous Capability Policy for managers to use when assessing individuals who require performance monitoring. It also ensures individuals are treated fairly, sensitive and in a consistent manner.

It is the responsibility of managers to ensure when recruiting that the right candidate is selected and they can perform the role they are applying for. Managers are given full support from their individual HR Managers to ensure the policy is adhered to.

There are 4 stages to the Capability Policy:

Stage 1 – Informal monitoring, coaching and counseling

Stage 2 – Formal meeting

Stage 3 – Formal meeting

Stage 4 – Formal hearing stage

This is a lengthy process and on occasion has been known to take 12 months to redeploy or dismiss an employee who is not performing their role.

Performance Management takes the form of a continuous self-renewing cycle, as illustrated in the figure below:

The performance Management Cycle Armstrong et al (2009)

There is a lot of ‘red tape’ to the current performance management technique. If a staff member is unable to perform the role to the required standard the process is so long that nobody really bothers to use it and usually waits for the individual to leave.

This workforce strategy was produced in 2007 and was scheduled to be periodically reviewed over the course of 5 years. Leopold et al (1999) suggests that the correct definition for Human Resource Strategy is ‘personnel strategy’.

Organisations which do not concentrate on attracting and retaining talents may find themselves in a very vulnerable position, as competitors may be outplaying them in the strategic employment of their human resources. With the increase in competition, locally or globally, organisations must adapt themselves to become more resilient, agile, and customer focused to succeed.

Human resource management challenges cost your organisation money, time, resources, lost opportunities, and reduced productivity, to name but a few. Organisations need to rethink their strategic HRM and think more about “strategic recruitment”. www.strategic-human-resource.com

Cole (2002) suggests that there should be strategic long-term goals when it comes to a HR strategy which includes:

Ensuring the HR needs for the next five years are met

Maintain wage and salary levels sufficient to recruit, retain and motivate staff at all levels in the organisation.

Give priority to the development of leadership skills

Ensure effective training and development opportunities

Effective communication systems between management and other employees

Provide mechanisms to cope with the human consequences of change

This is certainly reflected in Tameside’s Workforce Strategy.

How Human Resources Management (HRM) contributes to the achievement of organisational objectives.

HR Consultant Louise Allen suggests there are key steps in the quest to delivering a successful HR strategy that links to the organisation objectives of the business.

Aligning business and HR needs

The business goals sit at the heart of any HR strategy and in order to align business and HR needs “can your organisation’s internal capability deliver its business goals?”

A HR strategy which is aligned with the business strategy is about the growth of the organisation by increasing the performance of the employees and keeping budgets under control. The process of the alignment of the HR strategy with the business strategy is about going deeper and finding the real root of the successful human capital management in the organisation.

Developing your HR strategy

It needs to understand your business goals and the business model can identify any potential threats and opportunities in the quantity and quality of human resource required by your organisation.

It is critical the HR team as a whole has a high level of knowledge and expertise in aligning HR interventions and how this impacts on business performance.

Organisational performance

This is the process by which business goals and objectives are cascaded and managed across and down an organisation. It provides a rationale for all other HR activity and directly impacts the business success, enhancing HR’s reputation and contribution.

Organisation culture

Culture commonly described as the “way we do things round here” www.thetimes100.co.uk

Organisations tend to create their own culture and this gives the business a sense of identity. The organisation culture encapsulates what it is good at and what has worked for the business in the past. These values can often be acknowledged and accepted without question by long-serving members of the business. In re-aligning an organisation’s culture there can be real benefit and competitive advantage through improved service.

Changes to the Organisations Current HR Strategy

The fundamental change to our Workforce Strategy is that it needs updating. The current strategy differs somewhat to where we are currently. The change in government is not something that was envisaged and the impact of this change and how it would affect the Trust. I understand this would be difficult to envisage but all eventualities should be considered in a HR Strategy which has a 5 year plan.

“There isn’t a one-size-fits-all and your HR strategy may change as the business evolves”. www.humanresourcesiq.com

The organisation needs to create a robust performance management process that sets out performance objectives for all levels of staff within the business. This is an opportunity to develop line managers’ skills in being able to disseminate and set stretch targets for their business.

Another element is a personal development review process where individual strengths and weaknesses are identified for the purposes of assessing and meeting organisational development needs.

Evaluation of the impact of SHRM on the business

Even though HR professionals like Guest and Legge are convinced that their efforts add value to the organisation’s bottom-line, frequently there is little evidence to demonstrate such belief. www.allbusiness.com

Improvements could be made to our HR department but it seems to be a consistent trend throughout the organisation with regards to funding and resources which would enable you to deliver those objectives.

A prominent guru of HRM, David Ulrich discusses the role of HRM moving from a functional to a more operational role and involves partnership rather than being resource based. He describes HR as being a four sided partnership consisting of:

Strategic Partner

Change Agent

Employee champion

Administrative expert

This allows the challenge of change to be more transparent and enables a strategic involvement from the beginning involving all stakeholders from the macro and micro environment. The employee champions act as an advocate for the employees and protects them throughout the process of change. The administrative expert is a flexible role within Ulrich’s model ensure the maximum possible quality service is delivered at the lowest possible cost to the organisation. The Ulrich model relates very closely to how Tameisde will require support in the future developments and changes within the organisation.

Competitive Advantage

There is evidence to suggest that HR practices have a direct link to sustaining a competitive advantage in any organisation. Leopold et al suggests that in order to gain human resourcing advantage there should be a combination of efforts towards generating both human capital advantage (by recruiting and retaining outstanding people) and human process advantage (instigating difficult-to-imitate, socially complex, historically evolved processes such as learning, co-operation and innovation). There is also evidence to suggest that ‘mixing’ human resourcing activities inevitably presents HR planners with a major challenge. To help with this, the notion of horizontal integration, this relates to the degree to which different aspects of HR are compatible with each other.

Porter has argued that employers have three basic strategic options in order to gain competitive advantage:

Cost Leadership

Differentiation

Focus

www.business-fundas.com

Porters five forces model (Appendix 4) provides a simple perspective for assessing and analysing the competitive strength and position of an organisation. This model can be used alongside other models like SWOT and PESTEL with good analytical effect.

More recently Michael Porter has been working with Elizabeth Teisbery to revolutionise Healthcare reform in the United States. The Economist (Aug 2008) suggests that “Porter effectively redefined the way that businessmen think about competition”

Conclusion

After reviewing the HR strategy for Tameside Hospital it is clear that as an organisation we have yet to deal with any real human resource issue that leads to any disciplinary action. Our paperwork trail is not fluent and procedures are followed in a haphazard way. Due to a significant cut in resources even before the new round of government cuts it is difficult to follow out-of-date policies effectively.

There is a real need for training and education on Human Resource Management as Tameside is leaving itself wide open to legal disputes. Clear guidelines need to be in place to protect the workforce and also the employees and organisations interests.

The succession plans of the business are also ineffective. There are no established structured channels for promotion for staff within the business which are committed to their own self development.

With the future of the Primary Care Trust’s diminishing and the commissioning role transferring to the responsibility of the GP’s, Tameside will come under increasing pressure to have their policies and protocols up-to-date which are adhered to by staff at every level.