Avoiding management structures that hinder quality improvement

Published October 14, 2022

By Shorai Dzirambe Queen’s Nurse

Steps2Quality Director

In organisational settings, the way management structures are designed and implemented either acts as a barrier against or a passage to Quality Improvement (QI).  To manage their services effectively and for noticeable achievements to be made, providers should not only look at the service performance, but also at team dynamics, management behaviour and structures.

Willingness to change

There should be a willingness, within the organisation, to acknowledge and address issues even when the concerns relate to members of the senior management.  The reality is that although most managers are good managers, a small minority are toxic. This minority divert the workforce’s energy from the work that they need to do. As a result, interfering with team relationships, distorting the organisation’s ethos and becoming an impediment to improvements. If not addressed immediately, this behaviour does not only affect the immediate team, but far beyond the point of impact.

Senior Management Teams (SMT), including HR play a significant role in people management. Taking steps to address toxic leadership and destructive behaviours, regardless of the person’s role, will not only spare the organisations reputation, but also ensures that people have positive experience of care. The SMT should invest in staff development and in learning to identify toxic personality traits.

Structure implementation

When implementing management structures, there is a great need to consider, not only where each role sits within the management structure, but also which role is better placed to have direct line management.  Consideration should be given to issues such as possible conflict of interest, avoiding looking at personalities but the actual role. As an example, special attention should be paid to who manages the quality manager and safeguarding roles. Having the quality team managed by a role that has direct line management to the service is likely to hinder improvements because they will be reporting to a person whose role may be directly or indirectly affected by audit findings, i.e., shortfalls and risk to service. Such a management structure may result in constrained relations, bullying and even gaslighting.  For example, the line manager may relate the findings to their own performance.  Consequently, not all areas of risk and improvements are effectively communicated with other relevant professionals and board members.

Being intentional and relatable

Managers should be able to relate and connect with staff teams. While giving Quality Streets to staff is a very nice gesture, this does not make the management team relatable. The question that the management team should think about is “how do we genuinely connect with the staff.” An example would be, when visiting a service, avoiding wearing suits and heels may pay off, this avoids a power imbalance between staff and management. If the staff team wear jeans and trainers, you might consider wearing jeans when visiting them. Having a genuine general conversation with staff and clients over a cup of tea also helps as it assists in connecting with them on the same level and getting to know their interests.

What else?

Staff autonomy is necessary in order to create motivation and space for QI. Making managers responsible for departments that they do not have control over may be a recipe for disaster. Questions to be asked should include how much control and autonomy does the manager have over the department? If the answer is minimal control, the SMT should consider identifying the role that is better suited to manage that specific department. As an example, a registered manager is responsible and accountable for the management of a registered service. It is, therefore, important that they have budget ownership and are given the autonomy to make decisions e.g., purchasing of equipment, staff structure etc.

It is paramount that each role is clearly defined, and management structures promote transparency in the progress against QI. This also includes board members, who should play the role of enablers and be prepared to concede control and power, understand their purpose and how they fit in with operational roles.

REFERENCES:

1. https://www.nice.org.uk/guidance/qs147/chapter/quality-statement-2-role-of-line-managers
2. GOV.UK (2019), Adult Social Care: Quality Matters. [online] Available at: <https://www.gov.uk/government/collections/adult-social-care-quality-matters> [Accessed 5 February 2022].
3. https://www.theguardian.com/social-care-network/2013/jun/03/customer-service-in-social-care