TOWARDS INCLUSIVE MANAGEMENT

Responsive services are dependant on motivated staff . The thinking and values of staff are as crucial to transforming public service as are those of policy makers. Staff can engage with or sabotage transformation depending on their appraisal of the motives and reasons for change. Similarly work cultures and managerial frameworks can inhibit or encourage emergent and flexible practices . Those cultures which tip practitioners, users, policy makers and managers towards more open and across boundary relationships need reinforcing if innovations and one-off projects are to be sustained in the longer term. Equally management structures and measures need to generate synergy and partnership between staff, users and policy makers; this is not merely a matter of a system’s change but involves a ‘people and process’ approach on the part of policy-makers and managers. Although politicians may not have direct responsibility for management they must surely be aware of the impact that financial and performance management systems have on staff and on their capacity to collaborate. Management is a political issues and will continue to be system’s driven unless policy makers anchor management frameworks and performance measures in local detail and judgements. Corporate directives detached from local needs are unlikely to lead to an integration of service infrastructure or provision. The Third Way in Management is not merely ‘a socialised market model’ - it needs to loosen its connection with over-definition and be viewed as a direction based on shared values and as a processual approach to change. Social change is as much as about process as it is about models.

This article refers to NHS and local government management, but much is transferable to other public agencies.

 

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The current challenge is how to transform management systems in such a manner as they are driven by locality needs and involved staff. Clearly, complex public services have to be organised, it is a question of how management and its associated techniques can be driven by a social value framework. Whilst New Public Management-[NPM] rooted in objectives, may have been a good starting point - it is merely an empty system that needs grounding in the needs of service users, within local service contexts and which reflects practitioners' skills and experience. Public sector management could be harnessed to social objectives but policy makers lurch between handing power to managers or to professionals (doctors). In fact key players in the delivery of care and as definers of quality, outcome-measures are users and support staff. Excellence in any agency is based on the work and responsiveness of front-line employees.

Many public sector staff in health and social care are already involved in new roles, new practices and developing emergent partnerships often unnoticed on the margins of organisations and of their professions. Often these innovators are women, part-time and struggling to be heard - their activities frequently unrecorded by performance or activity measures. Counting the contact hours of chiropodists tells you little of their work , their contacts or their value in transferring knowledge and providing integrated care. ‘Cutting toes’ because it is quick can be seen by managers as great value for money,whereas because counselling and community development work are slow, they remain difficult to justify to trust boards and to local politicians. Yet, the Social Exclusion agenda will fail dismally if local agencies do not invest in community development and out-reach work. Because local/politicians continue to view ‘development’ as slow and difficult to predict in work targets - those projects actually tackling disadvantage are themselves disadvantaged. The traditional work-plans based on mechanical ‘cause and effect’ systems, rather than reinforcing transparency, reinforce a lack of responsibility for change and social outcomes. Working to tight log-frames and systems distorts activities away from development and social relationships towards functional activities. Most recognise this and yet persist in clinging to procedures and systems long past their sell-by -date; and the conundrum of balancing finance, systems, staff and health priorities is unlikely to be solved merely by the introduction of new IT systems.

The rational system’s approach to change of top-down restructurings usually fail because they alienate staff and involve a knowledge loss in the organization. Where staff perceive change to be driven by social need they are much more likely to co-operate with the changes, (and although the 1990s divisisions between medics and managers have been overcome in many places), staff remain mistrustful of management .Those change programmes which are based on negotiated, social objectives are far more likely to facilitate partnership between staff and managers. This is because most employees want to see a corporate commitment to a social change process, not ad-hoc and business driven reconfigurations and restructurings.

The national public sector management framework has been driven by financial and performance measures and not national policy documents, this continues to distort activities away from partnership, trust and confidence in change. A strategic framework is required which is inclusive but sensitive to innovation and emergent practices- such a framework needs to reverse the tight and loose grips of finance and policy and reverse them. Performance must be driven by social impact and outcomes not tradition and easy accounting for fragmented departments. A `people and process' approach is required which recognises the need for an acknowledged `social settlement' [Mackintosh 1997] between structure, value and agency. This focus has been adopted by those working collaboratively in innovative projects [Leicester Royal Infirmary NHS Trust /Lifespan Community NHS Trust] -but most staff do not have the allies or the trusting relationships to develop confident partnerships

Policy makers need to create environments where managers, users and practitioners feel confident enough to take risks and move beyond their own training and old habits. A revolution is needed within policy making and the professional bodies. This revolution requires the confidence of all staff , but most specifically it is managers who need to have more confidence in staff than in `systems'- It also requires a national strategic management framework to support the transition process towards a greater openness in relationships. A framework which closes down options at all levels is hardly likely to result in risk-taking or new forms of emergent practice. Democratic relations between public service staff and users is dependant on internal democracy and healthily work places. There is a need for sustaining work environments as well as for sparky individuals, and we must not exaggerate the ability of individuals to overcome powerful resistance and economic constraints. There is a big difference between the innovators who will struggle regardless of the climate and the majority of staff who want to be valued, reinforced in their changed roles and see a similar change in their managers as well as their colleagues.

Moving towards a collaborative culture and the mainstreaming of innovation and partnerships is clearly hard and very difficult given existing cultures and conditions. Most chief officers in local government and in health are looking to reward innovation but are unclear how to do this. Setting up pilots is easy- but mainstreaming requires and a strategic management framework. One single agency collaborative in a hostile climate will not survive any more than will one chief executive manage buck national performance measures.

IN TRANSITION

Many practitioners in health and social care have transcended the hostile climate of contracting and have developed integrated care and partnerships. Transforming managerialism has become a daily art in many health agencies, and the `quasi-market' was so defined because of persistent redefinitions and activities of of staff, practitioners and managers. In work places where staff are confident and united, they are much more likely to work across boundaries and develop more sensitive measures and integrated practices. This process is on-going and the mechanisms of commissioning, purchasing and contracting have been actively transformed since the 1980s. However, although crude contracting and activity measures are accepted as inadequate, there still remains a need for much more discussion on internal management practices and on the impact of management/economic systems on staff. and on their capacity to move beyond role towards flexible relationships.

Unfortunately, responsive social relationships have been confused with constant references to ‘flexibility’ as only referring only to the terms and conditions of work. Too often, flexibility is seen as a ‘catch-all’ when the need for flexible relationships at work is less likely to emerge in work contexts where flexibility has come to mean managers ‘picking and choosing’ staff and hours at will. Responsive services are dependent not only on flexible work practice and social relationships but also on motivated staff. Low morale and motivation are inversely related, and the latter requires dramatic changes in how managers, manage staff as well a resources; it requires a form of inclusive management. Inclusive, of local conditions, users but also of staff.

BUREAUCRACY MANAGERIALISM INCLUSIVE MANAGEMENT

working practices

rigid roles individual /agency competition open to stakeholder voices

inert cultures managed by task/finance targets local determined performance

line management macho cultures from shared learning

performance measurement

planned objectives central performance measures negotiated outcome measures

social milestones and

valuing sustain relationships

lacked user focus policy of user focus but user focus in connection

in reality system’ driven with practitioners

disregard for community

policy defined by national ad hoc management models regional and local debate

or elected members through centralised negotiated priorities to

performance measures partnerships manager/political divide

staff side/management/users

Services resources driven i.e. care-management inclusive not exclusive

Inclusive management depends on open communication between all parties, because shared experience is invaluable in reaching more informed judgements and in establishing ‘trust’. If managers are detached from service and users’ needs they are likely to be unaware of the impact that assessment and management systems have on staff and on ‘care’. Unfortunately, too many senior managers are detached from service deatil and from the impact that their own systems have on staff. One regional NHS director said she could only think of only one purchasing chief officer, in the region, who understood the need for management to be solidly grounded in service and user detail or need and on service development. This bodes ill for the future of service health strategy in that region.

* AN ENGAGING APPROACH to staff and communities

*VALUING STAFF and the development of partnerships between managers and staff -

* A FACILITATING AND NON-BLAME WORK CULTURE flexible management regime which facilitate communication, openness and the integration of staff development and organisation development,

* THE MEASUREMENT OF WHAT MATTERS

The biggest problem presenting itself to policy-makers after that of financial resources - it how to ensure national standards and equity and local diversity and flexibility. There has to be a balance between standards and flexibility, between protocol and judgements, and between the interests of staff and users. Grievances are bound to result in a climate of litigation if the community and its active representatives are excluded from decision-making. City dwellers do not expect helicopters and lifeboats - because they can see that they have little need of these facilities - whereas they are a lifeline in the Western Isles and in Cornwall. It is through a confidence in local discussion and decision-making, inside organisations and inside localities, that that a dialogue will result in adjustments which remove the stark contrast between ‘national standards’ and local diversity. Establishing baseline services cannot be used as a way of developing local specificity. Public sector staff in Britain are motivated by public service values and are therefore far more likely to collaborate with managers and policy makers if they are confident that these values are shared.. The problem within Britain is how to encourage a shifting from the thinking solely about policy to a perspective which develop a process of change which engages with all stakeholders, including staff who are mistrustful having borne the brunt of restructuring Without a local meeting of minds across the manager/employee/community divides, emergent practices will remain marginal. Proactive work is required which values and reinforces those relationships which stretch across the traditional trenches created by agency, status and profession. This requires a national and strategic approach to change and managing services with appropriate and flexible forms of performance management.

REFERENCES

Mackintosh,Maureen [1997] Social Exclusion. A paper to public sector management conference in  Manchester:IDPM

Maddock, Su. and Morgan,Glenn [1998] Beyond the Market and Bureauracy: conditions for collaboration  The International J of Public Sector Management