¶ … Renal & Transplant Unit (Renal Directorate) Mary's NHS Trust

I am the Personal Assistant to the Chief of Service, and also act as Administrator for the Renal Directorate, St. Mary's NHS Trust. The Directorate is a well established and busy Regional Renal Unit in North-West Thames. We offer haemodialysis, continuous ambulatory peritoneal dialysis, and Renal Transplantation / Simultaneous Renal Pancreas Transplantation to patients, in addition to a comprehensive inpatient and outpatient service. We currently have approximately 800 patients on our dialysis programme, 400 transplanted patients, and we see around 1200 patients in outpatient clinic each month. The Service has 5 Consultant Nephrologists, 2 Transplant Surgeons, 1 Service Manager and 1 Business Manager.

There is a Renal Ward, a laboratory to carry out assays, a Haemodialysis Unit, Acute Dialysis Team, a Peritoneal Dialysis Unit, a Renal Outpatients Department, and 3 Satellite dialysis units and outpatient cilnics.

Communication is the backbone of any organization and effective communication can mean the difference between efficiency and failure as a group. The manner in which communication occurs within an organization is one element that helps to define its corporate culture. The corporate culture is more than the actions of persons within an organization; it encompasses the prevailing logic, a set of social rules for maintaining order and coherence within the organization (Edwards, 1996). The following precis will examine the informational needs and communication structure within the Renal Directorate. It will examine the current situation and any measures that have been undertaken to correct communications deficiencies within the system.

Being the Personal Assistant to the Chief of Service of the Renal and Transplantation Medicine and Administrator for the Directorate, several deficiencies in communication became obvious soon after my appointment. St. Mary's NHS Trust stands as London's leading teaching hospital. Prior to my current position, I had the opportunity to work at several NHS Trusts and have several good examples for comparison. (Griffiths, D.M. 2000).

Communication is essential in any organization. However, nowhere else is it more essential than in the health care industry. Effective organizational communication not only affects an organization's ability to operate efficiently, it also has a significant effect on job performance and job satisfaction; and indeed, contributes to staff's well being. (Ajax, 2000).

Dialogue is an element, which is often removed from the managerial environment and usually only occurs when a crisis necessitates it (Barge and Little, 2002).

Through previous positions at other NHS Hospitals prior to my employment at St. Mary's, I know that the organizational culture of the system thrives on the effective assimilation and dissemination of information, both within the hospital and outside of the hospital to various organizations. A service delivery system that needs to be able to respond quickly and positively to customer preferences needs well-informed, motivated people (Boddy, 2002). Upon starting in the Directorate, it became painfully obvious that this Directorate suffered from poor communication skills, a lack of appropriate technology for proper job performance and communication, a disregard for its people, and a misuse of power by its management.

A found almost immediately that the Business Manager was unable to answer most of my questions during the first few months. The secretaries lacked adequate equipment necessary to perform their jobs and as expected, suffered from a high degree of job dissatisfaction. They were unable to maintain the necessary records such as leave of absence, meeting schedules, etc. There was no Internet access or inter-departmental e-mail system in place.

Meeting notifications and minutes were not distributed to the proper people. Communications were not passed on to the appropriate personnel in a timely manner. Key personnel on major projects, such as the Sister in charge of the opening of a new clinic, did not know essential information, e.g. when the new clinic would open. Personnel were not informed of meetings to which they were supposed to attend.

Corporate culture was such that Department heads would feel that they could say nothing about it for fear of repercussions. The communications environment was hostile, at best. Departments were territorial and hierarchical in nature. Most departmental heads ruled by authoritarian rule and exhibited a degree of protectiveness regarding information about their department. This environment created many errors due to a lack of communication. Staff felt threatened and expressed unhappiness in their positions. This severely affected their attitudes and job performance. Changes were needed fast.

As a new person in this protectionist environment, one must be careful in their approach to the situation. If a person feels threatened their first reaction may be to remove the threat. Walters...

Strategy masters see the big picture, but do not know how to execute the necessary steps to get there. Detail meisters do not see the big picture, but are excellent in taking care of the details involved in their own particular portion of the whole.
It became obvious that this Directorate had many strategy masters, but few detail meisters.

The detail meisters did not have the proper equipment to do what they do best.

In order to remedy this situation, my first task was to convince management (my boss, service manager, business manager) of the necessity of having proper equipment and effective communication strategies, without making them feel threatened. Many of the first tasks were logistical and were the first to be remedied. Internet access and e-mail were installed. Secretaries were provided with comfortable workstations and equipment.

When the new equipment was installed, this provided an excellent opportunity to train secretarial staff on proper record keeping techniques without making them feel inadequate. These measures made immediate and positive improvements in the daily operations in the Directorate.

The next group of tasks was more delicate, as it involved getting people to change old habits. Some of these habits, no matter how inappropriate they may be, are still comfortable and an intrusion might make the person feel insecure. This is especially the case when dealing with superiors in the Directorate. As far as the secretaries went, I decided to lead by example, passing on information as soon as possible and asking for information in return. As expected, when they saw how things should be, they soon followed suit.

A spoke to the Service Manager regarding her previous practice of writing meeting schedules in my diary and not informing me of them; she co-operated and now rings me and informs me of them. I also stressed the importance of meeting notifications and the proper distribution of meeting minutes; this situation was remedied as well.

Despite my successes with the above measures, however, there is still a considerable amount of hostility arising from upper management. Communications with my direct manager (Service Manager) have improved significantly and there is a good working relationship. However, there are still some, who seem to see me as a threat. Heads of other departments, who once acted hostile towards me in the past, now ring me up to clarify situations. Some heads are still withholding information and acting in a protectionist fashion. Perhaps in time, they will see the effective manner in which my Manager and others have learned to communicate and will in turn decide to follow suit.

CONCLUSION

The changes implemented to improve communication and procedures with the secretaries have been successful and have resulted in a more productive atmosphere, with a greater amount of job satisfaction. Communication deficiencies with my direct manager have been resolved and continue to improve. Communications between different departments have shown some improvement; however, there is still some degree of perceived hostility between other managers and myself. Overall, the improvements have been successful and it is expected that in time, the few remaining problems will resolve themselves as well.

The restructuring of the Directorate has been a large success and will continue to result in a pleasant and productive atmosphere.

RECOMMENDATIONS

1) Staff to be treated as the essential commodity.

2) Interaction with junior members of staff makes them feel valued which in turn would make them happy. People work better in a happier environment.

3) Remaining old computers to be replaced. Often documents are sent and cannot be opened because the old computers do not have the facility.

4) A telephone extension to be installed for the Research Fellows. Two telephones in an open plan office of 7 employees is inappropriate.

5) Somebody to be delegated to look after the interests of administrative staff, especially regarding training etc.

6) Since all the departments within the unit are working towards one goal, functions to be managed collectively to avoid individualism and unnecessary territorial protection.

IMPLEMENTATION OF RECOMMENDATIONS

The above set of recommendations will be implemented in a phased schedule. The first recommendation involves treating the staff as an essential commodity instead of an expendable item. This attitude has primarily been the fault of management and their authoritarian management styles. Under this type of management style little regard is afforded the employee and their needs. This creates a hostile environment and lead to disgruntled employees, stress, and a high turnover rate. Management must take extra measures to ensure that employees…