PHSO – can a dysfunctional organisation reform itself?

Jeremy Hunt, the Health Minister used the Sunday Times to share his rebuke of Dame Julie Mellor, Parliamentary and Health Service Ombudsman for insensitive treatment of bereaved families when dealing with their NHS complaints.

Hunt added: “When sometimes things go wrong, we need a humane complaints system which provides redress and does not feel like a faceless bureaucracy.”

The Sunday Times

It is unusual for a Minister to publicly criticise the Ombudsman, an organisation set up to be independent and effectively self-governing.  Mr. Hunt however felt so strongly that he has referred the matter to PACAC, the Public Administration and Constitutional Affairs Committee who monitor the work of the Ombudsman service.

 He has demanded that Mellor make an unreserved apology to Titcombe and other bereaved families and has referred the ombudsman to the Commons public administration and constitutional affairs committee.

There is a good deal of finger wagging going on here, but as neither PACAC nor Mr. Hunt have the power to take any direct action it will be down to the Ombudsman and her team to put the matter right.  The blind leading the short-sighted.

A dysfunctional organisation is incapable of reform

due to its own dysfunction.  

 The first step to reform is insight into your own strengths and weaknesses.  This is sadly lacking at PHSO where recent negative feedback, collected in preparation for a new service charter, has been dismissed as delusional myth in their new #mythbusting project.  Apparently you can make all the bad comments go away by using a toothy cartoon monster to cut them down to size.  

 http://www.ombudsman.org.uk/about-us/mythbusters/2

Daniel Newman, business professor and best selling author, warns of the dangers of a dysfunctional management team who can literally suck the life out of any organisation.8-signs-dysfunctional-management   Among the signs to look out for he includes;

• Narcissistic: When management (individual or as a whole) is obsessed with their individual success, it is a huge red flag. To lead, management must serve those on the front line. Upon driving performance, management will get their due recognition. However, when the sole purpose is to feed the ego and support the growth of management you can count on rampant dysfunction and less then desirable results.

If a sign of dysfunction is the growth of management to the detriment of front line delivery then this complex PHSO management chart screams a red flag warning.   PHSO/Org-Chart-July-2015

When you start making up titles like, ‘Director of Strategy and Insight’ and ‘Director of Quality and Service Integrity’ you are verging on farce.

Complex management structures diffuse decision making and accountability, resulting in no-one having the least idea who is responsible for what.

 

 

• Non-Committal: Strategy of the week, the day or the hour? It is a terrible feeling for an employee to feel like their direction is changing faster than the weather in Chicago. While change can be adapted more rapidly in a stronger culture, in a weak or dysfunctional culture the fragile nature of the employees can be broken by even positive change.

Both the Director of Strategy and Insight and the Director of Quality and Service Integrity were present at a recent PHSO meeting (April 2015) where staff concerns were discussed.

• Staff Engagement
  • There have been listening sessions with the staff to do three things: say thank to staff, discuss our role and listen to what the workforce has to say
  • A significant number of staff are dissatisfied about the way that change has been imposed at pace
  • Some staff think we have lost sight of our role and core purpose
  • The workforce wants us to explain how the new method and approach are supposed to work
  • Staff want us to respond more robustly to the external criticism and ‘fight our corner’.

It is perplexing to find that the staff at phso do not understand how the new method and approach work given that they have been part of this change programme since 2013.  Sharing a common understanding should be the starting point, not the end point.  Not to worry though as the Director of Quality and Service Integrity is able to clarify the situation.

• The Director of Quality & Service Integrity presented his paper to the Board and advised that the underlying rationale for the Integrated Change Programme is that staff often feel that change is ad hoc and unplanned (even when there has been sound planning), so there is a need for something that is explicitly and demonstrably cohesive and integrated.

So that’s all good then.   Until the Chair sums up with the statement that;

• Quality – we need to be sure what we’re trying to do before we can assess whether we’ve achieved it.

Which brings us back to the start, no wonder the staff are confused.  Damning Staff Survey 2015

• Turn-Over: Are you seeing a revolving door of people coming and going? This is a really bad sign and something that needs to be quickly rectified. If employees are leaving, whether by choice or not, then you can be fairly certain that management is dysfunctional. Hiring is never an exact science and the elimination of low performers is important. However, companies with high turn-over are often seeing this due to weak culture and poor leadership. The rapid change of people is a Band-Aid by management to cover up for a much bigger problem which they can find in the mirror.

Staff turnover for public service organisations is generally less than 12% per annum.  In 2013/14 the staff turnover for PHSO was 21.3%.  Despite a pledge to address this issue from the Ombudsman herself, it remained at 21.7% for 2014/15.  staff_turnover_at_phso

• Passive-Aggressive: Whether it is showing up late to meetings, forgetting to share important details, or consistent excuses for not getting things done. These behaviors are damaging in all cases. For instance, the late arrival to a meeting once can be an accident. Regularly showing up late is a sign of indifference and can likely be a sign that the person doesn’t care about or for what the meeting is about. In strong cultures this behavior is nipped in the bud, but in a dysfunctional environment this can be seen throughout the workplace.

Failure to meet deadlines is a common occurrence at PHSO.  At the end of the financial year, they release their annual report and accounts.  Each year the wait for the data grows increasingly longer.  According to the April minutes the first draft was ready in early May.  It is now September and the final draft has yet to emerge from the intricate layers of management and bureaucracy.

Mr. Hunt was right to point out that PHSO was failing to deliver a humane complaints system.  It is also failing to investigate complaints in any robust manner, failing to improve service delivery and regularly failing to deliver to an agreed time scale.

If  PHSO were a failing school the government would not hesitate to remove the entire management team within a week.  

Words are good Mr. Hunt, action is better.