The duties and roles that healthcare professionals fulfil on a day-to-day basis can be grouped under six key categories, namely:
- care interventions (i.e. direct patient care activities);
- the organisation and management of care;
- training and educating colleagues and students;
- teaching and promoting health and wellbeing;
- using research and evidence-based practice;
These are illustrated in Figure 1.1
. The six categories also apply to social care professionals, although the focus of ‘care interventions’ is more related to assessment of service user needs and commissioning appropriate care to meet their needs rather than direct care delivery as applied to healthcare. This book focuses on the leadership and management components of care professionals’ roles with the aim of providing the Duty Care Manager (DCM) with knowledge and evidence to inform and support the delivery of well-organised, high quality care and treatment for patients and service users.
This first chapter of this book starts by examining the work activities of the DCM, moving on from the six categories identified above, which DCMs have to engage in with full consideration of the prevailing context and ethos of the dynamics of contemporary health and social care provision and delivery. It thereby contextualises the DCM’s role by outlining government strategy and policy as detailed in the Health and Social Care Act 2012 (Legislation.gov.uk, 2012), and then in the Five Year Forward View (5YFV) (NHS England [NHSE], 2014a) strategy document as well as associated subsequent publications.
Figure 1.1 Roles of Duty Care Managers
The principal aim of the Health and Social Care Act 2012 was to establish the medium for delivering continuously improving healthcare, whilst building upon reforms that had already been made over preceding years. This chapter therefore explores the prevailing strategies, policies and social ethos in which health and social care are delivered, providing the context within which healthcare professionals and DCMs carry out their daily duties. Reference is also made to the roles of social care professionals in recognition of the important but problematic interface between health and social care in the United Kingdom.
The chapter begins by highlighting the significance of leadership and management in today’s care provision, and then examines the roles, responsibilities and duties of DCMs as well as the collaborative work that is fundamental to being part of a multi-disciplinary team (MDT) made up of both health and social care professionals. This leads to determining the contemporary social and economic context of care, healthcare legislation, strategies and policies, including the aims of the National Health Service (NHS) and the current structure of the NHS, together with the functions that each component has to fulfil to achieve these aims.
Consideration is given in this chapter to current issues and challenges, along with the respective directions in policy, principally those identified in 5YFV documents (e.g. NHSE, 2014a) whose triple aim is to encompass better health, transformed quality of care delivery and sustainable finances (this includes efficiency savings). The chapter then explores workforce issues in respect of health and social care delivery, the codes of practice that healthcare professionals must abide by and the regulation of care professions. All components are discussed with reference to the DCM’s role within them. The chapter objectives are therefore as follows.
On completion of this chapter you will be able to:
- identify the activities, roles and responsibilities of DCMs in relation to their leadership and managerial duties in practice settings;
- enunciate the prevailing social, demographic, economic and political contexts in which care is provided, as well as consideration of future impact;
- review the current legislation, strategies and policies that underpin care delivery and their relevance to DCMs in their leadership and management roles;
- analyse workforce issues for health and social care delivery; and
- explore the role of professional regulation of care professions and codes of practice that care professionals must abide by, for competent, safe and effective care delivery.
Leadership and Management in Contemporary Care Provision
Outcomes of effectiveness, safety and patient satisfaction with health and social care services are generally good. There are, however, numerous high profile examples of systemic failures in both health and social care services that have had adverse impacts on patient and service user outcomes. An early example is that of children’s cardiac surgery at the Bristol Royal Infirmary, with more recent examples including the case of Baby Peter’s care in Haringey, the Mid Staffordshire Hospital scandal, the abuse of people with a learning disability at Winterbourne View, failures of clinical care in the maternity unit at Furness General Hospital and the deaths of people with a learning disability or mental health problem at Southern Health NHS Foundation Trust.
When such failures occur, effective management and leadership entails learning from such incidents so that appropriate safety measures are instituted to prevent recurrence, both locally and nationally. This section explores the fundamentals of leadership and management, focusing on the role of individual health and social care professionals and DCMs. Examples of good and poor leadership are discussed together with opportunities for DCMs to reflect on this and consider how they can apply good practice within their day-to-day practice.
From another viewpoint, as published in care profession regulator fitness for practice reports, the Nursing and Midwifery Council (NMC) and Health and Care Professions Council (HCPC), for example, summarise instances of registered care professionals being found guilty of neglect or other aspects of professional malpractice. The Care Quality Commission (CQC), whose role is that of a ‘watchdog’ which monitors quality of care and treatment in all health and social care settings, also publishes details of instances where they identify poor practice that has put patients or service users at risk. Responsibility and accountability for care delivery is of prime importance, and the DCM must have a clear understanding of their role within this in terms of their own practice and that of their subordinates.
Where and how leadership has made a difference
Every care professional is accountable for their own standards of professional practice, as implementer and disseminator of the highest standards of care. From a more positive stance, health and social care journals, professional trade union organisations, as well as the CQC and other professional organisations, frequently publish information publicising and promoting innovation and examples of best practice in health and social care delivery. Thus nursing and health and social care profession journals comprise a rich source of examples of good practice and projects where vision and focus by individuals and teams in health and social care have had positive results in terms of care outcomes.
Areas of good practice are also highlighted by Royal Colleges, DH publications, bulletins from national Chief Officers, NHSE, and the National Institute for Health and Care Excellence (NICE). National clinical guidelines and protocols published by NICE, and similar organisations such as the Scottish Intercollegiate Guidelines Network (SIGN) also support the delivery of high standards of care.
The reduction in infections such as Methicillin-Resistant Staphylococcus Aureus (MRSA), bacteraemias and Clostridium difficile (C. diff) rates provide a positive and relatively recent example of how leadership in healthcare can make a difference. The approaches used include identifying a figurehead to lead and champion the approach, the application of collaborative leadership and developing and promoting a shared vision of how this will have a positive impact on patients, e.g. through surveillance, identifying outcomes, development and agreement of ambitions, benchmarking, incentives and penalties, publishing, and celebrating and sharing best practice.
Action point 1.1 Learning from failure
Select a recent high profile care or treatment failure (e.g. the case of Mid Staffordshire or one of the other examples referred to above) on which to focus. Search for the investigation report on the internet, and read the executive summary and recommendations. Consider the issues and findings in respect of leadership and management and how this relates to the DCM role. You may find it helpful to discuss this with a peer, mentor or manager.
Consider what you can learn from this and how you can apply the learning to your practice as a DCM to safeguard quality and patient safety, and ensure that you are working within the code of practice for your profession.
Learning from failure is imperative for health and social care managers, and the recommendations of the example mentioned in action Point 1.1
also include that ward managers should act as role models for all aspects of care of all patients they are responsible for (Francis, 2013). In An Organisation with Memory
, the DH (2000a) indicated that failure is almost always unintentional, and there is usually no single explanation for the type of major failures noted above, and that organisations should put in place measures to overcome such failures when they do occur, and also to learn from them so that they do not recur.
NHS England (2015a: 23) reminds us that learning from mistakes is an imperative, and it aims to improve ‘the number of staff who feel their organisation acts on concerns raised by clinical staff or patients’. Furthermore, in the guidance on duty of candour, jointly the NMC and GMC (2016: 1) indicate that registrants ‘need to be open and honest within organisations in reporting adverse incidents or near misses that may have led to harm’.
Furthermore, deducing from research conducted on the factors that lead to service failures, the researcher Andrews-Evans (2012) identifies a ‘senior nurses’ framework’ that he asserts should prevent such failures. The framework incorporates the ‘right skill-mix’ and an appropriate culture and ethos amongst the factors for success in preventing failure. Chapter 5
provides greater detail regarding quality assurance frameworks and ensuring high quality care in health and social care services.
Leadership at all levels
Leadership can and should be demonstrated by staff at all levels in health and social care and should not be considered exclusively the domain of those in supervisory and management roles. Focusing on the needs and preferences of patients and taking personal responsibility for meeting those needs is central to good leadership and the achievement of high quality care and patient outcomes.
Effective and positive leadership is often obvious through the leader’s personal traits or characteristics, their leadership styles or leadership behaviours. The NHS Leadership Academy (2014) identifies an NHS leadership model
which in addition to recognising personal characteristics of effective leaders concludes with nine leadership behaviours that include such behaviours as inspiring shared purpose, leading with care, sharing the vision, engaging the team, etc. (discussed in Chapter 3
So what are the qualities of a good leader? Qualities of good leaders in health and social care transcend grades, bandings and status in the hierarchy of management, and include:
- Being visionary: forward thinking and having foresight in considering how things could work differently and be improved in the future.
- Leading by example: a role model who does the right things.
- A patient/service user focus: involving patients wherever possible and listening to and respecting their wishes.
- Taking personal responsibility: a proactive and anticipatory approach to problems and challenges.
- Challenging poor standards: escalating issues where appropriate and taking steps to improve standards of care; adhering to their pr...