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How line managers lift commitment in hospital staff

July 19, 2017

  HR policy should translate into practical care of co-workers

Earlier this year, BusinessThink looked at how poor people management in Australian hospitals was leading to disengaged staff and impeding improvements in standards of care.

The reason given by the researchers was that HR management was too controlling and that highly skilled hospital workers were being stymied by too many procedures, lacking the freedom to act on their own initiative.

In a different but related piece of research, this time conducted in Dutch hospitals, a team including Karin Sanders – a professor and head of the school of management at UNSW Business School – examined the HR role and responsibilities of line managers in hospitals.

In particular, the focus was on how doctors, nurses and others with supervisory roles translate HR policy into practical care of their fellow employees.

Sanders, who hails from The Netherlands, found that employees respond positively when they know their manager is not only clued up about their workplace, but genuinely has their staff’s best interests at heart.

“Employees who are enthusiastic about work and willing to invest extra time and effort have a sense of the ‘big picture’, in that values set out by the organisation permeate all aspects of their working lives, and their own aspirations matter,” says Sanders.

“If line managers can demonstrate that they are committed to the employees and are taking care of their interests, as well as having strategic oversight and knowing what’s going on in the business, then these two factors combined will have best effect in terms of commitment from staff,” she says.

Making all the difference

Hospitals are by their very nature workplaces where people can experience a lot of stress and anxiety, notes Sanders. Perhaps, more than other arenas of work, employees have a need to talk through issues and experiences with colleagues and supervisors.

Another source of tension has been an increased bureaucratic component of hospital work, which takes nurses and doctors away from patient care – the very reason they signed up for the job in the first place.

'When line management works well, our research indicated that employees stay in the job longer and feel more committed to the hospital and less stressed'


It is against this background, says Sanders, that the HR role of line managers becomes quite influential in determining whether an employee remains happy in their job and place of work.

“When line management works well, our research indicated that employees stay in the job longer and feel more committed to the hospital and less stressed.

“This is particularly the case among white-collar workers where employee engagement plays a significant role, as they want to stay in work rather than feeling that they have to,” says Sanders.

While any organisation worth its salt will have an HR workforce strategy and systems in place, it’s how these are delivered to front-line staff that makes all the difference in job perception, motivation and wellbeing.

Given that employees have limited access to senior management, it’s clear that much rests on the abilities of these ‘middle men and women’ to do that HR job, and do it well.

Of course, in an ideal scenario the line manager isn’t overworked, is trained in people management, actually enjoys the HR function of the job, and gets on well with the employees they are required to manage. But what if none of those things are true?

Adequate training

In recent years, the shifting of responsibility for many core activities away from HR has presented new burdens and new opportunities for line managers. These can range from determining pay levels, to maintaining records, to organising training, to managing disputes.

While there are clear advantages in having more say in the hiring process, for example, and being able to choose the people you will be working with directly, the overall effect has been to intensify the line manager’s workload. Not only that, but training for these new responsibilities has often been lacking.

A research report on nurse unit managers (NUMs) in Victoria, whose HR responsibilities were the focus of a study by La Trobe and Deakin universities in 2012, describes these problems well.

“NUMs take a lead role in recruitment, selection, performance management and appraisal, and training and development. NUMs face challenges daily by the rising issues of work family balance, workplace stress, bullying and harassment and issues of workload and intensification of work,” says the report, Human resource management activities on the frontline: A nursing perspective.

NUMs are often responsible for the supervision and management of more than 100 front-line staff in departments such as intensive care and emergency, as well as non-nursing staff. Despite being in a management role, the NUM is not required to undertake human resource management (HRM) education.

Not surprisingly, NUMs reported that they were not adequately trained in the skills required to effectively manage staff conflict, for example, and there was an inadequate implementation and understanding of HRM policy and practice.

The consequences included reduced staff morale, decreased staff satisfaction, increased stress to the NUM and ultimately retention issues for both the NUM and unit staff.

In Australia, the labour force is the largest component of healthcare costs which makes HRM critical to the provision of high-quality, cost-effective healthcare.

A multiplicity of research has highlighted that continual professional development of managers and clinicians can be related to improved individual performance, perceived employee empowerment and attraction and retention of employees.

“We can train line managers to take control of [employee wellbeing]. If you spend time on ensuring that line managers are doing a good job then you have the commitment of employees who are motivated to work hard and statistics show that turnover is lower and burnout is lower,” says Sanders.

Developing the culture

Mark Cole would agree. He is head of learning and organisational development at Camden and Islington NHS Foundation Trust in the UK, and is responsible for training line managers. The trust employs 1300 people across 40 sites in north London. Cole says the challenge is often getting a clinician to wear two hats rather than one.

'We went from a kind of Ground Zero perspective which was saying … we’re going to equip everybody with the essential skills they need'


“For our middle managers, part of our job in L&D is convincing them that it’s a completely different skill set that they’re going to have to apply as a manager to the one they have applied as a clinician,” says Cole.

In an interview with the UK’s Chartered Institute of Personnel & Development (CIPD), Cole says: “We went from a kind of Ground Zero perspective which was saying … we’re going to equip everybody with the essential skills they need to manage, no matter where you are on your management career. You may be five years in, 10 years in, or just starting, but as of this date everyone who graduates into a Band 7 position, which is literally the middle management post, will be expected to do our First Line Manager Program.”

Context is everything, however, and the CIPD, which has produced multiple research papers on developing leadership capability, says that organisational culture is key to management effectiveness.

In its report, Leadership: easier said than done, the CIPD says that focus needs to shift from training individual leaders to improving leadership capacity of an organisation as a whole and that many of the qualities and skills associated with higher quality line management centre on the behaviours of those individuals.

“It’s not enough to educate line managers in the behaviours required; organisations must ensure they’re developing the environment and culture in which line managers are actively encouraged and permitted to exhibit the identified behaviours.”

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