In 2016, the HSE spent thousands of euro on seminars to teach staff about living the values contained in its Corporate Plan: Building a High Quality Health Service for a Healthier Ireland 2015-2017. The four values are care, compassion, trust and learning. The plan notes: "We will try to live our values every day and will continue to develop them over the course of this plan." The seminars, called "Values in Action", were held in Limerick last year and the HSE intends to roll out more seminars in 2017 at huge cost. This funding would be better spent on services. According to the HSE, the theory behind the Values in Action programme is that "real sustainable cultural change is shaped by the behaviours of small groups of influential individuals at all levels across the organisation". These individuals, called "champions" by the programme, "are capable of creating a bottom-up, grassroots social movement" to make the values part of everyday life.
The four values have been translated into nine behaviours which include being aware that staff actions can impact on how patients feel (do they not know this already), acknowledging the work of colleagues, challenging toxic attitudes such as negativity and cynicism, using patients’ names and introducing oneself, keeping patients informed and doing “an extra kind thing”. It seems extraordinary that HSE workers are not already practising these basic behaviours which are the least patients and colleagues can expect. They are, or should be, part of everyday organisation culture and cannot be learnt at seminars. In fact, unlike knowledge and skills, values and attitudes towards patients and colleagues cannot be taught in seminars or workshops. They are, in general, learnt through observing the behaviour of colleagues and managers, and day-to-day experience.
Positive values
Most people, if they are lucky, learn positive values such as care, compassion, trust and learning from their parents and relatives. They then, if they are still lucky, develop and refine these values at school from observing the behaviour of teachers and friends. By the time they are trained and socialised as health professionals their values are already almost fully developed. Indeed, it seems amazing that future health care workers would not have learnt how to be caring and compassionate, how to build and maintain trust, and be interested in life-long learning as part of their training and socialisation. Values are further developed by the culture – how we do things around here – of whatever hospital or HSE department they work in.
Unfortunately, from birth onwards many people learn negative values such as it’s okay to bully others, non-caring attitudes, lack of compassion and so on. They bring these negative values into the workplace and expensive seminars will not influence them. It is clear that the corporate plan values do not permeate the HSE. Nearly 20,000 complaints were received in 2015 by the HSE and the voluntary hospitals and agencies funded by the HSE, nearly 2,000 of which related to being treated with dignity and respect. Two weeks ago the UN Convention on the Elimination of All Forms of Discrimination against Women criticised the so-called active management of labour, which is neither caring nor compassionate, practised in Ireland’s maternity units. “The committee recommends that the State party revise its policy of medicalisation of child delivery and the use of maternity wards to ensure that women can have access to maternity and delivery services without time pressure or being exposed to artificial methods of accelerating births.”
‘Champions’
The Values in Action programme relies on "champions" to spread the values using peer-to-peer networks. Although this sounds good it seldom changes the culture. A 40-year old research paper, The Myth of the Hero-Innovator and Alternative Strategies for Organizational Change, by Nicholas Georgiades and Lynda Phillimore, and still relevant today, explores the over-reliance of organisations on training innovators, or champions, to change worker behaviour.
According to the authors large organisations, such as the HSE, “eat hero-innovators for breakfast”. “Behaviour patterns are part of and are moulded by the culture of the work situation.” Even first class training has little influence on how people behave when back at work if supervisors and managers behave differently.
The best way to change the culture of any organisation, including making values come alive, is to promote workers who demonstrate the values of care, compassion, trust and learning, in their dealings with patients and colleagues. The culture changes rapidly when managers and supervisors live the values every day.