My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

Engaging employees: The Circle example

Filed Under (Employee ownership, Reform of the NHS, Third party provision) by Paul on 19-09-2011

Long term readers of the blog will remember the Health White Paper statement from July 2010 when the Coalition Government made the extravagant promise, on page 36, that “Our ambition is to create the largest and most vibrant social enterprise sector in the world”

Admittedly this was written when they were having a revolutionary moment (an approach that has since been overwhelmed by layers of fear and conservatism) but it is still an important and interesting aim to think about.

Social enterprises come in many different forms. Some would include Foundation Trusts in that category and some would only include small start ups. My approach would be to develop an expansive definition which allows us to see if different models work.

The reason for this is that I don’t think it’s helpful to say that only one form of social enterprise is ‘true’ social enterprise. The whole purpose of developing new organisational forms is to experiment and try out different and new approaches. Over most of its 60 years most of the NHS has suffered from having too few organisational forms through which to deliver its services. This has left many people feeling the ‘NHS trust’ and ‘the GP practice’ are in some way ‘holy’ and the only way that ‘real NHS services’ can be delivered.

These old organisational forms were created by people – and new ones can be too. So if we have had only two major organisational forms – with a third, NHS Foundation Trusts, added in 2004 – I hope that in the next few years we become really inventive in how we develop new ideas for organising NHS provision.

One of the themes of social enterprises is involving employees in the organisation. Now I am not saying – see above – that all social enterprises have to be owned by their employees – that would be much too restrictive. But I am saying that all organisations – social enterprise or not – have to think hard about how they involve their employees in their organisation. So any lessons on this are interesting for all providers of health care.

This issue is important because many staff in large organisations such as hospitals complain about experiencing alienation from the aims and nature of management. There is a strong experience in many NHS trusts of a ‘them’ (being management) that is estranged from an ‘us’ (the staff), and there is a lot of evidence that such an experience detracts both from good care and good productivity.

So how we better engage with staff is an important issue for every organisation -whether it is a social enterprise or not.

About 10 days ago I attended the launch of an analysis of the health care provider Circle and all the quotes in the remaining part of this post come from the report,  “Engaging and Involving Employees at Circle” (Hannah Jameson, IPA September 2010).

The IPA is an organisation that is committed to employee involvement and partnership. Therefore – if it has a bias – it would perhaps be by saying this is a good thing. However it will not want to say that an organisation is practising employee involvement when it isn’t because it lets down the ‘brand’ of employee involvement. So whilst they will want to promote good stories about such involvement they will not want to tell them where they don’t exist – otherwise the ‘brand’ of employee involvement is degraded.

Circle is becoming an interesting and important part of the health care landscape in England. The leader of Circle, Ali Parsa, has been making increasingly large waves not just through being a health care provider but also through his interventions in policy and practice.

It was Circle that won the long drawn out tender for the hospital at Hinchinbrook, and it was Circle that was named by the Guardian earlier this week as a possible partner, with an NHS hospital, to take over a part of Epsom and St Helier hospital. As a private sector provider the waves that he makes for the NHS are either going to help it learn some new ways of working or cause it real problems if it fails to learn from what Circle are doing.

Circle has an unusual structure, 49% owned by its staff and 51% owned by the finance capital, that have invested in it. This is an interesting and probably important combination. Both parts of this organisation are different from traditional public sector organisations.

The staff ownership of 49% explores the staff ownership model and the investor ownership of 51% means that the organisation has to be driven by two different value drivers. I will return to investor finance drivers for value in a future post.

How does staff ownership add value to an organisation?

“Employee ownership is intended to align the interests of the workforce with those of the overall business, and in particular to encourage a greater sense of ownership of patient experience and outcomes. Ownership and the access to information and voice that flows from it can also help engage the workforce in the strategic objective and performance of the overall organisation, and not just their immediate area of work.”  (page 5-6)

How does the report see this actually happening on the ground? A health care assistant in Bath said,

“It’s more of an incentive to look after the make it better than other hospitals .. to make more people come to the hospital, but also ways to save money, so saying we don’t really need this, or scrap that. But to be honest, if you see something on the floor you don’t walk past it , because you know it’s your hospital , it’s your money, you pick it up … that’s what the whole hospital is about”. (page 6)

No one is saying that employee ownership is the ONLY way in which staff can feel they need to look after a hospital. There are those who will feel all of the above issues as reasons for believing in the hospital that they work for, but employees who own a hospital have the experience that it is THEIR hospital to add to the other motivations.

Whilst the idea of staff being motivated by their ownership of a hospital looks to be a useful additional driver for the improvement of services, the politics of this idea are very important to the wider debate.

It is significant that parts of the trades union movement seem to disagree with employee ownership. When they are working for public services, they see employee ownership as an assault on the nature of state ownership. They feel they can have more influence on the state through their national relationships than their members could have on the ownership of the places that they work in.

I will continue this debate in future posts.

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