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Of course any development in organisational terms that seeks to create an integrated structure will raise cultural and leadership issues. These can range from the perceived break up of settled teams that know each other well, to resentment at being incorporated into some new structure with different ways of working where there is fear of the unknown. Leaders' early and continuous attention to cultural issues is essential for success.
The key to all of this is communication, there can never be too much communication and all interested parties will have an unquenchable thirst for more knowledge. It is also important to realize that it is better to tell too much to the staff than to have them assume or invent their own versions of reality. Second to communication is consistency, in particular of approach, of practice and of direction. This requires relentless testing of process and procedure, and a willingness from management to adjust its trajectory if things are not working. Such adjustments will not matter if your staff know how management will handle an issue. Allied to this to this is the need to demonstrate flexibility around strategy and objectives for the new integrated service or structure, and the recognition that no initial vision for the future can ever completely survive contact with advisers and advice.
If you can link everyone’s efforts to the notion that this change will improve the outcome for patients then this can be a tremendously unifying force for good. A shared vision and set of objectives is very powerful, especially during times of change. In terms of the vision and mission, in any change programme the ability to identify refusniks who can then be converted to become advocates is vital – they will be your most powerful messengers.