Leadership is one of the most seemingly impactful and frequently cited factors associated with large-scale, ‘radical’ organisational change [1, 2]”.(Gutberg. J, Berta. W, 2017)
The article written by Jennifer Gutberg and Whitney Berta and published by BMC Health Services Research discusses the need for middle managers to use their “unique position between upper and lower levels in their organisation to engage in ‘ambidextrous’ learning, critical to implementing and sustaining radical change.
The article mentions the “importance of considering whether senior leadership may be a “necessary but insufficient” condition to enact meaningful sustained change”.
Instead the authors suggest, “If the middle manager has proper knowledge, abilities, and resources from senior management, they will be able to generate the necessary frequency of communication regarding the upcoming change”.
This type of thinking has informed Cognitive Institute’s approach to designing and implementing the Safety and Reliability Improvement Programmes, specifically courses relating to the development of clinical leadership and improving accountability and professionalism.
With outcomes focussed on culture change, these programmes offer a sustainable, organisation-wide framework to achieve the highest levels of safety and reliability. Though for these types of programmes to succeed, there needs to be visible commitment from senior leaders and a focus on training and development of middle leaders and influencers.
The article states that “the success of these initiatives is variable at best, this paper suggests that this is a result of implementation challenges – and specifically the relative absence of consideration of middle managers in effecting culture change – rather than a reflection of the interventions themselves”.
As part of the Speaking Up for Safety Programme, Cognitive Institute’s trained presenters conduct a licensed Train the Trainer Programme to selected in-house staff. This structure provides the skills, knowledge and educational material to enable these staff to become accredited presenters, so they can deliver a one hour training workshop for all employees on an ongoing basis.
The Institute’s delivery of the Promoting Professional Accountability Programme uses a similar strategy by incorporating peer messenger training to equip participants with the skills needed to address unprofessional behaviour and respond appropriately to pushbacks or resistance.
The programme also incorporates leadership training for leaders who review and manage behaviour that undermines a culture of safety. Coaching and feedback support for leaders and peer messengers is then provided to support the ongoing implementation and sustainability of the programme.
The article supports this structure by stating that “initial change efforts may require all-encompassing initiatives, however these efforts will never officially ‘end’, in that healthcare organisations will always have to uphold their standard of patient safety, facilitated by a strong patient safety culture (PSC)”.
Read the full article, Understanding middle managers’ influence in implementing patient safety culture.