Case Study

Accountability, performance and interpersonal issues

This project was conducted for the Theatre Department at a large public hospital. We worked directly with the Nursing Unit Manager responsible for the department and the hospital’s Nursing Director and the Nursing Director for Surgical and Perioperative Services. The Nurse Unit Manager was new to the role and also to formal leadership positions. She was responsible for around seventy staff on any day.

It was a high-pressure environment was high pressure with the responsibility for patients’ wellbeing made more challenging by under resourcing and chronic understaffing. The previous Nurse Unit Manager had an amiable style, avoided conflict and didn’t build accountability.

This project was conducted for the Theatre Department at a large public hospital. We worked directly with the Nursing Unit Manager responsible for the department and the hospital’s Nursing Director and the Nursing Director for Surgical and Perioperative Services. The Nurse Unit Manager was new to the role and also to formal leadership positions. She was responsible for around seventy staff on any day.

It was a high-pressure environment was high pressure with the responsibility for patients’ wellbeing made more challenging by under resourcing and chronic understaffing. The previous Nurse Unit Manager had an amiable style, avoided conflict and didn’t build accountability.

*Client comments are shown in italics

There was little structure or governance, and no accountability or responsibility among team members to each other, to the department, or to the patient. We had little groups who were doing whatever they liked. The people who worked hard, worked hard. The people who were lazy were super lazy. 

When COVID happened, people wanted the department manager to step up and protect them. They felt there was a gap between what they were saying to their manager and what was being heard by higher-level management. That led a lot of the staff losing faith in their leader, who eventually stepped down. There was a lot of instability, and everyone felt deserted. 

Expectations from different people didn’t align. That created a lot of conflict and unacceptable interpersonal behaviour. Work requirements increased while resources have decreased, and accountability and morale hit rock bottom.

People who complained loudest and caused most of the problems were rewarded with the roles they wanted, which made the situation worse. It meant people with no accountability were positions of power and control for their own self-gratification. The team continued to fracture, and sub-groups continued to form.

*Client comments are shown in italics

The two priorities were morale and accountability. We knew that outcomes for patients and staff engagement would improve as a result.

It had to start with getting people to treat each other better. There had been an acceptance of poor standards and inappropriate behaviour for so long, and we had to draw a line in the sand and let people know it would no longer be tolerated.

That’s where accountability came in. Inappropriate behaviour had become so normalised that people felt it was unacceptable to be given feedback about it. That had to change! First, I wanted to get people used to accountability. Then, I wanted all the managers in the department to hold others accountable. Finally, I wanted to make it okay for team members to talk to each other about issues.

*Client comments are shown in italics

Over a period of almost two years, we implemented several strategies:

  • Consulting and guidance: It made it heaps easier for us from a manager’s point of view to have an external person with no history, no prior relationships or prejudice. They (The Real Learning Experience) can be unemotive about the process. This was their role, and they were here because this is what they are good at. It brought an extra layer of accountability, which was highly effective for our team.
  • Workshops with the managers: I couldn’t do this alone. I needed to engage the other managers and have them step up, accept their responsibilities to be a leader, not just a manager.
    • Workshops and information sessions for team members: Most people knew what the problem was, but it was nice having The Real Learning Experience there so that team members could talk in groups and individually to them about the problems they were experiencing, what it was like to come to work each day. They instantly felt heard, and that made them open to playing their role in the changes. 
    • Individual coaching sessions: Some people didn’t know about the impact they were having, so how could they improve? Coaching brought so much awareness to people. Ongoing coaching, and the opportunity to be sit down, hear some uncomfortable feedback, and develop strategies were critical.
  • Establishing and implementing a values framework: There wasn’t a lot of buy-in to our values until we did the launch. The workshop helped them understand how the values would help them and be a useful tool for them in their roles. It helped them understand how to take the values from a poster on the wall, and embed them in everyday behaviours and conversations.
  • Team building activities: This was so important because it was entertaining and it was different, and it made people work together who rarely communicated well. It was fun, and it wasn’t just someone standing up and telling them what to do. That really helped.
  • Mediation: They also help us understand both sides and see where the other person is coming from. It helped with the communication and conversation, and people understood each other and moved towards working better with each other. Having an external person held us more accountable to the process, because of their expertise.

*Client comments are shown in italics

This place is 100% better than what it was before. Things are dealt with, people are heard, and they are also held accountable. Having tools and strategies is a big part of it too, instead of trying to band aid one thing while cracks appear elsewhere. 

It is a more positive place to be. There is an understanding of how to work with difficult people, how to deal with the people who are not aligning with the culture we wanted to create in the department. People saw accountability was taking place, team members were being held accountable for their behaviour, team members were feeling heard. Now I have people emailing me, wanting to come work in our department!

Because the issues were longstanding and entrenched, there will be a long maintenance phase. I still need to remember that people slip, but I have people helping me drive it so it doesn’t feel like it is all having come from me, which is the way it should be. More people are pushing the values. 

Things have improved out of sight compared to where it was, but we are still working on everyone driving the values and everyone having the conversations that need to happen.