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Who is driving the business?

29 March 2012

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“Your people are your greatest asset” is a well-used phrase, but for a business delivering a service this holds a great deal of truth. Every practice should have a strategic plan that sets out the direction in which the business is heading. It should clearly set out the vision and goals of the business and a set of values that everyone will follow. If your practice does have a business strategy, have you taken the important step of aligning your HR strategy with it?

Without an HR plan of this kind, the different personnel within the business are unlikely to be focused on the same objectives. When everyone is not working towards shared and understood goals it is less likely any will be achieved. Success is a great motivator, so the danger is that a business not achieving its potential may also be less highly motivated. In addition, if staff are not working together or do not know what they are aiming for then tensions are likely to exist.

Successful businesses with focused and motivated teams ensure they not only have a strategic plan but also that this is clearly communicated to everyone from the top down and that each department and individual has a plan and set of goals that support the overall aim of the business.

An example might be a practice wanting to achieve maximum Quality and Outcomes Framework (QOF) points as part of its strategy. This achievement would rely on most members of the practice: clinicians to do the work, administrators to do data searches, and receptionists to book appointments. It would be an objective easily shared and translated from the overall goal to department and individual level. Equally it would be clear at the individual level how their work was contributing to the main goal.

HR implications of the business strategy
If the strategic aim of the business has been established, it is important to consider what implications this has for the HR element of the organisation before goals are set for teams and individuals.

Do staff have the sufficient skills to achieve the goal? Are enough staff employed at the right place and time? Is the motivation level high enough to deliver the required performance? Do management have the necessary leadership skills? Do the required physical resources, such as facilities, computers and equipment, exist?

A useful way of establishing this is to conduct skills and resource audits to establish what you currently have and then compare to what will be needed. The gap that exists between the current position and that needed to deliver the strategic aim needs to be addressed as part of the HR strategy. If it is not realistic to do this (if, for example, equipment is required that would be too expensive or it would not be feasible to train the existing staff) then the overall strategic aim should be reviewed.

Taking the example of a practice wanting to achieve maximum QOF points, bridging the gap might mean increasing the skills of some clinicians to carry out clinical procedures, getting new equipment or training reception staff in order to identify ‘opportunities’ and book appointments accordingly.

Involving the workforce
While it is important to have a strategy for the business and an HR plan to support this, it is equally important to make sure everyone in the organisation is aware of these and what contribution they will need to make.

The importance of this communication and how individual performance contributes to overall achievement can be seen in a team of rowers. They will have an overall aim of winning the race and will be given directions by the cox, and to succeed they will all have to work together and focus on their objectives. Imagine the impact on performance and spirits if they were all pulling in different directions at differing speeds and given no orders.

Translated to the workplace, this might be a team or an individual who knows what their job is but not what the aim of the business is. They may be given conflicting instructions from different people or no direction at all. Given inconsistent or opposing instructions, staff will be confused and frustrated; those managing them may be seen as poor and open to accusations of “not knowing what they are doing”.

Given no or few instructions, staff will not know what they should be aiming for and are likely to be demotivated by the manager’s apparent lack of interest. In either case, staff are unlikely to be fully engaged and it is hard to see how any meaningful objectives can be achieved.

To avoid these situations, staff should be involved in strategy and planning from the start. Get their input from the beginning when considering the overall business strategy. Communicate it to everyone, explaining fully what it means and how it will benefit them individually and the business as a whole.

Emphasise the importance of their work and performance and ensure they are fully involved in setting their own objectives that contribute to the main goals. If your HR plan requires improved skills, extra staff hours or new resources, get the staff’s ideas on how these should be acquired.

Department and individual goals
Whatever the aim of the business, success is far more likely if everyone is working towards the same goals. This means the objectives set for teams and individuals must contribute to the overall aim.

Setting objectives in this way is not always an easy thing to do. The further you move away from the ‘top’ of the organisation, the more removed it can seem from the overall strategic aim. It is not always easy to see how the admin team or a receptionist can have an impact on a strategic goal such as increasing income or growing list size. While it is true that the work of some staff will have a less direct effect, their contribution is no less important – even if it only indirectly impacts on the strategic goal.

If we take the example of increasing income, first consider where the income for the business comes from: QOF, enhanced services, list size, ‘rental’ income from private providers using rooms and travel vaccinations are probably the main ones. Then consider: how can individual staff directly or indirectly impact each of these?

Box 1 below outlines some of the ways in which different staff roles can have objectives aligned with the overall strategic aim – in this example, to increase income. Some practice managers might argue that much of this is being done anyway – but is all of it? If it is being done, are you setting objectives for each individual in these areas? Is the individual’s performance in this respect monitored and discussed?


Using goals to motivate and measure performance
As well as communicating plans and objectives, it is equally important to communicate progress. This is vital for keeping everyone focused on the objectives and motivated to achieve them. If managers review and discuss performance and progress consistently this will also demonstrate to staff that they too believe in the aims and are focused on success.

If the goals that have been set are ones that will be judged or reached over a long time period, break these down into interim goals. If, for example, the practice is aiming to increase list size by 1,000 patients over three years, break this down to yearly and quarterly interim targets. These will seem far more real and achievable to staff.

If you break down your objectives in this way, remember to report progress at each step. Forget to do this even once and there is a danger that your staff will start to lose interest in their objectives.

Better still, get staff to report their results to you. By doing this they will have more ownership and relate more to the objectives; you may even find they end up monitoring progress more than the manager!

When things are going well, make the most of the opportunity to emphasise the good things that are working. Celebrating success is a powerful tool that is easily utilised, whether a simple “thank you and well done”, popping open the champagne or a fully fledged party. Be sure to keep staff morale up by celebrating every success, however small.

Equally, don’t let failures herald defeat but instead learn from them and use them as a platform to review the work being done. If changes are needed these should be embraced rather than sticking to a formula that has become tired and ineffectual. Remember to keep sight of your strategic goals and the need to align your HR plan and individuals’ targets with the overall business objective.

Gary Hughes is Practice Business Manager at The Waterfield Practice, Bracknell. He has more than 25 years’ experience as a director and manager of businesses in the primary care, optical and veterinary sectors. Gary is also a practice management consultant, providing business and management support to general practices.