Flexible and agileworking is not marginalto organisationalperformance, it's acultural essential

The Inspiring Leaders Network

A national survey of healthcare staff on flexible working

Table ofContents

INTRODUCTION 

BACKGROUND TO WORKFORCESTRATEGY IN THE NHS

WHY DO THIS SURVEY NOW?

KEY FINDINGS FROM THE SURVEY

DIVERSE MULTIFORM WORKING

ADDRESSING THE CULTURE IMPLICATIONS FOR POLICY,ORGANISATIONS AND SYSTEMS - A SUGGESTED WAY FORWARD WHAT DOES THIS MEAN FORINDIVIDUALS AND LEADERSHIPDEVELOPMENT? REFERENCES

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Kirstie Stott and Dean Royles, The Inspiring Leaders Network

INTRODUCTION

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There is a global workforce crisis in healthcare. With not enough staff to meet rising demand, theWorld Health Organisation (WHO) estimate that by2030 there will be a global shortage in healthcare of18 million workers. It is therefore no surprise that the biggest issuefacing the NHS is workforce; staff recruitment,retention, training and support. We not only need to attract more people to work inhealth we also need a new and more radical approachto people management, with flexible and agileworking a core element of this. This generational workforce challenge that is aheadof us affects everyone at all levels and almost everyrole in healthcare, from clinical to non-clinical staff,and all ages and genders. This discussion paper is based on the largestnational flexible working survey with healthcarestaff ever  undertaken, and includes  discussions andinsights from current leaders and those pursuingtheir careers.

The survey was carried out by The Inspiring LeadersNetwork, working in partnership with Yorkshire andThe Humber Leadership Academy. More than 800 people working in clinical and non-clinical roles across England responded, and theresults show clearly the importance of flexibleworking to those working in healthcare, and theimpact a lack of opportunity around flexible and agileworking has. Flexible working has to be seen as more than justreducing hours, occasionally working from home, jobshare or flexibility in roles. A cultural mindset shift isneeded to ensure a more agile, home-basedworkforce can contribute to the ever-changing andever-challenging healthcare needs of ourpopulation.  A failure by policy makers andorganisations to recognise and respond to this willexacerbate the problem.

Introduction

We not only need to attractmore people to work inhealth we also need a newand more radical approachto workforce management

Acknowledgements: With thanks to Yorkshire andThe Humber  Leadership Academy

From Kirstie Stott and Dean Royles, The Inspiring Leaders Network

We have not seen thetransformational changessuccessive plans andpolicies have led us tobelieve

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The NHS Long-Term Plan sees a shift towards moreintegrated partnership working, collaborativeworking and transformation of both services andthe workforce who deliver them. The concept of ensuring care closer to home is notnew, but we have not seen the transformationalchanges successive plans and policies have led us tobelieve. This time the challenge seems even harder given thenational and global healthcare crisis. The question iswhether this burning platform will accelerate changeor bring it to a stuttering halt. Taking a new fresh and radical approach to workforceplanning will begin to help us to meet the needs andfill the gaps and fragmentation in services that oftenexists in practice.  However we can’t simply plan formore of the same with the same type of workingpractices. Many argue for population-based workforceplanning, but we also have to start planning jobsaround people, not simply hoping we can recruitmore into the jobs as they are now designed.

Background to workforce strategy in the NHS

BACKGROUND TOWORKFORCE STRATEGYIN THE NHS

The world of work is changing, and whilst many of usare aware of the benefits of having an agile andflexible workforce, such as productivity, efficiency,retention and recruitment, we need to shift ourthinking about flexibility so it is seen as a culturalessential to thrive and sustain our services to thepublic.

We have to move from ‘accommodating’ staff whorequest flexible and agile working, to developing ourunderstanding of how work and health care can bebuilt around the changing way that more and morepeople want to work. If healthcare can’t retain existing staff and attractnew employees, there are plenty of otheropportunities for people to take up. The plethora of evidence, information and digitaladvancements are well known and if we don't fullyembrace and move forward we risk alienating futurepotential staff and, importantly, existing staff, at atime when we should be supporting and engagingthe talent of people wanting to be part of theworkforce. There are currently a significant number of vacanciesacross healthcare at all levels of the system. Weknow that there is an increasing number of peoplewanting more flexibility in the way they work both interms of hours but also in terms of role. Current demand and capacity gaps often lead tocompetitive practices that may be good for theorganisation but have an impact on the sustainabilityof systems.

Taking a more flexible approach to workforcepractices will enable systems to begin to really seethe benefits of integrated care through more joinedup roles and multiform working which will see asharing of knowledge between services and help tosupport a more holistic approach for the people weserve. Given we are working and living in a highly digitalworld it’s not unrealistic to think that people willwork differently and more flexibly, across sites,organisations and even sectors. As care is providedmore in people’s homes, so our staff can increasinglybe home-based. There are also  tens of thousands of staff in supportfunctions such as HR, Finance, Planning,Administration, IT and Informatics who don’t need tobe in the same place every day working a traditional‘9 till 5’. Multiform working enables and empowers people towork as a Nurse one day and in administrationanother, really harnessing the diversity of skills andknowledge of them as a whole person.

05Background to workforce strategy in the NHS

We need to stop thinking offlexible working as a‘women’s’ issue andrecognise that both menand women want flexibleworking

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The Inspiring Leaders Network have previouslyundertaken research into flexible working in the NHSand wanted to expand the findings to be morerepresentative of the healthcare workforce.

Why do this survey now?

Flexible working is so much more than justcompressed hours or flexitime. Increasingly it ismore around where and when people work and whatthey do when they are there. There is a real opportunity to take advantage of theopportunities this offers, and to keep pace with otherindustries who are working differently and movingtowards more workforce agility. This is not just an issue for managers to solve, it isnow about a cultural shift in healthcare to meet theever-demanding workforce challenges ahead.

WHY DO THISSURVEY NOW?

The original study was of a number of  Women’sNetworks and, whilst we know that women are oftenmarginalised by lack of flexible working, it’simportant to recognise this is about the wholeworkforce regardless of gender, age or generation. We need to stop thinking of flexible working as a‘women’s’ issue and recognise that both men andwomen want flexible working. Flexible and multiformworking is essential for organisational and systemperformance with clear evidenced benefits inproductively, efficiencies and health and wellbeing ofthe workforce. There is now a need to develop and embrace a newnarrative and mind-set around flexible working, tostretch thinking and be more innovative in aradical approach. Fundamentally, we need a rethink about what weconsider and think of as flexible working, and ourthoughts attitudes and behaviours towards it.

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The survey set out to identify the thoughts of a rangeof people who work in healthcare in England onflexible working. For the purposes of the survey,working flexibly was defined as ‘part-time, reducedhours, agility, work from home, job share,compressed hours, flexitime, annualised hours’.What was also considered as part of the survey was‘diverse multi-form working’ (sometimes referred toas multi hyphen working), offering flexibility in a role,such as taking on a mix of clinical and non-clinicalduties. The survey was carried out electronically in March2019 with 838 responses (nearly 45% of thoseapproached). The responses were from across the country, but themajority were in the North of England (71%). 96% worked in public sector healthcare, and 21% ofrespondents  were alumni of the NHS LeadershipAcademy Programmes. There was an approximate 50/50 split betweenclinicians and non-clinicians responding.

Key findings from the survey

The first thing to note was the overwhelmingresponse to ‘is flexible working hours/place importantto you?’ Of the respondents, 92% said yes it was. This is a very clear response from a significantsample across all roles, gender and geography acrossthe NHS and is something which is thereforeessential to take into account when local andnational NHS organisations and systems considertheir workforce attraction and retention strategies,as part of the current considerations arising from theNHS Long Term Plan.

KEY FINDINGSFROM THESURVEY

Is flexible working hours/placeimportant to you?

0102030405060708090

100

2019

Yes/No

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The survey asked if, in the past, respondents hadapplied for a job role, which they have not taken dueto lack of flexible working options. 19% said yes, andwhilst this equates to 159 people it is clear that ifpeople have accepted that lack of flexible workingoptions is the cultural norm and the way things aredone,  this response  doesn't capture the peoplewho  have left roles already due to this. Moreover, it’s clear from the survey that having aflexible option of work is highly important inpeople’s next career move with 85% of respondentssaying it is either very important or important,suggesting a need to ensure future roles across thesystem, and in organisations, are structured tomaximise the potential attraction of new recruits andpeople looking to change roles. When considering the workforce pipeline, agility andflexibility is an essential enabler. 44% ofrespondents said that lack of flexible working is abarrier to their career progression. This is important to note as we develop futureleadership capability in the system, and invest indevelopment to progress, but fail to recognise thepracticalities of working factors which impact onpeople’s ability to contribute and add value. 69% ofthose who answered yes were women, which wasbroadly consistent across the regions that weresurveyed. All too often we see as the first response to a lack ofwomen in senior leadership positions is theintroduction of 'women' leadership programmeswhen it is clearly a system issue, not a skills issue,that is preventing career advancement. Clearly there is a gender disparity in theopportunities for, and importance of, flexible workingto advancing your career in the health service. The previous survey carried out by the InspiringLeaders Network demonstrated that job share wasunder-utilised with only 1.9% working this way, andthis fell off completely in more senior positions.

Key findings from the survey

Again, this survey showed that of the 868respondents only 3% job shared. This is a starkfinding given that 42% of respondents said that theywould consider a job share if it was available to them.There is a clear need to consider how this can beaddressed as part of retention, recruitment andpromotion strategies. A flexible working approach should beindividualised rather than taking a ‘one-size fits all’approach. How one person wants to work is verymuch different to the next, and culturally we need tosee our workforce as individuals and not groups ofstaff who work the same way. What is apparent is that working flexitime andworking from home/agile working was most valuedby respondents, followed by the ability to work part-time.

85% of respondents said itwas important that therewas a flexible option ofwork in their next careermove

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Diverse Multiform Working (DMW) can help radicalisethe way people work and help bridge the gaps inservices. DMW simply means having flexibility in role as wellthe hours/way we work. For example, enablingpeople to work 2 days as Matron and two days as anOD manager, possibly in a differentorganisation, taking on two roles instead of one. Having a fresh and flexible approach to how we viewour workforce enables staff to feel more valued andthat they are contributing, supports health andwellbeing and enables people to feel more fulfilled intheir roles. With the rise of portfolio working, the NHS has theopportunity to fully embrace this approach whilstretaining, talent, skills, knowledge and experience. Our workforce is multifaceted, diverse and highlyskilled, and by thinking more creatively about howwe work more collaboratively we can start to fill thegaps that exist and industrialise the sharing ofknowledge. The survey had a significantly  positive response toDMW with 64% of those surveyed expressing aninterest in working this way and there were anoverwhelming 500 comments on DMW from thesurvey, the vast majority positive.

Diverse multiform working

DIVERSEMULTIFORMWORKINGLet's implement some new thinking around flexible roles

Giving up clinical work as youget more senior is a loss to allstakeholders Splitting between ops andcorporate functions would begreat but the opportunity islimited at present. I amcurrently working corporatelybut have chosen to support anoperational division over winterto retain some of my operationalskills Continuing being a clinician isof utmost importance to me, butI am also certain that I have alot to offer as a leader. I needthe opportunity to mix all these.Direct patient contact is stillvery important to me This would be perfect for me. Ihave avoided management rolesdue to the difficulties combiningthis with clinical work This is the way forward if theNHS is to retain experiencedstaff and recruit new staff

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The NHS has often been seen as progressive whenit comes to equality, diversity and inclusion.Despite a lack of BAME  representation in seniorroles the NHS is still one of the country’s mostdiverse employers.  41% of CEOs are women and a significant percentagework part-time.  Many new industries are thinkingradically differently about flexible and agile working,building and designing jobs around employees ratherthan forcing employees into existing and historic jobrole designs. Agile working has its detractors with legitimateconcerns about zero-hours contracts andexploitative practices for example. However, the NHSnow has an opportunity to reimagine and redefinewhat a good and progressive employer of an agile orflexible worker can be, with employment guaranteesand access to training, CPD, education and careerprospects. There are already a number of progressiveemployers in the NHS, innovating how they supporttheir workforce to get the best out of them, supportwellbeing and to add value. However, these are still inpockets and we now need to move towards beingexemplars in this field. There also needs to be a move from a paradoxicalmind-set that people working flexibly are not doing afull job. Flexibility often seems to be tolerated andaccommodated rather than promoted andencouraged;  it's been suggested that people whowork flexibly are often healthier, happier and moreproductive.

Addressing the culture

ADDRESSINGTHE CULTURE

As part of their workforce strategy andcommitment to ‘creating a great place towork’ where people are valued, supported

and appreciated, Chesterfield RoyalHospital Board of Directors are committedto creating a culture where flexible working

is welcomed and encouraged andconversations start from a ‘say yes'

approach to flexibility.

This is aligned with the Inspiring LeadersNetwork ethos of creating a ‘Flexible First’approach and is seen as a positive rather

than something to have to beaccommodated.

The Trust sees that to attract and retain

people with a range of skills andexperience, it helps staff to stay healthy

and look after their wellbeing.

Chesterfield encourage and embrace a ‘norules’ approach to flexible working and base

decisions on conversations and if theservice can be delivered and has no

negative impact on role and health andwellbeing.

Their information guidance to staff

welcomes a flexible approach to staff andoffers information on different types ofworking alongside varied case studies

including clinicians and senior managersand even a General Manager Job Share.

This is the sort of approach where the

impact will be felt on the ground and will beseen positively by potential new staff andwhere all organisations should be aiming

for.

Chesterfield RoyalHospital Foundation Trust

Addressing the culture

We need to move away from thinking purely abouthours worked and focus conversations around theactual work and outcomes. With positive intent, we have viewed working outsideof ‘traditional hours’ as something to be discouraged.For example, senior managers emailing out of hoursbut caveating this with there not being a need torespond to their emails out of hours if that is not atypical work pattern. However, we know that, given the choice, a largeproportion of people would like to work in a moreflexible way, and this could include working earlybetween 6-9am and after the traditional 5pm finish. For many this would help to accommodate andmanage complex lifestyles and we should beencouraging people to work in a way which meetsboth the service and their own personal needs.Moving the narrative from work-life balance towork-life flow.

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We need to move awayfrom thinking purely abouthours worked and focusconversations around theactual work and outcomes.

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Policies makers and regulators need to includeflexible and agile working in assessing progressiveemployment practice. Well led organisations should be able to demonstratehow their leadership enables flexible and  agileworking for their staff and the impact this approachhas on the health and wellbeing of these staff, andthe impact on patient care and service delivery. Job adverts should actively welcome approaches toflexible working, making it clear organisations will doall they can to assimilate requests to flexibleworking. The assumption should be flexibility ispossible in all roles. Governments and policy makers need to see thepublic sector as an important area of the economythat can set the tone for flexible and agile workingand in so doing attract talent to some of the mostdemanding and challenging jobs and roles in oursociety. For too long the public sector has traded on a ‘job forlife’ mantra. Stability and security are important, butwe need individuals to see the public sector, and thehealthcare sector in particular, as a job for ‘their life’;a job that may change and a career that will be asagile as they are. Organisations need to be setting the example andpromoting agile working. There can be more homeworkers - particularly in support functions - andorganisations and systems need to be gaining thebenefits from this.

Implications for policy, organisations and systems – a suggested way forward

IMPLICATIONSFOR POLICY,ORGANISATIONSAND SYSTEMS

Policies and procedures around flexible workingneed to be rewritten and staff reassured that out ofsight doesn’t mean out of mind and know that theywill still have access to supervision, training andcareer opportunities. Trade Unions should be involved, working withemployers to define progressive and agile workingpractices. Managers will need training and encouragement onhow to manage a more distant and flexible workforceand embrace a new style of management which ismore facilitative and empowering to support theirteams. With a shift to integrated working at both place andacross the wider system, workforce transformationneeds to consider how agility, flexibility andmultiform working can help support and bridge thegaps. Building relationships across sectors andcollaborating to support service need and demandwill require a radical shift in workforce agility. There is a responsibility of system leaders to supportand rethink the way their workforce will work acrosstraditional boundaries and how having a freshapproach to what is seen as normal practice will helpenable them to recruit and retain the right people,with the right skills and mind-set to work throughand in these challenging times.

A suggested way forward

For too long the publicsector has traded on a 'jobfor life' mantra

What does this mean for individuals and leadership development? 13

WHAT DOES THISMEAN FORINDIVIDUALSAND LEADERSHIPDEVELOPMENT?

Over recent years there has been a rise inexperienced staff, including many men, leaving fulltime employment to take up more flexibleconsultancy/freelance work. With senior roles beingmore demanding the NHS is at risk of falling shortof supporting retention of this experience. Increasingly staff have been taking up agency orbank roles to give them the flexibility and agility theyseek. However this means that they often sacrificetraining and development in this semi-detached formof employment. A culture of encouraging flexible andagile working can also reconnect employees,ensuring greater scope for training and developmentand better access to career developmentopportunities. In terms of leadership development, we have put apremium on the visibility of leaders.  A more agileand flexible workforce makes that even morechallenging.   There will need to be a shift in how we develop bothleaders and managers to become more facilitative,empowering and connected to enable them to leadand manage an agile workforce. Both will be essentialand it will be important to view leadership andmanagement development as two halves of the samewhole.

Leadership development programmes will need toinclude information and insights on leadingorganisations and systems with an increasingnumber of staff working flexibly. This hasimplications for ensuring staff are connected tovalues, communication channels and how staff aredeveloped and supported. Personal contact and face to face discussions willalways be important but we need leaders to be moreconfident in being visible and communicatingthrough new technology and social media. Animportant ‘virtual visibility’

14References

References

NHS Long Term Plan > NHS Staff will get the backing they need > Acomprehensive new workforce implementation plan

- https://www.longtermplan.nhs.uk/online-version/chapter-4-nhs-staff-will-get-the-backing-they-need/1-a-comprehensive-new-workforce-implementation-plan/ NHS Long Term Plan  > NHS Staff will get the backing they need >Supporting our current NHS staff

- https://www.longtermplan.nhs.uk/online-version/chapter-4-nhs-staff-will-get-the-backing-they-need/5-supporting-our-current-nhs-staff/ Business in the Community > Exemplar Employers Best PracticeRecommendations Flexible Working - https://gender.bitc.org.uk/exemplarflexibleworking Guidance on flexible working for the NHS-  https://www.nhsemployers.org/-/media/Employers/Documents/Pay-and-reward/Guidance-on-flexible-working-28-Jan.pdf A Universal Truth: No Health Without a WorkforceThird Global Forum on Human Resources for Health Report- https://www.who.int/workforcealliance/knowledge/resources/hrhreport2013/en/

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