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Communicating the job in a hospital trust

Alexander Braddell

This paper draws on the experiences of a five-year workplace literacy project at a large acute hospital trust to reflect on the role of speaking and listening in the low-paid, low-skilled workplace. It references a number of reports produced by the project, including the report of an investigation carried out by the project into mechanisms to ‘communicate the job’. 

Project background

The project itself was known as the Stepping Stones programme. It was managed and delivered by a team of approximately ten workplace, basic skills practitioners employed by Oxfordshire County Council. It was funded by the South East England Development Agency as part of the agency’s work to reduce low skills in the region. It ran for five years from March 2001 to March 2006 at Oxford Radcliffe Hospitals (ORH), which is a teaching trust. At the time of the project it employed some 10,000 staff across four main hospital sites.

The programme’s initial brief was to interview 100 ancillary staff (working mostly as cleaners, caterers and porters) to elicit their learning aspirations, to analyse their skills needs and then to deliver ten hours of free literacy, English language, numeracy or information communications technology (ICT) learning to any staff who were interested, in paid work time. Some of these staff were employed directly by the trust; others worked for one of two contractors. Through the programme, ORH’s head of facilities sought to add value to the facilities’ employment offer and simultaneously to address ‘communication issues’. 

The desire to add value to its employment offer reflected concerns around the recruitment and (particularly) retention of ancillary staff, at a time when National Health Service (NHS) performance targets demanded cleaner hospitals and better hospital food. At initial project meetings, the trust specified ‘communication issues’ in relation to customer service and to team work and identified the diversity of its workforce as a contributory factor. 

In common with many low-paid, low-skilled workforces, the low-paid, low-skilled workforce at ORH was diverse in age, gender, ethnicity, first language, educational attainment, employment history and career aspiration. Initial interviewing and analysis suggested two characteristics in particular informed communication issues. First, migrant workers (from a wide range of countries) with limited English language skills made up at least 50% of many work teams. Second, native speakers (including a majority of the supervisors) tended to have low educational attainment (were not qualified to level 2) (Stepping Stones, 2001). 

Those potentially best placed to support the language development of the migrant workers – their native-speaker work mates and supervisors – in many cases lacked the skills to do so, especially where supervisors were concerned. It was not uncommon to find native-speaker supervisors with low educational attainment in charge of non-native speakers with intermediate and higher-level qualifications from their countries of origin. In addition to limited English, these workers brought expectations and attitudes to the job that were often significantly different from those of their native speaker colleagues. 

Work organisation appeared to be broadly neo-Taylorist.[1] Before the programme, there were few opportunities for training and development. There was no appraisal, no personal development planning and little evidence of constructive feedback being given. Supervisors, responsible for delivering ambitious performance targets with limited resources, appeared to rely on command and control. Asked by the programme team, ‘How do you know when you’re doing a good job?’ workers would not infrequently answer, ‘When no one is shouting at me.’ A number of staff reported feeling patronised by managers and supervisors, as exemplified by the comment, ‘They talk to us like children.’

The Stepping Stones programme began in spring 2001, coinciding with the launch of Skills for Life (DfEE, 2001) and, more broadly, with a series of radical initiatives in the NHS designed to ‘modernise’ the service (see for example DH, 2000, 2001, 2002 and 2004). These initiatives included an unprecedented investment in the learning and development of staff who were previously excluded from workplace learning. The aim of this investment was both to make fuller use of the talents and potential of non-professional employees and to raise performance standards in areas related to customer care, such as cleanliness and catering (Stepping Stones, 2005).[2] 

These NHS initiatives set the context for the Stepping Stones programme. However, despite this investment and managers’ willingness to support the programme, pressure of work ensured that at no point during the five years could departments release significant numbers of staff for significant amounts of classroom learning. Consequently the programme was preoccupied with two questions throughout its five-year life: 

1                  What support is most useful to help staff do their jobs effectively?

2                  How can learning opportunities for staff be maximised and optimised? 

Of the various activities undertaken by Stepping Stones to answer those questions, three in particular related to speaking and listening in the workplace. The first was the design and delivery of a team appraisal process to eleven departments and over 330 management, supervisory and operative level staff (Stepping Stones Programme, 2005). The second was the delivery of health and safety training to eight departments and several hundred staff. The third was an investigation of the systems and processes through which staff roles and responsibilities, including the aims and objectives of departments and of the trust as a whole, are communicated (Stepping Stones Programme, 2006). 

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Taylorism’ describes a type of work organisation associated with the American engineer and management theorist, F. W. Taylor (1856–1915). Taylorism (also known as ‘scientific management’) was based on close analysis of a task’s constituent parts in order to maximise efficiency and achieve greater productivity. Taylorism required workers to follow specified processes exactly, and closely monitored them to ensure conformity. Neo-Taylorism describes modern variants of this system that seek to achieve standard outputs by closely prescribing worker behaviour. Neo-Taylorist workplaces tend to be characterised by limited worker involvement in decision-making. 




Thus, for example, from the trust’s staff magazine: ‘How does the [trust] become a customer focused organisation, in the new world of patient choice? This was the challenge discussed by [the trust’s chief executive], during his most recent round of open sessions for staff. He stressed the need for the [trust] to think about the whole patient experience, not just the quality of clinical care. When patients are given a choice, cleanliness, the food, the general environment and the courtesy of staff are all going to be important too. How we tackle these issues will influence how well we do in the future. Given the financial restrictions within which we have to work, some difficult and unfamiliar choices may have to be made as we move into a much more competitive marketplace.’ ORH News (2005).