Several years ago Prof Michael Rutter, in a major study of children on the Isle of Wight, recognised that some schools were very successful, while others were not. It appeared that the very good schools had certain internal characteristics, or a certain climate, that distinguished them from the not-so-good schools. These internal characteristics were very evident to those who worked in the good schools, yet his research team was unable to identify exactly what is was that created such a difference between the schools on the island.
I suspect that if we examine different services within the health service we would make the same discovery. At a time when every cent counts, it is essential that we identify what it is that makes certain services successful. If we fail to identify the important characteristics that distinguish the good from the poor, or if we simply choose to ignore them, then we will continue to invest vast quantities in resources in the health services, and obtain limited returns.
After many years of organisational research we are beginning to identify the internal characteristics that distinguish good services from poor and ineffective ones. Not surprisingly, perhaps, the way staff in a service view the way they are treated by management is known to have a major bearing on teamwork, communication, morale, job-satisfaction and the level of commitment they have towards achieving the aims of the service. Collectively, these characteristics can be measured, and the results analysed, using an organisational climate questionnaire. People who measure organisational climate analyse it in terms of four basic systems. Each of these systems is seen to have an internally consistent set of characteristics that will influence the effectiveness and the quality of service clients receive.
Within System 1, control, goal setting and decision making are concentrated at the top. Staff’s suggestions and ideas are hardly ever sought and are not involved in decision making related to their work. In general, little or no confidence is shown in staff; they feel unappreciated by management and morale is very low. Staff receive no recognition or praise for their work and feedback from the top; if it is given, it is usually negative. Communication is largely downwards and staff members are told exactly what to do and have little or no control over their own work. Staff believe that they are not listened to by management, and that the problems they experience are generally ignored. The service is seen as resistant to change and policies concerning conditions at work are considered out of date. Mistrust and hostility are extensive and there is usually considerable resistance in the organisation to directives from above. Teamwork is essentially non-existent and motivation, except at the top, is low.
System 2 is slightly more participative that System 1. Here control, direction and decision making are perceived to be largely concentrated at the top, but there is some delegation of decision making relative to implementing policies. Some comments are invited about organisational goals. The ideas of staff are sometimes sought and they are occasionally consulted before decisions are made about their work. Communication is mostly downwards. There is some lateral communication, and upward communication is usually filtered for superiors. Cooperation between staff and management is relatively low, and teamwork is poor. Though not totally resistant to change, management is seen as largely out-of-date with new developments and there is little willingness on their part to try out new approaches to service delivery. The organisation is usually perceived as being unaware of, or prepared to ignore rather than to face, problems that staff experience. Recognition and credit for good work is infrequent. Overall morale and commitment are relatively low, but higher than in System 1.
System 3 is significantly more participative than System 1 or System 2. Broad policy is decided at the top, but there is substantial delegation of decision making down through the organisation. Goals are formulated at the top, after consultation. There is moderate delegation of review and control activities. Ideas from staff are usually sought, and staff are generally consulted about decisions relating to their work. Substantial confidence is shown in staff. Communication tends to be both downwards and upwards without much distortion. Lateral communication is common and encouraged. Recognition and credit are often given for effort and good results. Goals and priorities are generally perceived to be clear. Staff are generally encouraged to take responsibility and they have control over their work. Teamwork generally exists in moderate amounts and there is a perception of a warm and friendly atmosphere among staff. Management is seen to be progressive and up-to-date with new developments and there is a general willingness to try out new and better approaches.
System 4 is the most participative and is highly group-process orientated. As viewed by employees, goals are established through participation and many decisions are made by consensus. The ideas of staff are sought as a matter a course, and they are fully involved in decisions relating to their work. A high level of confidence is shown in staff members. The flow of communication is downwards, upwards and sideways, and there is little distortion. Extensive use is made of rewards and credit for good work or effort. Level of morale and motivation are high and are based on extensive involvement, group goals and consultation systems developed through participation. Attitudes are generally quite favourable. People at all levels feel responsible for achieving the service’s goals when there is little or no covert resistance to unit goals and policies. The organisation is seen as being up-to-date and progressive in its policies and staff are encouraged to take calculated risks. Teamwork is evident throughout the organisation.
Each of these systems works, although there is considerable evidence to show that System 1 services usually pay a heavy price in terms of all kinds of resistance, low morale and lack of commitment. These are not characteristics that a good health service would cherish. In general, there is an increasing expectation among managers and employees that services should shift towards Systems 3 or 4, in contrast to System 1.