The way in which you package yourself has a direct influence on how others perceive your abilities including your sense of quality, professionalism, creativity and how you value yourself.

Just think about our political leaders: Gordon Brown may think of himself as PM in waiting but he certainly doesn’t look like it.  Most of the time he looks like he’s got dressed in the dark, picked up his clothes form the bedroom floor and has given up trying to find his comb.  One word springs to mind- crumpled.  And what about Tony Blair?  He may do ‘suited and booted’ just fine but whenever he tries to dress down (remember the slightly grubby polo shirt?) It’s just cringe worthy!

Appropriateness is what counts.  Like him or not, David Cameron manages to alter his look from formal to casual to suit his environment with great effect.  He manages to portray a relaxed confidence, whether cycling to work in combats and trainers or wearing a suit and tie.  His dress style compliments his youthful, non-confrontational approach.

It’s not just the men either.  A shining example of someone whose reportage would have been a whole lot more complimentary if she had taken the time to put a little more effort into her image is Margaret Beckett.  Whilst you cannot deny that her hair is always coiffed and her outfits accessorised, it’s usually a few too many of the wrong accessories and too much backcombing of a dated hairstyle.  All this combined with poorly fitting clothes gives and overall jumbled appearance, particularly when you stand her next to the pristine Condoleezza Rice.  That is a woman who really values the importance of personal image, from her pearly white teeth to her perfectly chosen shoes: not too high, not too sensible, not too trendy but just the right side of sexy.

So how do you make sure you’re more Condoleezza & Cameron and less Brown & Beckitt? Here are a few tips:

• Always buy the best you can afford – it really does show.
• Don’t scrimp on the grooming – scuffed shoes, dirty finger-nails and stubble will stand out no matter how well fitting your clothes are.
• Have regular haircuts and take the time to style it – every day.
• Don’t wear the same clothes twice in a row – the fibres need a chance to retract so your clothes keep their   shape (they’ll last longer too).
• Always hang up your clothes on hangers and iron your shirt.
• Don’t become predictable – update your look with new shoes, ties and accessories on a regular basis. 

Put your best foot forward    

It’s the little details that count, two in particular can make a difference: your shoes! They can make or break any outfit so don’t just reach for the same pair everyday.  Indeed, the same pair of shoes, just like clothes, should not be worn twice in a row or more.  The quickest way to update your look is with a pair of new shoes.  Look out for new colours and shapes each session.  If you don’t want to buy a whole new wardrobe a pair of new shoes will have an instant uplifting effect. 

For women (for men it’s more tricky unless you work in a creative industry) shoes are a great way to bring a bit of colour into your wardrobe and show your personality.  LK Bennett always has a great selection of colours in appropriate styles every season.

For men a lace-up style with a suit usually works best.  If you are more business casual or dress down slip-on or loafer style can look more contemporary. 

Open-toed shoes should always be avoided if you work in a professional environment. For women sling back styles can be a cooler and more acceptable option over a full shoe once it starts getting warmer. (graphics look for a nice sling back shoe, bright colours if possible)

• Look after your shoes and they will last longer:
• Spray suede or nubuck leather shoes with a protective spray before wearing.
• Polish leather shoes regularly. If they get wet allow to dry thoroughly away from direct heat. If it’s a very fine sole get them re-soled too before wearing.
• Invest in some shoe trees to help them maintain their shape.

CMBimage is the corporate division of colour me beautiful. Established for 24 years we offer a range of programs designed to show individuals and organisations how to get the best from their employee’s image.

For more information click: www.cmbimage.co.uk info@cmb.co.uk or
Tel: 020-7627-5211 Ext 214.

I think if he was alive today, he would add a third, change.

The big ‘C’ is now constantly on the agenda both in and outside the workplace.

It’s an exciting time to be alive with unprecedented opportunities for discovery and development.

Yet there is also a flip side. With change comes uncertainty and anxiety.

Despite our insatiable appetite for the new and the different, we also cling to the comfort and security of

the familiar. The clash of these two words mean we live in ‘crazy times’ where excitement, stress advancement and

breakdown co-exist like a typical family gathering at Christmas.

So how do people respond to change in the workplace?  Let’s explore six responses.

1. Cynic.

They have seen it all before and are convinced the change will never work and may question the motives behind the change.
However, despite this verbal resistance, cynics invariably and begrudgingly go along with the change.

2. The Camper.

This person sits on the fence and is neither positive or negative about the change.
They seem prepared to ‘sit it out’ and see how others in the team respond. 

3. The Co-operator. 

They seem resigned to yet more change, so you rarely hear complaints, but are more likely to hear “Oh well, it’s going to happen so we might as well get on with it”.

4. The Champion. 

Openly welcomes and promotes the change.  It might have been their idea, or they see a direct benefit to themselves.
Whatever the reason, they are definitely on board. 

5. The Confused. 

The change seems to overwhelm them and they feel unable to respond either positively or negatively. 
They struggle to grasp the implication of the change and may well go into denial as a way of coping. 
Of course their confused state may also have something to do with the lack of clear communication surrounding the change. 

6. The Conspirator. 

Seeks either covertly or overtly to resist the change.
This person simply doesn’t believe the change is a good thing and they are committed to ensuring it doesn’t work. 
They may employ a number of tactics in order to sabotage the change, from ‘forgetting’ to pass on important messages, ‘losing’ documents or being openly cynical of the organisation to customers.

What Can We Do About It?

The good news is that in most cases, people’s responses to change are not permanently set. 
You’re dealing with people made of clay as opposed to concrete.
Having worked with organisations around the globe over the last ten years, here are my top ten tips for managers to help staff deal more positively with change.
1. Sell the reason. 

People need to understand the reasons for the change and you may need to spell out the consequences of not changing.

2. Don’t flee to the trenches. 

As a manager be visible and available. Conspiracy theories flourish in a vacuum.

3. Involve people where you can. 

Seek ideas on how best to implement the changes. 
When Clive Woodward took over the England Rugby Union Team, the players decided what the consequences would be for players being late to team meetings.
He introduced the ideas, the team implemented the detail. 

4. Go for quick wins.

Nothing is more demotivating than seeing things getting worse as a result of change.
Margaret Thatcher wanted a quick win during the Falkland conflict.
Despite being of no real military significance, the Capture of Goose Green provided the quick moral boosting win she and the commanders craved.

5.Lance the boil.

Don’t allow staff’s cynicism and negativity to fester beneath the surface.
Address the issues head on and draw them out into the open. 
This may be appropriate to do in a group situation, but is often more effective done face to face behind closed doors.
Remember, if you fail to tackle the issue, your silence or denial of the problem gives people permission to continue their negative behaviour.

6. Allow some Hippo Time. 

Not all changes have a clear benefit to employees.
Acknowledge that people may need time out to wallow and reflect (Hippo Time) to air their grievances and talk through their issues.

7. Listen up.

Avoid hijacking peoples Hippo Time. Allow people time to express openly their feelings and frustrations. 
Give them your attention and determine to ‘listen to understand rather than defend’.

8. Go Greek.

When Greece won the 2004 European Championships they did not have the best football players, but they had the best team.
Do all you can to encourage the team to come together, work together and have fun together?

9. Don’t ignore your stars. 

During change, the trap many managers fall into is to spend all their time with the cynics and the conspirators.
They cannot be ignored, but don’t take your champions for granted. 
It might only take four words to make them aware you value them, “I appreciate your help”.

10.Remember to S.U.M.O.

Despite all your best efforts and intentions, mistakes will be made and not everyone on the team will positively embrace the changes. But there comes a point when we all need to Shut Up, Move On.

Change can be a challenge but by adopting some of the above approaches, it doesn’t have to lead to a crisis.

Our mindset is the first thing we have to overcome before we step forward to doing anything else.

We can spend our lives second-guessing ourselves and never move from one spot for fear of making the wrong move.

We can turn our mindset around by turning the questions we ask ourselves around.

Here are a few…

1. Instead of “Why…” … ask “why not…”

Step up to the plate of challenge.

You’ll never know the positive outcomes unless you try.

Better to fail from making an effort than from inertia.

You can always step back, regroup, and start again.

2.  Instead of “not me..”… say “Yes, I can if I want to…”

It takes more effort not to do something than to do it.

Open up to new experiences, you’ll discover potential in yourself you never knew you had.

The time to start is now.

3. Instead of “I can’t…” …say “Yes, I can if I want to…”

You can do ANYTHING you put your mind to.

Never be intimidated by the fact that you’ve never done it.

Do it.

Discover wonderful talents about yourself.

4. Instead of “not now…” … ask “why not now…”

The best time to do anything that your mind conceives is now.

Yesterday is gone, tomorrow is a promissory note, today is all you have: use it or lose it.

5. Instead of “I have to do (this or that) first…” … ask “what can I do that will move me toward my goal?”

There will always be a reason for not taking action.

Don’t wait for that one big thing to happen before you move forward, do one small thing today that will catapult you forward toward your goal, no matter how small.

The point is to start immediately.

6. Instead of “I don’t have the money to…” …say “What can I do to get the money I need to…”

Get a part-time job, do some freelance work, sell something.

Do whatever it is you need to do to get that extra cash to support your goal.

There is always a way.

7. Instead of “I’m only one person…” …say “Who do I know who can help me…”

Everyone knows someone who has a talent or skill that can complement their own.

Put your minds and time together to create whatever it is you want.

8. Instead of “I don’t have the money to…” … say “What can I do to get the money I need to…”

Write down everything you do in a typical day then analyze it closely for the time, money, energy-wasters.

Use that resource to begin your campaign towards your goal.

9. Instead of “I don’t know how to…” …ask “where can I get this information…”

Become internet savvy to research your topic, service, product, or idea.

Go to the local library to learn how to do an internet search or use other resources there to gain information.

Information is readily available today.

10. Instead of “My spouse ( girlfriend, boyfriend, parent, boss ) Won’t let me…” …ask “how can I engage this person to my point of view…”

Most people’s objections to an idea are due to ignorance or misperceptions.

Use data, testimonials,news items, etc. that will support your viewpoints.

Speak with conviction. Step up to the plate and don’t let yourself be dissuaded if you really want it.

This causes a great strain on their “normal” weekly workload, resulting in a serious backlog of appointment availability and soon demoralises the Nurses as they get “fed up” with this repetitive procedure.

The GP’s had grown accustomed to viewing the vaccinations as something that they generally no longer participated in, until perhaps late on in the season when chasing those final numbers.

GP’s have seen their responsibilities change which in turn has altered the work carried out by Practice Nurses and this has also cascaded to the workload of the Health Care Assistants (HCA).

The HCA are now a valuable resource taking ECGs, new patient checks etc. as well as phlebotomy duties.

Many now hold an NVQ 3 in Care and are keen to expand their role further.

With ever expanding numbers of recommended patients to vaccinate, the increasingly specialist role of many Practice Nurses and the knock on effect of weeks of flu clinics, some changes had to be made.

With the above in mind, we therefore decided to investigate the possibility of our HCA partaking in vaccinating the influenza target population.

Medical Insurance Cover

The first port of call was to contact the Defence Union to ensure that they would indemnify our HCA when providing flu vaccinations.

This approval was obtained in writing, subject to various conditions including strictly operating to protocols.

This meant that significant training was required in advance of the actual flu season.

To ensure that we covered everything possible, we took a “belt and braces” approach to the training and fully documented everything.

Training

Firstly, the HCA attended a “theory and technique” training session led by our senior nurse which included a practical session using oranges.

All of the HCA enjoyed the session but initially found the procedure awkward as it was alien to them.

A handout on the Administration of Vaccine (UK guidance on Best Practice in Vaccine Administration) was given to each HCA at the end of the session.

The lead GP then facilitated the next training session, which included actual vaccinations by the HCA, enabling them to experience injecting patients.

We did this with pneumococcal clinics which were closely supervised and enabled us to carry out this training in advance of the flu clinics.

The final training session involved the HCA holding their own short flu clinics, again supervised by a GP.

Immediately after completing this final training session, the HCA completed a self-assessment competency grid.

A separate competency grid was also completed by the lead GP with both parties “signing off” that competency had been achieved.

The HCA were now ready for the flu clinics.

Team Involvement

During the training I saw an opportunity to totally change the way we deal with this large, annual task.

Many other surgeries were now carrying out the vaccinations on a Saturday so as to prevent the impact on the normal working week.

It was an area I wanted to explore further.

I aimed to coerce the 8 GP’s into partaking one Saturday morning each.

This would show support to the HCA and Nurses in what can be a mundane duty, one which seemingly never ends.

By including the HCA and GP’s I would have 16 clinicians vaccinating rather than the historic 4! I estimated that we could vaccinate over 80% of our patients on 2 Saturday mornings with each clinician and admin staff working 1 morning.

Protocols

Protocols were drawn up for the HCA, the reception staff and the GP’s.

The reception staff used the protocol when the patient rang to book an appointment to ensure that the HCA only saw patients without complications, e.g. vaccinated previously with no reaction, not allergic to eggs, not ill, not pregnant etc.

These questions were repeated by the HCA on the day with any concerns or positive responses referred to a nurse or GP.

Each clinician had the option of having an admin person (except the HCA who we felt should have one) to enter the information onto the computer.

The surgery closed for twenty minutes mid-morning for a coffee break with the practice providing cakes or bacon sandwiches.

The team spirit generated was absolutely brilliant (undoubtedly helped by all the GP’s being involved) and a welcome surprise was how successful it was as a patient relations exercise.

We received many compliments throughout the day and during the following weeks.

Of course, it also helped the business (and the nurses) as we did not have endless clinics throughout the winter months.

Additionally it has expanded the skills of our HCA and given them a greater sense of job satisfaction.

In our first article, we looked at the difference between being efficient and being effective.

Efficient people follow the rules - they do things right, whilst effective people do the right thing- they add value.

We saw that efficient people are good at ‘maintenance’ and ‘crisis prevention’ whilst effective people add value through ‘continuous improvement’ and the ‘management of change’.

When we appraise our staff, we either want them to be more efficient or want them to add more value.

So appraisal is all about improving people performance, so much so that in many organisations, appraisal is often referred to as the ‘Performance Improvement Process’.

Why appraise employees?

• Helps develop an individual’s skill so they are more efficient and/or more effective.
• To discuss with the individual new skills that may be required as the job changes.
• To review past performance as a guide to future performance.
• To assess career planning. Are they in the right job, what other jobs could they do?
• To assess future potential. Could they take on other roles or take on more responsibility.
• To set objectives for the coming year.Objectives to do with improvement or objectives to do with new tasks and responsibilities.
• If we look at some of the aims of appraisal outlined above then it is obvious that another aim of appraisal must be to identify an individual’s training and development needs as well.

What are the benefits for the individual?

• Others are constantly evaluating an employee’s performance, so they have a right to know what others think of them.We all need some feedback about how we are getting on in the job, especially if the job is new to us.
• Employees can use the appraisal meeting to discuss the detail of their work with the Practice Manager.What do they gain satisfaction from? What do they find difficult and what other things can they do?
• The individual can check that their ‘key result areas’ correspond with those of the Practice Manager. It is no good trying to spend more time on those activities that the Practice Manager feels are less important. Not all employees know how to prioritise.
• The individual can explore ways to add value in the job. They can add value in their role through ‘continuous improvement’ activities (improving the job) or radically changing things (the ‘management of change’).
• The individual can discuss their career prospects, or how they can be ‘developed’ within the job.
• The ‘appraisal meeting’ is also a chance for the individual to discuss problematic issues to do with their role or issues to do with the team. A chance for an open dialogue.
• Above all, the individual expects the appraisal meeting to leave them motivated and encouraged.

What are the benefits for the Practice Manager?

• The Practice Manager can find out how the individual feels about work and what motivates them.
• The individual’s strengths and ‘development areas’ can be identified.
• The Practice Manager can use the process to talk about changes in the practice and strategic developments.
• The Practice Manager can identify training and development needs for individuals or even groups of individuals.
• The Practice Manager can use the appraisal system to improve the overall performance of the Primary Health Care Team.

SMART objectives!

One of the outcomes of the appraisal meeting is to set performance improvement objectives with the employee, these objectives should always be along SMART lines.

SMART stands for:

Specific
This means that the objectives should be well defined.

Measurable
The objective should be measurable in some way. For example it might be an objective that saves time or money.
It might be an objective that improves patient care or improves communication with other health service agencies.

Agreed
The Practice Manager and the employee should agree together the performance improvement, whether it is to do with efficiency or effectiveness.

Realistic
The objective should be one that is achievable for the individual and for the resources available. It is no good setting objectives that are unrealistic.

Time bound
The objective should have a start, a review and an end date.

Appraisal Style

There are three styles of appraising individuals: Tell and Sell, Tell and Listen, and Self-Appraisal.
Let us look at each in turn and identify their strengths and weaknesses. We will note that the best style is self-appraisal but the other styles may have to be used on occasions.

Tell and Sell
In this case the Practice Manager just tells the employee about how he or she sees their performance and sells, or persuades them, that this evaluation is the correct one. The Practice Manager also tries to get the employee to follow the Practice Manager’s own improvement plan.
Unless this is a very new employee, or a poor performer who has to be told what to do, this style is not likely to be acceptable.
No one likes to be told what to do and how to do it. Also the employee is less likely to take ownership for the improvement plan.

The employee is seldom going to be motivated by this approach and they can also become hostile and defensive, especially if they feel there is some degree of ‘criticism’ in the appraisal.

Tell and Listen
In this case the Practice Manager conveys a provisional assessment of the employee’s performance and listens to their response.
Again the employee can still become defensive or just reject the appraiser’s evaluation. In addition the Practice Manager may also become defensive if their recommendations are rejected.

Self-Appraisal
In this case the Practice Manager aims to get the employee to appraise, or evaluate, their own performance. The advantage of this approach is that the employee is very likely to take on ownership for their performance improvement. Most employees have a realistic view about how they are performing and in many cases they can be modest and over critical of themselves. Only in a small minority of cases do we find employees who are overconfident and unrealistic in their selfevaluation. We will show how to deal with these ‘difficult’ employees in a future article.

Appraisal in practice

The Practice Manager should prepare to appraise the individual by looking at their performance over the past six months. If there were issues or problems they would have been clearly raised at the time so there should be no surprises for the employee in the appraisal itself.

In this preparation, the employee’s strengths need to be noted, with the intention of building on them for the next period. If there are areas of poor performance then the Practice Manager should select just one or two to deal with in the appraisal itself - very few people can cope with more than one or two areas of poor performance.

Start off the appraisal meeting - it is a meeting, not an interview- with an open question about how they feel they are getting on. This allows them to raise any worries or concerns they may have. Then move on to ask open questions about how they evaluate their own performance. The idea is to be able to praise and motivate the employee.

In the self-appraisal process, some employees may not mention some areas of poor performance. The reason for this is that they are unaware of them or want to hide them. In this case the Practice Manager asks more open questions. Let us assume there was an issue with a patient or another member of staff, ask an open question such as “what went well?” and then another open question “what went less well?” or “what would you do differently next time?”

The Practice Manager only resorts to the “Tell and Listen” approach if the employee avoids, or is unaware of, the problem or issue at hand. In very rare cases, such a totally new employee, or a resistant employee, then the Practice Manager may have to resort to the Tell and Sell approach, the ‘this is what is wrong and this is what you have got to do about it’ approach!

In self-appraisal, the Practice Manager can ask the employee how they see their own learning and development. Don’t forget, development can mean taking on new responsibilities, self-study, coaching others and so on. It does not always mean external training courses.

A final point worth making is that in the appraisal meeting the word ‘weakness’ or the term ‘criticism’ should never be used-it only makes people defensive. Always adopt the ‘merits and concerns’ approach. Mention people’s strengths or merits and then, if you do have to mention some aspect of poor performance, use the term ‘concern’. “You are very good at ABCD and have done very well, but I am a bit concerned about…”

Next issue we are going to look at job ‘competencies’ and show how the competence approach can supply the criteria by which we appraise people. We are also going to show you how to use a simple checklist when giving feedback to ‘difficult’ employees.

“Marching to the beat of your own drum, no matter how faint or far away.”

So, do I recommend you have a personal coach? Well, duh!
But if you can’t afford one, or aren’t ready for one, why not be your own coach?

Here are a few suggestions:

1. Write down your goals.

Review and re-write them once a week.
This is old advice, but there is power and magic in writing your goals on paper! Write them down, then review them, think about them and up-date them every week.
It may only take 20 minutes, but it will double your rate of success, I guarantee it!

2. Show up!

Many of life’s most important achievements simply require that we show up, pay attention, tell the truth, work hard, go the extra mile, and do our best!
Superior performance is not about the future, or the past.
It’s about doing a superior job right now, on the work that lies right in front of you.

3. Eliminate Distractions.

Keep your eye on the ball.
Life is full of frustrations and distractions.
Successful people do NOT tolerate the things that drive most of us crazy – they take the time to stop, solve the problem and eliminate the distraction once and for all.
Stay focused!

4. Manage your environment.

Top performers know that space management is more important than time management, and they have neat offices, clean cars, orderly appointment books, and they keep an extra suit at the office, just in case.
Make your office (and your home) a space where you can do your very best work.

5. Read every day.

Read something useful, challenging or fun every day.
If you only spend 20 minutes with a book that motivates, excites and educates you, it will make a world of difference. I promise!
Aim to read at least one book every month!

6. Attend a “University on Wheels”.

Listen to educational, motivational and fun tapes while you drive.
At least listen to soothing, appropriate music, rather than the ‘terror of the day’ on talk radio! Fill your mind with the BEST information you can find!

7. Use a Master-Mind group.

The term refers to a group of people who are committed to helping you be successful.
Often, they meet once a week.
Think of them as your ‘Advisory Committee’.
Bounce ideas off them, ask them for advice, let them coach you!

8. Focus on values.

Take time every week to review your values, the things that cost you nothing, but make life worth living. Write them down, share them with a friend, and remind yourself of what’s most important to you.
Remembering your values will get you back on course!

9. Play more!

Play a game of tennis, wrestle with the dog, shoot hoops with the kid next door.
Laugh, get sweaty, have fun.
It doesn’t cost; it pays!

10. Practice Gratitude!

Periodically, ask yourself how many ‘good’ days you’ve had this week.
Notice what made the good ones good, and do more of the good stuff! And, be grateful.

Even the most sophisticated, modern cruise ships must constantly monitor their course.
On one cruise, I took a tour of the bridge and was told the ship had no less than 5 automatic navigation computers and that at least 2 officers were on duty at all times.

Why the redundancy?

Because having a cruise ship get lost, even briefly, is a very bad thing!

How many navigation systems do you use to guide your path? Having a handful of books, journals, friends and daily routines to ‘coach’ you is not expensive, it’s the best investment you’ll ever make! Set up routines and use the best resources you can find to stay on course.

Coach yourself to the top!

We are going to start off with a brief discussion about the difference between people being efficient and people being effective.

This is actually very important because it is fundamental to employee selection and appraisal, both of which we will cover in future articles.

The theme of this article is that there is a difference between being efficient and being effective and that not all efficient employees are necessarily effective!

Dr Ted Johns, Chairman of the Institute of Customer Service, suggests that each employee has four important parts of his or her job:

1. They have to carry out their duties,
2. They have to anticipate events,
3. They have to improve what they do and
4. They should also be involved in change.

He describes the four parts of everyone’s job as follows:

Maintenance.
Maintenance is fulfilling ones duties, following the job description and delivering what is required for the role.
Needless to say, if employees did not carry out their duties as described in their job description, it is very likely that they would be disciplined or even dismissed.
We should be aware that, when it comes to job descriptions, there is always an element of ‘drift’.
The reason for this is two-fold.
Firstly, technology and jobs change and job descriptions often become out of date.
Secondly, all employees, over time, tend to redefine their role so they do more of the things they like and less of the things they don’t like.
In general terms, if people are fulfilling their duties they are seen as efficient.

Crisis Prevention.

There is more to a job than just fulfilling ones duties (maintenance).
In addition, we expect employees to anticipate events, identify things that could go wrong and do some ‘fire fighting’.
We expect employees to learn from mistakes and think ahead.
So ‘crisis prevention’ is an essential part of everyone’s job and it is again linked to being efficient.
Employees who are efficient are involved in ‘maintenance’ and ‘crisis prevention’.
These employees keep their jobs but they are not effective.
In management terms, efficiency is about doing things right, following the rules, doing one’s duty, anticipating events, and so on.
Effectiveness, on the other hand, means doing the right thing. Effectiveness is nearly always about getting results and improving things - not just doing what has always been done.
Effectiveness is involved in the next two aspects of an employee’s role, improving things and changing things; to be effective means that an employee is ‘adding value’.
As a Practice Manager, you employ someone to carry out the ‘maintenance’ and the ‘crisis prevention’ but you hope they do more than this, you hope they improve things and change things for the better.
Lets us look at the next two elements of an employees role, the ones that lead to effectiveness and ‘add value’.

Continuous Improvement.
Continuous Improvement is a process where an employee adds value by improving their job.
That is, improving quality, reducing costs, reducing errors, doing things more quickly and improving the service that is offered to both internal as well as external customers (other Health Care Professionals, suppliers as well as patients).
All jobs can be improved, even if it is just doing things quicker, smarter and cheaper. Many processes soon become out of date so there is usually plenty of ways people can add value in their own job by better ways of working.

When it comes to the Primary Health Care team, many of these improvements have a positive effect on the service that patients receive or improve the working life of Primary Care employees.

The Management of Change.
Although continuous improvement is about change, it is not radical change; it is more about improving some aspect of the job. The management of change is about coming up with change ideas and implementing them.
You can often identify change because it often challenges current assumptions.
Generally speaking, people resist change, they are happy in their comfort zone of experience.
It is often easy to identify change ideas but difficult to implement them.
But change means adding value, it is another way to be truly effective.

To sum up:

Efficiency is all about ‘maintenance’ and ‘crisis prevention’ and effectiveness is about adding value through Continuous Improvement and/or the Management of Change.

As a Practice Manager, you should look at your own role and estimate to what extent you are efficient and to what extent you are effective!

Many employees are efficient but not effective.

The fundamental reason is that many people are happy to be efficient, keeping their jobs, but reluctant to be effective and add value.
There are several reasons for this sad state of affairs:

• We tend to select people on the basis of ‘can they do the job?’, not on ‘can they improve the job?’.
• Poor time management often means that employees find very little time to improve things; they are too busy with ‘maintenance’ and ‘crisis prevention’.
• We appraise people on the job itself and not how they have changed or improved the job.
• Many Practice Managers and GPs do not encourage employees to think beyond the job. Innovation and change are not encouraged. In some cases senior partners may want to keep things as they are.
• Employees are not motivated to improve things, they would rather just complain.
• All change involves risk. Many people do not like taking risks, however small, there is the fear of failure.
• Those involved in change and risk fear criticism. People do not like change so they are happy to criticise those who try to improve things.
• There might be a blame culture in the PCT; it is safer not to try to improve things than to stick your neck out.
• People find it difficult to think of new ways of doing things, in management terms this is called ‘thinking outside the box’.
• Challenging current assumptions is always difficult because they are ‘current assumptions’.

Many innovations and inventions take a long time to be adopted.
Dyson invented a new form of vacuum cleaner but no manufacturer was interested.
They were more concerned about not selling their vacuum cleaner bags than thinking about the possibility that at some future date they might not be able to sell their vacuum cleaners!

So what should the practice manager do?

• Incorporate continuous improvement and the management of change in all job descriptions. Use words that incorporate improvement and change, not words like ‘to do’ or ‘carry out’ but phrases like; ‘to enhance’, ‘to improve’, ‘To add value’ and ‘change’.
• Select and appraise employees on being effective as well as being efficient. What have they done to improve their previous job over the last year? What plans do they have to improve their present job in the future?
• Praise employees for being innovative - even if the new idea or improvement does not work. Celebrate changes and improvement.
• Tell employees that if the new idea does not cost money, consume too much time and is of low risk then ‘just do it!’
• Visit other PCT’s to see new ideas at work.
• Go to conferences to share new ideas.
• Constantly ask employees about ‘how their job can be improved?’ What wastes their time? What gets in the way of customer/patient satisfaction?

What are the bottlenecks that prevent improvement and change? How can quality be improved and how can costs be reduced?

• Explore new ways of purchasing
• Look at all the systems and processes. Are they out of date? Do they slow things down? Are they necessary?
• Remember, the Practice Manager can add value through how they motivate and manage the Practice Team.

My next article will show you how you can select employees and aim to select those who are not only efficient but effective as well!

Following his highly popular keynote presentation at our PM07 National Practice Management Conference last April, British Lions and Scotland rugby legend, Ian McGeechan transfers the skills learnt from the sporting arena to running a successful surgery.

As a former rugby player and British Lions and Scotland coach, I feel that there are many parallels between my profession and the role of a GP Practice Manager.

For one, both a coach and a Practice Manager are in the front-line - and there is no hiding place! In both cases, it is important to display powerful leadership qualities to be able to deal with people and work out how to get the best out of them.

In both roles it is also necessary to create an operational structure and have the confidence to implement ideas.

The similarities between the two roles do not end there.

In both professions there is a diverse range of tasks to be juggled, such as recruitment, profit and loss, budget, analysis and getting results.

I firmly believe that, in any business, it is the people who make the difference and that individuals need to be nurtured if they are to perform to the best of their ability.

Supportive Ethos

Early in my career I was able to develop in a positive way because I had the necessary support from people when I needed it most.

I have carried on that supportive ethos throughout my professional career.

People need to be encouraged if they are to blossom.

If team members or employees feel as if they are on their own, they will start looking for ways out rather than ways in, and this means that an organisation will not thrive.

Giving team members praise and recognition is essential, for building both trust and motivation.

A good GP surgery needs more than decent doctors; everyone, from the top to the bottom, plays a part and it is essential that everyone feels as if their contribution is valued.

A Practice Manager, like a sports coach, needs to have clearly defined goals and should be able to take a step back from the operation and view it objectively.

Practice Managers should try and see their surgery through the eyes of others - how is the practice generally perceived, does it inspire positive thoughts in others?

It is a good idea for Practice Managers to put down a marker, asking what they want their surgery to achieve and how they would like the outside world to view it.

Aims should be identified and then followed through.

As well as doing the groundwork, it is essential to have conviction in the practice’s ability to achieve the desired goals - confidence is the key to success.

My Advice

My advice is to always give 100%.

Whatever the outcome of manager’s efforts, he or she needs to know that they have given their best, and given it unstintingly.

The following 10 strategies are a place to begin that personal and organizational change.

1 - Release people from prior commitment.

Probably most overlooked is this strategy.

Most often, we forget that one of the reasons people don’t change their attitude is that they have made a conscious or subconscious prior commitment.

Uncovering those hidden agendas usually results in an opportunity to change one’s attitude about previous commitments.

Even stability can be a prior commitment and until I understand that this new change, method or system is going to produce stability, I am not willing to let go of what is stable.

Most people would much rather be right than happy.

2 - Provide new information

Often, people don’t see or feel the need to change.

Providing information to support change, or the need to change, can often open previously closed doors.

Communicating change initiatives prior to implementation is often scary but almost always better than not doing it until the implementation begins.

3 - Use fear positively

Edward Demings says “drive out fear!”

Yet fear can be positive if we take the time to frame it correctly.

Fear of some sort, often creates the urgency needed for change to take place and for change gaps to be bridged, BUT THE KEY TO USING FEAR to show how the present path is NOT the best one.

You don’t just threaten people by stating if they don’t do it they will suffer the consequences.

You use a combination of tactics to show, with information, how the present direction will lead to lower levels benefits and more sacrifice than changing directions, personally or organizationally.

4 - Resolve cognitive dissonance

Most often, each of us has a dialogue taking place inside ourselves about our attitudes and about the results of our behaviours.

To resolve this conflict can often lead to positive changes in attitudes for us personally as well as in organizations.

People are certain that their behaviour always works, yet must often protect that faulty behaviour with an attitude.

Helping them to understand the conflict between their attitude and the behaviour can lead to positive change.

5 - Gather influence from friends, peers and family

One of the major reasons, in my view, for using 360-degree assessment is so that someone can get hit over the head by people whose opinions often matter, saving leadership from doing it.

While this may be the crass side of 360, it works because of the influence of friends and peers. 360’s certainly have weaknesses and, used solely for the purpose of changing attitudes, is probably more harmful than helpful in the “long term.”

However, a structured ongoing program of development that includes regular 360 assessments and training can be effective in changing attitudes in a positive way.

6 - Co-opt

Giving people, whose attitude is different from the norm, leadership opportunity can often lead to positive change for the person and the organization.

Some say “resistance is energy” and this resistant energy occurs often in the form of challenging attitudes and opposition, disagreeableness.

Yet, often this energy can be harnessed to propel the organization forward while leading to attitudinal change in the opposition.

Remember people are different - not difficult.

7 - Have compassion

This may seem like a strange change initiative and a few years ago I would have thought you were “different” even mentioning it, yet compassion appears to hold the key to changing attitudes.

Of course the Buddhist philosophy enamors this method in its teachings and it is consistently brought forward by people like the Dali Lama.

Compassion has a way of building both rapport and offering peace to oneself and those in opposition.

Often the worst thing we can do is to fight fire with fire, merely fuelling the opposing forces and heightening our own negative emotions.

8 - Seek first to understand.

An age old maxim made popular by Stephen Covey’s “7 habits”, empathy, like compassion, forces us to take the view of the opposing force and to attempt to understand the reasons for the resistance.

Much has been written about this “soft” skill but by far, the caring sense that someone expresses authentically towards another person removes barriers to changes in attitudes.

Empathy creates openings for new information and influence to reach through previously locked doors.

9 - Have acceptance.

I hesitated a moment when offering this particular point, yet feel that without acceptance, recognizing that we are all different and that resistance is not always bad, we would lose valuable energy and innovation.

Change occurs consciously and unconsciously and sometimes resistance is just change occurring unconsciously, forcing us to examine things that are outside of our own path.

By accepting that some people will oppose our path, we open ourselves and our organizations to the innovative spark of difference.

10 - Dialog

Providing the space for the disclosure of assumptions, mental models and tightlyheld beliefs in safe harbours can lead to effective attitude change.

If the above strategies are combined into an amalgam of actions, then change in attitude is likely to precipitate. None of this is easy, especially in those organizations or those people that are fully ingrained in the attitudes of resistance for resistance sake.

Yet, taking the time to structure an ongoing dialog can be the initiative for many of the other strategies to provide motivational force to change one’s attitude.

Coaching often stages this personal dialog and can lead to further dialog in organizations as a result.

Coaching often stabilizes the long term effects of short term intervention strategies and enables lasting and continuous change.

It’s been said before, of course - Practice Managers have to be masters of many business disciplines.

There are human resources, legal compliance, financial management, IT support, administration, and customer services to master for any Practice Manager in today’s Primary Care environment - and all that was before Alan Johnson stood up at the Labour Party conference in Bournemouth in September and blew the lid on the next one.

That’s right, yours is going to be a competitive market as never before, with your patients (customers) about to be encouraged to shop around - so what else do you have to tackle to stay at the top of your practice manager profession?

Competition isn’t new!!

Competition isn’t new of course. The fact is though, that your practice is going to have to adapt and find its niche if you are going to be commercially successful.

To my mind, this means that you are going to have to add marketing to your skills quiver.

And I don’t mean creating the odd job vacancy advert for the local paper and next weeks’ GP newspaper - critically, you are going to have to create a marketing strategy.

What are your Your key competitive advantages?

Fundamentally, you need to decide what your practice’s key competitive advantage (or ‘differentiator’ to use marketing twaddle is).

What do you and your practice offer (or want to offer) patients that sets you apart (for the better!) from other practices and is a fit for the direction that your practice wants to take?

You need to find something that, of course, really matters to patients as opposed to something that you or your partners feel is great, but that doesn’t really make your patients say ‘wow’.

Make your patients say “WOW”

It may be that you have new, easily accessible and well-lit premises, or that your teams’ customer service skills are terrific, or that you operate what is acknowledged as a magnificent mother and baby clinic, or that (gulp!) you are open on Saturdays and until 9.00pm Monday to Friday.

Whatever your competitive advantage is doesn’t really matter - so long as it’s worth promoting to patients and means something positive to them.

Note that I have not said that you need to grow.

You and your practice colleagues may decide that you want to shrink - but change the demographic of the patients who choose to use you.

Either way, it’s up to you.

Critically, in tomorrow’s competitive market (and here’s the contentious bit) telling yourself that everything you are doing now is just fine and doesn’t need to improve, adapt or change is a recipe for ruin.

You can be sure that other practices will be hungrily eyeing the best aspects of your practice and aiming to copy or take them - whilst looking at the worst aspects and aiming to make capital from them.

It may all sound a little bit daunting - but don’t worry.

You have a proven ability to keep any number of plates spinning.

You aren’t going to let any smash now.

Your marketing role is 3-fold

1. Agree with your partners the “target” patients that you want to keep or attract.

2. Create a means of doing so.

3. Implement the means and measure the effectiveness.

Why you want them is up to you.

It may be a financial reason, or may be a caring and vocational one - either way it needs to be heartfelt and understood.

As far as (1) is concerned, play to your strengths.

Look at the demographic map of your local catchment area (which you might, incidentally, now expand if you are in the ‘cherry picking’ business) and marry it to the skills and aspirations of your clinical and administrative team.

Then consider your target alongside your commercial requirements - and make sure that they can be reconciled.

With regards to (2), keep a look out for the next edition of Primary Business Today where I’ll be laying out my approach to creating the perfect marketing plan.

As far as (3) is concerned, well you are already a great Practice Manager or you wouldn’t be reading this magazine, so you are already well used to measuring the effectiveness of everything.