Contents -

Editorial

N.H.S. Reorganisation News Sheet No. 4

Winwick Study Course in Participative Management

Around the Hospital

Round the N.H.S.

Nursing News

EDITORIAL

We are holding over part 5 of the Attitude Survey this week to publish an account of the Study Course in Participative Management which took place last Friday.

Since October last year there has been no news of Participative Management, and its implications - particularly with reference to Joint Consultation have been unclear.

We are encouraged now that positive action has again been undertaken, and our account, while not 'official', is as complete and accurate as we can make it.

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N.H.S. Re-Organisation
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NEWS SHEET No.4

Training Courses.

Courses for dentists are soon to be started, in addition to the Multi-professional ones already in existence.

Regional Joint Liaison Committees.
These are now working out plans for informing staff in all branches of the N.H.S. about the proposals for re-organisation.

Information.
The Department's central computers at Fleetwood are already producing 2 million items of information per year on Hospital Activity Analysis* and payment of general dental practitioners. While stressing that information is essential to the provision of health care, it is observed that those who demand information should assess whether they could do with less, and that at each stage the benefits from investments in information systems have to be compared with the benefits from using the same financial resources and staff for other health service tasks.

* Data on some in-patient service in acute hospitals. Two regions are developing H.A.A. for application to all psychiatric and mentally-handicapped patients.

PUBLICATIONS COMMITTEE

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STUDY COURSE IN PARTICIPATIVE MANAGEMENT
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Sixty representatives of nursing staff within the Warrington Group attended a Study Day on1 Participative Management held in the Recreational Hall Annexe on Friday, February, 16th.

Amongst the speakers were Mr. P.R. Ditchburn, Chief Nursing Officer, Mr. E. Fox, Group Secretary and Mr. W.A. Wilson, Surgeon. Mr. Llewellyn Jones of Applied Management Ltd. led the discussion, and an observer was present from the Department of Health & Social Security.

The morning session was given over to a review of the meeting held on September 1st, 1972, and a report of progress to date on Participative Management within the Warrington Hospitals Group. Mr. Fox introduced the speakers, and, in outlining the development of the Participative Management Exercise, said that Departmental Productivity/Participative Groups (DPGs) would shortly be set up. He added that these groups would initially involve staff at the lower - rather than the upper - levels of the hierarchy,and said that 'nothing but good could come from the exercise, not only from the introduction of incentive bonus schemes, but also by increasing the efficiency of our service to the community'. He said that one of the early tasks would be to decide how best to select - or elect - people from the nursing staff to serve on the DPGs and ultimately the top Steering Committee.

Mr. Llewellyn Jones then spoke on the main principles of the Participative Management Exercise. He said, 'Participative Management can be defined briefly as a method by which staff at all levels can be involved to contribute as full human beings to the effective performance of their jobs and to obtain the fullest satisfaction from their work.' It was necessary for involvement to be genuine, and for a climate of trust to be created, not only vertically, between all levels in the organisation, but also laterally, 'across the board', embracing different functions, departments and sections. He said that no group could function in isolation in the hospital service, and that the value of PM in breaking down the barriers between groups 'could not be overstressed.'

Joint Consultation
He went on to say that whilst Winwick's Joint Consultative Staffs Committee had worked better than most he had seen, people had difficulty in accepting Joint Consultation as an ongoing attitude of mind - they left it to their representatives and failed to be involved in problem solving. He saw PM as being independent of formal meetings and working parties, but more as a continuous process, involving staff who feel 'this is the right way'. However, machinery would help, and he discussed one problem-solving group who had met recently at Warrington Infirmary to examine the catering service there. He said that this was a practical example of the participative approach, and a decision had been reached in 1½ hours which would have involved innumerable hours of discussion by conventional methods.

Mr. Llewellyn Jones then led discussion on three areas of difficulty cited by staff at the last Participative Management meeting: Medical Staff; Ancillary Staff and administration. He was pleased that some progress had been made in solving long-standing problems, and outlined how the DPGs would prove useful in resolving others.

Departmental Productivity/Participative Groups
DPGs were then described by another speaker as 'a gathering together of a representative group of management and staff who can talk about problems within their sphere of occupation and suggest ways of removing frustration caused by these problems'.

The constitution of these groups was described as follows:

Chairman	- management representative, appointed by management.
Vice Chairman	- staff representative, appointed by staff. (Duties would include deputising for the Chairman in his absence, and agreeing the notes of meetings.
Management Representatives	- these would be from the particular department represented by the group, and would be seen to be part of the group in terms of expressing any recommendation at their particular level of management.
Staff Representatives	- these could be elected by staff and would be seen as representative of staff. It would be vital that they should communicate with the staff and be communicated to by staff also.
Consumer Representative	- this would be someone to act as the patients' representative.
Permanent Secretary	- this person would function for all groups, and his or her role would be more far-reaching than the traditional role of secretary, in that it would involve the avoidance of duplication of work by various groups, the pressurising for implementation of a recommendation by careful wording of the notes of meetings (setting out the action recommended and the facts on which the decision is based), and the followup of recommendations.
Ex-officio Secretary	- this would be a Trade Union representative in an advisory capacity. He would ensure that the DPG did not allow its work to overlap the existing negotiating machinery, and that it understood the full significance of decisions reached.

It was important that discussions in the groups were not merely 'chats'. There was a recognised technique of discussion-leading, involving a number of stages:

1)	Defining the problem
2)	Assessing the savings (how much frustration can be resolved).
3)	Asking what management can do.
4)	Asking what staff can do.
5)	Making recommendations.

Once recommendations had been made, it was then up to management to consider them, and either implement them or give a reason why this could not be done. It should be remembered that management are the decision-makers and their word was final.

Mr. Ditchburn then initiated a short discussion on Joint Consultative Machinery - would it be replaced by Participative Management? It was said that this very much depended on the effectiveness of current machinery; participative management could be added to this if necessary. In one hospital where the J.C.S.C. had become sluggish, DPGs had been established and Joint Consultative meetings had been revived, and were held quarterly to co-ordinate the work of the DPGs.

Mr. Ditchburn was concerned that the Participative Management Exercise was not merely designed to speed the introduction of incentive bonus schemes. If so, he felt it would be a meaningless exercise, for whilst the involvement of nurses in PM could be extremely useful in promoting the patients' interests, if the exercise was not continued it could merely serve to bring frustration to the surface without allowing for it to be resolved. Mr. Llewellyn Jones assured him that PM was intended as an ongoing exercise.

Discussion Groups

After an excellent lunch, which prompted Mr. Hodgkinson (Warrington Infirmary) to express appreciation of Winwick's hospitality on behalf of those present, the meeting reconvened. Further analysis of the syndicate exercise from the last meeting then took place, and the gathering then split up into four groups to try for themselves the process of Participative Management in discussing some medico-nursing problems.

Mr. Llewellyn Jones said it had been hoped that two of the medical staff from Winwick would be present at the ensuing discussion, but unfortunately they were unable to attend. However, Mr. W.A. Wilson played a much appreciated part in the afternoon's business by joining in the discussion and providing a medical viewpoint of the nurses' problems and the solutions which they proposed.

Mr. Llewellyn Jones then summed up by saying that he hoped the day's work had allowed those present to gain some insight into the theory of Participative Management, and the type of results which could be obtained.

PUBLICATIONS COMMITTEE

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SOCIAL THERAPY III - Social Therapist
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The Therapists, whether nurse or any other grade of aide, have first to recognise that there is more to psychiatric involvement with groups of patients than purely custodial care. They require something supplementary in the working situation in order to increase their level of involvement with the patient.

The motivation of the Therapist must be towards greater staff/patient interaction, which will increase and strengthen the contact between them and enable them to achieve effective therapy within any programmed situation.

One aspect of staff/patient interaction was the traditional barrier of 'us and them' (not frequently referred to and never fully admitted). It was recognised that this is a real handicap, especially in the field of resocialization, and the team itself decided that steps to minimise this faulty attitude must be devised. One such step was the discontinuance of the use of uniform at all social activities. This policy was eventually adopted in spite of opposition, and results have proved it to be beneficial in the drive towards more effective relationships.

Enthusiasm in the field of resocialisation is probably the most important single qualification necessary for the Therapist's successful participation (note the impact made by the voluntary helpers), plus a warm, understanding, attitude to their patients, and a willingness to go further in the job than just what is 'necessary'. This is only too apparent when one observes the low level of effectiveness when other grades of nurses are expected to participate in the various aspects of a social therapy programme - in spite of the fact that the expertise of these nurses is unquestionable in their own specific fields.

In addition to what the Therapist can give to a Social Therapy project, this work can, in return, give a great deal to the Therapist, Nurse, Nursing Aide or whatever, by increasing their contact with their patients and thereby creating a positive means of assisting the patient to eventual (possibly complete) rehabilitation.

Social Therapeutics is still too new an area to allow for the establishment of hard and fast rules concerning administrative policy.

However, in the light of four years' experience one fact has become apparent: a Social Therapy programme in any hospital must have the enthusiastic support and approval of the heads of the medical and nursing services. If these people are not in accord with its ideas and ideals, the therapeutics of the situation will fail completely.

A disturbing feature for anyone working in such a Department is the low prestige rating within the therapeutic team. Reasons for this low ranking as far as doctors and senior nurses are concerned may well be lack cf knowledge and insufficient appreciation of the services rendered by Social Therapists.

An understandable response to the contribution of this ancillary service to the total therapeutic concept.

Function and Meaning
Although there is a lamentable lack of adequate theory relating to the aims of the Social Therapy, some basics are clear. Staff starting work in this field of psychiatric care must, as a first step in their training, learn to reject the long held concept that work and recreation per se have the required remedial effect on the mentally ill, and that provision of these is all that is required of the Therapist. They must, and do, recognize the value of resocialization and social motivation as a learning, as well as a teaching process, and must fully realise the great degree of functional impoverishment experienced by many patients, resulting from long periods of hospitalization superimposed on the original illness.

The problem of developing a positive interaction between numbers of patients and staff acting as Social Therapists, is probably the most important single factor in terms of understanding the function of Social Therapy.

Certainly, one of the prime functions of Social Therapy is remotivation. Modestly defined, remotivaticn is a technique of simple group interaction which can be used by the Therapist with his patients. It is a structured activity which enables him to reach the patients in a meaningful and constructive way, over and beyond the custodial care which constitutes the rather limited role of most levels of nursing care practised in large psychiatric hospitals.

It is, without doubt, this inter-relationship with the patients and with each other that is responsible for producing meaning, as opposed to function, and which creates the climate in which sincere involvement, dynamism and the resulting job satisfaction can be achieved.

Remotivation technique -

Alice M. Robinson, R.N., M.S., Director of Nursing Education, Vermont State Hospital, Vermont, U.S.A.

A Textbook of Psychiatry - Henderson and Gillespie.

Cqelius Aurelianus, AD 200, is worthy of much praise. Of particular interest are his reference to:

'Theatricals, entertainment, riding, walking and work. All recommended, particularly during the period of convalescence. Topics of conversation were to be such as would suit the patient's condition. Later, excursions by land and water, and various other distractions were to be used.'

J.A. JOLLEY,
Rehabilitation Officer
Winwick Hospital.

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AROUND THE HOSPITAL
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FOR SALE

Formica-topped kitchen table and four matching chairs (Blue)   £5.

Box No.2

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TECHNICAL NURSING LIBRARY

The tutorial staff would like all the hospital staff to know that they are welcome to use the facilities offered by the above library. As many will know, this is located in the Nurse Teaching Department and is available for the borrowing and return of books from 8. a.m. to 1. p.m. and from 2 p.m. to 5 p.m., Monday to Friday inclusive.

It is intended to offer for publication in the Standard, a weekly list of new books that are available on loan.

The first list is as follows.

'Chamber's Dictionary of Psychiatry' - Brussel & Cantzlaar

'Helping the Aged' - E.M. Goldberg

'Recent Developments in Psychogeriatrics' - Kay & Walk

'Hospitals of the Long Stay Patient' - D. Norton

'A Guide to Activities for Older People' - MC Wallis

'Nursing the Mentally Retarded' - Gibson & French.

NURSE TEACHING DEPARTMENT

** ** ** ** League of Friends of Winwick Hospital

Sale of Christmas Cards, etc

Profit made to date is £237.39.

As I now qualify for a Sales Bonus which is paid in April, this should be increased by at least a further £20, making a total of approximately £257.

On behalf of the Winwick Hospital League of Friends I wish to thank EVERYONE who has participated in making this effort such a success.

Edna Thomasson
League of Friends Member

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PROFESSIONAL HOUR

Charge Nurses and Ward Sisters heard Dr. Briggs lecture on the subject of 'Hypnosis' at their 'Professional Hour' held in the in-service training room on Thursday, February 8th.

Dr. Briggs, founder member of the Society for Medical and Dental Hypnosis, gave a fascinating account of the subject, and demonstrated some of the hypnotic phenomena with the aid of P/T/S/N K. Meeks.

PUBLICATICNS COMMITTEE

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ROUND THE N.H.S.
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Guidelines for '74.

The Department of Health and Social Security recently issued the first circular of guidance on the management arrangements for the reorganised health service.

Issued by the Secretary of State in view of the comments received on the report 'Management Arrangements for the Reorganised Health Service', the circular sets out three essential features which the new health authorities are to be required to adopt. The first is a system of control in which 'performance is monitored against plans and budgets'. Secondly, it is confirmed that the district is to be the key operational unit of the N.H.S. The third essential feature will be the multi-disciplinary teams at district and area level, which will be responsible to the area health authorities, and at regional level, which will be responsible to the Regional Health Authorities. These teams will be responsible for formulating plans for health services and for co-ordinating implementation.

The Secretary of State accepts that the district should wherever possible be the basic operational unit of the reorganised health service. The district is defined as 'a population served by community health services supported by the specialist services of a district general hospital'. Although there will be no strict limit to the size of districts, the usual population will be between 150,000 -- 250,000. The majority of areas will either not be divided into districts or will have only two districts.

Area and Regional Tears .
The Secretary of State accepts that teams will be set up along the lines described in the original management arrangements report. The Chairman of the teams will either be elected by the teams themselves or appointed by the relevant authorities 'after such consultation with the team as the authority thinks fit'.

Both the area and regional teams will include a nursing officer, medical officer, treasurer and administrator. In addition, the regional team will have a works officer as a member. These teams will be known as the regional team of officers (RT0) and the area team of officers (ATO). In areas which are not divided into districts, the team will also consist of a representative consultant and a representative general practitioner.

The multi-disciplinary team at district level will be composed of a district community physician, a district nursing officer, a district finance officer and a district administrator. Together with a representative consultant and a representative general practitioner these officers will form a district management team (DMT).

PUBLICATIONS COMMITTEE

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NURSING NEWS
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Welcome to:

Mrs. J. Houghton, S.E.N.
Mrs. C. Cunnane, N/A
Mrs.M. Cook, T/Staff Nurse, N.D.

Farewell to:

Mrs. P.A. Marsh, T/NA

Visit

Students from Greaves Hall will be visiting the Hospital on Thursday, 1st March, 1973.

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