The concept of autonomy at work reflects people's need to have sufficient control over their work life and to be able to act consistently with their values. This could include having the influence within your organisation to change how care is structured and delivered, as well shaping your working conditions or working patterns.
London Ambulance Service NHS Trust
The role of paramedic or call-handler is responsive, requiring sound judgement in an environment which is highly reactive and in which the events of the working day cannot be planned.
Paramedics in particular, operate in small, mobile teams, with a risk of feeling isolated or disconnected from teams, and the role of managers or larger teams onsite whose daily focus may seem quite different from their roles. It can be difficult to forge usual working relationships and connect with colleagues across the organisation making face to face team briefings, line management relationships, visibility from senior leadership and training and development critically important.
Despite the many unique challenges of their roles, paramedics and call handlers often operate with high levels of autonomy, empowered to make informed, clinical decisions within an agreed approach to risk management.
Daniel Elkeles explained to us how the LAS is working to ensure all staff have sufficient autonomy to shape how their roles are delivered. Taking learnings from the Buurtzorg Model of self-managing teams, LAS is implementing an approach which sees local operational teams come together to manage their own rotas and have team huddles ahead of a sequence of shifts.
So far just over a quarter of the LAS’ operational teams have adopted this model of self-management, with more teams working to implement the change.
The groups that are working on a self-managing basis develop their own rotas, which are only signed off when 50% of the team agrees. The core principles are that consecutive night shifts should be avoided, there should be proper downtime between shifts and managers are expected to work shift patterns as well.
This form of self-management helps remove a sense of a central “head office” imposing working patterns, providing staff a greater sense of ownership and autonomy in their work. Daniel told us that the approval rate for the change is very high, at around 90% and the sickness rate has dropped to around 3%, compared to a national average of 7% for ambulance trusts.
East of England Ambulance Service NHS Trust (EEAST)
EEAST are in an earlier phase of implementing more autonomous models of working. Tom Abell has already led a process of reorganising the trust’s leadership structure, with a view to creating local teams with more autonomy. EEAST took the view that embedding a leadership culture of respect and compassion is key to developing a sense of autonomy across the workforce, however this leadership approach was not consistently applied across the trust.
Investing in training and upskilling managers is a priority for EEAST, but so too is taking a firm and clear approach to setting out the behaviours and values that are expected in leadership roles.
As well as putting in place a positive support scheme and training offer, the trust also launched a voluntary severance scheme (Mutually Agreed Resignation Scheme) to support some leaders to move on from the organisation at the appropriate time for them. In taking this direct approach, being clear about the kind of leadership that is needed to support autonomy, the trust has taken early steps in developing self-managing autonomous teams.