Africa Business Communities

Stallone Obaraemi-Samuel: What Nigerian Businesses can Learn from the Mordernising Medical Careers Program

At different points in an organization’s life there may be perceived needs for certain changes to be done. In most cases such changes are achieved through the enactment and implementation of relevant policies. Painfully in some cases although beautiful policies may be created, the bane has almost always been lack of effective implemention. Same was the case with the Modernising Medical Careers (MMC) programme. 

According to Wikipedia (2014), in 2005, the Modernising Medical Careers (MMC) programme  was introduced in the United Kingdom for postgraduate medical training. The original plan was for the programme to replace the known elementary and mid-grades of medical career before practitioners get to the level of consultants. Although the different stages of the programme were built to contribute towards a "Certificate of Completion of Training” (CCT). It was later bathed with myriads of criticism within and outside the medical profession. For purposes of this submission, it is worthy of note that by MMC we are referring to both the programme itself, according to Wikipedia,  and also to the temporary organization, formed in 2003, responsible for its nationwide implementation.

The primary aim of the programme was to reform the postgraduate medical education, develop a credibly flexible pool of doctors that will both help patients and effectively communicate with both patients and colleagues.

What factors and practices led to the failure of Modernising Medical Careers from a Human Resource Management Perspective?

At the earlier stages of its existence, the MMC faced series of challenges and criticisms and eventually failed. NHS (2007) shows that the various factors responsible were

Faulty Strategic Foundation

According to Tooke (2007) the MMC was a laudable and honest attempt to accelerate the training and development of doctors in preparation for the next generation of doctors, the initiative almost crumbled upon its very foundation, which was built around a system of central selection and training of specialists.

No Consensus

From that same article above, another report from Sir John's canvas explored the background and context—of the factors that may have contributed to the perceived problems of the organisation and programme. His inquiry found grim “vagueness and frailty.”  (Tooke 2007 p. 1) The various stakeholders seldom or sometimes never reached a unanimous agreement on the modus operandi, principles and processes that were to guide the postgraduate medical training. Furthermore there were weak or sometimes no clear design for creating the relevant consensus.

There were weak links everywhere; unclear principles, weak contractual base, all led to having a fragmented structure.  There was also little link between those in the academic world of medicine, and the actual practitioners.  There was no team, and this was evidenced by the massive policy vacuum.

Absence of  Accountability

Another factor that possibly led to the failure of MMC was conspiracy and lack of ownership. For organisations to function effectively, the entire plan and design should be put together in the form of a huge project. The objectives must be specific, measurable, achievable, relevant to the business of the organisation, and must be time bound. It should be clear who is responsible for what and who is accountable to whom and for what. Above all there must not be any doubt as to the collaboration of the team towards achieving set goals. In the case of the MMC, there was a huge gap, in some cases probably occasioned by deliberate conspiracy and sabotage.

Management Style

The MMC story and its failures reveal that that the management style used was a top-down approach. Decisions were taken at the top without due consideration for  the peculiarities and differences of others below the ladder. Rather than a consensus approach, the top simply meted out prescriptions to the rest and this eventually led to failure to engage properly and extensively with the medical profession. Consequently this resulted in the fear and scepticism as to the quality of healthcare delivery.

Issues of Diversity

The policies and processes of the MMC at the time was diversity limiting, and this affected flexibility and excellence in medical training.

Faulty Pilot Scheme Design

Considering the mammoth size of the MMC programme and its attendant departments, pilot schemes and major organisational changes required extensive and in-depth, well thought-out designs that are properly laid out to test and refine ideas. This unfortunately was not the case. Eventually unintended consequences were met with. 

Absence Of Proper and Constructive Dialogue in Developing Solutions

There was no strong relationship between doctors, there professional bodies and the government. There were widespread suspicions and criticism across the various stakeholders.

Low Employee Morale

The morale of trainees was very low as they faced the prospect of not having a job, and various uncertainties that surrounded their career and their future.

Lack of Clear-cut performance management System

The performance assessment and management processes were grossly insufficient in terms of robustness, and inherently inflexible. Consequently there occurred a lack of competitive progression , and no natural point at which individuals could adjust their career choices as par their specialties in tandem with their discovered abilities.

Weak Resourcing Programme

The success of the organisation is heavily hinged on having the right workforce, attract, maintain and retain same. For the MMC, their recruitment and resourcing policies and procedures were faulty and implementation, weak. There were also technological failures both with the tools they had and in the processes. Their culture eventually began to fall apart as even their internal stake holders lost faith in the quality of the recruitment process and the resources eventually brought into the organisation. These failures became viral that the MMC lost brand strength and relevance, and doubts in its efficacy and capacity to deliver the desired results became rife.

Work-life imbalance

Employees were overly stretched beyond the prescribed work periods and hours. Work-life balance came under heavy strain. Health and safety regulations were neglected and occupational health issues suffered.

Little or no Commitment to Learning and Development Programmes

The existent policy infrastructure did not fully support learning and development. The learning and development avenues, methods and tools were not sufficiently flexible and accessible. Career paths were not clearly defined and maintained so that employees were not also encouraged to pursue same. Consequently there seldom were management and leadership trainings. Because employees worked long hours, they did not have sufficient time to study qualitatively and to become trustworthy specialists.

Insufficiently Knowledgeable Line Managers;

Line managers form the beam for the successes of policies and their implementation. The recurrent gaps evident in the failures of the MMC especially in the areas of communications and collaboration reveal that line managers were not sufficiently carried along and engaged in the various human resource programmes and policies. Consequently by the time the message passes from the policy origin to the employees via the managers, it would have been adulterated somehow and because the firm buy-in of the line managers was not obtained from the outset, implementation is weak and eventual failure follows.

Take Home for Nigerian businesses

For businesses in Nigeria the level of structural non-alignment and in some cases decay is disturbing. The leadership of organisations cannot afford to be quasi-inclusive in formulation of policies which will in the long run impact implementation. Fantastic policies may amount to nothing without adequate collaboration across board. Emphasis must shift from the rank and file and focus on the leadership. Discipline in imbibing a great corporate culture is not negotiable. Like we saw, despite the great vision and good intention of the MMC programme, it met a tremendous flop at implementation stage. Any organisation could face the same fate. Therefore, African organisations must pay rapt attention to employee engagement and performance management from top to bottom.

Stallone-Obaraemi Samuel is Senior Human Resources Manager with TNS Global. Follow him @twitter.com/Stupendousstal

 

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