Nobody asked for more people
A practice that had grown to four surgeries, eighteen people, four flip charts and two hours. And a complete list of what they asked for, with no staff on it.
You’re short of people. You’ve been saying it for months, the rota backs you up, and about the symptom you’re very probably right.
I spent a morning in the summer with a practice that was just as sure. They’d grown from a couple of surgeries and a handful of people to four surgeries and a team of eighteen, they’d hired well, and things were still getting lost somewhere between the clinician, the desk and the patient. So eleven of them in the room, four flip charts, two rooms and one question: what needs the most work around here?
The exercise that didn’t work
I split them into four groups and put them in separate rooms so nobody could hear anyone else. Twenty minutes later I ran the part I’ve run in more practices than I can count, where each group reads the other boards and ranks them one, two, three, so the room ends up with its own priorities rather than mine. People usually argue a bit, and something always rises to the top.
Not this time. Somebody asked me to read all four boards out again because she’d lost track, and when I did you could hear it in the room. Board one and board three were the same board in different handwriting, and the other two weren’t far off. Then one of the nurses said it: “We’ve all sort of said similar things, so it’s quite hard.”
There was nothing to rank. And on none of the four boards, in over two hours, did anybody ask for another pair of hands.
They already knew
That’s the bit worth slowing down on. If nobody knew what needed fixing, you’d have got four different answers. Four groups working separately landed on the same list, which tells you agreement was never the problem, and neither was effort. This was a caring, capable team with a good owner, and they’d known what needed fixing for months.
One of the nurses showed me exactly how long. She described a problem they’d already met about, already talked through and were, in her words, working on, while the notes from that meeting were still on the whiteboard behind her. Nobody was ignoring it. They’d met about it, which feels like doing something, and it was still happening.
What growth does to a handover
One of the groups put the whole thing better than I could have. Their systems had been built for two surgeries, and they were now running four.
Growth is what exposes this. In a small practice the handover between clinician, nurse and desk runs on everyone being in earshot. You don’t need it written down, because the person who knows is ten feet away. Double the surgeries and that stops being true, and nobody notices the day it happens. What they notice is things getting lost.
And the natural response to things getting lost is to hire, because it feels like a workload problem. It is a workload problem, but only on the surface. Every new person you bring in is another handover, so if the handover is the weak point, more people make it weaker, not stronger. The hiring didn’t cause the problem and it didn’t fix it. It exposed it.
The tally
Here’s everything that team asked for, across four boards and two hours.
A manual. A flowchart. A protocol. Clearer roles. A training session for the nurses. A leaflet. One extra step in the recall process. A phone call.
And here’s what nobody asked for. Another pair of hands. Nobody asked anyone to care more, try harder or be nicer to each other either.
I’ve seen that pattern in enough rooms now that I’ve stopped calling it a coincidence. Give a stretched team some time, a flip chart and every reason to ask for more staff, and they tend to ask for structure instead. They’d diagnosed it themselves, too: a huge amount of change and more work for everybody, without the framework to support it.
Why a good team is exactly the point
It would be easy to read this as a story about a team that had let things slip. It’s the opposite. They scored themselves well and they were right to. They were warm with patients, they covered for each other, and they knew what good looked like.
That’s precisely why another person wouldn’t have helped. The gap wasn’t in the people. It was in the space between knowing what good looks like and having something in the working week that makes it happen on a Tuesday when two people are off. You can’t recruit into that space. You have to build across it.
None of that is a criticism of how they’d got there. The systems had been right for the practice they used to be. The only real mistake left available is to keep running them for the practice they are now.
Before you write the job advert
So before the next advert goes out, three questions. I’d answer them honestly, on paper, before anyone touches the job description.
What would this person actually own? Not what they’d help with, what would be theirs.
Who decides it when they’re not in?
Would the handover survive them being off for a week?
If you can answer all three, you probably do need the person, and you’ll be hiring into something that will hold them. If you can’t, the vacancy isn’t really the problem. The new person will walk into the same gap the last one did, and the good ones don’t tend to stay in it for long.
That’s what I’m talking about on Tuesday 13 October at 7pm, in an hour with Dentistry called You Can’t Hire Your Way Out: why good people really leave, what makes them stay, and the four things that hold a team together. It’s free and it counts as an hour of CPD.
Save your place → https://marktopley.co.uk/webinar ·
from 14 Oct: https://marktopley.co.uk/replay
from 24 Oct: https://scorecard.marktopley.co.uk/
