Key trends for health and care leaders in 2023

In a kinder world, health and care leaders might be looking forward to a less stressful 2023.

After the extraordinary challenges, scrutiny and reputational issues experienced during the height of the Covid-19 pandemic, the sector would have been forgiven for hoping for a period of reduced intensity. Issues like strike action, Strep A and seasonal pressures, regulatory enquiries, political pressure and media scrutiny of individual setbacks – to name just a few – mean that this is highly unlikely to be the case.

Of course, directors of NHS and other health and care organisations know that this is a sector in which the phrase ‘quiet period’, let alone the concept of taking your foot off the gas, is completely foreign. This frenzied pace can make it difficult to take time to consider future trends and reputational risks – but it also makes it especially important to do so.

Here, we look at five of the most important things to keep an eye on as 2023 develops. All of these were important last year, 5 years ago and 25 years ago. None of them are entirely new in and of themselves, but there are key nuances and implications which are very specific to the current climate.

Visibility

Health and care leaders have huge workloads. But they have to be very careful to resist the temptation to use this as a reason to ‘go dark’, spending long periods of time at their desk hoping to demonstrate that they are working hard at sorting out the difficulties their organisation faces. It can be easy to think that communications is dispensable or less valuable than day-to-day operational priorities, but the reality is that providing clarity and reassurance around what you are doing, is just as important as actually doing it.

Particularly during times of crisis and turmoil, people benefit and take heart from visible leadership. On the flip side, internal and external stakeholders are likely to be disappointed and disengaged if an organisation’s leadership appears to be in hiding. Yes, time is precious but senior management must make sure that they are willing and adequately prepared to make media and other public appearances.

It’s also key that they keep up their internal visibility, both through everyday behaviours and routines in the workplace, as well as the more ‘formal’ internal communications channel their organisation has. As we have written previously, if an organisation doesn’t have well-developed internal communications, then that presents a risk to their resilience when a moment of crisis arrives.

Whistleblowing and incident reporting

It’s important to foster a healthy whistleblowing culture and to respect the fact that whistleblowers are to be championed rather than treated as a threat.

That’s because they help organisations nip problems in the bud. Internal cultural problems which may lead not just to bad publicity, but to potentially tragic patient outcomes, are often initially flagged by whistleblowers.

Bear in mind that someone making a disclosure may not see themselves as a whistleblower, or grasp the wider significance of the concern they are raising. There therefore needs to be clarity about how disclosures and concerns are handled and escalated.

This is particularly important at a time when ‘the NHS is in crisis’ or ‘the health service is stretched to breaking point’ is a more established public narrative than ever before. That narrative must not allow health and care workers to think they simply have to put up with substandard or dangerous practices and just muddle on regardless. And it also means journalists and outsiders are particularly proactive in seeking evidence of such practice.

Families

It has never been more important that families of patients, especially bereaved families or those facing particular hardship, are in the minds of organisations and staff. They deserve to be communicated with in a way that is clear, jargon-free and realistic, but also human and empathetic.

This becomes particularly important in cases where mistakes have led to a bad outcome for a patient, or where circumstances have conspired against you. That’s because these cases, especially if children are involved, are the ones most likely to cause reputational damage via media, something which can happen at lightning-quick speed in the social media age.

Once a case which appears to pose a reputational risk has come to a head, put the family’s needs front and centre of all communications – including those communications which they won’t see. Ask these questions; what are their needs? How should we speak about them? How often do they want to hear from us? Who do they want to hear from? A family which receives good communication may be less minded to go public with their grievances.

Cultural awareness

While some crises are impossible to predict, others raise red flags raised long before they become problems needing an organisational response. These ‘slow boil’ issues tend to have a workplace culture or behavioural element to them, e.g. bullying, harassment, discrimination, unsafe working practices. Most healthcare organisations will have excellent HR departments, dedicated to ensuring employees are happy, safe and fulfilled; however, too often boards and senior management pay scant attention to mechanisms – such as staff surveys and complaints procedures – that flag those cultural issues which may present reputational risks.

Cultural issues are easiest dealt with early, and your employees are your canaries in the mine. Leaving complaints and concerns to fester without due reflection can undermine trust in senior management, which in turn can increase the risk of leaks to the press and the likelihood of stakeholder dissatisfaction were a crisis to arise.

Workforce trends

The already-discussed cosmopolitan workforce will continue to shift in character as a result of Brexit and other migration and international recruitment trends. Alongside increasing competition for jobs across the economy, and the factors which have led to strike action, this adds up to long- and short-term headaches for the health and care sector.

There is likely to be continued media, political and regulatory scrutiny around issues like reliance on people from overseas, the use of agency workers, attempts to innovate around staffing, or measures taken during times of understaffing. These are likely to be particularly fraught when they overlap with Brexit, which is a particularly fraught and divisive topic. This means that it is important for an organisation’s leadership to be able to clearly articulate the rationale behind its policies and decisions.

Leaders in the sector will be aware that when you are asked to articulate them, there will be people who disagree, sometimes fiercely so. They will also be aware that there are no silver bullets or perfect answers to the challenges they face – making it even more important to spend time ensuring that their explanations sound clear and reasonable.