The ‘F word' may be standing in the way of increasing health and social care productivity: FEAR. 

All too often the drive to ‘do more' is accompanied by the words ‘with less' – two words that generate anxiety and leave people worrying about their financial security. 

But if health and social care leaders were to assure staff that increasing productivity would not result in job losses – after all there is pent up demand across the whole of the health and social care economy – then they may reap massive benefits. In addition, if leaders agreed to follow the evidence rather than their preconceptions, then things might move forward at pace. 

The temptation, in trying to sort out public sector productivity, is to set up some sort of government led working group or commission. Nothing could be less productive. It would produce, no doubt, a series of recommendations and leaders may attempt to foist them on a reluctant workforce. The local version – top-down big pushes – simply trigger fear and cause people to hunker down. 

The solution should be far simpler  –  and more effective: ask each worker to do it themselves and trust their judgment; they do the job, after all. 

Leaders would start by defining success for each team or directorate. These should be measured in units that are meaningful both to staff and importantly clients, patients or service users. If they're too vague (‘we're here to make a difference') then you may as well have none at all. Equally, a goal such as ‘spend less time in meetings' is no more than an enabler to a greater goal, apparently meaningful though it may appear. 

Then staff could be asked to do a time and outcome audit - looking at where their time goes and what they get for it, what outputs or outcomes they are able to achieve. Time audits, recommended by management guru, Peter Drucker (The Effective Executive) involve noting how we spend each unit of time. This could be as little as 15-minute blocks. Typically, time audit categories would include: face-to-face client time; meetings with colleagues; email; and phone calls.

The key is honesty; chatting with mates in the corridor should be noted as ‘chatting' rather than ‘networking' or ‘sharing knowledge'. But time audits will never work, though, if they're perceived by staff to be a route to cutting posts or pushing people out. So, these logs would not be widely shared or used to build a case for downsizing. Rather, they'd be there to ensure that changes are built on hard facts not supposition. 

Next, staff would be asked to consider their audit and look at any emerging patterns, places where simply doing things differently could increase daily output. For example, they may find they can get more paperwork done at home or they can make more phone calls in the morning. Equally, they may be able to see ways in which technology can increase their workload. These are the productivity ‘low hanging fruits' and may already be in the gift of leaders. 

Next, and crucially because health and social care are collective operations – we work in teams – each member of staff would look at their dependencies. These can be obstacles to getting more done – if one person has done all their work but needs other people to do theirs before completing the task, then nothing will change unless they work together differently. Bringing teams together to consider what they could do in other ways – independently facilitated – could unlock more. 

Finally, staff would present their recommendations to their leaders. This could be challenging for them – and it may cause them to recognise they are part of the problem. For example, despite evidence that hybrid working allows staff to achieve more, there is a persistent obsession with presenteeism. This may say more about outdated leadership attitudes than anything else. Follow the evidence. 

Leaders and staff then need to agree to both make the changes and to re-evaluate in six months' time. Facts matter. They help to build the case for better ways of working. Lessons in each organisation can provide guidance that can be shared with other staff across the health and social care sector.