Multi‐skilling for success Available to Purchase

Attempts to introduce multi‐skilled “hotel services” workers in several NHS trusts have been studied using Scott‐Morgan’s Unwritten Rules of the Game methodology. In‐depth interviews reveal that, even for staff traditionally regarded as “marginal” and low paid, pride in helping patients is a powerful motivator, one which frequently ensures services are maintained, especially during periods of compulsory competitive tendering (CCT). A traditional “command and control” style of management and the fear engendered by CCT produced powerful barriers to different performance levels from multi‐skilling. We contrast this approach with a more emergent exercise fostered in a group of wards where responsibility for the ancillary workers was transferred to the wards’ director of nursing. These wards have now developed more highly motivated, confident support workers and demonstrate a number of resulting performance gains. We interpret the results in terms of the cultivation of a new pattern and a systemic positive feedback.