In charge but not in control 

Who is in charge is a question that comes up a lot at work in all types of organisations. At one stage in my management career I was responsible for 83 Nursing and Residential  care Homes. Before we changed their job titles each Home had an Officer in Charge. This type of institutional care regularly throws up scandals involving abuse and neglect and routinely involves allegations of bad or indifferent care and establishments run more for the convenience of staff/ management than the needs of residents. When these situations come to light the question is asked who is in charge? But all too often what is really being asked is who is responsible and who is to blame. The answer is rarely the person in charge. 

As is often the case in organisations the individual who is formerly disciplined is the front line worker. In this example the care assistant. Which of course is right. However as a chair of these disciplinary hearings I often heard the individual or their representative state in mitigation poor management both at officer in charge and senior management level. They would draw attention to the inadequate staffing level that obliged staff to take short cuts if they were to get everyone dressed, washed and toileted in time for breakfast. That the reason patients were over medicated/ sedated was that a number of residents/patients had dementia and their resulting agitated, disinhibited and wandering behaviour could not be managed on minimum staffing levels. That the individual subject of the hearing had not received a proper induction or specific training in caring for people with dementia. Whilst this did not excuse their poor and inappropriate care practises it did go some way to explain how such practises developed especially when accompanied by inadequate supervision levels. 

Whilst this would often be a blatant attempt to deflect blame poor management at a unit level was obviously a contributing factor. But was the Officer in Charge really in charge when they had so little control of factors influencing the quality of care. After all it was a senior management decision to cut the training budget, to freeze vacancies and restrict the use of agency staff as an ,”urgent budget measure”. It was senior management that introduced greater use of zero contacts as part of reducing staffing costs. And senior management who reduced the number of supervisory post as part of cutting management overheads. 

Senior managers/the board would point out the constraints that they are obliged to operate within. So we know who is in charge but are they in control ? 

Blair Mcpherson former Director author and blogger www.blairmcpherson.co.uk