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Staff empowerment in pathology

Chika Eze, Cellular Pathology Training Officer, explains why leaving micromanaging behind can have a positive impact. 

Due to the current economic situation and scarcity of resources in the NHS, it is important to empower employees to perform at a higher level, as there is a link between structural empowerment and organisational effectiveness and satisfaction.

The outcome of structural workplace empowerment – which will provide employees with support, information and resources – will be a positive impact on service delivery for both stakeholders and service users. 

In order to achieve a high-quality standard of care in the NHS, mainstream employees should be involved in problem-solving and allowed to develop the skills and expertise required to carry out autonomous professional practice. An empowered work environment also leads to job satisfaction for the employees. 

Kanter’s theory of organisational empowerment provides a basic model for structural empowerment in the NHS. He stated that power is the ability to get things done, and this power can be derived from both formal and informal systems of the organisation. Formal power relates to the individual’s visibility, discretion, recognition and relevance to the accomplishments of organisational goals, while the informal power is developed through alliances with sponsors, peers and subordinates within the organisation.

Staff empowerment gives the employee more authority and responsibility to carry out their daily activities without supervision. Most organisations are designed to micromanage people, but a manager in such an organisation would likely incorporate staff empowerment in order to give more lean way.

For instance, in histology, which is my background, certain grades of biomedical scientists are not allowed to carry out histological dissection, due to inadequate empowerment. The procedure is a complex process and requires highly-skilled individuals and only an advanced biomedical scientist is allowed to do this. But when the advanced biomedical scientist is not available, cases are delayed longer than necessary, which affects the turnaround times. Empowering experienced biomedical scientists at specialist level to carry out these procedures would help. 

The safe application of empowerment in an organisation at the grass-roots level is not always straightforward, especially in the NHS. The outcomes of work to empower employees include positive and negative implications for the manager.


In order to empower the employees, the organogram, as well as the span of control, will have to change to reflect these added responsibilities. Redesigning the organisational structure will be the starting point, if a manager decides to champion this concept. This change could be due to an increase in span of control, or additional roles, or change in reporting system or the reductions of oversight. 

The major advantage of this change in organisational structure is that more work can carefully be designated to an employee. However, there could be lesser performance (not up to the manager’s standards) from the employee. 

Another uncertainty is managerial inefficiency of skill – increasing the amount of work to one average person without knowing their potentials; diminishing returns may creep in. There is also a tendency for managers to under-supervise, due to delegation.  

But there are more rewards of changing the organisational structure for an employee:

  • Motivation
  • High level of employee engagement 
  • Better management of resources, for instance a field manager will be able to take decisions on the spot
  • Job satisfaction
  • Organisational commitment
  • Saves the manager time for other engagements i.e. the manager will be able to spend more time on leadingthan management
  • There is pressure to perform –energised to carry out given task.

Job descriptions

If an organisational structure changes, the manager would need to re-write the employee’s job description and review and update the objectives and key performance indicators.

It is also essential for the manager to have regular meetings with empowered employees to monitor progress of service delivery, but this must be designed so as to not undermine the employee’s authority. This will keep the empowered staff focused and break the barrier of working as a separate entity.  

Increased risk

When employees are left to make critical decisions on their daily activities, there is a high tendency for failure. This is the risk involved in empowerment, because the empowered employees may not see the need to involve the management in order to avoid seeming incompetent. Some may not realise that they are producing an unsatisfactory result and, because they have no on-site manager to keep them focused, they will miss goals and targets. When this happens in the health sector, it is always catastrophic. For instance, with the Francis report, when the processes were breaking down, employees did not seem to realise the actual impact until there was an extensive damage in the system and then a whistleblower. 

As a business manager, when risk is identified, the initial step is to eliminate or minimise the impact on service delivery. The best mitigation strategy is by devising ways of monitoring the
target delivery and more so empowered employees should not be allowed to work as separate entities from the organisation.

Training and cost

Manpower development is a major implication for a manager or an organisation championing the concept of empowerment. Empowerment furthermore involves giving people the tools they need to carry out their task effectively, which is basically knowledge and skills. The learning and development framework will be reviewed to tally with the competency model. There will be cost incurred in every reorganisation for service improvement. In order to ensure appropriate empowerment, there will be costs for training, costs for quality issues that may arise, costs for errors and supervision and costs for losing customers’ or service users’ trust. 


Any manager championing empowerment as a basic concept should also devise ways of monitoring the delivery. This still requires more commitment from the manager to increase their supervisory role. Overall, empowered employees are more motivated to accept extra work and show highly innovative and creative work performance. An organisation that does not encourage employee empowerment is most likely to lose employees and spend more on recruiting, training and replacing lost staff members.    

Chika Eze is a Training Officer in the Cellular Pathology Department at Royal Liverpool and Broadgreen University Hospitals Trust.

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