Relationships and reorganisation in the NHS

Quote

“When wealth is lost, nothing is lost; when health is lost, something is lost; when character is lost, all is lost.” Billy Graham

News

Far reaching reforms to the English National Health Service (NHS) were implemented this week, as responsibility for health care spending was passed down to over 200 local commissioning groups.   At the same time, deep problems in the NHS were brought to light in a damning report into poor care in North Staffs, which led to 1200 unnecessary deaths and a culture of neglect.

NHS reorganisations are hugely expensive.  A senior NHS executive admitted that during the last restructuring, the service lost its focus on patients and was preoccupied with managing the changes and merging organisations. 

The effectiveness of any reforms depends on accurate diagnosis and appropriate prescription.  The fundamental issue is an absence of values around care and respect; managers pursue financial targets rather than patient care.  But the prescription proposed is more of the same: setting new targets around values, holding people accountable for care and punishing staff who fail to deliver.

Such remedies view the healthcare service as a giant machine, which can be micro-managed to improve performance.  But what if the NHS is essentially a vast network of relationships?  Changing organisational values and culture then becomes an organic, relational challenge, involving leadership by example, cultivation of trust and responsibility, and a focus on patients’ experiences as much as clinical outcomes.

These softer goals are less amenable to target setting from a centralised bureaucracy; but they are more human, more caring, and more likely to deliver positive outcomes – not only to patients, but to anxious, overworked staff too.  

Read on…

A much more thorough analysis of relationships in the NHS was made by John Ashcroft and Geoff Meads in 1999.  Although the context of the NHS has changed, much of the underlying thinking and analysis is still pertinent.  Read the book online here.

Walk the talk

Is there an organisational problem you are trying to solve by tightening up the rules?   Might a focus on cultivating more healthy relationships of trust and respect produce a better result in the long run?

The last word

From the Bible, Proverbs 11, verse 17: “Those who are kind benefit themselves, but the cruel bring ruin on themselves.”