Potiphar12's Blog
An Octogenarian in the modern world


The UK media are giving extensive coverage to problems in our National Health Service. Failures have been uncovered and fingers are being pointed. The problem is so complex that assigning blame to a single person, or group, or practice or event would be a simplification. Yet, there are lessons to be learnt (or re-learnt) about the dangers facing large organisations. Here are some ideas.

NO COW MUST EVER BECOME SACRED. The NHS became a sacred cow because the morality behind its creation was compelling. A situation in which some people were denied medical care because of povertywas disgraceful. The NHS was so clearly an improvement that any criticism was seen as opposition to a beneficial change. The NHS was also the achievement of one political party. That party naturally wished to defend it (which meant fending off any criticism). The other party had no wish to be seen as attacking such a morally good institution. So serious examination of the efficiency of the NHS was a non-starter. If things went wrong, the response was to provide more money. It is interesting that the present crisis was not provoked by cost. It really got going when the NHS was seen to be failing in its duty of patient care. All organisations in the public sector need constant scrutiny.

THE BUCK HAS TO STOP SOMEWHERE. As human organisations have grown bigger, there has been a change in attitudes towards the top man or woman. Sometimes the post-holder is viewed as a figurehead, and a person is appointed with that task in mind. We forget that the top man or woman is responsible for everything – the lot. We have come to accept the excuse that “I was never told”. Properly, the task of the top person is to appoint and direct staff members so that he is fully aware of what is happening and can act to rectify any errors. It is an extremely demanding job and those who fail should resign. It is hardly surprising that some do fail, but that is the risk that they take. It is unfortunate that in our society failure as the head of one organisation is quickly followed by appointment as head of another.

IDEOLOGY CAN BE DANGEROUS. Our society has exalted EQUALITY and FAIRNESS and SAFETY to a point at which they reduce the ability of an organisation to fullfil its purpose. Time and money and effort are wasted in bureaucratic attempts to achieve the impossible. Life is not fair. We are not all equal. The elimination of all risk is impossible. For an organisation to be efficient there needs to be discipline. Where performance is sub-standard, correction must be firm and clear without any regard to possible complaints or legal action.The Human Rights of the patient are far more important than the personal feelings of individual staff members.

THE PRICE OF COMFORT IS TERRIBLY HIGH. Human beings like to feel comfortable, and a stable environmemt contributes to that feeling. It is a matter of knowing that one can perform ones’s work to a satisfactory standard and that there is nothing to worry about. The prospect of change suggests new learning to be attempted and new standards to be reached. It is not generally welcomed. Human nature can’t be changed, but there is something to be said for deliberate organisational changes just to ‘shake the bag’. The idea behind the Chinese Cultural Revolution was not wholly ridiculous. The price of comfort may be inertia.

VISIBILITY. It makes a huge difference to morale and commitment if the person in charge is seen by staff. This idea may seem ridiculous in a world where he or she is constantly moving from one essential high-powered meeting to another. A moderniser might poor scorn on the image of Henry V going round the English camp before Agincourt. “Quite impossible in the modern age.” That will be said. But how often might a high-powered meeting be attended by a well-briefed colleague? For the ultimate boss of the NHS, there are just too many places to be visited and people to be seen. But for the boss of a single hospital it would not be that difficult. Has the importance of connecting with the foot-soldiers been forgotten? I fear that current attempts to put things right may be just the substitution of one bureaucratic procedure for another.


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