The buck stops with you

A number of times over the past few months I’ve found myself getting slightly hot under the collar about the fact it’s easy to say ‘no’ or ‘I don’t agree with this’.  Sometimes saying no or not agreeing is absolutely the right approach, but there is a difference with not agreeing because something will definitely be detrimental, with not agreeing because something doesn’t sound good, will require working in a different way and possibly be a lot of hard work.  

 On one level the health service challenge is relatively straightforward.  We cannot afford to maintain the system we have in the way that we currently have it, something has to change.  There are many people who still seem not to get this and for once I do not mean the politicians.  Whilst their approach, how they communicated and the speed of  the proposed reforms is far from ideal, the underlying point remains the same, the NHS needs to change, that also means us.  Of course success will mean politicians supporting and backing radical and possibly unpopular changes to the way hospitals (and the wider healthcare system) provide care, but just for now let’s not focus on the politics because that’s too easy, for now let’s focus on ourselves.   

The longer we carry on resisting change the worse it will be.   Many agree that the NHS can become more efficient, we have been talking about it for years.   Many can articulate the need for further joined up, integrated working, so what exactly is the problem?  It is multifactorial, but to a large extent we are the problem.   This includes you and me.  Why?   Because fundamentally we don’t like change and it’s hard.

There are many reasons for being change adverse including a lack of self-confidence, lack of sense of urgency, self / turf protection, career risk, conflict avoidance and fear of the unknown.  Furthermore, and people dance round this topic, some blame everything and anyone else; politicians, the system, processes (often those that originally we put in place), other people and even on occasions next doors cat, when really the problem is us.  We all have an ego, some are bigger than others.

There is good ego; appropriate pride in oneself, self-esteem etc. but there is also bad ego; an exaggerated sense of self-importance and conceit which tends to be what gets in the way of change.   As unpopular as it will make me we have quite a lot of bad ego in the NHS, particularly prevalent in a couple of groups.  

More great efforts have been abandoned or undone by ego left unchecked and conflict not resolved than for other reasons.  Some individuals and groups create such negative energy that they bring down entire teams or systems quite quickly.   Paralysis by one voice (monovoxoplegia) is common; we all will have experience of this.

Ego and conflict can be positive, providing energy and inspiration if managed and controlled.  But when not controlled they become a monster that can destroy teams, causing people to argue and work against each other, focusing more on what is not working rather than what is.

Some consider the reforms unachievable.  Bu how do we know unless we try?  I don’t know what is possible and what isn’t, but I do know that we will not maximise the positive impact of the reforms if we don’t acknowledge that some of the problem is our attitude.   We will go some way towards achieving the unachievable by changing our mind-set and adopting a different approach.   Every single one of us has and can play a part in this; where you sit in the hierarchy or what job you do is irrelevant.

I had not heard of the Nolan Principles, the seven principles of public life, until about 18 months ago. I thought the Nolan’s were sisters from Ireland in the 70’s, I had no idea there was a Nolan Committee which defined principles for holders of public office to adhere to.  These principles are for the benefit of everyone who serves the public, even in a voluntary capacity.   Maybe I’m the only one who wasn’t aware, but just in case I’m not alone or if you need reminding of them, here they are;

• Selflessness
• Integrity
• Objectivity
• Accountability
• Openness
• Honesty
• Leadership

We are experiencing the biggest reorganisation that the NHS has ever seen.   The scale of the change is unprecedented; we don’t really know what’s going to happen or how it’s going to happen but we know that it will happen.   We are the people who have responsibility to make it happen and we have a choice; we either try and make this as positive as possible (positive does not mean agreeing wholeheartedly or mean that it will be easy) or we can take what perhaps might be the easier but weaker option, by saying ‘we don’t like it’, ‘it will never work’, by not taking personal responsibility and using all our energy rallying against it.  The latter option will undoubtedly impact negatively on patient care and in theory we are all against this. 

Our actions need to speak louder than our words.  Pride and bad ego need be put to one side.  For some this will be very uncomfortable and scary and for all it will be very difficult, but we have an opportunity for taking control by getting involved rather than commentating.  

Every time you feel a bit hard done by, aggrieved or scared by change, try and think about the seven principles and then focus on what is better for patients, not what best suits you.   As I write this, I hope I can too.

Attitude determines choice and choice determines results.