In my report on Lincolnshire I recommended that health system development plans should be introduced across the NHS. This is quite deliberately a recommendation about process because when dysfunctional organisations or health systems are examined the single biggest issue is a breakdown in relationships.


The research is abundantly clear about the crucial importance of 'soft' skills, such as relationship building, to personal, organisational and inter-organisational success. Failure in developing effective relationships is one of the half-dozen or so symptoms of failure in healthcare organisations. Of course, other things do have to be in place such as decisiveness and follow through. Being pleasant and possessing good listening skills by themselves are not enough.


What I'm proposing is not a bureaucratic planning process but a simple and straightforward one-side of A4 list of what leaders across a health system are going to do to improve the way they do business with each other. After all it's people who actually do business with each other, not departments, services or organisations. Simple examples would be board-to-board events, strategy summits, clinical leaders working together to develop specific clinical networks, committing joint resources to change or develop services, the appointment of joint staff, and so on. 


The point about the recommendation is whilst there's frequently an explicit discussion between leaders about what has to be achieved there's not always a discussion about the importance of developing more mature relationships as the basis for stronger partnership and collaboration. This is not only to avoid the risk of failure but also because mature relationships make it easier for people to discuss their differences without falling out completely. Also, stronger system-wide collaboration is going to be much more important in managing the impact of the recession. At times of adversity most people will want to huddle together for warmth and survival.


I regularly hear about interpersonal differences between organisational leaders that have lapsed into an exchange of emails and letters to avoid face-to-face meetings. Essentially what these leaders are doing is digging themselves in by continual repetition of their position. This is an abrogation of responsibility, not just to themselves but more importantly to their staff, communities and stakeholders. Eventually these leaders will come unstuck as the 130 or so inquiries into healthcare organisation failures over the last forty years have shown again and again.