NHS managers are not taught to understand how the symptoms of the NHS are generated by the invisible processes they and their colleagues in other departments manage. NHS shop floor staff are experts in these processes - but only as far as their own role goes. This process blindness leads to frustration in both parties.

Senior managers in the NHS are frustrated at the limited return for the investment so far (aren’t we all?). Since they are even further removed from the shop floor, they understand the processes even less. So the only mechanisms they have at their disposal are to either restructure the organisation (in the hope that this will remove ‘the problem’) and/or to implement a ‘cultural change programme’ linked to a ‘performance management system’.

Repeated organisational change not only disrupts the invisible processes, it removes stability, leaving everyone vulnerable - especially if the divine right of management enforces performance that is impossible to achieve with broken processes.

Worse, we have seen how incompetent measuring feeds an inconsistent performance management process. And resentment builds on frustration.

So what do frustrated parents or children do (see my last column)? Call in a rescuer. Rescuers are parents in nurturing mode. They damp down the emotional situation but they fail to resolve the underlying process problems in the system that is generating this frustration in the first place. The inference is that rescuers are OK, but the managers and the managed are not.

Moving on

So the smouldering game of persecutor, victim, rescuer continues with the only option being for some players to move on. For managers moving on is an acceptable outcome, but for senior clinical staff it is not. In such an environment being a victim is the righteous place to be and we get the managers we deserve.

Over time the net consequence for the NHS is a system where the broken processes are never addressed and where bureaucracy compensates for management incompetence and a lack of discipline.

Discipline? What, more persecution? No, discipline means an ability to learn by adhering to a consistent approach to problem solving and having the freedom and responsibility to deliver within that framework. Good jazz players are so disciplined in the musical framework they can improvise without disrupting the system.

So the secret to unlocking the NHS frustration is more discipline not less. Who has a discipline for understanding and improving a complex system made up of many interacting processes? How is it done? How is it taught? How is it learned? The implication from the jazz players is that whatever this management discipline is it will require time to learn, relentless practice, consistent teams, professionalism and dedication. Is anyone else frustrated enough to stop, listen and learn? It might even be fun.

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