Published: 10/03/2005, Volume II5, No. 5946 Page 36

Most NHS managers may not realise it, but the news that Brad Pitt and Jennifer Aniston may be divorcing has direct implications for health service management. The divorce could be down to a psychological process which managers encounter on a daily basis.

The latest psychological theory about why very attractive people tend to divorce is that their very desirability is at fault. Might it be that the attractive are less likely to stay committed during the difficult times because they know they can always find an alternative?

New research by Denise Previti and Paul R Amato at Pennsylvania State University found that up to one in four marriages in the general population only stay together because partners couldn't find a better alternative.

It would seem that some of us only stay married because there are significant barriers to leaving.

Staying married for the sake of the children was the most commonly mentioned, cited by 31 per cent of all respondents in the research. Others included a lack of financial resources and religious beliefs. Now suppose you have no financial barriers to leaving a relationship because you are wealthy, you feel you can purchase the best childcare money can buy and you're completely confident you will find another gorgeous partner - then how many of the rest of us would really stay married to our current partners?

The problem for NHS staff is not dissimilar. Being a monopoly employer with increasingly uniform work practices, do many stay in their jobs not because they really want to but simply because there is not much alternative?

We are used to the idea that patient choice might drive higher quality. If workers felt they had more choice in terms of a variety of working practices, then poorly run hospitals might find it more difficult to retain staff, and as a result be driven to get their act together.

If we all felt like Brad Pitt, how many of us would stay wedded to this ugly sister? If she knew Brad Pitt had a roving eye and some options - might she not spruce her act up?

Raj Persaud is consultant psychiatrist at South London and Maudsley trust and Gresham professor for public understanding of psychiatry. His new book, The Motivated Mind, is published by Bantam Press.