For an organisation which restructures itself more frequently than the Italian government, the NHS doesn't seem to do it very efficiently. In its pursuit of political correctness and 'visible equity' the NHS treats its staff unfairly, prolongs disruption and damages clinical services.

Of course, it would be nice to believe reorganisations will be less frequent in future - for a stable environment is key to developing services successfully. The winning projects in last year's HSJ Health Management Awards all had project leaders and chief executives in posts longer than three years.

But we have to accept that the politician's answer to an awkward question is to announce a 'review', and that NHS managers have a duty to minimise the disruption subsequent reorganisations cause. Yet current consultation and selection procedures have more to do with the 'pursuit of visible equity' than with getting the right people in the right jobs as quickly as possible.

The process goes like this: rumours, announcement that change is being considered, production of consultation document, consultation period, decision/protest/confirmation, procedural agenda, job specifications, advertisement, selection, appointment of chief executive. The process is then repeated down the various levels of management. It may well exceed the time interval between reorganisations.

Once, a reorganisation was the only way to remove ineffective staff - but no longer. A selection process should ensure the organisation gets the people most suited to its needs at reasonable cost. This is not the same as getting the best person into a single job. If a company always recruited its directors from external sources, it is unlikely its middle management would be full of rising stars.

Companies handle selection in a number of ways. At one end of the spectrum are companies with powerful human resources departments that generate change in the interest of career development.

At the other end are companies where operational management is in the driving seat, and an HR department is viewed as a database. External recruitment is more common, and teams are built by successful leaders and moved within large organisations or industries. Right across the spectrum, a company's ability to reorganise quickly and with minimum risk is considered vital for success.

In the NHS, by contrast, through its pursuit of visible equity, reorganisation procedures are long drawn out, and staff selection is either a sham or ignores the known abilities of staff by relying on the panel interview.

As a trustee of a small charity, I was discussing recently whether to change the title of our single employee from development officer to director. This was to make her job easier as well as recognising she was doing it well. A colleague said that if we were really an equal opportunities employer, we should redefine the job and advertise it nationally. In this climate of political correctness, we decided to keep the original title.

This scenario is effectively repeated almost every time there is organisational change. 'Promotion' is not a dirty word, and it is time the NHS valued its staff sufficiently to select them without the lottery of a panel interview. Sure, we have to be aware that we all like selecting in our own image, but why disregard the evidence of years of evaluated employment in favour of a 20-minute panel interview?

If the NHS is to go through the next round of restructuring without losing sight of the need to provide cost-effective healthcare, it is time to change the way we manage change. The architects of the change should agree the board's composition and the procedure for appointing the chair, chief executive and HR director.

Advertising externally should be necessary only in exceptional circumstances. Unsuccessful candidates should be allowed to exit with dignity, or be placed in secondary positions. Early retirement should not be an easy option.

Assuming the chief executive or HR director was involved in the organisation before the change, and that the change was subject to consultation, the new structure can be determined within a few days and existing staff matched to available positions. It should be necessary to resort to the panel interview in only a few instances.

So that any aggrieved staff have a chance to go for a more senior position, it might be worth considering a practice in one Australian bank where the personnel department makes appointments following informal discussion with the manager.

All are subject to confirmation after four weeks, during which any other employee can challenge the promotion and put themselves forward to an adjudication panel as a superior candidate.

The system ensures anyone posted to Wagga Wagga can be reasonably sure of not being overlooked. Worth a try?

The process of settling the structure and getting staff in post could be completed within a month of a decision being taken. In my experience as an NHS manager in inner London, it usually took over two years. The pain to the dispossessed would remain, but the stress through uncertainty would be dramatically reduced. There might even be a retirement party for a manager - an event I never had the opportunity to attend in seven years in the NHS.

But don't underestimate the opposition to change. Most senior managers have thrived on reorganisations and the panel interview. Few have ever been 'promoted'.

This has bred a culture in which top managers owe their success to short articulate interviews, and

seem to believe this skill is as important for a ward sister as it is for a PR spokesperson. Could they handle a change which reduced change?