Published: 12/08/2004, Volume II4, No. 5918 Page 31

Understanding the subtle dynamics of rank can pay dividends in the workplace, as Mick Collins explains

Relationships are at the heart of the NHS's core business, and these are governed by strict codes of conduct and organisational policies.But we all know of high-profile cases where misuse and abuse of position has led to terrible outcomes.Even where there is not scandal there is widespread stress.

A big part of this problem is the way rank is understood and used.Rank issues include the dynamics that surround gender, age, sexual orientation, race, health, education, finances and psychological and spiritual beliefs.When rank is not addressed, tensions build.

Rank is not only about what status is achieved or given in the hierarchy.We all have rank that we earn through life's experiences.Let's say a Tibetan refugee is a hospital porter.

People like him and he has a calming manner, never getting too flustered.Then it transpires that he is, in fact, a Buddhist Lama who now has to adapt to life in the West.

Within the system he has quite low rank and status, and yet his spiritual rank is very high, and others were at some level aware of that.

And we have all probably come across the person with low rank in the hierarchy who is capable of sabotaging a good manager's best efforts.Rank can be used in a more overt way to create something dynamic, bringing out the best in everyone.

We have all met people who act like petty tyrants or robots.We will certainly have met people in authority who radiate solid human qualities of genuineness, warmth, and who have regard for themselves and others.The critical point is simple.Most people feel good around a person who uses their rank well.The hidden rank of every employee is like buried treasure. It takes training and patience to understand the dynamics.The work always starts with ourselves.

Dr Arnold Mindell developed this concept of rank in his 2002 publication, The Deep Democracy of Open Forums . It is essentially a book about dealing with conflict.With open forums you get to see a bit more of me, and I get to see a bit more of you.Forums still respect position and status, and yet invite us all into a bit more relationship work with each other.Some people may say that too much relationship work will undermine authority.The opposite is true.Relationship work and rank awareness is a core element of NHS business.Are we any good at it?

Mick Collins is head occupational therapist at Norfolk and Waveney Mental Health Partnership trust.