Making Sense of the NHS

I have just gotten around to reading ‘Health Reform in England: Update and Next Steps’ written by Bill McCarthy, the DoH’s new Director of Policy. This is an attempt to show how, in retrospect, the various major policy initiatives of the last couple of years fit together. Actually, it’s very good at explaining, from Bill’s perspective at least, the major reform strands – More Choice, More Diverse Providers, Payment by Results and More Focused System Regulation - are “intended to be mutually reinforcing” and lead to an NHS that is more capable of improving itself on a continuous basis without the need for excessive central intervention.

Reading it has reminded me, albeit somewhat hazily, about Karl Weick’s ideas about Sense Making in Organisations. Something about how reality can only be constructed by people within the organisation not outside of it. With so much going on at the moment it’s to be hoped that local leaders are making some time to craft their own narratives and share this with staff in ways that, in turn, will help them to develop their own mental models. Incidentally, it also reminds me of what a ex-colleague used to say a lot when addressing groups of clinicians when seeking to get them ‘on board’ – “What do you want, the truth or a good story”!

Bill’s ‘big picture’ story also came into my head when meeting recently with a group of managers and clinicians planning an Away Day for 80 or so staff from their Directorate. They were keen to have a series of very short presentations at the beginning to help people understand the context for the work of the Directorate over the next year or two (PBC, Trust merger, integration etc). That is a good idea I thought, but how do people build on this during the day? My question fell on stony ground; “Unfortunatly we don’t have the time to keep playing around with this stuff" came the reply. “We have to use the afternoon to address more urgent questions about next year's business plan”. “Oh yes, I see that but....”

Making sense of what is happening to us, our teams, our organisations and the NHS is vitally important when change is all around. But, like the continuously improving NHS sought by national policy, sense making is itself a continuous process. It’s also a social process. Things are just too damn complicated at first for us to figure it out on our own. Also, it's not just about intellectually understanding how all the pieces of the jigsaw fit (or can be forced together). It's also about figuring out what this means for our own careers and our personal job security. There's no point having a great business plan if everyone is so distracted that they can't commit to implementing it!

Steve

www.stevepashley.co.uk

P.S.The Health Reform paper is at http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/HealthReform/fs/en

 Dip into Karl Weick’s theory at http://www.onepine.info/pweick.htm