Tuesday, 5 February 2013

Outsiders cannot change NHS Culture - only NHS staff can do that

The responsibility for a change in behaviour and subsequent culture in NHS organisations, lies with the staff employed in those organisations, not with any external body.

NHS Organisation: the NHS is not an organisation by most definitions  It is not a singular corporate body..

Definition of "Organisation" from Business Dictionary:

A" social unit of people that is structured and managed to meet a need or to pursue collective goals. All organizations have a management structure that determines relationships between the different activities and the members, and subdivides and assigns roles, responsibilities, and authority to carry out different tasks. Organizations are open systems--they affect and are affected by their environment."

The NHS is a system, and one composed of formal organisations (with differing structures) and informal networks and collaborative structures that include other government bodies (social care) as well as NGO's and social enterprises. The Department of Health is not the NHS. Nor are consultancies, improvement bodies (acting as consultancies), regulators etc. These are their own organisations, with their own cultures with underlying behaviours, that also need to change.

It's easy to tell someone else or another organisation that they need to shift their mindsets and behaviours. However, following the Francis Report, the best place for everyone to start is by looking at their own teams and organisations, assessing their own culture, and making the efforts to change their own personal and group behaviours. This needs to happen not only for those organisations who deliver health care services, but also those organisations that are government funded to support the delivery of healthcare.

For these "outsider" organisations, the cultural and behavioural questions need to be reflective of their own internal behaviours and the impact these have had on NHS delivery organisations. They also need to be an honest appraisal of the cultural norms that exist within, and how these may be played out in the way they "support" the NHS Delivery organisations.

No-one needs a consultant or a clever framework to do these reviews, nor an expensive and complicated change programme. Large change initiatives operate as a displacement activity for not facing up to the details of the changes required. Real change starts with two people sitting down, telling their stories to each other, listening, mulling over the behaviours that may need adapting, then committing to have a go at changing their own behaviour, and to including others in their conversations.

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