What it feels like to work in the NHS – a look at system instability

By Michael Shaw

As a leader of a hospital, as a Doctor or Nurse at the front line, as a Project Manager in the back office or any other roles within the NHS and possible the wider public sector, then I have a question; is this what it feels like for you and your organisation today?

As a leader of a hospital, as a Doctor or Nurse at the front line, as a Project Manager in the back office or any other roles within the NHS and possible the wider public sector, then I have a question; is this what it feels like for you and your organisation today?
The impact
Time horizons seem to be getting shorter Long-term strategies are replaced by spontaneous reactions
Plans are in a constant state of flux Individuals and teams are confused and ambiguity prevails
We jump straight to the solution without understanding the problem The wrong solution is selected
Any idea is a good idea; we try to implement everything Demand exceeds capacity to deliver change, nothing gets implemented
The trial phase of the change is suspended, we just do We don’t know if the solution works
Change resource is constantly switched between initiatives Progress stops during transitioning
The capacity for assurance grows disproportionality The capacity to improve diminishes
Meeting frequency and volumes are intensifying The ability to follow-up actions becomes near impossible
Change & Operational management boundaries are becoming blurred Operational delivery always takes priority and change stops
The governance is seen as the change Compliance becomes the job of the change agent
Leaders have stopped leading Leaders become managers
Unacceptable behaviour has become acceptable Staff tell leaders want they want to hear, not what is reality
My delegated decision rights have been suspended Staff become disenfranchised
Distributed leadership has manifested into command and control Initiative & innovation stops; seeking approval prevails
Deadlines are imposed Quality of deliverables is compromised in order to meet dates
Rising failure demand as we struggle to get it right first time Deteriorating productivity and performance
Performance data is based on failure demand Critical decisions are made on this baseline performance data
Growing interference from external system partners & regulators Relationships deteriorates and partnership working stops
We are losing sight of our purpose and vision of our future Progress has stopped

These are the symptoms and the impact upon individuals and teams when organisations and wider systems begin to de-stabilise. The impact upon the patient and taxpayer is just as profound as the outcome of this downward spiral manifests itself into a deterioration in the quality of care, longer waiting times and rising costs.
Lack of funding?
Is this all down to a lack of money... or is there something else at play?
“No 10 insisted that there would be no emergency cash injection for the NHS in the coming weeks and claimed that the A&E problems were not unusual for winter. A downing street source said: “Theresa May doesn’t believe in quick fixes. There are stark variants in performance trust that are not explained by cash injections.” The Time 11th January 2017.
Could a legacy of poor process and structure design, variable operational leadership and failed attempts at change have left care systems with rising failure demand, rising clinical risk and significant ‘locked in’ cost. A cost exasperated by the need to manage that uncontrolled failure demand with temporary variable resources and an ever-expanding capacity of assurance.

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