I've been witnessing the NHS at reasonably close quarters again in the past fortnight. Dad has been in for fairly major surgery, and will be convalescing for some time to come.
My experience of the health service, both as punter and as consultant (management variety) makes me think that the fundamental issues facing the NHS are of the managerial challenges posed by vast quantities of expertise. The continual sideshow of left-versus-right ideology in terms of state control miss the big issue. Bottom line is that we all seem to crave expertise, but experts generally make poor managers and even poorer leaders.
Over the years I have taken part in a management training game that is based on the scenario of a plane that has crash-landed in the desert. A number of items are salvageable by the survivors, and the aim of the exercise is for the group of participants to collectively rank the priority of the items in terms of their importance to survival in the desert. The game is used to observe group and negotiation behaviours.
As both participant and facilitator of the game, I have seen the emergence of 'experts', usually when someone utters the words “I've done this before, and…”.
On the basis of such little evidence, a whole group can be taken in by someone who shows enough conviction. At least once, as a result, a group ranked the object that would be of least use to them as most important to take (for the record, a box of salt tablets).
We seem to love the words of an expert. They allow us to stop thinking and pass the buck to someone else. Being an expert also can then reinforce expert behaviour… making pronouncements from on high which will be followed.
And there's the rub in the health service – lots of powerful experts strutting around issuing edicts to minions who will do their bidding (or, after a while, start to push against it subtly and possibly quite destructively). Describe “doctors” and “consultants” as “scientists” or “medical boffins”, and maybe you start to see less of a caring profession and more of the not-particularly-socially-skilled world that's all to easy to observe in hospitals.
The problem in health is that how people feel about the way in which they are treated has a very material impact on the way in which they respond to treatment. Just read Ben Goldacre's description of the placebo effect to understand that.
What about other industries? Well, engineering-based worlds (including IT) tend to have more than their fair share of expert boffins. The risk is if expertise alone is allowed to run organisations… Good leadership comes from inclusion, not just bossing people around on either dictatorial or expertise-based principals.
(as an aside, given these election times, an interesting report on the BBC News last night which kind of puts pay to any of the nonsense being spoken at the moment by any of the parties about maintaining NHS frontline spending by cutting back on management costs. Management costs amount to just 3% of NHS spend…)
mmitII 