As the sixth month-long dispute continues over junior doctors’ contracts, it sheds light on the longer term issues facing NHS staff shortages, long term skill shortages, working conditions including abuse of staff, budget cuts, wage freezes, the emigration of British medical staff and the immigration of foreign staff, that is causing its own set of concerns.
How has this institution set up for the health of our nation, run by health professionals with a vocation to help, heal and support got into such an unhealthy state; and who or how can anyone lead it though this crisis to effective change?
In an attempt to streamline, cut back and economise, the vital human and relationship elements of the health system have been lost, ironically leading to great financial cost. The short answer is that within the current business paradigm, which defines success from a primarily commercial perspective, there can be no real change or salvation.
But if a new business model was not only introduced but accepted, let’s call it the human paradigm, where the context for defining success is not primarily profit and quantifiable commercial figures, but about the experience of the work, meaning healthy functioning relationships between all levels of staff and departments internally and with patients externally, then real changes could be achieved for staff and patients alike.
Health care is a vocation, with the majority of staff driven to their careers by a desire beyond financial gain. If healthy functioning relationships became the primary goal of the NHS and its leaders, engineered through the strength of its staff’s shared values and the institution’s vision, a new united and invigorated NHS would emerge.
The values and purpose of NHS England already include:
“Everyone has greater control of their health and their wellbeing, supported to live longer, healthier lives by high quality health and care services that are compassionate, inclusive and constantly-improving”
How are the junior doctors in control of their health and well-being if they are being forced to accept what they deem as unsafe and unacceptable? And beyond that, in this instance, where is the element of constant improvement if all these changes to pay and hours are proven to be discouraging people from going into and staying in medical professions.
Preventing the exploitation of vocational staff
To prevent the exploitation of junior doctors’ (and all NHS staff’s) vocational values there needs to be a mind-set of partnership between politicians, leaders, staff and patients, to adequately support the emotional and physical strain on health workers with mutual respect and appreciation being the primary currency of communication on every occasion.
Within this new human paradigm the vocational aspect of the business is its commitment to creating, alongside profit, a healthy, happy and sustainable operational community. The well-being of the business community taking precedence over the creation of profit as the primary motivating force, which in essence is taking it back to the original purpose of the NHS.
This is not to ignore the budget restrictions and burden on the NHS to deliver increasing services to a population that is asking more from it daily, ironically with increasingly preventable issues such as obesity and alcohol related injuries. These epidemics further threaten to exploit the vocational values of NHS staff, as patients are increasingly distanced from the humanity of the NHS and consider it not as a partner to maintaining health, but a commercial enterprise who’s services and staff are disposable if not expendable, with no responsibility on the patient to respect, understand or support any part of it, human or otherwise.
The psychology of partnership
All NHS staff are trained in the psychology of partnership which places equal responsibility on both parties, the staff and patient, for success, specifically; how to foster and cultivate mutual respect and appreciation is at the heart of the NHS ethos.
“we work in partnership with patients, clinicians in the NHS, the public and our partners because we get the very best outcomes when we work together with common purpose”.
But without society as a whole, including patients, government and management, understanding the need for partnership the NHS will continue to fail until the human paradigm can be established and bring the ‘advertised’ values of the NHS in line with reality which can then support a transition of attitudes to its patients.
It is the responsibility of NHS leaders to fully understand how to create and sustain healthy working cultures that sustain and support the staff in the work that they are engaged in.
Politicians and NHS leaders need to be emotionally intelligent, self-aware and conscious of their own issues, ego and emotional baggage which could compromise the integrity of the delivery of their responsibilities. BMA junior doctor’s leader, Dr Johann Malawana, accused the government of blocking a deal “due to pride and politics”. Whether true or not it is an example of how emotional agendas, pride, fear and prejudice can make or break understanding and negotiation.
NHS leaders need to ‘walk the talk’ of the governing values and principles that are the bedrock of the organisation’s existence, so they cannot be accused of lying as Mr Hunt was, in the ongoing debate of new junior doctor rotas.
Recruitment practices need to change to emphasise the need for interpersonal qualifications and the focus on continual learning and development in this area in alignment with the organisations aspirations to be truly excellent culturally, as well as technically. Then appraisal and progression can be evaluated and rewarded with equal emphasis on the quality of engagement, cooperation and effective integration into the NHS community (staff and patients/clients) as well as on technical competence and accomplishment.
A more enlightened calibre of NHS leadership could be the remedy; promoting mutual respect and appreciation across the board to prevent toxicity, with time, effort and budget being invested in creating wellness and fulfilment for all levels of staff. Incorporating emotionally intelligent coaching and leadership programmes into all aspects of health service training to help clear away egotistical and emotional debris and re-engage leaders and staff with the vital human elements of the service.
Serving in the service
By investing in excellent support networks, leaders and staff will be more able to maintain reasonable levels of empathy with clients and each other during the delivery of services, overcoming pride, ego, fear, prejudice and imbedded preconceptions to create a truly transparent singular goal and vision of wellness. Openness, vulnerability and fundamental change is a very challenging thing to achieve on an individual level let alone throughout a huge organisation.
The most effective leaders in any industry will share in and effuse the vision of their organisations creating a solid integrity, leaders in the health service need to demonstrate a commitment to their own emotional, physical and mental health and have the skills to create and inspire this in the people working with them.
If prevention is a fundamental common sense principle of any credible health manifesto, then those in charge need to lead the way and be conscious of their own health needs and the emotional and spiritual needs of the community work force they are there to serve.