28 Jan

The junior doctors’ strike: which relationships matter most?

Junior Doctor's strike

Letter to the Times (unpublished) – On Tuesday 12th January, across the UK Junior doctors went on strike in a dispute over pay and working hours. The dispute centres around the Healthy Secretary’s (Jeremy Hunt) proposals under which ‘normal’ working hours will include weekends and evenings. This means that doctor’s pay for these anti-social hours will be greatly reduced.

This is part of a move by the government to turn the NHS into a ‘seven-day-a-week’ service. Jeremy Hunt wants to get more work out of the same workforce for the same overall cost. And as it will make it cheaper for hospitals to roster doctors during these hours, more will be working time for which they were previously paid a premium.

The important question to ask, is who are the ‘stakeholders’ in the junior doctors’ strike? Which relationships matter most?

The government argue that relationships between patients and the NHS trump all other considerations; patient care can be improved by a 24/7 service, so it is an open and shut case. But is it so simple?

Which relationships are the ‘losers’ if the government succeeds in its plans? There is no point in junior doctors working without other related professional groups – anaesthetists, bed managers, nurses, radiologists, pharmacists, social workers, and ancillary staff. Has the government thought through the effects on relationships among professionals if they come under the stress of a 7-day work pattern?

Has it considered mental health and burn-out effects, which all damage relationships both inside and outside the NHS? Has it also considered the cost to partners, children, extended families and communities if another chunk of the workforce is removed from being present in their households over weekends?

And it is not even clear that the public either want or need additional medical services on Sundays. Early trials with 7-day GP surgeries did not demonstrate public demand. There is in effect already a 7-day NHS. Those who urgently need help always get it.

Are the ‘market men’ really more important to government than those concerned for public sector efficiency and social well-being which is most people’s priority?

Author: Dr Michael Schluter CBE – founder of the Relational Thinking Network

Photo: West Suffolk Hospital, Not Hunt’s to Sell (By sasastro from Flickr).

31 Mar

Translating the best…to the rest

pizza

I was at Jamie’s Italian recently in Liverpool. The menu had all the trademarks of the man’s appreciation of simple quality. The décor combined a sense of kitchen with a marketplace. The staff, albeit without a hint of Essex, had a familiar enthusiasm about the food they were serving (apparently they are trained to know about each recipe). It worked – a tried and tested approach with a distinctly local character, crammed full of customers.

But it doesn’t always work. The chain’s flagship Istanbul branch reportedly filed for bankruptcy earlier this year.

A restaurant offers a combination of concept, venue, recipe, ingredients, a chef’s skill, service and customers. The mix of these elements is often dynamic and subtle. Knowing how a great restaurant is working today does not tell you how it got to be great, let alone how to replicate it elsewhere. Which is why successfully rolling out a complex package to a wider constituency is challenging.

The NHS England Vanguard programme of New Models of Care has set out its stall to explore scaleable and replicable solutions. It is planned that the first wave of sites will pave the way for a group of early followers within a matter of months and years. Simon Stevens described the choice of Vanguard sites being made on the basis that they were already ‘performing strongly and have good relationships’. Selecting sites with strong relationships makes sense, as the success of an organisation depends on how well it connects internally and externally. The biggest challenges lie post-vanguard: how to translate what works for established partnerships (that also have access to a coordinated support programme and a share of £200m) into success for the rest.

Prominent amongst these challenges is how to replicate relational capital. Relational capital already exists within the Vanguard sites. Like an established restaurant, these sites have the wherewithal to adapt to improve customer service. How those sites got their strong relationships and how to help others build strong relationships is a different question.

Taking another example, it is striking how the relationships (some of them longstanding) behind devo Manc were so crucial in getting the agreement for devolved health and social care budgets for the city region. Where capital is less developed, as amongst some of the hoped for early followers, the parties to the relationships will need help to develop the capital they need. Unlike financial capital, relational capital cannot simply be transferred from headquarters. Adopting only the model or method or even providing the finances will not be the whole package for the post-vanguard sites, as numerous examples of public sector ‘pilot-itis’ testify.

The Vanguard has a real opportunity to address this. If NHS England generates a detailed understanding of the relational capital fuelling the first wave of sites, it can support the next wave to develop good relationships more quickly. Many areas struggle to broker trust and common purpose amongst stakeholders, finding themselves battling organisational self-preservation and chequered histories of engagement. However, relational capital can now be quantified and explained in ways that can be adopted by another system relatively quickly. Introducing a common language and understanding of inter-organisational relationship will practically help areas ‘make it real here, regardless of where we are starting from’. With this sort of outcome, the New Models of Care programme will truly be transformative.

This article was originally published by Renuma, one of our member organisations, and is republished here with their permission.