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Discussion: Local acceptance of the need for changeReported This is a featured thread

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davemiller
davemiller
Local acceptance of the need for change
Nov 14 2008, 5:49 AM EST | Post edited: Nov 14 2008, 5:49 AM EST
All the recommendations made here are admirable and will, I am sure, improve the chance of effective change. And I suspect there is little disagreement with the list. An interesting observation made on the day alluded to the NHS not being a single entity ... I'm not sure if we used the word 'franchise' of organisations. We are dealing with an organisations (if we can call it that) which tends to be driven by very high level directives and large national initiatives, having to work with (rather than compete with) locally drivan care decisions. The end goal is a healthier nation but the driving forces tend to vary, from politics and macro economics natinally, to targets driven care objectives and micro economics locally.

This pull and push on organisations has a tendency to create environments where groups and organisations tend to work in opposition rather than in collaboration ... this might include cliniciancs, managers, commissioners and providers, and national projects.

If we can accept that we are all working towards the same goals, and forge partnerships instead of rival factions, we might make more headway. This requires time within change activity to consider the needs (the benefits) of change, to engage those that will be impacted by the change, and to realise the benefits of change.

There's clearly no easy fix, but I've added my twopennyworth by marking some of the bullets above with * where I think there are realistic opportunities to bring people on side, to focus on improving care, and to increase the chances of success. Do you find this valuable?    
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hadleyac
1. RE: opposition v collaboration
Nov 17 2008, 7:10 AM EST | Post edited: Nov 17 2008, 7:10 AM EST
Interesting comment, and this highlights a significant problem. The current DoH push towards a more clearly defined commissioner / provider split, and an 'any provider' mentality by commissioners cuts across the ethos of sharing information and considering the holistic needs of the patient. That also covers organisations (FTs and private) choosing a different system to the expensive 'free' ones, because they value the operational efficiency of what they already have (and fear disruption and lowered efficiency), and because they fear the collaboration or external access might be abused to gain competitive advantage.

Can the commissioners drive collaboration ? In my experience so far, they are not, and that is because they are unable to specify the detail, or prepared to cope with the complexities this presents. Equally for individual providers, the current ethos is not condusive to willing collaboration, though the clinical practitioners often seem to work and think across organisational boundaries, oblivious to the contractural framework. Do you find this valuable?