Tuesday, January 09, 2007

Can Gerry Robinson Fix the NHS? – Let’s hope the answer is ‘Yes’.

Management guru Gerry Robinson was the star of a BBC 2 series last night when he was set his ‘biggest challenge’ - to reduce hospital waiting lists. For those of us who work within NHS hospitals, the stories seemed all too familiar. Delays getting patients in and out of theatre (or in reality anywhere), different specialties not working in harmony, committees and sub-committee’s having endless meetings with no conclusions or outcomes…..

He admitted, that after spending just 2 days a week in a hospital environment he returned home feeling “depressed”, “frustrated” and even doubting his own self-belief to make simple changes. Another familiar tale.

So what was his main challenge? He understood that hospital workers were all highly dedicated to their patients, skilled, and often worked long hours under stressful conditions. But what he came to realize, without actually the coining the term, was that his challenge was how to overcome ‘learned helplessness’.

Learned helplessness is a psychological condition, when a human or animal has ‘learned to believe that it is helpless’. It thinks that it has no control over its situation and that whatever it does is futile. As a result it will stay passive when the situation is unpleasant or harmful and damaging.

In an interview with Gerry Robinson he said “It’s actually quite hard to explain, the psyche…you had any number of people saying well we’ve been talking about this for two years, or I’ve brought this up with this committee for the last 10 years.” Historically it has been difficult to take control of a system undergoing rapid regular changes and cutbacks. Often basic questions just never got answered. In simple economic terms it would seem almost impossible to comprehend any business which could not calculate basic supply and demand data. Yet in the case of hospitals, working in the dark and not having access to vaguely accurate patient numbers was common.

So how can we break this cycle? Let’s hope that having people like Gerry Robinson going into hospitals will allow the workers to realize that they are free to be entrepreneurs. He may just be that paternalistic figure who entered Rotherham NHS hospital, and rather than saying "no", said the unmentionable word - "yes"….. this may well be the catalyst to start breaking the 'cycle of learned helplessness'.


QUASAR9 said...

Hi Michelle,
I did comment at length yesterday, but blogger was having an outage - so it got dumped.

I think Gerry Anderson was not only addressing the culture of cannot be done - but was really quite frank & blunt about the archaic hierarchical culture by who it will not be done.

You say you missed the first half. Well the Chief Executive has the authority to hire & fire at will. Any & all that is bit consultants. When he tried to introduce changes to improve performance - and revenies from the 'cash cow' that is theatre, surgery and especially orthopaedic surgey - he was confronted not only by resistance from the surgeons - they even held a vote of no confidence against the Chief Executive.

The NHS needs chief executives to run (manage) the buildings, investment, resources & staff.

The Chief Executive needs someone like I (or Gerry Anderson) with the authority to tell consultants where they are failing to fulfil their obligations - and detached from vested interests of administrators (meeting targets or increasing revenues) - one who can detach himself and measure surgical performance and patient satisfaction.

If the £90 billion NHS were geared to patient needs - instead of doctors and government or administrator priorities & targets - it would be the envy of the world.

Dr Michelle Tempest said...

Thanks for your comment - I liked the programme and if you could be as enthusiastic and empowering as Sir Gerry, then I suggest you get involved. The only extra point which I would make is that consultants, nurses, porters and ward staff put patients as their priority everyday, and the TV programme did not show that patient dedication. Patients needs are put at the centre of clinical practice - if management can work that way as well - I can see a brighter future for the NHS. Every hospital needs good management as well as good clinical practice - so get involved!

QUASAR9 said...

Hi Michelle, the world is not just black and white, but I like to call black - black, and white - white.

Dentistry in the nhs has hit rock bottom. Dentists do not want to do nhs work. They can make a comfortable living from paying customers.

NHS patients receive inadequate treatment. Dentists consider nhs patients a lost cause, they are happy to let them lose their teeth and offer them dentures. That is not a solution - that is criminal medical negligence.

And when they are referred to NHS hospitals because of complications, the Consultants instead of being appalled by the poor quality of treatment and obvious late intervention - will further cover up the crime and remove more teeth.

There is no excuse for dental loss in this day & age except greed and incompetence by dentists.
Regardless of personal responsibility for oral hygiene, teeth in a bad state of disrepair are evidence & proof of poor dentistry. No pastient refuses good dentistry, no patient refuses painless treatment - no patient wants to lose his teeth unless he's been convinced that it is the only remedy available to his pain or dilemma ...

Hip surgery is exactly the same, except surgeons are more willing to do nhs hip surgery ... but the incentive is still to keep waiting lists high - so that people in desperation will pay the higher costs of private surgery or demand the nhs offer them private surgery.

And if it were 'guaranteed' to be high quality surgery - I might even overlook the corruption in the system. But the quality of the surgery and the skills of the surgeon still leave much to be desired.

They are overpaid.
We need to train more surgeons, and more surgeons able to meet higher expectations. I cannot accept that in health care, surgery or even dentistry we should settlefor less. Being pragmatic is a slippery slope which enables surgery & dentistry of such poor quality to be provided to patients in pain & desperation - where anything is better than nothing.
Until we grab this bull by the horns, we are really just dancing around the real issue, in the hope than some miracle drug or magic bullet can be prescribed to patients by highly paid (overpaid) consultants surgeons & specialists
Who really want the money, but would rather not have to meet the patient.

And bringing in the issues of young doctors working long hours for low (relatively speaking) only serves to disguise where the REAL problem lies in the nhs ...
Overpaid, unsympathetic Consultants surgeons and specialists with an incentive to keep waiting lists high.

This is no longer a minority giving the majority a bad name. This is endemic - they are the minority in the health care profession around who the rest of the health system is working.

Unless we start here, we are just tinkering & blowing bubbles, and Gerry Anderson and the Chief Executive of Rotherham know it too.
The BMA is not fit to self-regulate, nor is the BDA, nor is The Royal College of Surgeons.

Vicky Ford said...

Thank you Michelle - Gerry has certainly got people thinking and that can only good. Ive added a link from my blog.