A guest blog by John Higgins
The corporate rah-rah is still there, how something a bit like triumph was heroically snatched from the jaws of disaster, but its leavened by more personal stories – people will talk of the anxieties, fears and doubts that the first wave of the pandemic evoked in them. The institution of the NHS may have creaked but it coped, while personally the cost is still being counted and old hands had the all but forgotten experience of not knowing what to do. This willingness to admit the personal into the professional NHS experience is a striking development – people rarely admit to having a felt reaction to the normal upheavals that have marked their career through the health system; they’re usually just expected to suck it up.
Meanwhile some conversations remain stuck. Organizational Development professionals feel compelled to offer frameworks, models, opinions and solutions that they expect to be helpful, but which impose a particular way of talking about people’s lives and lock out the possibility for people to express what is specific and unique to their experience. The need for fast, tangible action continues to be privileged (however little is often achieved by such sugar-rush diagnosis and implementation). Staff reconfigured yet again into new operational units, the most established fast action move in the management playbook, and reporting lines fall into line with an expectation that they will forget their old boss and pay due allegiance to the new – the NHS has always been the plaything of politicians and their advisers and when the old boss dies, there is always a new boss to follow.
People respond instinctively to the cry that: ‘The King is dead! Long live the King!’ and the simulacrum of loyalty easily transfers to whoever claims to be the latest top of the pops. With all this attention to who currently wears the crown, so the ordinary relationships between colleagues that make the formal system work, are discounted. Something so taken-for-granted and intangible lies beyond the scope of meaningful measurement and we all know that if something can’t be measured, it doesn’t matter…
Recent conversations in which I and others have been involved tend to cleave to the one-dimensional, where the focus is on the pandemic experience as an organisational “learning resource” rather than an intense, alarming and awakening moment of human existence. It is seen as impractical to explore what went on as an invitation to make sense of what it means to be a part of an inter-dependent social community, to be valued so highly in one moment and so little the next, to have so much responsibility in one breath and none in the next.
The carefully curated facts, within this narrowly approved institutional focus, are part of the ideology which assumes that a structural re-organization, with a change in personnel at the top and new teams for them to govern, are a meaningful (and practical!) response to what has just happened – especially when reinforced by a statement of wishful policy, such as a zero tolerance of this or that. So much easier, and dramatic and fast, to wish away prejudice and habit than engage with a world where people are shaped by a myriad of learned attitudes, not all of them HR approved.
What people find difficult to do is step back and look at the factors within which the facts happen – contextual analysis is limited because so much seems unchallengeable. This has long been the case in organisational life, of course, but is especially noticeable at this time, when the present rupture opens up the possibility to see things askance, to take a more oblique perspective on the commonplace. A note of caution; this possibility of staying with the experience of the un-commonplace might well be a dwindling hope. There is an ever-growing queue of people keen to repair that rupture, return things to the ‘old normal’, for fear that it might permanently disrupt life to which many have become comfortably (or even uncomfortably) accustomed. The advisers who helped put in place so much of what is seen as unquestionable are being invited in again – proof positive of the saying that ‘the more things change, the more they stay the same’.
Secretaries of State and Ministers of Health will come and go. McKinsey and associated firms will always be there promoting an uncritical reapplication of their organizational ideologies and their pseudo-objective diagnostic methodology – the misapplication of the scientific method to the social sphere is hard to stop, when its supporters ironically offer ‘objective’ certainty, while their opponents are so full of tentative uncertainty and embrace subjectivity.
Within the social pyramid of the NHS there are the great mass of employees who are at the bottom of crudely constructed pay grades, the poor, benighted “Bands 2 to 4”, who will remain unheard and have their experience overlooked. Meanwhile, our attention has been forced to return to those notionally at the top of the tree, especially those who wear the now fashionable badge of ‘leader’ – ‘managers’ are so last century and also accept the now buried reality of a more conflictual relationship with staff. Leaders are great people who have followers, and following is a broadly passive activity where ‘we are all in it together’ and conflicts of interest can be disappeared in the warm bath of consensus.
Then there is the persistence of the day-to-day and the priorities it reveals. Data migrations and organisation design projects, driven by historic reconfiguration plans, go ahead in the midst of crisis, never quite being as seamless as they’re meant to be and actively undermining staff as they try and get on with their work. Information is lost. Couriers emerge from the gig economy and appear on the doorstep, the precariat attending to the salariat, in order to provide homeworkers with new kit and whisk away the old – which is still perfectly serviceable. Assets are correctly allocated to the newly transformed organisational unit, in line with what the dead-eyed world of rational economic management sees as the most important priority in staff’s working day. Assets can be counted, unlike relationships. If the assets are in the right place, then all will be right with the world.
The NHS – in keeping with so many other corporate entities these days – has a deeply anti-reflexive culture which undermines its collective intelligence. The rush is always towards the bubble-gum of immediate action, that fits within the status quo and can be rolled out and made applicable across the board. Scalability is all – the particular, the unique and the individual mere noise to be eliminated, an outlier to be discounted. Our obsession is with the discovery of patterns, with endless aggregation; this focus means that we disregard the unusual and exceptional, the instances that are even more worthy of exploration and – in so many instances – celebration, in favour of the managerial fascination with the “Big Picture” and the general.
It is hard for people to take seriously the need to pay attention to the assumptions that are underpinning the current organizational practice – it is hard work to swim against the tide and invite people from many walks of life to come and think together. It takes time and the outcome cannot be predicted. And it is of course inefficient – efficiency being the curse that keeps the world locked into an uncritical acceptance of the rules of the game because it squeezes out the space and time for reflection and inquiry.
Instead what we have is a perfect example of the same people (or people of the same world view) coming together to come up with the same diagnosis and course of what passes for action – a flaw that I and my co-researcher Professor Megan Reitz clearly identify as one of the causes that lie behind so many organizations being caught unawares in the face of predictable and known developments. In the field of institutional scandals, there is always someone, or a whole tranche of people, who knew what was going on. The pandemic has made some new conversations possible, namely an acknowledgement of the personal. But it has made no difference to the collective decision making of the organizations that make up the NHS, with their mandated addiction to the one-dimensional understanding of what an organization is and how best to manage it. Always rushing, always spinning, always overlooking anything that can’t fill a cell in a spreadsheet, always hoping that some miracle technology can make redundant the twisted timber human beings are made of. The NHS is not a machine to be fixed – but the way many of its managers, advisers and political leaders speak, reveal this still to be the metaphor they live by and metaphors shape minds and minds shape what people know is possible and can be talked about.
John Higgins is a researcher and author. His most recent book, ‘Speak Up. Say what needs to be said and hear what needs to be heard’, co-authored with Megan Reitz, was shortlisted for the CMI management book of the year 2020. Next year will see a new book co-authored with Mark Cole published by Routledge, which expands and deepens the assertions and suggestions in this piece.