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We don’t talk nearly enough about…how we could do things differently

Nick Black considers why we need to talk more about doing things differently in health and social care. Let's stop sitting on our hands and work to change our culture.

Everyone working in health and social care knows how the services they provide could be improved. It may be a receptionist who bears the brunt of angry patients being kept waiting, a community nurse who knows they could avoid a patient having to attend a hospital appointment, a consultant doctor fed up with seeing inappropriate outpatients, or a manager completing endless forms that contribute nothing to improving services.

Whatever our role, we all experience frustrations and generally do nothing about it (other than moan). Why, when we often think we know how things could be organised better for the benefit of patients and staff, do we sit on our hands?

Well, some of us have tried to change the status quo, met indifference or even opposition, and given up. We know that new, bright young staff enter the system bubbling with great ideas. They bring fresh, untainted views into the system but within a year or two they have become disenchanted about the prospects of change happening. And this in a system that is focused on trying to improve the quality of life of citizens and be compassionate.

The consequences are not only a failure to adopt new ways of working but also the demoralisation and demotivation of that most precious resource, our staff.

Another consequence is that staff and patients settle for accepting that things are the way they are, assuming there are good reasons for the status quo. The flame of questioning and challenging established views is extinguished by recourse to a quiet, safe existence of ‘just doing my job’.

Having emerged from an education system that should, and generally does, nurture a spirit of inquiry and learning, new entrants emerge into a work environment that discourages such radical initiative.

We are wedded to being cautious. This is the safest approach – no one is reprimanded for adhering to the established ways of working.

An important reason for this state of affairs (which is not confined to health and care) is a prevailing culture of risk avoidance. We are wedded to being cautious. This is the safest approach – no one is reprimanded for adhering to the established ways of working. Innovation and entrepreneurship come with associated risks that are not seen as worth taking by most of us. Fortunately, there are exceptions, but too few to produce the transformative change we need.

We need wholesale change in the culture of the health and care system. New ways of working should be encouraged. And when this results, as it inevitably will, in greater rather than less variation in care between places, this should be accepted rather than used to resist change. Reasonable concerns about the impact of innovations mean that they must be accompanied by rigorous evaluation (using appropriate methods). Those that are successful should be widely celebrated so we can all learn from others’ experiences.

Without encouraging innovation and embracing new ways of working we face the prospect of struggling just to stand still. So, why is it that we don’t talk nearly enough about how we could do things differently?

Nick Black is Professor of Health Services Research at the London School of Hygiene and Tropical Medicine.

Nick Black19 November 2019