"Can Gerry Robinson Fix The NHS?"

[rhythmaning]

For the last three evenings, BBC2 have run a series of programmes in which Gerry Robinson set out to fix NHS - well, to help one hospital in Rotherham reduce its waiting lists.

Robinson has had a couple of tv series – one was called (if I remember) Tell Them Who’s Boss – in which acted as a business troubleshooter, sorting out small firms in trouble. Generally, all the problems he came across involved leadership and communication (usually, it was because there were family firms in which siblings had fallen out – and weren’t talking, despite jointly managing the firm – or patriarchs who refused to hand over the reins, leaving everyone confused about who was in charge).

What he found in Rotherham was, to my mind, much the same.

Despite his earlier belief to the contrary, Robinson now believes the NHS is different from other organisations, and shouldn’t be managed as a business. From what I saw of the three, very riveting, programmes, I am not sure that I agree.

There were very severe communication issues: the clinicians – doctors and consultants – didn’t think the chief executive and other managers knew what they were doing, and ignored them; the chief executives and managers thought the clinicians were a law unto themselves, and could not be managed; and both the clinicians and the managers seemed to ignore the nurses, who bore the brunt of just about every initiative going.

The chief executive felt powerless: he was unable to bring about change, and he was subject to extreme pressures (often political) coming from the Department of Health. As a result, he sat in his room and talked about strategy, and played with spreadsheets. So no one in the hospital even knew who he was.

Managers, clinicians and nurses had very strong views about each other, and barely tolerated each. Every meeting they had reinforced their biased views. As a result, nothing ever happened: they had meetings about meetings, talked about changing things, and then got back to whatever they were doing.

Robinson identified all sorts of bottlenecks in the way the hospital worked. Clinicians didn’t want to work on Friday afternoons (ostensibly for genuine medical reasons – operating on Friday afternoon meant that patients might not get the care they needed over the weekend – although it also seemed like they wanted to go off for their long weekends). One surgeon refused to use local anaesthetic, relying on the methods he learnt when a student. Managers dismissed ideas from the nurses out of hand.

And no one really wanted to change.

It was fascinating. And I reckoned that I have seen all the issues elsewhere in business – not to the same extent, not all at the same time – but I thought that the hospital was like any other people-oriented business, just more so.

And that was important, too – because Robinson wasn’t trying to sort out the NHS – he was trying to sort out bits of one hospital – so an organisation of 3,000 or so, rather than the third largest employer in the world with a payroll of 1.2 million. It was a much more personal scale.

There were several small initiatives that Robinson catalysed (he didn’t come up with the ideas, and he didn’t implement them – it was rather amusing to hear his rant against management consultants, when really that was exactly what he was doing, too – only he had a tv crew with him). All the ideas that people – particularly the nurses (who seemed to be in the thick of things, and much closer to the patients than the clinicians) – were pretty simple, no-brainers that Robinson was surprised they hadn’t been considered before.

Thing is, because staff – managers, nurses and clinicians – thought no one was listening, and no one was interested, and no one cared – they didn’t bother having ideas. They kept their heads down and got on with fighting their way through the day.

Once Robinson started wandering about, asking simple questions, and listening to what anyone had to say – people realised they were allowed to have ideas. They began to care.

And things began to change.

By the way, the programme was produced by the Open University. It was rather good, if somewhat sensationalised, “reality tv”. The programme website is here.

ETA: Each programme was a bit like the Apprentice crossed with Er. They kept cutting to orthopedic operation - knees mostly. This is why I did botany, and why I am so glad I decided not to become a doctor.

Chris Dillow has an interesting post on his blog about the programme here.

Comments

[kittenexploring.livejournal.com]

All your links need fixing.

Sounds like an interesting programme (which will likely never make it here).

[rhythmaning.livejournal.com]

Thanks - I fixed the links.

Memo to self: "I must remember to test links before I post... I must remember to test links before I post..."

If I believed in New Year reasolutions, I would make that one. But I don't!

[rhythmaning.livejournal.com]

And I meant to say that the series website - the very first (now functioning!) link - has quite a bit about each programme, the issues found and what happened - including perspectives from each of the parties involved.