In the NHS, much of the dialogue on its current state and its future is about NHS-the Noun, and not NHS-the Verb. It is unfortunate that so much air time is given to this ideological debate because the service matters most, improving access and building clinical quality and patient experience. The ideological debate is in our view becoming increasingly redundant.
Our group was in a meeting today with a private sector team and we were asked to predict the future of the NHS in the next 2 years, and therefore what should their focus be. In October we wrote a blog on disruption and the NHS. In summary, our view was that if the NHS and its constituents ignore current dynamics at work in our society, they do so at their own peril. Despite recession, currency crises, and financial instability, the pace of disruption is roaring ahead. The frictionless spread of information and the expansion of personal, corporate, and global networks have plenty of room to run. And here’s the conundrum:
When NHS professionals and others search for the right forecast for the NHS–the road map and model that will define the next era – no credible long-term picture emerges. On top of that, there is an election in 2015, which is likely to cause delay in action but no change in societal disruption.
If you are NHS leader or commentator wedded to the institutional response, your answer often lies in a bygone system reaction, matched to a hope for survival and legitimacy. How many times have you recently heard or advocated that the whole system needs to respond, or we need Hospitals to get bigger, or systems of care to become more integrated?
For many NHS professionals, nostalgia is the natural human emotion, a survival mechanism that pushes people to avoid risk by applying what we’ve learned and relying on what’s worked before. The system has the answer. This is now about as useful as an appendix.
When times seem uncertain, we instinctively become more conservative; we look to the past, to times that seem simpler, and we have the urge to re-create them. This impulse is as true for the NHS as for people. But when the past has been blown away by new technology, market instability, by the ubiquitous and always-on global hypernetwork, beloved past practices may well be useless.
There is one certainty, however. The next decade or two will be defined more by fluidity than by any new, settled paradigm; if there is a pattern to all this, it is that there is no pattern. The most valuable insight is that we are, in a critical sense, in a time of chaos.
“Most big organizations are good at solving clear but complicated problems. They’re absolutely horrible at solving ambiguous problems – when you don’t know what you don’t know. Faced with ambiguity, their gears grind to a halt.”
So what do we think you can do..
We advise many organisations in the NHS to try to develop agile and multiple scenario based strategies. We encourage them to first improve quality, performance and team resilience.
We encourage focus on smaller localised changes, developing core agility, decisions becoming more pragmatic and fostering more enjoyment and confidence in uncertainty.
Our message: Promote the challenge of uncertainty instead of the warmth of nostalgia. The “system” (whoever and whatever that may be now) doesn’t have the answer. You and your professional teams have it and you can unlock and embrace the opportunities that this represents.