Start the Car: Disruption and the NHS

  |   Thought Leadership

An adaptation from a Nilofer Merchant (@nilofer) essay.


s_engine_start_close-400x300From classrooms arranged in rows of seats to Undergraduate Deans, from the theatre floor to the way we promote Chief Executives, NHS professionals have been trained to expect an orderly life. Yet the expectation that these systems provide safety and stability is now a trap.


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.


If you are part of the Gorilla group of Healthcare Institutions the answer often lies in a bygone system response, matched to their own survival hopes.


“Enforced Disruption” (tariff changes), “Integrated Care”, “Hospitals can become Systems”, “Review DGH models of care”, “Primary Care needs more investment”.


In many respects, the NHS is currently suffering at the hands of who is shaping its enforced disruption and in the manner in which the professionals are responding back.


Let us look at both parties.


What happened when the EU Commission tried to “disrupt” Big 4 monopolies and conflicts of interest arising in both Auditing and Consulting in business? Threatened with disruption and change head on, even though it was “in the interests of competition”, the Big 4 lobbied the government so hard that the proposals have been scaled back.


These are the experts who are advising Monitor on how to disrupt the NHS.


The current set up is like an economist’s laboratory experiment, conducted by economists from a bygone era. And they are applying their outdated tools on the UK health system.


For 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. It’s also about as useful as an appendix right now.


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, 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.


Remind you of anything?