It’s not what you say, it’s how you said it!

21 09 2009

A phrase guaranteed to strike a chill in the heart of anyone who has ever heard these words.

The recurring theme on this blog and the probable theme of my dissertation is the engagement of clinicians and management. I regularly bemoan the state of this interface and long for improvement. Some would suggest my view is biased and I have tried to reflect on this and question why it should be that some believe there is effective interaction and yet others disagree.

On the one hand Staff Surveys, Clinical Leadership Engagement programmes, such complex human resource terms as High Performance Work Systems (HPWS), Chief Executive Briefings and even open staff meetings such as “The Big Conversation” show a significant desire and investment from management in finding out what staff actually feel about the organisation within which they work. On the other hand is the negativity and lack of interest show by significant numbers and elements of staff towards such initiatives. When I personally consider the relational coordination as described by Hoffer Gittel it leaves me cold as our unit, department and organisation fail (from my perspective) across all seven criteria.  Clearly the signals that are being put out are not those that are being received.

The failure of each side to effectively engage with the other is not due simply to lack of available avenues of discussion. There are many contributing problems such as deeply held beliefs and suspicions; hurts and barriers from previous experiences; misunderstandings and mistrusts; all have so tainted the relationship that despite there being opportunities for rapprochement, neither side can really make any headway.

This is made worse by fundamental attributional error: “everything” is the fault of “management”. This might be lack of car parking spaces; the peeling paint in the theatre changing room; decisions regarding resource allocation in oncology; appointment of  junior service managers or even the corporate logo; everything bad appears to be blamed upon “management”. Consequently, whether such actions were valid or not, there is direct allocation of blame, with its implicit presumption that such actions and all future actions are examples just the “sort of thing that management does.”

And so we are doomed to follow this path towards permanent mutual resentment until each side effectively engages with the other. Is that a consumation devoutly to be wished?

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