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VIEWS & REVIEWS: Jeffrey Braithwaite How to restructure-proof your health service BMJ 2007; 335: 99 [Full text]

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NHS Review - turning the world upside down

Annabelle L Mark   (18 July 2007)

NHS Review - turning the world upside down 18 July 2007
Annabelle L Mark, Professor of Healthcare Organization Middlesex University Business School Send response to journal: Re: NHS Review - turning the world upside down	Not for the first time do we have useful and practical insight from our colleagues in Australia as they look back across the world to comment on the politics of UK healthcare. Jeffrey Braithwaite has however highlighted what too many UK based individuals may feel unable to voice, but he has helpfully also provided a practical strategy for coping. NHS organisations are, as I have said elsewhere (Mark 2003) distinguished only by their instability and the costs of this are significant. So why do we do it? It is, as he suggests a symbolic act for politicians, as Browns actions imply, so what is also of interest now is the symbolism of who is appointed to lead this - and, whatever the personal characteristics of the individual, the symbolism of a surgeon sends out specific messages about doctor led action. From a social anthropological perspective(Linstead 1997)it may also represent the reaffirmation of the order of tribes( Maffesoli 1996) in healthcare, which increase in significance in forming and maintaining identity for individuals, as the organisational identities yet again fail. But in case anyone is under any illusion lets not forget that the continual costly and often ineffective process of merger and aquistion in private industry (Christofferson et al 2004) is predicated on similar tribalism and results in similar costs, so the lessons from any sector which can be learnt are largely about minimising the negative impact. Besides the guidance in the change management literature further useful insight from Australia is provided in the notion of Caddys(2001) "Orphan Knowledge" which provides an evocative term for what was originally an observation about knowledge management, but has wider application because, as he says, there are situations where organizations forget things and repeat past mistakes. Do organizations really "unlearn" or is it because as he suggests knowledge is forgotten, separated, or isolated within the organization. The processes of orphan knowledge recovery or the development of strategies to minimize orphan knowledge must therefore play a significant part in any organization's strategic knowledge management plan. Braithwaites suggestions will be important in maintaining these stores of information as well as providing emotional support. While the NHS still carries a global message about healthcare provision in theory, we need in practice to also think yet again about not just what we may do, but also how it is done. Caddy, I. 2001, "Orphan Knowledge: the new challenge for knowledge management", Journal of Intellectual Capital, vol. 2,no. 3, pp. 236-245. Christofferson S.A McNish R .S. Sias,D.L (2004) Where Mergers go wrong Global Insight McKinsey Quarterly Linstead S 1997 The Social Anthropology of Management Stephen Linstead,British Journal of Management 8(1) 85-98 Maffesoli, M. 1996, The time of the tribes:the decline of individualism in mass society Sage, London. Mark A 2003 "Trust me I'm not a doctor" HRM Discussion Paper Series Number 11 Middlesex University Business School London Competing interests: None declared