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Analysis Essay

Reform reform: an essay by John Oldham

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6716 (Published 20 November 2013) Cite this as: BMJ 2013;347:f6716

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Re: Reform reform: an essay by John Oldham

Sir John's essay touches on the work of Michael Fullan who claims that "leaders have a deeper and more lasting influence on organizations and provide more comprehensive leadership if their focus extends beyond maintaining high standards" (Fullan, 2002). In this statement Fullan is referring to the need to change the culture in an institution, which he states involves "changing what people in the organization value and how they work together to accomplish it". It is this need for a change of culture that Sir John is eluding to.

As a doctor working in the NHS it is clear that the culture of the health service, or indeed a single hospital, is the product of the attitudes of the doctors, nurse and other allied health professionals in addition to those of the non-clinical staff who work as part of that institution. Given this, it is striking that each of these professional groups works in isolation with regard to hospital business. For example, different groups attend their own meetings in which members of the other professions are rarely present. Ward meetings are nurse dominated and hospital medical meetings involve the doctors but no one else. In my experience, there are very few, if any, formal hospital meetings where both the doctors and the staff nurses on the same ward are in attendance. There are of course the multi-disciplinary team meetings that are held to discuss specific issues on an individual case-by-case basis, however these are not a forum for discussion of the general direction or aims of the ward or hospital. As a consequence, the aims of each professional group don't align in real terms, even if we subscribe to the same nebulous notion of putting the patient at the centre of everything.

I am not advocating multi-disciplinary training as I strongly feel that the educational needs of these professional groups are very different. However, it seems illogical to keep these groups separate once they have entered the workplace as, in the final analysis, we are all striving to use our particular skills for the benefit of the same patients. Getting members from these different groups together at the same meetings would improve working relationships and facilitate the emergence of real common goals. Only then will there be a platform for real cultural change.

References:
Fullan, M. 2002. The Change Leader. Educational Leadership, May Issue, pp.16-20.

Competing interests: No competing interests

29 November 2013
Aled R Jones
FY2 Doctor
Bronglais Hospital
Caradog Rd, Aberystwyth