Yesterday I explored the failure of ‘plans’ to provide much guidance for how staff and organisations need to carry out new and different tasks to provide new and different care. Given the fact that there is going to be a ‘long-term plan’ and that plan is going to expect different (better) outcomes to be created, then we need something to transmit that intention from the centre of the NHS (and the nation) to the country as a whole.
My contention is that a narrative, a story if you like, is a much better way of communicating what the new NHS is trying to achieve than a plan. A plan interests those few – very few – people who are interested in policy. A story interests those millions who are interested in practice.
Everyone who works has a ‘story’ within which they live their lives and do their job. Inside the NHS that story is both a very big national and historical one, and a very small and very local one. For nearly everyone who comes to work in our health service their personal story mirrors the very big historical/national one that is the NHS.
A cleaner who comes in to clean a health centre may look as if they are doing the same job as one cleaning the offices next door, but their story is actually and potentially different.
Cleaning in a health centre is a core part of the NHS mission because it plays a central role in stopping infection. Stop cleaning for a week and sites of infection increase dangerously. A week’s effective cleaning and infection finds nowhere to grow. So the two stories of cleaning – in the health centre and the offices next door – are two very different stories.
Alongside their work against infection, the cleaner working within the NHS centre is part of a nationally loved set of organisations that provides services for everyone in that locality – whether they have a lot of money or no money at all. The cleaner is a part of something that was featured in the Olympic opening ceremony. That has meaning.
This is a big story to work within. And it has very important local meaning as well. The mother of the cleaner’s neighbour went to the centre last week and received a further diagnosis about her long-term conditions. They had met each other there and talked about her illnesses.
The long-term plan suggests that, to improve cancer survival rates, we need many more diagnostic tests for cancer. So in the short term the local health centre is going to have lorries in the car park carrying diagnostic equipment. Are they part of the NHS centre? Are they to be cleaned as part of the centre? Why are they here and what are they for? And what about the reduced number of car parking spaces that have led to so much complaint from patients and their relatives?
All this is part of both the long-term plan (the continuing story of the NHS) and the cleaner’s new story.
In one version of that new story the cleaner is helping more local people to survive cancer. In another the cleaner just has some very odd additions to their work and a bunch of lorries that are taking up parking space.
Given the importance of the NHS to British society these wider influences of the story have a bigger impact on that narrative than most. How do we ensure that the new parts of the service in the long-term plan are a part of that story?
Over the last few years many parts of the NHS have been trying to create new models of care that involve integration of various parts of the NHS, other public services, and patients and their communities. The long-term plan is probably going to increase that work. Day-by-day these changes are experienced by staff as being very hard indeed.
Whilst the compelling case for change behind the new care models outlined in the Five Year forward view seems to have been agreed at the top, on many occasions staff and the public at the local level revert to their old way of understanding care. To ensure long-term change, leaders need to work with staff and the public to create a new story, one that encompasses the changes and places staff and patients securely within the story.
A story that includes people in it will engage with their emotions in a way that ‘plans’ for change do not.
Despite many explanations of how to embed change within an organisation stressing the importance of creating a new story, leaders in the NHS and public service seem to find even talking about the need for new stories a bit embarrassing. To expect any long-term plan to actually work and impact the real world of practice we need to overcome this embarrassment and engage with story-making and telling.
You can watch a 30 minute video I made describing how narratives are constructed and what needs to be included here. Have a look, and tomorrow I’ll run through the main points of how it might work.