Putting The Social Back Into Care

Having worked in and around healthcare for nearly 40 years, and having been involved in, co-designed, led, and evaluated multiple organisational development and change initiatives and interventions, with teams, groups, departments, boards, within whole organisations, and amongst organisations/across a system, I have observed multiple structural, technological, and process changes, some of which have worked for the better, some maybe not so.

Where there has been a focus on people – a more sociological perspective, humanistic, with people and relationships at the forefront of whatever the change is, there has seemed to have been more participation in the change, with change that has a ripple effect on relationships, values, culture and behaviour.

At a brilliant meeting today where a group of people from mixed professions and backgrounds, all of whom had some connection to healthcare, I was inspired to reconsider change in the NHS from a more sociological perspective, and, reminded of an organisational development intervention two decades ago.

A healthcare organisation in England had had feedback from staff that the structure of the organisation wasn’t working – and asked for the organisation to review the structure. So the board of this organisation tendered for an independent facilitator to oversee the review of the structure. In being contracted to do the work, a few months was spent engaging staff, and stakeholders from within the organisation and external to the organisation, and staff in the organisation came up with a few new structural options, which were narrowed down by a series of ‘voting’ interventions to two structures.

After extensive engagement and further tweaking of the two structures the day came for the staff to vote on which would be the new organisational structure. The board team purposely went off site for the afternoon to allow for a series of ‘voting’ discussions with large groups of staff to take place.

It came to crunch time, later in the afternoon of the ‘voting’ day – and a very large room was filled with 100’s of staff. The staff were asked what their verdict was – and they were asked to vote. They didn’t put their hands up, nor did they engage in the voting, the room was silent for a while. At this moment, there was some discomfort in the knowing that the board were waiting that evening to meet to discuss the newly voted for organisational structure, and someone's head would be on the block if something had gone ‘wrong’ or there was no vote – as the organisation had invested in a few months of work to get to this point.

Then someone in the room spoke – they said ‘we have realised it is not the structure that is the issue – indeed we could have all manner of structures that could potentially work well – but we can’t vote for a structure’. What they then said was ‘we have realised it is about relationships, communication, and people’ – and that whatever structure we have if we don’t do the work to build relationships, or communicate or make it about people, it wont work – so we can’t vote for a structure – but we do have a recommendation’.

That recommendation was to have an organisation-wide programme based on communication, values, people and relationships.

The Board realised the outcome was a great outcome, and, they appointed a head of communications, relationships, and culture to oversee the change.

In the conversations at the meeting today it became blatantly clear through some excellent work undertaken by someone in the group that when we focus on the sociological aspect of work, on relationships, on people, on communication, on equality, and on the freedom to express that something shifts, and new ways of working emerge from that. No structural interventions, no technological solutions, simply a focus on the ‘sociological’ aspect of work.

Look in any dictionary and it will say sociology is something along the lines of – a study of human society, of organisations, institutions, human social relationships, with a focus on changing relationships amongst individuals and in groups.

What if it is time to put the social back into care, and put the social back into social care, and take a sociological approach to healthcare organisations as one of the foundational aspects of change?

The bottom line is that work is about people, healthcare is about people, by people for people. Sociology is unavoidable, yet, why is it that this factor is so ‘under nourished’ in Health and Social Care at this time?

(and thank you Kaleidoscope Health and Care and Abbvie for organising and hosting the lunchtime meeting)