Set against the changes of the NHS in the 1990’s, management at all levels were anxious and exhausted. Over a period of five years, a Health Authority in the Home Counties went through seven mergers.

Context

Many managers opted for early retirement. Others were regarded as ‘not up to job’ for the next reorganisation. Shifting the balance of power, involved giving clinicians in Trusts more responsibility for delivering and developing services, but for many, things were not making sense any more, morale was declining, and there was apprehension that the proposed changes would be cosmetic. New ways of working had to be found and new skills acquired, especially how to manage under conditions of rapid change and organisational turbulence. The ‘new’ manager would be less concerned with order, prediction and control and would be more at home with volatility, turmoil and chaos.

Objectives

To: (i) improve delivery of patient services within budget (ii) improve working across organisational and professional boundaries, (iii) raise morale throughout the Health Economy and (iv) develop managers’ self-worth through direct involvement in the changes.

Methodology

Phase I: 10 consultation syndicates for 100 clinical and professional managers from different parts of the Health Economy. Four major themes emerged: 

• The role that senior and middle managers would play in managing the NHS modernisation agenda;
• implementing joined-up forms of management and service delivery that had traditionally been competitive;
• improving inter-agency collaboration within Health, and inter-sector collaboration between Health and Social Care organisations;
• building cross-boundary management capability into the modernisation agenda to off-set the tendency for organisations and units to form themselves into competitive and disconnected silos.

Phase II:

• Three Large Community Change Conferences at 6-monthly intervals
• Six Action Learning Sets meeting monthly over 12 months

Results

The Action Learning Sets, with the assistance of the Tavistock consultation, learned to develop a political relatedness to the Health Economy’s formal management structures, that effectively led to re-shaped strategies and new operations (often in novel and unexpected ways) in the following areas:• Communication systems with colleagues and staff • cross-boundary working relationships with and between individuals, teams, professions, organisations and sectors • developing a shared vision • Creating the conditions for the smooth transfer of patients across services • Increasing competences in negotiating and brokering • Increasing their power, empowerment of others and influencing capabilities.