It had all the ingredients needed for a collective meltdown: accusations of a cover-up; a significant untoward incident with the potential to damage public trust; a high profile resignation; the launch of several inquiries; a media feeding frenzy; and questions in the House of Commons. But this time, the organisation at the centre of it all wasn’t an NHS hospital but another prominent public institution.
Of course, many NHS professionals will be all-too-familiar with the sight of an organisation in the throes of a crisis. On this occasion it was the BBC but there are a number of NHS trusts which have been plunged into chaos by financial difficulties, significant clinical failings or external events such as a decision to close a unit. In nearly every case, the problems are compounded by a lack of communication which allows rumour and even despair to take hold among staff.
In my own experience of working with hospital trusts in difficulties, the most common cry is that ‘no one tells us what is going on’. For this reason I would argue that one of the most important organisational objectives in a crisis should be to establish honest and open communication. Easier said than done I appreciate but without this, it will be impossible to restore morale and equally importantly, the care provided to patients is also likely to suffer. After all, how often have we seen hospitals where one disaster seems to follow another in quick succession?
I believe doctors in leadership positions within crisis-hit hospitals can play an important part in restoring calm and dealing with the anxieties of staff and patients if they are given consistent and useful information. Hospital trusts who keep staff in the dark about what is happening are unlikely to get their organisation back on an even keel but if information is not forthcoming, senior doctors should themselves be prepared to collectively approach hospital directors for answers to the questions of greatest concern.
By contrast, firing off letters to the press or expounding upon trust failings with outsiders will usually escalate the sense of crisis. To return to the BBC analogy, while some have argued that the readiness of the corporation’s journalists to question and even humiliate their bosses was a sign of strength and integrity, the sight of any organisation publicly picking at its wounds is usually disturbing for outsiders and is likely to further knock their confidence in the organisation.
For more junior staff working within struggling organisations, it may also be tempting to use tea breaks to gossip about the latest failures at the top but this is better avoided because it may simply add to a sense of powerlessness and frustration. Instead, I think it’s more helpful for individuals to adopt a business-as-usual approach, for their own sake as well as patients. Practical concerns about their ability to deliver patient care should be directed to their supervisor who should then be prepared to raise them with someone who has decision-making responsibility or if necessary to seek advice from an appropriate external professional or regulatory body, in line with GMC advice.
Of course, confusion over who is actually in charge is another common theme in crisis-hit organisations where senior staff are obliged to step aside. As seems to have been the case at the BBC, such leadership vacuums can easily result in organisational paralysis and instances of poor decision-making. As they are currently discovering at Broadcasting House, it is only by moving swiftly to re-establish clear lines of decision-making, accountability and communication that the confidence of staff and public alike can really be restored.
Healthcare Performance is run by two doctors with over 30 years’ experience of clinical governance and medico-legal work. It specialises in careers coaching, professional development and organisational trouble-shooting within the healthcare sector.