The NHS is experiencing a staff shortage which is being defined as a crisis. In this article, we apply a process philosophy perspective on the situation in the hope of generating some insights into a problem which has been building up for a long time in slow motion.
We have been placing a focus on the philosophy of Alfred Whitehead in our recent articles which we’ll continue. We’ll draw from Whitehead’s function of reason which he argued is to “promote the art of life” (1929). Reason is expressed in three stages
- To survive and live
- To live well
- To live better
Whitehead argues that there is an upward normative trend to live better. To discover ways of living better requires departure from the routines which maintain our ability to a) survive b) live well. In other words, to realize ways of living better requires novel ideas and imagination. The relevance of novelty is then tested in practice (ibid).
If the idea works in practice, it then becomes a way of living, and living well. However, without the continual interjection of imagination and novelty, we (and all living things within the universe) become static at the levels of surviving and living well. Whitehead (1929) posits that stability in any form is always in a state of decay, that is the natural order of things.
Stability requires repetition, and repetition eventually produces fatigue and decay. A rock which is repetitively exposed to wind, eventually erodes to nothing. The same is true for human beings. Repetition is certainly essential to many areas of our lives expressed in habits and routines, procedures, and processes. Repetition allows us to put certain aspects of our lives on auto pilot and turn our attention to more demanding challenges. It allows us to avoid renegotiating all aspects of our lives daily. If every aspect of our life was novel, we could become easily overwhelmed.
However, if we place too much emphasis on repetition then habits and routines can overly constrain us and leave us unable to notice and attend to potential (McGilchrist, 2019). In the workplace, procedures and processes are essential to fly a plane safely and operate on a patient. However, if they are not exposed to novelty, they can become unfit for purpose as they fail to notice subtle environmental changes and chances to “live better” (Klein, 2014).
If an organization is locked into surviving and living well, it could potentially fail to notice opportunities to live better. It could also fail to notice when the repetition of procedures and processes has led to fatigue and are no longer fit for purpose (Klein and Wright, 2016). This places basic survival under threat.
Returning to the NHS. The NHS possibly has three critical objectives to achieve
- To survive, by having enough staff for supply to meet demand
- To live well, by ensuring that staff stay in the workforce to make survival sustainable
- To liver better, by ensuring that staff at all levels feel able to contribute to the continual improvement of the routines, procedures, processes, and cultures.
If someone enters the NHS, do they find an organization struggling to survive? In such an environment there is not the cognitive space to do any more than repetition. Repetition would lead to fatigue, fatigue to burnout, and the organization, like any fatigued organic structure, would atrophy and decay. We can evidence this in high NHS staff turnover, sickness absence and burnout.
The NHS uses agency staff to fill staff shortages despite efforts to move toward a more sustainable model
“However, since the start of 2018/19, the volume of agency shifts has increased, largely due to increased activity. Despite a drop in agency prices, these conditions have created a challenging environment for trusts”
This approach, although currently necessary for survival, is not operating at the living well level, and nowhere near the living better level. If staff are temporary, there is little opportunity to attend to the environment in a manner which notices novelty and produce ideas of how live to live better. This again leaves the NHS at a stage of repetition, fatigue, and decay.
Sticking with the commitment to Whitehead’s argument of reason as the art of promoting life, the point follows that if the NHS could interject novelty and imagination into how people attend to their work, then an upward trend would follow- an organization continually focused on how to live better. How could this be done?
It could possibly be done at the educational level. This could apply to educational providers but also to locum agencies who supply staff. A locum agency could have an educational responsibility to train staff in how to find meaning and purpose in their work by attending to the environment in a manner focused on living better. This would be the philosophy of continuous improvement moving into the NHS all over again. However, with a key difference.
The emphasis is more on philosophy as opposed to importing a management structure from another culture andor sector. The structure would emerge out of the practice of the philosophy. If all newly registered and agency staff were trained in how to practically apply imagination, to notice how things could be done better, then a structure of attending to these ideas and testing them (not all would work) could emerge.
This may involve a communication flow, but it could also involve innovation labs to safe test ideas and develop incremental change strategies. The important point is that structure would emerge from the implementation of philosophy directed at developing the art of life. This is not the art of constant repetition that leads to having to do more and more to simply survive.
In the past ideas such as Total Quality Management from been brought into the NHS with the aim of developing continuous improvement. Unfortunately, they have been brought in as structures, without the philosophy and cultural development to make them work. Without these foundations, the structure just clashes, it doesn’t develop.
If everyone becomes focused, overtime, on imaginatively engaging with how to live better, then these occasions of imagination could add up to actual events which slowly transform the NHS. Maybe.
Reading
Klein, G., & Wright, C. (2016). Macrocognition: From theory to toolbox. Frontiers in Psychology, 7(54).
Whitehead, A. (1929) The Function of Reason. Sage Egmont.
McGilchrist, I. (2019) The Master and his Emissary. The Divided Brain and the Making of the Western World. Yale University Press; Expanded Edition.
