'Sceptics or realists' - Authors' response
We note Dr Checkland’s comments on our paper on scepticism with interest. In response, we do not believe that the paper argues that it is not legitimate for staff to be sceptical; indeed, we acknowledge the fact that scepticism can be useful in highlighting gaps and flaws in improvement initiatives. Nevertheless, the study – based on interviews that centred on listening to the opinions of others – did identify the negative impact that scepticism and resistance are having on the pace of change in the NHS.
With regard to the use of terms such as modernisation and improvement, we think that this is a semantic argument that ignores the underlying spirit and intent of planned reform. It is surely legitimate to make certain assumptions about meaning in this context. Changes designed to make health care better for patients deserve to be described as improvements until subsequent research evidence demonstrates otherwise. The drive to involve frontline staff in leading service improvement encompasses the notion that change that proves not to be beneficial in practice can be reversed. If we implement only that which has been scientifically proven to be effective, the pace of change will be very slow.
1. Checkland KH. Sceptics or realists [electonic response to Gollop et al. Influencing sceptical staff to become supporters of service improvement: a qualitative study of doctors’ and managers’ views] qshc.com 2004http://qhc.bmjjournals.com/cgi/eletters/13/2/108#80
Sceptics or realists
The article by Gollop et al. raises an interesting question: does labelling a programme of change an "improvement" programme mean that such a programme will automatically deliver improvements?
I am disturbed by the implication that simply because something is "a key component of the government's strategy to modernise the NHS and make it more accessible to patients" it is therefore not legitimate for staff to be sceptical. In fact, the inclusion of such a sentence in the article provokes me to yet greater scepticism: what exactly does "modernise" mean in this context, and when did it become synonymous with "improve?" This Orwellian use of language and the presumption that it is not legitimate for intelligent observers to be sceptical about unproven innovation are two of the reasons that many of us are so disillusioned with life in the NHS. Having worked in the NHS for nearly twenty years, I have experienced many waves of change: some have brought improvements, some have been disastrous; some I have embraced and some I have resisted. I reserve the right to remain sceptical and questioning, and I hope that the Modernisation Agency will, as it matures as an institution, lose some of its evangelical fervour and learn to listen to the opinions of others. Changing its name might be a start!
1. R Gollop, E Whitby, D Buchanan, and D Ketley. Influencing sceptical staff to become supporters of service improvement: a qualitative study of doctors' and managers' views, QSHC 2004; 13:108-114.
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