Just now, many of us are improvising – bringing established skill sets to bear on radically different, unfamiliar, situations.  This suits some types of personality more than others, yet we may all have to do it.

Over many years the NHS and social care have evolved into ‘command and control’ systems.  Individual responsibility, and even sense of vocation, has been eroded by ‘industrialisation’, a whole raft of directives as to what should be done by who and when.  At the same time a risk-averse ‘blame’ culture arose.  People began to fear that every action they took, regardless of context, could be subject to detailed hostile scrutiny, at work, or in a court of law.

Neither of these developments is conducive to improvising, yet that’s what’s needed now.

We need a readiness to share collective responsibility, to collaborate at all levels in monitoring and working to improve the system. 

We need to find ways of having a lively dialogue, continuously sustained in our organisations, and communicated when needed.   At a time when staff and services face being practically and emotionally overwhelmed, this is not easy.  It can only begin with awareness, and agreement, that raising concerns, generating ideas, and solving problems together is both necessary and welcome.  

If we can’t do this, with an open attitude, the risk is that anxiety and criticism will just pass unhelpfully up and down the system; with staff on the frontline berated for failing to follow instructions, or attend to the right priorities, and managers and politicians ‘on high’ accused of being ‘out of touch’, of incompetence, and of dereliction of their duty. 

We’re all improvising, and we all need feedback and the chance to discuss what’s going on.  Overall, we need to trust that we’re all doing our best – and if we could do better, this needs to be communicated in a way that can be heard, rather than felt as criticism, and thus reacted to defensively. Then all our performances can improve.


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