Confusing the path with those who walk it

I can see few clearer examples of the consequences of confusing paths and people than in the National Health Service here in England.

We are in a period of acute austerity, which has resulted in the wide-scale degradation (some would say dismantling) of social care services, leaving hospitals filled with elderly people who should not be there at all but have nowhere else to go. This, coupled with a funding model for hospitals that pays them less for caring for such patients than for other vital services, forces those who run NHS Trusts to choose between:

(1) running up a huge deficit to prop up the failing social care system, while continuing to provide the services that people rely on

(2) or greatly cutting back on spending in order to balance the books, either by limiting elective surgery (which, while not life-critical, can have an enormous effect on the quality of life of the people served by the hospital), or by cutting back on the quality of care, with all the attendant risks to safety and dignity of patients.

Each choice is fraught with difficulty and the potential for harm. And each is the product of a much wider societal, political and economic environment which itself shapes the paths that are possible.

When we fall back on our familiar individualistic interpretations, we quickly conclude that someone must be to blame for having to make such choices at all. And this leads us to conclude (a) that the people involved in making such choices must clearly be incompetent or misguided, otherwise they’d be able to make the right decision, and (b) that someone else – a new leader, someone with their head screwed on – will be able to sort it out.

And all of this draws our explanations away from the path itself and what creates it, and towards those who find themselves on it.

We get blinded to the systemic difficulty by our insistence that it’s personal.

And this in turn lays out and reinforces a particular kind of path of its own – one which holds even talented and committed people responsible for that which they cannot control, and leads those who would otherwise wish to contribute to stay well away.

It’s easy to see the effect of this path on people’s willingness to step in: the average tenure for an NHS Chief Executive is only two and a half years (Source: NHS Leadership Academy), nearly 1 in 10 NHS Trusts has no finance director, around 1 in 8 has no director of operations, and vacancies for these posts remain unfilled for months at a time (Source: The King’s Fund).

In the NHS the discipline of good path-making has implications at all levels, including the political and policy situation that could brought about by government if the will was there (the purposeful cultivation of paths that could have the NHS thrive instead of the cultivation of those that have it and those within it flounder). But the phenomenon is also visible at a much more local level in smaller organisations, because the narrative of individual accountability is a background assumption upon which many so organisations are founded.

And until we’re willing to treat the systemic and collective practice of path-making as a serious project in our organisations and in our wider culture, we’re writing ourselves again and again into paths that sustain the very difficulties we most want to solve.

Photo Credit: Andrew_Writer via Compfight cc

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