Organisational Dementia

I have been in in my current job for over seven years. In that time, at my PCT I have seen the comings and goings of four chief executives, four directors of finance, seven directors/managers of primary care, two directors of commissioning, three finance managers, three directors of clinical governance and three directors of human resources. Not one of the heads of the major departments was in post more than three years ago.

This need not be a bad thing. indeed, for these individuals, it's usually a very good thing. New appointments usually mean promotion, more cash and new interests. For those of us left behind, it is often a source of irritation and frustration.

Why is it frustrating? Well, because quite often we find that the useful suggestions (and accepted as such by the management), we made about improving services fall by the wayside. The replacement arrives at the next meeting with a clean sheet, fresh start, and other manifestations of the lack of an effective handover. The good idea has to emerge all over again and the clock is reset. As far as the new incumbent is concerned, there is no delay because the count has just started.

Then there's the irritation. We negotiate an agreement with a director and do whatever the agreement requires of us. A couple of directors later, the new leaner, meaner, "we must reduce costs" senior gunslinger calls us in and says we're not doing it properly. Our response that "we are doing what was agreed" is brushed aside. "I wasn't here then" which is intended to mean: "that agreement doesn't count and we can and will ignore it".

Efficient organisations learn from their successes and their mistakes. The NHS doesn't seem to learn. I cannot see any evidence of any determination for our PCT to retain a clear view of who did what, when, and the outcomes. The process of finding a replacements for a departing senior executive usually starts after his or her departure. Frequent reorganisations mean the shifting of some duties from one person to another and departments are broken up and re-established with the energy of a Scottish country dance. In amongst all this organisational musical chairs, knowledge and experience evaporates.

Never mind, a new director will soon be here, brimming with "fresh" ideas.