Organisational dysfunction in the NHS: What are the causal factors?
The NHS appears to be an institution where negative and dysfunctional behaviours can flourish and be rewarded. What is driving and encouraging this organisational dysfunction? From the research findings some fundamental causal drivers/factors are proposed (diagram below). The situation is complex and many factors impact upon the situation. The protection of individual and organisational image and esteem appears to be a dominant influence particularly from the political tier at the top of UK society. The societal relationship with the NHS, and the apparent idealisation, may also have a huge impact and assist in preventing the learning that is required for change and improvement. The NHS is described as “…unimpeachable”, and “…you cannot, cannot, criticise the NHS”.
The NHS was also viewed as a "political pawn" and a "vast political machine". There has to be a recognition at the highest levels of the impact of political behaviour and the resulting dysfunction. Reality has to be faced and there is a need to have some honest, multi-party, collaborative conversations around how the NHS conducts its business for the sake of both staff and patients. The NHS urgently needs to 'put its house in order'.
Proposed fundamental causal drivers/factors for the developed model of organisational dysfunction