First published in the NASGP Newsletter in August 2021
Suddenly, sometime in the 1990s, NHS managers began talking about HR. What was that? Human Resources. What are Human Resources? What we knew as personnel. So the people seeing patients on the front line had become widgets in a corporate machine.
Put like that, it sounds Stalinist. And it is. On one shift in 1935 Alexei Stakhanov, a Soviet miner, extracted over 100 tonnes of coal. The average worker managed 7 tonnes. If one miner could do it, surely they could all increase their production and so help the USSR catch up with the West. Stakhanov rapidly became a Soviet hero and role model throughout Soviet industry. And beyond. Stakhanovism caught on in the West, and Stakhanov made the cover of Time Magazine.
Now, few remember his name, but Stakhanovism is preserved, not only in industry but in the NHS. The ideal is lightly disguised in political expectations and mission statements. Consider the way performance is rewarded: in the USSR Stakhanovites were given medals, a ploy adopted in 2020 by then Health Secretary Matt Hancock. And the NHS has now received the George Cross. Most people working for the NHS would have preferred to see proper investment in the service.
I once challenged a Health Authority apparatchik whose corporate-speak included her determination to establish a ‘world class’ health service. She was setting a very low bar, I suggested, given the tragically poor provision of healthcare worldwide. And managers aspired to ensure that all the practices in their remit should be above average They were puzzled when GPs pointed out that whatever the average, 50% must always be destined to fall below it.
In fact, Stakhanov’s achievement was not because he worked incredibly hard. It was innovation – he realised that a drill would be more efficient than the traditional pick. But in the subsequent 75 years management has continued to use hours worked as a surrogate for quality and be wary of innovative ideas from the front line – “We don’t do things that way here”.
Even in 1930s USSR, Stakhanovism was being questioned by fellow workers who found their lives harder, and by some managers who saw that the pressure to achieve super-outputs exhausted workers and threatened production.
In the real world most of us fail to become Stakhanovs. We can’t all be an Olympic medallist. Or one of the 20% high performing civil servants. Or the colleague who always spots the diagnosis.
It’s so easy to feel inadequate. But every day we take the wrong lessons from people around us. A colleague who makes you feel bad because he is always at work when you arrive may not be a role model; perhaps he works very slowly and is trying to catch up. ‘Superwoman’ probably has live-in nannies, home helps, and someone else to place the Ocado order. Of course, poor performance needs to be identified and rectified. But if doing your best isn’t good enough, it isn’t you who is wrong. You’re in the wrong job. ‘Good enough’ has to be good enough.
Seventy years ago, paediatrician and psychoanalyst Donald Winnicott saw a lot of parents who felt they had failed because their children were not top of the class. But he found that parents who were not perfectionists had offspring who were better adjusted to the realities of an unfair world. Children of ‘tiger parents’ may occasionally score 100% across the board. But some schools collude in a cruel deception by encouraging all pupils to believe that they can achieve anything they want. In the long run ‘good enough’ is the more successful strategy. For parents, for organisations, even for your smart phone, for all of us in whatever we are doing. We will be better prepared for setbacks and disappointment, less likely to burn out, more productive and happier.
In China some of Xi Jinping’s subjects don’t buy his mantra that “Hard work is the path to happiness”. They see people dying from overwork and advocate tang ping, translated as ‘lying flat’. It’s catching on, and Beijing quickly censors on-line mentions of tang ping.
I read recently in the Health Service Journal that some senior specialists are accusing their hospital management of excessive authoritarianism. (Query: what degree of authoritarianism is appropriate?) Stakhanovism is all around us and we need to be aware of it if we are not to surrender to it. George Orwell was the scourge of totalitarian newspeak. Animal Farm describes how creeping Stakhanovism can overtake good intentions. Company-speak has a soporific effect which cloaks its Stakhanovite implications, so when we are faced with a policy document, we need to work out what the latest reorganisation of the NHS really means. Cut out the jargon and the tired figures of speech. Has anyone actually drawn a line in the sand since the battle of the Alamo in 1836? Change a passive to an active voice. Rephrase it in simple English so the writer’s real intentions emerge.
If you are unlucky enough to have an appraiser with Stakhanovite tendencies, look on it as a challenge and ensure that your PDP isn’t a guilt-inducing burden. When considering a locum post, remember that some practices and commercial agencies treat locums as widgets. So keep an eye out for Stakhanovite clauses in the employment contract. And compare it with NASGP’s Locum Deck. NASGP offers ‘More Opportunities and Better Control’ for both locums and practices. That’s what all healthy relationships are all about.