This week has been difficult for doctors in the UK. More than that it has been difficult for all healthcare workers in the UK. The feelings engendered by the imposition of a contract to make Saturday a normal working day are complex and for many deeply unsettling. I think it feels hugely aggressive and plain wrong from the point of the compassionate humanistic ethos that most of us in healthcare base our working lives on. In trying to make sense of the almost physical pain that I saw in colleagues at work I started to think about this conflict.
Conflict, an inherent incompatibility between the objectives of two or more characters or forces, is what we are involved in. As a healthcare worker I want to understand it more, so that I can make it better, that is what we do. Our training, our community, our professionalism sets us up to heal not fight, to do that right thing no matter how difficult, to continue with quiet resolve and a firm hand on a true course, these are the paradigms healthcare workers exist by. So when in doubt I choose to fall back to the familar, what is the diagnosis?
I think that the work of Edgar Schein is helpful here. Schein, a former professor at the MIT Sloan School of Management, is a hugely influential organisation psychologist having proposed a widely accepted model of orgaisational culture. The model describes three distinct levels in organizational cultures:
- Artifacts and behaviours – these are openly visible things such as offices, dress codes, official structures
- Espoused values – these are the stated values and rules of behaviour
- Shared basic assumptions -these are deeply embedded, taken-for-granted behaviours which are usually unconscious, but constitute the essence of culture.
The model also describes sub-cultures within a multifaceted organisation like the healthcare. Trouble arise if espoused values by leaders or leaders basic assumptions are not in line with the deeper tacit assumptions of the subcultures. I think this captures the current situation. In healthcare, you can describe some basic assumptions, these are things that are givens and many of us would consider incontrovertible. That everyone deserve to be treatment and reduced suffering. That all people deserve fair consideration. That we respect the individuals right to decision making. But deeper than that, that we do good, that we are kind, that we look after society.
When our basic asdumptions as a group are challenged, it creates a schism and conflict. This is a clash of cultures. Culture clashes are known to be profoundly unsettling as they threaten the world perceptions of a group. I think this is the centre of the disquiet we feel over the events of the last few days. The culture of healthcare as we have grown-up in feels threatened, the basic assumptions we all work by seem ignored. We work daily as teams, we negotiate treatments, we care, we believe compassion is a cornerstone to our working lives. The enforced encrochment on the British cultural assumption of the weekend is deeply counter to our world view.
Unfortunately culture clashes do not disappear because of any edict or because someone says they are not so, they are a real thing and need careful managing, otherwise they continue in one form or another whether that is visible resistance as in stikes or avoidance as in seeking alternative career paths. For all our sakes we must recognise the diagnosis, and act on the root causes.