Can Organisations Learn From Experience? Intervening To Improve Cross-Boundary Management in Health and Social Care

The NHS is subject to many political, economic and social forces. During the late 1990's, anxious and exhausted managers oversaw many partial or total mergers to create new organisations: Partnership Trusts (Health Authority and County Council), Acute Trusts, specialist services and Primary Care Trusts. Many managers opted for early retirement. Others were regarded as 'not up to job' for the next reorganisation. Shifting the Balance of Power (Department of Health, 2002), giving clinicians in Trusts more responsibility for delivering and developing services was applauded, but there were reservations things were not making sense any more, morale was declining, and there was apprehension that the proposed changes would be merely cosmetic. Managers, clinical and professional, were struggling with over winners and losers in the shake-up of organisational roles, jobs and responsibilities. For many, management tool kits that were no longer relevant or useful. New ways of working had to be found and new skills acquired to manage under conditions of rapid change and organisational turbulence. The 'new' manager would be less concerned with order, prediction and control and would be more comfortable with volatility, turmoil and chaos. In 1999, the Lead HR Director of a Health Economy and the Tavistock Institute designed a management development programme for middle and senior managers to meet the requirements of the new NHS Plan. This cadre of managers had previously identified the value of having a 'space to think' in which to review traditional roles, provide new working concepts and understand organisational processes and change, as key management development issues. The joint programme, called the Cross-Boundary Management Development Initiative (CBMDI), aimed to (i) improve delivery of patient services within a budget (ii) improve working across inter-organisational and inter-professional boundaries, (iii) raise morale throughout the Health Economy and (iv) develop managers' self-worth through direct involvement in the changes. Few have managed to explain or demonstrate what 'organisational learning' in the NHS means in practice. The CBDMI was meant to be an example of both a process that could be used to foster organisational learning in the NHS. It had a further advantage in that it was an approach that was designed 'bottom-up' that followed the 'contours' of the specific organisations and did not import external models uncritically.