It is noticeable in my work with clinical teams in difficulty, especially where operational matters are one of the strong contributing features of the dysfunction that the team has not had stable management support. Managers are often new and inexperienced, their tenure is short affording them little time to accumulate experience and their responsibilities are too broad for them to invest sustained time and interest in the issues facing one of their team in their large portfolio. I often hear clinicians saying “Our manager is new and inexperienced and s/he won’t be staying long anyway so we might as well not bother trying to change anything! Let’s just wait it out.”

Organisational memory is the accumulated, often undocumented, wisdom, knowledge and information gathered through the experience of working in a job. The individual carries this knowledge with them when they leave to start another job and if they haven’t ensured the transfer of the knowledge to their successor, the new manager usually has to start all over again, often reinventing the wheel, making the same mistakes, wasting time and thus making slow progress. Even if the outgoing manager has transferred organisational knowledge, the new manager is likely to want to make their own way ensuring they have an understanding of what the unit has been doing. They often spend the first few months getting to know the clinicians and the system thus delaying progress and frustrating the team which might have been eager to move on. The new manager may propose different ways of doing things without even trying to gain access to what has gone before. And just as they become familiar with the issues they are promoted, moved sideways or leave. Whatever their approach, the loss of organisational memory hampers progress and dilutes busy clinicians’ good will. Whether manager turnover is every year or every two years is immaterial – it is the fact that there is little or no continuity and stability and the repetitive effort of building a relationship, explaining things from scratch and finding the energy to work on new initiatives starts to feel tiresome with so little return on personal time investment. Clinicians have come to expect managers’ tenure to be brief and their scepticism has grown so that they are cynical of even the most well-intentioned manager’s intention to stay the course with them.

Organisational change is slow and most doctors are willing to change recognising how important it is to become more efficient and effective. To engage doctors in meaningful and sustained efforts to change the way they work and the service they offer for the better, it is important that the NHS recognises the value that managers can bring by investing in their development at the same time as providing continuity for the services they manage and the clinicians who do the day-to-day work. The loss of organisational memory is expensive – it wastes time, money and motivation.

by Dr. Megan Joffe