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21. The More Things Change...

'May you live in interesting times' Ancient Chinese curse If you work in the NHS you may still be reeling from the news that the government is planning to abolish your organisation. I was certainly surprised myself by the sheer scale of transformation planned in this particular NHS reorganisation - so the subject of change seemed an obvious one this week. But first I'd like to ask you a favour. In September it'll be a year since I started writing these tips and I've been very grateful for the feedback that I've had from many of you. I aim to vary the content between the psychological and the practical on the basis that knowing how to do things is useful, but sometimes however much you know what you should be doing, you still feel blocked. At those times what is needed more is a change in mindset or perspective. What would be very helpful is to know is whether the balance feels right to you, what you would like more of, what you would like less of, and whether there are any topics that you'd like me to cover? 'Plus ca change, plus c'est la meme chose' Jean Baptiste Alphonse Karr Roughly translated, 'The more things change the more they remain the same'. My first public health job was in Hackney in East London. It was a vibrant, exciting department that was trying to improve health in a deprived, diverse and engagingly upbeat community. It was a wonderful job. Hackney was constantly in the news, whether through fame or infamy, and there was always some crisis going on. Working there was challenging, engaging, complex and huge fun. These were the days before the purchaser-provider split, when the health service was managed by consensus. There was no chief executive over whose genitals hovered a guillotine, but a senior management team with a district medical officer, nursing officer, administrator, finance person and head of personnel. Decisions were made together. I can't with all honesty say how effective this team was because I was too junior to know; all I can say is that the general atmosphere at work was optimistic and friendly and that good things were done. Then came the Griffiths report. Mrs Thatcher took a pretty dim view of this cosy consensual arrangement, so on the advice from the man from Sainsbury's she introduced a pyramidal management structure. There was to be a chief executive and he or she would definitely not have one of those absurd arrangements called 'permanent contracts', but would be employed on a limited, three year contract. He or she would be ultimately responsible for everything that happened in their hospital and could be summarily dismissed if anything went wrong. This, as you can imagine, meant a titanic shift in culture. At this time I had a consultant boss called Jane. One day in a department meeting I was railing against the proposed changes and she took me aside, very kindly, and said: 'Listen Anita, I've been through SO many of these reorganisations and I can assure you, nothing ever really changes'. This was a fascinating perspective because things certainly did change, dramatically, and I often speculated what it was that made her think that nothing ever changed. It was years before I worked it out: what was important to her, and that was her day to day work helping the people of Hackney, didn't actually change. Everything changed around her, but she carried on doing exactly what she had done for years. My focus, on the other hand, had been on what was changing. Obviously, carrying on doing what you've done for years is not an option if you are no longer in a job, but the perspective is helpful even so. One thing you would have noticed about my ex-colleague, had you met her back then, is that she was unerringly upbeat. Whether she learnt that optimism when, as a young doctor and mother of two children, she was diagnosed with a malignant brain tumour, or whether she coped with that and the ensuing years of radiotherapy and uncertainty so well because of some cheerful gene handed on to her by her ancestors, I don't know, but she never moaned. Even now, in her seventies and having suffered a stroke, you will rarely hear her complain about her failing health and often hear her wax lyrical over her grandchildren. No doubt there was more than one factor contributing to Jane's optimism, but the one I learnt from her was this: even at times of great change, there's also continuity. What creates most of our misery is focussing on the things we stand to lose. If you focus instead on the things you stand to keep, and then on the things you might gain, then a brighter mood could well ensue! If you're faced with a significant change in your life, try this: 1. First conduct a reality check. What is happening right now; what precisely is changing, and when; what is likely to remain the same; what is certain, what is not? 2. Work out what is and is not in your control. For example, imposed government change is not in your control, whereas whether or not you apply for a new job is. 3. Try to let go of what you can't control. Fighting is pointless and frustrating (I should know, I've done it!). 4. Focussing on what you can control, what can you do now? 5. Focussing still on what you can control, what are your future options? 'May you survive interesting times and live to enjoy a little restful boredom'. Lesley Garner, journalist and author of 'Everything I've Ever Learned About Change'. Do let me know how you get on, and have a good week!

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