Is The NHS a Burning Platform?

 

Did someone mention a burning platform? As operational managers, many burning platforms distract us from planning and effectively running our clinical services on a daily basis. Some would say that putting out fires is the job of an operational manager; this is undoubtedly true. However, in our blindspot there is an uncomfortable truth. Allowing a fire to take hold is also a sign of failure, our failure. This could be due to an act, or omission, on the part of the manager and clinical team. It can often be the result of system failure, as the corporate wheel spins in the opposite direction, preventing managers from managing effectively (pyromania is for another article and will not be debated here).

A burning platform is a description often used in the NHS to describe an impending service catastrophe, one which we may or may not be able to fix (rather than prevent). The best operational managers have developed fire-fighting as a selling point or winning strategy and this has become an essential part of our roles. If we scale this up it would reflect our evolving healthcare ethos, closing the stable door after the horse has bolted (remember Sir Derek Wanless?).

Undoubtedly we have the best emergency care services in the world – another example of our flare for fire fighting. Our A & E services are so efficient (unless an inpatient bed is required) that patients flock to our doors. As victims of our success, the patients keep coming, the majority of whom we treat within four hours.

But there’s a good reason to be talking about burning platforms. Some years ago, I was in conversation with an oil industry health and safety manager, talking about training off-shore workers in light of the Piper Alpha disaster (a North Sea oil rig that caught fire). The fire was responsible for the death of 167 men. Lord Cullan reported inadequate maintenance and safety procedures as responsible and made 100 recommendations.

I learned that as part of the fire safety procedures, personnel were required to move to the designated fire point and wait for instruction. Personnel were advised not to jump off the rig into the sea as this would result in certain death. As the fire worsened, men continued to stand at the designated point waiting for instruction; however they were unaware that the fire marshals had already been killed in the fire. A number of men, in the face of certain death, jumped overboard; others stayed waiting to be told what to do. In this instance, those who jumped had a greater chance of survival because it was the worst oil platform fire in history.

The fire took thirty-six days to be extinguished by wild well controller Red Adair (The Guardian 2103). Red Adair, as you can guess, wasn’t famous for fire-prevention, he was famous for dealing with burning platforms. To be an expert at this, you would need to spend at least 10,000 hours practising, and the same is true for fire prevention.

In light of the above, do we really believe that the NHS is a burning platform? As much as I jump at the chance of putting out fires, fires are a sign of system failure and should not become the norm. But like a turkey fattening itself up for Christmas, it’s a big ask for those of us who have developed a career out of fire-fighting. The first stage is to recognise the number of burning platforms we own. What we allow persists.

I’m uncomfortable thinking that I may contribute to this Red Adair culture. However, to transform we must feel uncomfortable with the status quo. We must feel the heat of the flames licking at our feet in order to shift positions or jump; either that or die complaining. The Kings Fund leadership team teach that we are all part of the solution regardless of the problem and I believe this too. But it’s a scary environment: we’re programmed to respond to fear and as Florence Nightingale once said, ‘How very little can be done under the spirit of fear.’

But the news is good: we don’t work on an oil rig or a burning platform, we work in the NHS. Although somedays it can feel as if we are on fire, we are not. The burning platform is a powerful illusion but we must decide whether we are going to stand around waiting for instructions or whether we feel uncomfortable enough to shift our position. We don’t need to jump into the cold North Sea, we’re on solid ground. Once we can see this, our vision of what is possible will change and we can find new ways to work that take the heat out of our experience.

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