When I was a general surgical registrar in Auckland, New Zealand the 'management era' was just beginning. Someone, who I expect had never worn greens and didn't know one end of a retractor from another, was examining the operating theatre budget in some office remote from the front line.
About $15,000 needed to be saved and in the mind of the 'micromanager' the deed could be done by one stroke in the expenditure column. The theatre tea lady was sacked. The next day a metal and glass substitute arrived and took its place in the corner of the theatre tearoom.
If a committee had studied the theatre environment for a decade in order to determine how to deal the worst blow possible to productivity, morale and efficiency for the minimal possible cost they could not have done better; because in value for money terms the theatre tea lady was the most important staff member in the department. I expect she graduated into her low-paid, low prestige role in the health service through managing to flunk her school exams and close the door to other possible career paths. Perhaps she chose her path willingly and cheerfully.
Regardless, she loved her job and considered it a privilege and pleasure to be part of the team - and in many ways her fussing, appreciation, smiles and sheer human warmth as she dispensed cake, sandwiches and cups of tea made to personal order were part of the glue that kept morale up. Despite her low status she had a gift for making everyone feel they were appreciated and valued. And I think that helped us in doing the best possible job. By contrast her sudden unannounced departure without a scrap of consultation just fuelled the resentment.
What the faceless bureaucrats failed to understand is that people perform best when they feel they are recognised and appreciated for the work that they do. The sacking of the tea lady was the first step in a long series of management blunders by people who in Oscar Wilde's words 'knew the price of everything and the value of nothing'.
Little things like clean on-call rooms, after hours meals for hard working staff, rubbish bins you don't have to empty yourself and tea ladies who smile and make you feel important make a huge difference to morale, self-worth and performance. But you have to rub shoulders with those on the clinical front line to appreciate it. And that takes a special sort of manager - regrettably seen rarely in the administrative corridors of the NHS or the Department of Health.
Jesus was that special sort of manager - entering our world at the lowest level, taking the form of servant, and bearing our burdens. We desperately need more of him in the NHS.
