This is a difficult time to be a health professional. There are substantial clinical and resource challenges and change seems to be the one constant in our health services. This article examines three questions: What makes these hard times? Why, as Christians, should we seek to influence decision makers? How do we influence decision makers in a way that is compatible with biblical values?
Hard times: what's happening?
There are several issues which make the present time particularly hard. We face tightening resources. All our services have to find around 4% savings each year, at a time when there is increased demand both from demographic changes and increased consumer expectations. This means that there is enormous pressure to change radically the way in which we deliver services. Another pressure is increased regulation. Governance failures such as those shown in Mid Staffs have resulted in significant increases in regulatory pressures. My own organisation is currently expecting 140 CQC Inspectors for one of the new-style inspections. While external regulation and inspection clearly have value, there is a risk that regulatory pressures move 'time for care' into time spent making copious defensive records. Changes in society have also made things harder. Increased access to information and a digital generation's expectation of immediacy has increased pressures on health services. Consumerism has increased people's expectations whilst intensive media and social media criticisms potentially undermine morale.
Why influence decision makers?
First, because governance is a gift from God. The apostle Paul taught that 'the authorities that exist have been established by God' (1) and 'the decision maker' is 'God's servant to do you good'. (2) Thus Government (and governance) which seeks to deliver justice and a fair distribution of resources is a 'means of a common grace', something God has given us to ameliorate the impact of evil in the world. Given how hard times are, decision makers have a lot of difficult decisions to make and they need our help.
Second, because we are called to be salt and light. (3) Some Christians argue that as 'strangers in a foreign land' we should avoid involvement in secular structures. But Jeremiah, writing to the people of God in exile, instructs them to work for the peace and prosperity of the city in which God placed them. (4)
Third, we have the necessary expertise and wisdom. Many of the 'decision makers' are managers and commissioners without a clinical background. They want to do the right thing but they need the technical clinical expertise that we can offer as clinicians at the 'coal face'. Too often managers experience clinicians who will not share their expertise, but then complain about poor decisions made without it. We have a responsibility to share our expertise and God's wisdom with those called to make difficult decisions. We also have examples of God's people involved in large scale civil governance projects. There is not space to detail all of these, however they include Nehemiah running a major capital investment programme (as well as social reforms, a welfare system and religious revival); Daniel running large scale service delivery and Joseph handling huge fluctuations in resource availability.
Finally, we must use our influence because we have no choice. In reality our practice and behaviour have a profound impact on the decision makers around us. Our actual choice is – are we going to influence decision makers intentionally or unintentionally influence them through our behaviour? Will our influence be for good or for ill? Do we allow ourselves to be carried along with being angry, cynical, bitter and complaining? Or do we seek to do what we can do to make things better?
How do we influence decision makers?
Understand how the decision is going to be made.
We need to make some effort to understand the systems in which we work. We need to understand who will be involved in decision making and when and where the decision will be taken. This is not about trying to cynically manipulate decisions; it is about helping people make the best possible decisions.
Servant leadership. Paul wrote to the Philippians, 'Do nothing out of selfish ambition…have the same mindset as Christ Jesus who, being in very nature God, did not consider equality with God something to be used to his own advantage; rather he made himself nothing by taking the very nature of a servant'. (5) Servant leadership is lived out in several ways. Firstly, we need to listen actively to others, rather than coming with advice and solutions based on our own preconceptions. Secondly, we need at least to consider the possibility that other people who take a different view from ourselves may be right. Thirdly, we need to be prepared to work for the good of the wider service, rather than just a small part of it, and we need to understand what other people need to accomplish and help them.
We need to be present, reliable, helpful and truthful. It is important to decide where we can have an influence and then reliably turn up for the meetings that are making decisions. This includes turning up for meetings which are important to others, not just the ones important to us. If we understand what needs to be achieved we can often find win/win solutions that leave everyone happy. We need to be truthful. Distorting information to get our own way is not only wrong, but people have long memories and they will not believe us a second time.
Be proportional. Effectively influencing decision makers means we often have to work through the hierarchy and it is important to respect a leader or manager's view. This can be particularly challenging when dealing with someone who appears to be making the wrong decision. I recently listened to a very useful talk by a senior airline pilot who described the different levels at which a junior pilot could respond to a senior pilot when the latter was involved in 'destructive goal pursuit' (ie crashing the plane). Interventions started with hinting and hoping: 'Aren't we flying a little low Sir?'. The next level of intervention was stating the situation: 'If we continue in this direction we will crash'. The third level of intervention was to be direct: 'Pull up at once'. The final level was to take control of the aircraft directly. We need to know what our bottom line is and how to respond proportionally.
Practise positive behaviours
Manage anger. 'In your anger do not sin'. (6) The health service is full of gossip and misinformation and it is very easy to get angry at things which are half-truths or gossip but even when the situation is very serious it has been my experience that 'anger does not produce the righteousness that God desires'. (7) One practical tip is do not send an email when you are angry and do not copy it to all and sundry. You will inevitably do much more damage than good.
Be a peacemaker. Actively seek to understand others objectives and viewpoints. Challenge gossip and misinformation when it is leading to division. Even when people have to make difficult decisions that you disagree with, do not allow these decisions to destroy your relationship with them.
Practise hospitality. Care for the people you work with and make decisions with. My experience is providing biscuits to manage the hypoglycaemic irritability that occurs in the middle of long meetings is much appreciated. (8)
Be Enthusiastic. 'Whatever you do, work at it with all your heart, as working for the Lord.' (9)
Pray continually. (10) Pray 'for all those in authority' (11) and pray 'for wisdom'. (12) We need to pray for our practices, services and hospitals and for leaders and decision makers.
'For we are God's handiwork, created in Christ Jesus to do good works, which God prepared in advance for us to do.' (13) Part of these 'good works' is to use the skills and gifts that God has given us to influence and support those he has given the responsibility to make decisions in order to make those decisions as fair and compassionate as possible.
Nick Land is Medical Director to the Tees, Esk and Wear Valley NHS Foundation Trust. This article is based on a talk given at the 2014 CMF East Anglia Day Conference.