Politics, Power and Persuasion

This blog title immediately brought to mind the Houses of Parliament. Not surprising, but the next logical thought should have been the Prime Minister or some well-known MP.

However a fictional politician came to mind, Aidan Hoynes from the BBC drama The Politician's Husband [1]. Hoynes’ failed attempts at persuasion – and more often manipulation, had significant consequences that adversely affected his political and personal life. He is an example for all of us, and I will explain why later.

In the meantime, where to look when considering the three P’s of politics, power and persuasion in the context of healthcare? If I use the term ‘NHS’ to describe UK public healthcare, then this must be an organisation that people look to for leadership and should provide examples of the three P’s that resonates widely. However a significant chunk of my junior doctor colleagues are unaware of whom the Health Secretary is. Therefore I have to question whether many of them know the role of David Nicholson. Unfortunately I’m not convinced that the work performed at the top of the NHS engages enough employees within the organisation, and there is evidence that concurs [2]. So where next to look?

A chief executive of an NHS trust once told me that he felt power in his organisation was arranged in an inverted pyramid – it lay with those working on the frontline. It seems he is in good company with this thought. A core theme of the Francis report was the importance of frontline staff in relation to patient experience in hospitals, and Bruce Keogh recently described junior doctors as the "clinical leaders of today" [3]. With this in mind it’s was not surprising that when I thought about people I had worked with, I produced the best examples of the three P’s.

There are a few nurses that I have worked with who are universally adored by their fellow nurses and by doctors because of their pragmatism. In my opinion, actually what these 'super-nurses' have is a very astute awareness of the priorities of their colleagues. Knowing what issues will gain the attention of a physiotherapist or doctor quickly. Knowing when viewpoints between staff groups conflict and how to manage this mismatch. This understanding leads to great power in the form of influence. Passive persuasion is a term used to describe the art of persuading others without actually doing so. These nurses are brilliant at it. They simply let people know what they think, and let others catch onto their trail of thought on their own.

Another example is a junior doctor who had a very good relationship with the radiology department of a hospital. This doctor became the 'go-to' person within their team for radiology requests. They had a habit of getting requests accepted and scans performed in a timely manner. This doctor wasn’t successful all the time – any radiologist will attest to the fact that some requests are simply inappropriate in the given clinical context. However this person had an awareness of the politics between staff and had a good relationship with seemingly, the entire department.  They had an understanding of the information certain radiologists wanted in requests, and the pressures the radiographers faced with lists and waiting times. Having seen this doctor in action, they simply knew what to ask for and how to ask it.

These individuals have one unifying theme. They have an understanding of people and the priorities of those people. These are in effect the missing prologue to the three P’s. An understanding of people makes possible good politics, incredible power and appropriate persuasion. There are different types of people who respond to behaviours in their own way. Healthcare workers have an excellent learning ground to appreciate these differences between people. They benefit from meeting a diverse array of people every day – patients. Going back to the fictional Aidan Hoynes, what he didn’t have was an adequate understanding of certain individuals, particularly in the context of their needs and priorities. The reason he sticks in the mind is because failures (even fictional ones) are easy to learn from.

NHS employees are increasing their participation in leadership programmes and quality improvement projects. What should follow is an increased self-awareness of people and priorities. Individuals that interact with patients should be that have the greatest appreciation of politics, power and persuasion. These are the people that can have the greatest positive effect on patient experience. Public healthcare in the UK will be better off for it if frontline staff utilise this awareness effectively.

References

1. BBC Two – The Politician’s Husband. www.bbc.co.uk/programmes/p00yfm4l
2. Junior doctors lack understanding of NHS reforms. Royal Society of Medicine. www.rsm.ac.uk/media/pr317.php
3. Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report. www.nhs.uk/NHSEngland/bruce-keogh-review/Documents/outcomes/keogh-review...