General Hospitals

The organisations that we put in place to manage or deliver an objective go through a constant cycle of being swept away for “new” or “modern” way of doing something only for that “new” and modern way to be eventually be swept away too. Eventually (it seems) an old structure will be reinvented as “new” and sweep all that has gone before.

My observations are: -
No matter how good a organisations structure or the processes eventually they fail to some extent. This maybe they stop delivering the objective, they fail to adopt and adapt, they become inefficient. However this is not the main reason they get swept away. The main reason is that new person comes in and changes things. I’ve done this myself when I took over an organisation.

There are a variety of reasons for sweeping away the old.

• To align to new objectives
• To change a culture
• To drive out inefficiencies, often adopt different (maybe new) technologies or processes.
• To put into place something the instigator understands, make a name, avoid delivering by blaming the change or any other number of completely irrelevant purposes.

Usually evolution, rather than revolution, delivers the best results. Changing one or two things letting them bed in. Dealing with the unanticipated impacts before the next change. This can be a luxury though, as occasionally a system is left in place for so long and become so corrupt from its original intent that time, money or some other finite resource has run out.

Two thing got me thinking about this: -

• One was the suggestion that GP centres and local health centres took on more of the general medical duties of hospitals to allow the Hospitals to become specialist centres of expertise where high cost technology could concentrated. This reminded me of the old “General Hospital” and Cottage Hospital network which was shut down to move nurses and doctors into regional hospitals.

• The second was the suggestion that some of the stations shut down by Dr Beaching in the 1070’s should be reopened to cope with the increasing demand for rail travel

I wonder how long it will be before it is suggested that the mines be reopened.
It seem that what is relatively short term benefits are realised instead of sustainable progress.