PSYCHOLOGICAL CONTRACTS Keep the faith . The value of an explicit psychological contract by Tina Kiefer, Graeme Currie, & Nicola Burgess
R elationships between public service providers, such as hospital trusts, and regulators are fraught at the best of times. This is no surprise when taxpayers’ money is at stake, and the consequences of regulatory failure are severe, not only financially and reputationally, but also in relation to people’s lives. Yet, the nature of these relationships can often impede service delivery, prioritising top-down compliance over a genuine culture of improvement and learning. In healthcare, the demands on the NHS are expanding rapidly, while resources are not. At the same time, providers are under pressure from those above them – be it politicians, regulators, or both – to meet targets that are often quite narrowly focused. That leads to a degree of game-playing to ensure those narrow targets are met, even though this may not deliver the best services or care outcomes. This has resulted in several cases in which financial or institutional concerns have been prioritised over an organisation’s duty of care. One extreme example was at the Mid Staffordshire Trust, where patients died unnecessarily because of the trust’s focus on financial targets over patient safety. When high-profile failures occur, the public demand for accountability often triggers a ‘blame culture’ that singles out individuals and favours short-term fixes over solving systemic problems. To avoid both the initial failures and the ensuing blame culture, we need a different form of governance. One suggestion has been to move away from a top-down hierarchical approach towards ‘meta-regulation’.
Warwick Business School | wbs.ac.uk
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