Why is Mediocrity Celebrated in the NHS?
This week’s edition focuses on a single critical point: the celebration of mediocrity in our healthcare system.
Professor Sam Shah, Chief Medical Strategy Officer of Numan, and the previous Director of Digital Development at NHS England recently guested on the Health Beyond Tomorrow podcast to discuss this very topic.
Why Has Mediocre Become the Norm?
It’s a disturbing question we have come to face:
Why has mediocrity become the accepted standard in the NHS?
This isn't a matter of pointing fingers but rather understanding a systemic lapse that has secretly taken root.
From the POV of a medical student, take a busy GP practice where the medical student has been allocated to for their placement:
The reality of the constraints of “10 minute consultations”.
Enter an excellent medical student, with lots of questions, and who wants to use this time to better themselves as a practitioner.
However, they are paired with an immensely overworked GP, whose schedule is stretched by an overwhelming patient load. Despite the GP's best intentions to mentor, the reality is a relentless stream of appointments that leaves no room for the educational nurturing of a student.
As the day progresses, the GP moves from patient to patient with mechanical efficiency, occasionally promising the student a later discussion that never materialises.
The student's initial enthusiasm begins to dampen; the feeling of being ignored and unwanted takes its toll. They witness the GP’s fatigue, the weight of clinical demands, and the student's questions remain unasked, their desire to learn stifled by an unspoken understanding of the GP's exhaustion.
By the close of the morning, the student recognises the impracticality of them using this time to ask their questions or even take a history themselves, in the face of the GP’s evident burnout. This is the quiet erosion of excellence – where the system's demands impose mediocrity not only on the healthcare professionals but also on the next generation of doctors.
Mediocrity, in this context, isn’t just about settling for less; it's a byproduct of a system under immense pressure. The overstretched GP represents countless healthcare professionals who entered the field to make a difference, only to find themselves constrained by a relentless system that often values quantity over quality. The student’s stifled enthusiasm and curiosity symbolises the next generation's impaired potential for excellence, which risks being extinguished by the overwhelming demands placed on the system.
These are examples of the cumulative burden of challenges facing the NHS:
The GP's packed schedule is a direct result of the long waiting times and extensive patient backlogs.
The inability to provide mentoring reflects the dire staff shortages and under-resourcing that leave little room for education.
The overarching feeling of defeat speaks to the low staff morale and retention issues.
The cumulative effect of these issues has, inadvertently, lowered the bar of excellence.
This normalisation of 'just enough' is corrosive; it undermines the potential for excellence and settles into a dangerous complacency that affects patient care and staff satisfaction alike. It's crucial to identify not only the symptoms of this mediocrity but also the systemic maladies that feed it.
The Creativity Conundrum
It is encouraged to be a cog in a broken system than find new creative and outside the box ways to fix the system.
A critical obstruction to transformation in the NHS is that creativity is NOT celebrated.
Sam goes into detail about a homogenous leadership circle resistant to change within the NHS.
He talks about how decision-making at the highest levels in the NHS are being monopolised by a closed 'club' of individuals from similar backgrounds, with uniform training, and a shared mindset. This fosters ‘groupthink’, where conformity is rewarded and innovative thinking is discouraged or even penalised.
Sam talks about this issue as not being unique to the NHS but extent and rigidity of these leaders are particularly pronounced. They prioritise the need of maintaining the “status-quo” over the need for reform, further encouraging mediocrity.
The phrase ‘optimism bias’ is mentioned by Sam - optimism bias refers to our tendency to overestimate our likelihood of experiencing positive events and underestimate our likelihood of experiencing negative events.
This bias is prevalent amongst well-intentioned individuals within the system. However their tremendous efforts to improve the system amount to little more than bureaucratic reshuffling, as Sam puts it “pen and paper pushing that takes place”.
Without a fundamental shift in the leadership dynamics and an embrace of diverse thinking, the NHS is unlikely to achieve different or improved outcomes for the population it serves.
Actionable Steps
What are Sam’s views on how the NHS can, work from the ground up to change and nurture the next generation of talent?
Training to allow for portfolio careers - As Sam said,
“Give them the sense that they can achieve and do anything, create people that have got that ability to work in different environments, different settings, recognise the different pressures and factors in those environments.”
In today's diverse world, a single focused mindset limits possibilities. If we are to cultivate the next generation of talent, especially in healthcare, we must embrace interdisciplinary learning.
Exposure to various career opportunities - This would help people to understand that their career does not have to just be one thing, and it may not just be clinical, and making that more acceptable, that it shouldn't be frowned upon.
Create opportunities for leaders in the space to get into senior roles - Sam elaborates on this,
“Even if these leaders have the skill set and the desire to do it, we haven't really created the route for them to do it. And the other thing that goes alongside this is we haven't done anything that necessarily creates the next cadre of those leaders and gives them the training and experiential opportunities to get there. We have some schemes, but not enough.”
Embrace the opportunity for healthcare professionals to work in and out of the NHS - working in different settings can enhance professional development, offering healthcare workers new challenges and the opportunity to develop a broader skill set. By supporting professionals who seek external opportunities, the NHS can foster a culture of continuous learning and adaptability.
If you haven’t yet, watch the full episode below and don’t forgot to subscribe to our channel!
Bye for now,
The Beyond Tomorrow Team