17. NHSH as a Dysfunctioning Family
17.1. One senior member of staff described the situation eloquently with a family allegory which I am authorised to share:
"I would describe the current leadership crisis in NHS Highland to that of a dysfunctional and distressed family. The adults (Executive team) over the years were often distracted by the acquisition of wealth (operational area/budget/staff or professional group represented) and status (Highland Quality Approach). The parenting style is in the main, chaotic disinterested in the children (staff) and authoritarian as required. The extended family of aunts and uncles (non-executives) are variously concerned and troubled by the behaviours of the parents but lack the confidence to challenge, it is easier to acquiesce, recalling what happened to some who previously raised concerns and who chose to leave.
The various children (staff) serve a purpose when they meet the needs of the parents, particularly when they do this without challenge, even if this involves ignoring the dysfunction and power play. While the older children (senior managers) are left to manage the day to day of the little ones and if they do harm no one is really that interested, just so long as the needs of the parents are met. Sibling (staff) pressures and relationship challenges are not well understood or well managed. The more vulnerable or smaller children have been known to come to harm. No one is really that interested, as long as no one outside the family gets involved. No one looks for this, as there are likely to be consequences. A child every so often might be picked for special attention, particularly if they are attractive in some way to the parents. They might be given special opportunities and privileges, unless they cross the parents in which case they can fall from favour. This can be a very unpleasant and isolating experience. Some leave, others find a place to work at a distance from the parents, out of sight and mind.
The parents at times, can overstep the mark with inappropriate parenting styles that can leave some of the children in day to day contact with them really quite vulnerable (administrative and clerical staff). No one takes action to address these indiscretions and those affected have small voices and no power. Some manage to get away, others stay and somehow get by, but at a cost to their wellbeing. Few seem to notice or care about this.
No one is really interested in naming or addressing these issues. Even when there are family meetings that children are fearful or anxious about attending, because they do not want to be ritually humiliated, or left exposed by the parents if they have not met their needs in the moment: too complex and risky because some of the parents will not allow or tolerate dissent. Somehere / somehow, the parents with less influence are distracted and caught up with meeting the more important needs of the more powerful. They can be vulnerable and needy, even tearful at times, especially when the pressures of parenting a large family become too much.
The wider family (Scottish Government) might, or might not, be aware of some of the difficulties/challenges in the family. They might have tried to intervene, offer some relationship support, however they have found it is easier and safer to appease rather than follow through with more formal measures. The consequences of following through are seen to be too risky and too great for the wider reputation of the family at large. Some personality/relationship dynamics do not lend themselves to mediation, which requires a willingness, capacity and a mutual desire to understand and redress harms done. For some, this is just too threatening or exposing to entertain and those involved are made subtly, or not so, aware that if this is required there will be a price to pay."
17.2. Again, the challenge is to change the setting, the relationships and the responses so that the family begins to function again in a psychologically and otherwise mature and safe way. Some of the issues which arise are covered in the next chapter on management roles and behaviours.