The definition of ‘dementia’ in neurology has experienced a number of different iterations in recent years. This has been a direct result of physicians developing a growing awareness that Alzheimer’s Disease, although the most common form of dementia in the senile age group, is not the only form of dementia. In fact, there are about 200 different types of dementia at least. This means that dementia is not always typified by loss of memory, the so-called amnestic syndrome. However, in Alzheimer’s Disease, the most pervasive cognitive deficit is inability to learn new memories, whilst memory for previous events or people can be relatively well preserved consistent with that outstanding French physician from the Paris School, Ribot, in his famous 1881 treatise on memory. Frontal lobe dementia has been speculated to be the most common form of dementia in the pre-senile age-group, characterised instead by a profound change in behaviour and personality, rather a cognitive deficit of a strong amnestic flavour. The NHS is undergoing now, against the will of the medical Royal Colleges and the British Medical Association, a fundamental strategic change, and this tweet yesterday evening caught me eye. It seems to me that the term ‘organisational dementia‘ could be applied to this organisational change at a number of levels.

In organisational development, learning is a characteristic of an adaptive organization, i.e., an organisation that is able to sense changes in signals from its environment (both internal and external) and adapt accordingly.  A central issue is how adaptable the culture of the NHS is in general – many would like to see the NHS to adopt a stronger innovation culture, and in fact the NHS Innovation and Change provides extremely useful guidance on how innovative change in the NHS can be implemented successfully.  Helen Bevan from that unit points to Harold Sirkin and colleagues who have published a model in the Harvard Business Review. The reason Bevan likes this model is that it is based on evidence from more than 1,000 change initiatives globally. I view a failure to implement change in the NHS, for example as will be necessary following the implementation of the Health and Social Act, will be in part be due to a failure in organisational learning, what you could call an ‘organisational dementia’. Bevan, in her brief article, points to two critical factors where organisational change will be impossible to achieve, and this should very much be borne in mind as the Government, with the help of McKinseys, try to effect their change without stakeholder cooperation.

“There must be active, visible backing for the change from the most influential senior leaders. They say that if, as a senior leader, you feel you are talking up the change initiative at least three times as much as you need to, your organisation will feel you are backing the transformation. In addition, the change is unlikely to succeed if it is not enthusiastically supported by the people who will have to operate within the new structures and systems that it creates. Staff need to understand the reasons for the change and believe it is worthwhile. The final factor is effort. There is an NHS tendency to launch major improvement initiatives without taking account of the extra responsibilities for change projects on top of busy operational jobs. The authors assert that if anyone’s workload increases by more than ten per cent as a result of the initiative, it is likely to run into problems. Organisations need to calculate upfront how much extra time and effort will be required to execute the change and create the space for it to happen.”

A further interesting contribution to the ‘organisational learning’ research comes from Common (2004) who discusses the concept of organisational learning in a political environment to improve public policy-making. The author details the initial uncontroversial reception of organisational learning in the public sector and the development of the concept with the learning organisation. According to Common (2004), research in UK local government has centred around four powerful obstacles for organizational learning in the public sector: (1) overemphasis of the individual, (2) resistance to change and politics, (3) social learning is self-limiting, i.e. individualism, and (4) political “blame culture.” This could be responsible also for a type of organisational dementia in the NHS; resistance to change and ‘blame cultures’ are two particular potentially serious issues for the NHS.

So far, I have considered an ‘organisational dementia’ in the NHS where the dementia has an amnestic flavour. There could of course be relatively change in its capacity for learning or memory, but there could be a profound change in its behaviour and personality. As the NHS becomes increasingly privatised, where patient care is reconciled more-and-more with an obligation in law to maximise shareholder dividend, it may be that the personality of the NHS becomes unrecognisable in a few years’ time. This to me, and I suspect many others, would be very sad.

So, in conclusion, I have outlined how a label of ‘organisational dementia’ might be applied to the NHS using organisational learning defects as a basis of an argument, using Alzheimer’s disease as a corollary. I have also applied the term in the way akin to frontal dementia. Organisational learning is a very powerful notion in business management, and its critical application to the strategic change in the NHS has not gone unnoticed by me.