The health secretary, Jeremy Hunt, has been embroiled in the dispute with Junior doctors for months on end with no immediate hope of resolution in sight. ‘When two elephants fight, it is the grass that gets hurt’ goes a wise African saying. This saying captures the protagonists and the plight of the only losers in all this – the poor patients. The government is in dispute with the doctors and the patients suffer for it.
Truth is Jeremy Hunt has backed himself into a corner and so long as the doctors have the stomach to keep fighting, and doctors have the public on their side, Mr Hunt would be left with only one option – throw in the towel. Considering this impasse through the lens of the decades old contingency theory – Fiedler’s Contingency Model – might help Jeremy Hunt and the government understand their options and help them to find a quick way to end the dispute. I concede the model is outdated and have been criticised multiple times but I think it illustrates the situation and how the health secretary got it so wrong.
The model, (Figure 1), has three main contingencies that gives a good handle to model the scenario on.
Starting with ‘Task Structure’, the first error the health secretary made was to lose sight of the fact that he was dealing with doctors. They are highly qualified, highly skilled, highly educated professionals with ultra-high task structure. One cannot deal with people such as these as one would labourers. It would be in the interest of any leader of a group of doctors to work extremely high to have a good Leader-Member relations. Jeremy Hunt lost sight of whom he was dealing with and created the situation of ‘poor relationship’ that limited the options at his disposal.
Looking at the model from the top row, starting with poor leader-member relations position the scenario in the right half. From that half, when the second row (from the top) is considered, it further positions the scenario in the ‘High’ task structure section. The next contingency to consider for a final placement is one of ‘position power’. The submission is that the health secretary has a Weak Position Power because the position of health secretary hasn’t got any measure of power over a formidable professional body such as the British Medical Association (BMA).
According to the model, that places the health secretary in Octant 5 (types of situation; bottom row). In that situation, the most effective leadership contingency is one of ‘relationship-motivation’. Mr Hunt can resolve the impasse if he works really hard to rebuild the relationship he had with the BMA and junior doctors. Acting like a ‘Task-Motivated Leader’, as he has been doing for months, and focusing on delivering the reforms (task), by force if necessary, would only end in failure unless the landscape changes – unless the doctors back down or public support for the junior doctors wane or disappears altogether.
The government has succeeded to a large extent in emasculating the teaching unions through ‘academisation’ and by being very stealthy with some of the reforms; even then, Nicky Morgan had to do a U-turn about forced academisation because of widespread uproar. They, Jeremy Hunt and the government, underestimated the resolve of the BMA and find themselves in this intractable situation. Another U-turn seems to be the only reasonable line of action for the time being at least.