What makes the health system tick?

Between Gesellschaft and Gemeinschaft the difference literally is only four characters, but conceptually they are a world apart, as students of sociology (and the Germans) know. For the health care sector, it is a distinction worth appreciating if we want to deliver better quality, safer care. Gesellschaft denotes that official, impersonal web of organizational structures, hierarchies, departmental divisions, policies and procedures which govern human interactions and relationships in big, complex bureaucracies, such as modern hospitals and health care systems. Gemeinschaft refers to that other defining web of human interactions built on emotional, personal bonds, which are often overlooked in the perpetual requirements to fall into line with the official, formal frameworks of our lives. This vital distinction was conceived by sociologist Ferdinand Tönnies in the late 19th century to explore the breakdown of the natural, personal ties of rural communities as industrialization reorganized German society, re-casting individuals as functional units in a modern economy [1]. In today's NHS, and many other health systems, a parallel gulf persists. There is a relentless focus on the formal organizational structures and prescribed roles of health care professionals and comparative ignorance of the sociologically deep and psychologically rich networks which make people— including clinicians—tick. While substantial amounts of time, energy and resources go into scrutinizing and fine-tuning the former (there is a large industry devoted to 'restructuring') there are extraordinary opportunities to improve health care outcomes by tapping into the Gemeinschaft. Intuitively, we recognize the intersections between the formal hierarchies we work within and the socially fulfilling networks any profession throws up. It is widely accepted that social inclusion amongst professional communities can make for happier workers which, in turn, enhances organizational success [2 – 4]. Satisfying work in social – professional networks [5 – 8] has been credited with a long list of positive outcomes from employee retention [9], safer workplaces for staff [10, 11] and patients [12] and professional motivation [13] through to organizational resilience [14]. Most clinicians have felt the productive buzz of inclusiveness and social cohesion at work. Puzzlingly, public health professionals have long known about the healthy impact of interconnected communities [15]. But we have mostly neglected systematically applying the principles to the organization of clinical practices despite confronting evidence of high suicide rates [16] and poor mental health [17] indicating that social and organizational support networks often fail health professionals [18]. Interest in social – professional networks has …