Jo Pritchard on the challenges and rewards of being a social entrepreneur
Back in 1845, Florence Nightingale asked her father if she could work as a nurse and he, being informed of the ‘low moral standards’ then associated with nursing, forbade her to do so.
However, Ms Nightingale had a ‘fixed determination and an indomitable will’, which eventually led her to dramatically improve outcomes for soldiers at the Scutari hospital and to establish training for nurses, shaping a modern and respectable profession.
Florence Nightingale also worked with a political ally to push for the establishment of royal commissions to investigate health in society but, being a woman, she was not permitted to sit on them. She nevertheless guided them and significant improvements resulted. Commissions continue today, of course, with prime minister Gordon Brown and health secretary Alan Johnson launching the Commission on the Future of Nursing and Midwifery in March this year.
So nurse entrepreneurship is not new - there are several role models and there is plenty of opportunity. The combination of wanting to make a difference, which so many of us can understand, together with a commitment to social change, makes every one of us a potential entrepreneur.
Why, then, do there seem to be so few nurse entrepreneurs? This is a particularly pertinent question at the moment with the NHS agenda including the splitting of provider and commissioning functions, the Transforming Community Services programme and the development of competition among providers, together with the challenges of an ageing population with increasingly unhealthy lifestyles.
Being a social entrepreneur is not for the faint-hearted but once you have experienced the opportunities and rewards you would not wish to turn back
It is a question we have often debated at Central Surrey Health since our establishment in 2006. We have been besieged by interest in the company and in what makes us social entrepreneurs. Not a day goes by without requests for information or advice. Perhaps it is difficult not to be excited by a concept that combines patient-centred values with a commitment to operate effectively and add value to our local communities.
I sometimes feel the term ‘entrepreneur’ is misunderstood and associated too much with a commercial focus and TV programme The Apprentice. For me, the social entrepreneur is a transformative force, a person who relentlessly pursues new ideas so that major problems can be addressed.
A similar misunderstanding often occurs with the term social enterprise. I favour the simple definition, loosely taken from social entrepreneur Kim Alter, that they are ‘businesses which operate with the drive, determination and discipline of a for profit company but, critically, which trade for a social purpose’.
Most importantly, social enterprise is a philosophy rather than an organisational form. All types of organisations can operate as social enterprises as it is how they operate rather than the form they take that is most important.
Being an entrepreneur is by its very nature challenging. It requires focus, determination, energy and absolute belief, along with creativity. Entrepreneurs need to change systems and that means changing attitudes and behaviours.
Conversations over the last couple of years have led me to question whether nurses have enough self-belief. Senior nurses have told me they feel they do not have the skills or are brave enough to do something entrepreneurial. Yet why is it that our medical colleagues are able to run their own successful businesses without any such questioning and so often our therapy colleagues demonstrate more entrepreneurial flair than ourselves?
We all begin our clinical careers with a similar focus, so why is it that nurses seem to prefer to be led rather than to lead? It places us at a significant disadvantage.
As the healthcare market opens up and there is increasing competition for the provision of health services, nurses have an opportunity to respond to the challenge and take control - or accept that others will. The words of the US naval demolitions expert, Rear Admiral Draper L. Kaufman Junior, are surely relevant: ‘Those who do not create the future they want must endure the future they get.’
The opportunity for nurses to innovate has never been greater and nor has the Department of Health’s commitment to that goal. However, I believe the window of opportunity is a limited one and too much procrastination will be the downfall of many services, especially those in the community.
The recent Healthcare 100 survey of Central Surrey Health employees identified strong support for our different way of working. ‘I feel so valued’, ‘It allows us to put the patient first and is a very “can do” environment’ and it gives ‘the opportunity to be flexible and motivated in my working life’, were just some of the responses.
The life of a social entrepreneur is not for the faint-hearted. It is, however, liberating and energising, and once you have experienced the opportunities and rewards you would not wish to turn back.
Jo Pritchard is joint managing director of social enterprise Central Surrey Health and a commissioner on the recently launched Prime Minister’sCommission on the Future of Nursing and Midwifery