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We are entering a different phase of NHS management that to be successful will have to be characterised by a stronger emphasis on management than leadership, more process and communication, and more perspiration than inspiration. The reason is the recession.
Strange for me to say as a leadership consultant but we have placed too much emphasis on leadership and insufficient on developing good quality management and administration. It is the latter that makes organisations work and deliver services to patients. I recall a story I am over fond of telling about my time as chief executive of a London hospital some years ago. I had been appointed to sort out the finances and strategy. After three months of beavering away I was approached by a consultant who said he and his colleagues thought I was doing a good job. Excellent I thought, must be the financial and strategic development work. Not a bit of it. He said it was because I always answered their letters and when they wanted to see me, I always made the effort to go to their office.
This was a valuable lesson. If managers are going to take difficult decisions then process, particularly communication with staff and stakeholders, will be crucial. It was also a good lesson in that much-hyped conference generating process called clinical engagement. Isn’t clinical engagement really about getting out and about talking and listening to doctors and other clinical staff?
Another example of process was in the mid-1990s when I led a difficult public consultation to establish a new children’s hospital for Greater Manchester. At the end of the extensive multi-stage process that lasted almost 12 months, I was approached by the then community health council who said that although they disagreed with the decision they could not fault the process. They had had ample opportunity, they said, to put across their views. The new hospital opened a few months ago.
Just in case you think I’m now sounding rather smug I messed up big time, also in the mid-1990s, when consulting on merging three neuroscience centres to create a single centre. The first consultation produced the wrong result because I had paid insufficient attention to process and been unduly influenced – against my better judgement – by a few powerful stakeholders. The consultation had to be run again to produce the right result. Embarrassing for me but right for the service. The new centre opened a few years later, which I promptly experienced as a patient. I guess it’s not every manager who not only sees the results of their strategic efforts but also experiences them too!
Finally, something about perspiration. It’s tempting when pursuing development activities to search for inspiration, for perfection. Leadership development is a good example. It’s easy to spend inordinate amounts of time, money and process on the search for the perfect model – believe me it doesn’t exist. Far better to get stuck in with something that best fits local context and tweak it in the light of experience. The majority of development activities are systematic processes not events. In other words, more perspiration than inspiration.
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From The Leadership Consultant
Neil Goodwin is a director of GoodwinHannah and visiting professor of leadership studies at Manchester Business School.
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Readers' comments (7)
Kim Smith | 25-Sep-2009 1:36 pm
I'm interested in the idea of consultation producing the right or wrong result. It may be a matter of language use, but it smacks of a fait accomplee and is exactly what those who accuse us of tokenist consultations complain about.
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Neil Goodwin | 25-Sep-2009 4:01 pm
Thanks for the above comment. It is a matter of language. Without going into too much detail suffice it to say that there was too much professional pressure exerted to retain the status quo rather than the better quality option of merging the high-tech element of the service within a network that embraced rehabilitation and related services. I hope this explains?
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Kais Uddin | 26-Sep-2009 10:10 pm
I agree very much with your view on the need for better management, communications and processes. So called leaders are so high up in their helicopters that they don't6 see the woods for the trees.
In the late 80's I persuaded the then DGM at Central Manchester to establish board meetings with the local black, minority ethnic and faith communities to improve local healthcare.
We set out some ground rules and met with the Board each quarter, alternating the roles of chairing, minute taking and venue choice. Ours was a highly cohesive and demanding community network of some 100 groups, each with it's own demands of us and the hospitals.
This was a highly successful collaboration that has yet to be bettered.
The Chief Executive thanked me for the support, he said it helped to secure self governing status at the first attempt.
The key ingredients for support were built through slog and hard work, on both sided, and the building of trust and respect. It was a relationship that endured for a decade,
Successful leadership in this difficult period is not in the hiring of strategy, cost reduction or lean consultants.
Instead we need clear long term goals, engagement and honest dealings with with all interested parties, including local communites, and good communications.
A good friend once told me that "present approximation is better than deferred precision". A sentiment I agree with, as well as the adage that strategy is what you do and not what you say you are going to to.
It's time for senior managers to start rolling up their sleaves, put away the prescriptions, and get down to business. If a judicious dose of skills development is needed, so be it.
Perhaps the starting point is learning to listen and persuade, having honest dealings with others, a pinch of humility and self awareness, and the willingness to be held accountable.
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Neil Goodwin | 28-Sep-2009 10:26 am
Thanks for this, I entirely agree. I really like the phrase 'present approximation is better than deferred precision' - forgive me if I use it, with suitable acknowledegment of course!
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Kais Uddin | 28-Sep-2009 12:27 pm
Good morning Neil,
Thanks for responding to was supposed to be a short note. The phrase was used by Hal Williams,The Rensselaerville Institute, upstate New York. He is well known for work on outcome based funding and innovation in health and social care.
In terms of getting on with it - it seems that so much is invested in management development but people struggle to see the relevance in their working lives. Yesterday I spoke to a friend in an international organisation, undergoing yet another reorganisation. They have had their dose of culture change, but back in the department the senior managers are at each others throat and carry on being horrible to their staff.
In terms of managing the next period, I still remember the CEO of a Trust telling me 20 odd years ago, that with a hundred years of efficiency at 1 percent a year, the NHS would be in the happy position of doing everything for nothing! Not sure about the maths, but we know what he meant.
How times changed, with the huge and rather hurried investments over the past 10 years, but, before we get carried away with world class ambitions, it it would help if patients can get through to the call centre without having to call 15 times, only to be told that the busy surgeons in spinal surgery do not put up their availability on the Choose and Book System as they are too busy, then ending up at the war zone, known as the local A&E, and spending six hours in a holding area, and asked about medications 3 times by the time they reach the medical ward.
I do agree about getting stuck in, but my experience is that up and coming managers are up and off to the new post before they have had time to get their hands dirty. So many promotions rest on potential and promise. So many unfinished projects, so little accountability.
Perhaps Trusts should stop chasing talent, the grass is always greener elsewhere. Instead they should invest more in developing and supporting their own staff, with a bit of hands on coaching and mentoring from senior colleagues.
A bit of continuity and focus on the job at hand may be just what the Doctor ordered and patient needs.
Regards
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Blair Mcpherson | 29-Sep-2009 2:42 pm
There is a risk we confuse being a leader with showing leadership qualities. Management is certainly about perspiration but effective managers also show leadership. They take responsibility and they inspire staff. The action you describe as a manager putting the time and effort in being accessible and being willing to listen are what I would call leadership qualities.
Blair
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Mike Swift | 2-Oct-2009 1:02 pm
Neil
Your conclusion that;
"we have placed too much emphasis on leadership and insufficient on developing good quality management and administration" is a welcome breath of fresh air. When I joined the service in 1970 you didn't get far up the ladder without an IHM qualification or its equivalent. Alas no longer. We'll certainly notice the lack when unpleasant descisions have to be made after the general election. Now that most clinicians can progress clinically to being consultants, there's not much wrong with the model whereby with the appropriate training, qualifications & experience, doctors doctor, nurses nurse & managers manage. (Lordy I sound like a whingeing neaderthal {no offence to any neaderthals, or whingers, who may be reading this} but its an option well worth revisiting.
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