Tesco and Starbucks have little to teach the NHS
Retail may serve as an attractive analogy for the NHS, but comparisons and subsequent insights are misguided. By Catherine Needham, Yvonne Sawbridge and Iestyn Williams
Earlier in this month, Craig Barratt considered whether Terry Leahy, former CEO of Tesco, would make a good chief executive of the NHS. On the same day, the BBC carried a story from the NHS Confederation about what the health service can learn from coffee chains.
In brief, the conclusions were that Leahy would bring a lot of useful insights to the chief executive role and that Starbucks et al can teach the NHS about customer choice and feedback.
‘Why is it that retail analogies are so persistently alluring in relation to the NHS?’
Both articles carried some caveats indicating that the authors were aware of the ways in which the NHS differs from the retail industry (although a full list of such caveats would fill an article much longer than this one). Yet the analogies were still offered and most commentators at the end of the Leahy article were sold on the idea of getting him in to head up the NHS.
While inter-sector learning has its place, why is it that retail analogies are so persistently alluring in relation to the NHS? Why does learning never go the other way? Here we offer three reasons for the prevalence of such stories.
The hero leader
Support for the Leahy appointment suggests that if we can just bring in a leader who has made a lot of money in the retail sector, he/she will be able to inspire the NHS to new heights of effectiveness and efficiency.
Similar thinking is evident in the TV programmes, Can Gerry Robinson Fix The NHS? (answer, no), and can be traced back at least as far as Thatcher’s invitation to Sainsbury’s general manager Roy Griffiths to sort out NHS management in 1983.
Business leaders proclaim a no-nonsense approach that can neutralise the meddling politicians and vested interests that currently stand in the way of reform.
‘Hero leaders are rarely able to deliver the sorts of sustained organisational change that is expected of them’
In practice those moving into the NHS from the retail sector have often been confounded by the system, despite their skills. Indeed, hero leaders are rarely able to deliver the sorts of sustained organisational change that is expected of them, as the legacy of Griffiths indicates.
Theories of leadership now emphasise the importance of distributed leadership rather than “great man” approaches. James Turnbull proposed that “leadership needs to be understood in terms of leadership practices and organisational interventions rather than just personal behavioural style and competencies”. The scale of innovation and change required is too vast to invest responsibility in a small organisational elite.
The scale and complexity of what the NHS does is daunting. Local systems defy easy understanding, let alone the national set of organisational arrangements and policy commitments. This is not to say that nothing can be learned from elsewhere.
However, there is a growing consensus that health and social care share characteristics of “complex adaptive systems” that confound simple recipes for change and improvement, not least because of the multiple aims - health improvement, equity, protection of the vulnerable, promoting wellbeing, and so on - that need to be addressed.
Suggesting that the NHS can learn from a supermarket or a coffee chain is alluring because they are single-purpose organisations whose business we think we understand (partly because the complex supply chains are hidden from view). They are staffed by people who give us what we want without trying to tell us that we don’t want it, can’t have it or need to take on some of the work of producing it ourselves as a GP might do.
Yet the complexity of the NHS isn’t something that can be circumvented through simplistic analogies to large-scale corporate enterprise. If it could, it would probably have been achieved already.
At a time when the NHS is struggling to absorb huge organisational change and to recover from the problems highlighted in the Francis report and the CQC/Morecombe Bay controversy, the retail sector looks like a success story from which the NHS can learn.
As Jonny Marshall from the NHS Confederation puts it in his coffee chain article: “It is time for us to empower patients like the retail industry does, put them in control and encourage them to complain if we don’t get it right, so we’ve got a chance to put things straight immediately.”
There are some examples of the NHS opting for the more immediate kinds of feedback that Marshall talks about. Birmingham Children’s Hospital, for example, has an app to enable patients and families to upload comments directly to its website.
‘There are many ways in which the retail sectors’ behaviour can be highly disempowering for consumers’
But Marshall’s notion of empowerment as the offer of a replacement coffee or a right to return your goods (neither of which have an obvious NHS equivalent) is a very limited one. There are many ways in which the retail sectors’ behaviour can be highly disempowering for consumers, as the deserted high streets of many towns bear witness.
It surely won’t be long before another “What the NHS can learn from the high street’ article comes along. No one writes about what the high street can learn from the NHS, not because it is a failing organisation - NHS performance in international league tables suggests that there is much that works well - but because staff generally don’t feel they have much insight into cappuccinos and ready-meals. An amnesty on simplistic analogies coming the other way would be most welcome.
Catherine Needham is senior lecturer, Yvonne Sawbridge is senior fellow and Iestyn Williams is senior lecturer at the Health Services Management Centre, Birmingham University