The HSJChallenge offers managers the opportunity to escape their day jobs and pit their wits against their peers in a in a multi-agency health economy with more than its fair share of problems. The good news is that it's not for real. Jennifer Taylor reports

Taking risks, working in partnership, making decisions in the midst of competing priorities - these are some of the key themes of today's NHS, and they are what the HSJChallenge is all about.

The simulation event, held on 26 October, provides a developmental opportunity for managers by recreating the complex multi-agency interactions so common in the NHS. It was created for HSJby former strategic health authority chief executive - and HSJ columnist - Neil Goodwin.

Teams are exposed to the risks that come with that complex environment and need to consider national policy when taking decisions, while also dealing with unexpected events. But it all happens in a safe way, allowing participants to learn from their mistakes and build up their confidence and self belief by succeeding at unfamiliar challenges.

Sixteen teams from a variety of NHS organisations took part this year; they were divided into four clusters to make up the local health economy. The 'health economy' consisted of Riverside primary care trust, Barset General Hospitals trust, Riverside Mental Health and Social Care foundation trust and Riverside Hospital, an independent treatment centre owned and managed by private company Eurohealth UK.

Each team became an organisation within its cluster that was different to their real-life organisation. Throughout the day, the organisations were given scenarios to deal with, starting with a memo from the director of finance to the chief executive and executive team on month-five financial results, which showed substantial deficits. Other scenarios included Riverside Daily Post's discovery that Casterbridge's medical director had been received a police caution for kerb crawling. The head of communications wanted the chief executive's advice on how to handle the situation.

The scenarios put the health economy and its component parts to the test, but at the end of the day there were six awards up for grabs.

Cambridge University Hospitals foundation trust was the Most Improved team. 'After a slow start they got their act together,' said the assessors. 'Their energy levels rose and they went out and engaged proactively.'

The Most Entertaining award went to Central and North West London Mental Health trust. 'They were enthusiastic, positive and maintained energy. And they came up with good solutions.' The assessors particularly enjoyed the team's discussions about the kerb-crawling medical director.

The award for Best Partnership Working was shared by Birmingham Children's Hospital trust and team 1 from Monitor. The assessors said of both groups: 'From the very beginning they were very keen to be engaged with everyone else, and meeting with people across the health economy.'

Media savvy
After gruelling tests in the press conference and media interviews, the blue cluster came out on top for the Best Media award.

Although many of the teams showed some good media savvy, the blue cluster was 'assured and in control', according to the assessors. 'They dealt well with provocation and attempts to confuse them.'

When choosing the Winning Team, the assessors were looking for people who participated strategically and were prepared to give things up. This was done best by the team from the Breaking Through programme, a network supporting the development of diverse leaders. The assessors liked their style, language and strategic approach. 'They were a cohesive team and worked well together. They showed clear thinking and were very good on tactics.'

Breaking Through was able to anticipate how other organisations would act. They also went immediately for partnership working.

The winning cluster was the blue one. The assessors said the team had considered strategic, financial and political elements, and came up with proposals that would be sustainable for a long time in the future.

'When looking at the extent to which the clusters were able to balance all these things, the blue cluster came out on top,' said the assessors. They were also very strong on the financial aspects.

Overall, the judges felt that a strong thread throughout the day was that the teams, as organisations, could have improved their game by placing more emphasis on engaging clinicians, patients and politicians from the start, rather than waiting for a formal consultation process.

The teams playing the mental health trust shared similar characteristics in that they were introspective at the start of the day, then proactively talked to all their partners as the day progressed. The assessors said: 'They began in a self-contained bubble, with others asking them for meetings, but by the end of the morning they were approaching people.'

The assessors felt it was possible that people felt less comfortable taking on the role of a mental health trust than they did with assuming any of the other roles.

The fictitious PCTs were the 'weakest link', according to the assessors, and the hospital trust took over. Because the people playing the PCT role did not normally work for those organisations, observers wondered whether, in reality, they did not perceive the PCT as a main player.

None of the PCT teams wanted to upset people and employ independent sector expertise. And only one team mentioned the possibility of the mental health trust working with private company Eurohealth.

Teams could have taken more risks, said the assessors. They found it difficult to take the hard decisions of closing beds and wards, or making redundancies.

The assessors said the day showed how complex leadership, planning, strategy and management is, and why sophisticated thinking is required.

'We've condensed about six months of learning into one day,' they said. 'To take account of stakeholder requirements, political issues and the views of clinical staff is very challenging.'

Participants said they had learned from each other and would take that back to their own organisation. 'It's good working with people from other organisations because they have a different perspective - you get a completely different view,' was one comment.

Exhausting, fun and challenging - that was this year's HSJChallenge.