Is the NHS suffocating in its own froth?

I’ve been using a cappuccino to describe the feeling of working in operational management. Managers often float (feels more like hanging) at the interface between froth and real coffee. Real coffee, that brown stuff, represents the nitty gritty: the coalface, the frontline.

It’s where I prefer to spend time, where the purpose of the organisation demonstrates meaning; where the human condition reveals itself with vulnerability and raw honesty. It’s where the “why” of our organisation (Simon Sinek TED talk) reveals itself.

Froth can occupy disproportionate space in the corporate cup, adding little value to the coffee.

Intellectualising about healthcare doesn’t make it more efficient or more effective.

Managers need to be trained to operationally manage healthcare but they learn the hard way, a costly oversight. Instead we procure expensive consultancy firms to diagnose ongoing problems that could have been avoided had money been spent on operational management development.

Disruption or innovation?

Every team in the NHS requires space to breathe, reflect and learn. But the penny hasn’t dropped: it’s been snatched for savings. The continued presence of oversized and overpaid commercial fish does nothing but waste more time and money in an organisation that’s already drowning. Are we buying disruption or innovation with our public money? Disappointingly neither, we usually buy accountants.

Leadership and management are verbs. They both require action; usually doing something other than what we are doing now. There was a day when the purpose of NHS hierarchy was to support professionals delivering care; the priorities were determined by clinical need and service requirements.

There’s been a misplaced obsession with reducing bed numbers in the NHS (or a conspiracy to drive activity into the private sector, perhaps?). I don’t know which (it’s baffling)

In the contemporary NHS at least 60 per cent of senior management time is spent calculating how to spend less, including the eternal negotiation to replace leavers. Other available time is divided between workforce issues and managing the impact of recruitment freezes. This undoubtedly distracts us from managing waiting lists.

There’s a certain nonsense to the amount of time spent trying to save money. This time should be allocated to managing patient care and flow, acquiring the right number of beds needed to effectively run a safe and responsive service. There’s been a misplaced obsession with reducing bed numbers in the NHS (or a conspiracy to drive activity into the private sector, perhaps?). I don’t know which (it’s baffling).

Caring for people in corridors makes no sense, leaving patients in ambulances that are unable to offload makes no sense, not commissioning enough critical care beds makes no sense. By rendering the NHS inefficient, it costs more for less.

Feeding the beast

And yet, we must focus on actions within our sphere of influence: the everyday win-win. We can develop the ability to move beyond the intractable, the habitual, a cyclical learned helplessness to achieve something, anything. We can do this despite the increasing froth which threatens to replace our patient focused ideology for what? We await the email to find out.

“Feeding the beast” is a commonly used phrase in operational management. It‘s the amount of time spent upwardly managing expectations in the form of report writing, presentations of creative financial optimism and, in essence, anything that keeps us away from operationally managing the service (this is also applies to clinical leaders)

Unfortunately the nature of leadership can leave us lonely, out in front and unsure of success; but somewhere up ahead has to be better than this

Yet anecdotally, shifting our attention to operational delivery (approximately 20 per cent on budget management and 60 per cent on service delivery), would significantly improve the financial position. We’ve created a lose-lose scenario. The effective and sustainable management of waiting lists would reduce risk and reliably shift any financial position in the right direction.

Remember Unipart and getting it right first time? This was an optimistic era and perhaps a paradigm shift too far. Intellectualising about what needs to be done requires less effort but nobody said it would be easy.

Liberated state

There are no shortcuts to success. Along with effort comes the psychological game. Most of us are watchful waiting; waiting for someone else to say something or do something. Unfortunately the nature of leadership can leave us lonely, out in front and unsure of success; but somewhere up ahead has to be better than this.

Putting effort into something worthwhile doesn’t feel like effort, it’s satisfying. Choose something worthwhile and do that. Find allies, people who share your enthusiasm and you’ll shock those naysayers into submission.

Brian Tracy in his book Eat That Frog suggests that we must first do the task we find most difficult, psychologically it’s freeing. In this liberated state we become more productive.

What we’ve been avoiding often appears monstrous, this obscures the simplicity of focused action. Break the actions down one day and one frog at a time – I could be addressing Jeremy Hunt about more critical care beds, or the admissions coordinator regarding a patient. Before you know it, we might have got ourselves a damn fine cup of NHS coffee.

Paula Goode is a transformative coach and operational healthcare management specialist. www.square1hundred.com