As a clinical leader, I have always known that some skill sets are more suited to following protocols than others - is it better to discover for oneself or accept collective, evidence-based practice? The credit crunch has undoubtedly been a wake-up call.

A recent Harvard Business Review article quotes the author Douglas Adams. He had it right in stating: "Human beings, who are almost unique in having the ability to learn from the experience of others, are also remarkable for their apparent disinclination to do so."

This is the time to look at evidence and speak to those with accumulated wisdom about the right decisions. Hindsight is wonderful to work out that the halt in market liquidity in August 2007 led to a housing fall in January 2008 followed rapidly in September 2008 by the consumer recession.

To give you some context, at Nuffield Health, the largest trading charity in the UK, the calendar year end coincides with our financial year. Performance matters, capital matters and cash and banking covenant focus the mind even more. As a stable independent entity, we are rowing hard to emerge smarter from the business turmoil. I know I am rowing hard, my team is undoubtedly rowing incredibly hard and colleagues all around are putting in the hours to deliver. This is not the time to discover, it is the time to look at business wisdom and research to inform the right decisions.

There has never been a better time for executive teams and boards to gel. Wise counsel and the permission to stop doing things have never been so important or welcome.

The consumer recession has caught the attention of business. Falling tax revenues, rising welfare demand and widening governmental borrowing will inevitably lead to payback, and if I were working in the public sector I would start rowing faster too.

What to focus on

The record on what smart health organisations do in lean times is clear. In between rowing harder, putting principle into practice really matters. The hit list will be familiar to many:

  • organising to learn (listening to the team);

  • restating strategic priorities (cash, cash and more cash);

  • defining short-term deliverables (welcome to 1+11 budgeting);

  • building leadership potential (training matters even more);

  • securing early wins (differentiation, cash, productivity);

  • creating collaborative relationships (getting it done).

The question, therefore, is what to do less of. The evidence-based business practice is clear on this. Concentrate less on detail, consider critique to be helpful, collaborate rather that dictate, evaluate before making decisions and avoid micromanagement. For some, this may seem easy, but stress moves people in unusual psychometric lines.

I sense the public sector is one step behind this learning curve. It fixed the financial turmoil of 2006-07, but the absent Wanless principles of full engagement, public health ticking time bombs and the greying population could create a perfect storm when the government finance black hole needs sorting out.

Anyone for rowing lessons?

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