The foundation trust regulator asked Sandhurst Academy to give managers an insight into the military ‘chain of understanding’. Helen Mooney reports for duty

In October, foundation trust regulator Monitor held a somewhat different leadership workshop for senior foundation trust managers. Thirty chairs, chief executives and medical directors, representing 14 organisations, were enrolled for a day of leadership training at the Royal Military Academy Sandhurst.

I started looking for signs of management bravery and found that they were largely lacking

Monitor and management consultants IDG hosted the workshop to introduce a new type of leadership programme.

It offers NHS general managers and clinicians within foundation trusts the chance to learn from military style training and help develop a “mission command” approach, “a style of command developed to facilitate leadership in intensely complex, high pressure situations - such as battle - by decentralising command and initiative”.

The programme, Monitor hopes, will help managers to better deal with leadership, finances, quality and services in the current economic climate to ensure they are as well prepared as possible.

Monitor hopes it can help foundation trust leaders to overcome their greatest fears, encourage others and know when to “go against the flow in defence of what is right”, while making decisions, managing risks, and setting goals.

It is intended to help leaders ensure all staff understand what needs doing and why, and then are given the freedom to decide how best to do it.

Although the regulator says the Sandhurst programme may not be for everyone, it hopes those who attend will gain a perspective on how military leadership can be applied to their own leadership.

Monitor policy director Robert Harris has been in charge of developing the programme.

“Some of the biggest challenges in NHS organisations are not yet being met head on, both the financial challenge and particularly the challenge of improving clinical quality,” he says. “I was drawn to the importance of managers at board and service line level being courageous and brave. Taking a difficult decision is never going to be popular but it is absolutely necessary. I started looking for signs of management bravery and found that they were largely lacking.”

Professor Harris blames this on an NHS which is “largely permission seeking” but also on a deeper cultural issue which means staff do not like giving or receiving instruction.

“Having served in the army, where understanding objectives and being able to relay them down the chain of command was critical, I recalled how the military deals with giving and receiving orders,” he says.

“There is a very clear chain of understanding… what the military does is create explicit values that people can relate to… and a ‘mission command’ mechanism where people are told what they need to do, they are told why need to do it, but they are not told how to do it,” he says.

Immediacy impact

Professor Harris continues: “The ‘how’ is left up to the individual - this chimes with the devolved autonomy structure I have been promoting under Monitor’s service line management programme: getting individuals to the position of having to make smart, informed choices and being held accountable for performance and delivery.”

Professor Harris thinks the workshop had an “immediacy and impact” because participants saw a cohort of cadets passing out, many of whom would be in frontline positions in Afghanistan.

“I believe those attending the course felt how important it is to get it right and act decisively and swiftly with the information you have because if you dither you die,” he says.

The next step will be to tailor a four month programme for trusts that want to do this training, aimed at general managers and clinical leaders.

‘The military have magnificent clarity’

Harrogate and District Foundation Trust medical director Carl Gray says: “I have been on courses with the Navy and the RAF in the past and am sympathetic to military matters and also interested in management training for all doctors.

“The military have a strong track record. They have a magnificent clarity and don’t bark orders at unwilling people, but they have a clarity of mission command - they don’t use micromanagement to achieve their goals, army leaders tell their troops what they want them to do and they go off and do it.”

Dr Gray says the military has also developed people as good followers as well as leaders, which is something he feels has been lost in the NHS.

“I will definitely recommend the programme but it is a case of whether we can afford it,” he admits.

Countess of Chester Foundation Trust chief executive Peter Herring says: “I have a military background in the Territorial Army. It was interesting to go back to Sandhurst but also here at Countess of Chester we are trying to achieve more organisational simplicity and I knew from my military background that it has a lot to offer in terms of structure and leadership styles.”

Mr Herring says one of the military’s strength is “strong decisive leadership” and the health service has something to learn from that.

“Combined with collective effort… artillery, infantry, armour and seeing it all works very effectively… there is also a strong acceptance of personal responsibility,” he says.

He concludes: “There are a lot of transferable skills from the military that the health service could take on board.”

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