'Start planning the execution, instead of dreaming about the ambition'

The Year of the Dragon is upon us. In ancient China, the celestial dragon represented power; today it is the ultimate symbol of success and happiness. As we shrug off the last vestiges of hope for those doomed New Year’s resolutions, it is time to focus on how we can seize the success the dragon offers.

It is now time for clinical commissioning groups to move from the passenger to the driving seat. So what are the few crucial areas on which they need to focus in the sea of priorities?

Let’s start with strategy. We spend a great deal of time planning but relatively little on strategy. Ask yourselves a simple question: what is it that will define your group and how will you add value for your patients? Strategies need to be developed with the whole organisation and across organisational boundaries. Some elements of strategic planning will be led by the health and wellbeing board, however CCGs as commissioners must be clear on their overall strategy and communicate.

The next logical step is to transfer these ambitions into a clear, credible plan – a process that often leads to terminal constipation. It is a crucial part, but must be done quickly to avoid getting stuck in an endless cycle of revising and redoing your plans, while missing the point as the world passes by.

Then on to the crucial next step – execution. Execution is king, but it’s a participation sport sadly undertaken by too few. All too often we assume that a well crafted plan will cunningly leap into action. It will not. This is one of those areas that requires intense assessment of the barriers, the challenges and a cunning plan to overcome them. What follows is a relentless focus on the doing and reviewing.

One of the foundations on which execution rests is to understand how decisions are made within your organisation. This is an area that is often assumed to take care of itself but, sadly, rarely does. Why should we make good decisions? At every turn the process is inherently flawed and biased – it needs attention from the outset. Undertaking an audit of decisions – looking at the quality, speed and yield of your organisation’s decisions – is a good place to start.

One of the best tools for execution is to get out a bit and take in the air. Commissioning is an active sport and requires you to check out the services your patients receive, wherever they may be. If we’re not careful we are all at risk of believing our own rhetoric and this is a great tool for sifting it from the reality.

Strategy and execution are crucially important but will only succeed if they emerge from a positive culture. Yes, that intangible prize called “culture” trumps all. Much has been written on this subject but it is all too often relegated to the “nice to have” category rather than forming an essential foundation.

Leadership will play an important part in developing the culture of the group; we need to move away from the notion of leadership embodied in an individual to that of “leading from any chair” as described by Benjamin Zander, conductor of the Boston Philharmonic Orchestra.

The culture of the successful groups will be those that are able to reframe traditional NHS issues and see them from different perspectives, and those that can tap into the rich seam of innovation that we have yet to successfully mine.

Innovative ideas are around every corner yet often we subconsciously conspire to frustrate their liberation. Leadership, plain and simple, is required now to drive this forward. Indeed to succeed over the next few years we can’t afford the luxury of being the “late adopters” any longer.

There are many pressing priorities for CCGs, but what are the crucial few on which you need to focus?