Stephen Eames on managing the future of the NHS

This would fundamentally reshape the behaviours of our staff and the nature of our external relationships.

If you accept the premise that one of the main roles of the board is to manage the future, then how should it be approached?

We determined that the swift execution of our strategies and major operational plans would be even more vital and that we needed to accelerate the pace across our services and with our partners. We also concluded that, while leadership must be our heartbeat, we needed more management development and capability at every level. We discussed the thorny challenge of delayering hierarchies and engaging and motivating our staff, while at the same time reducing the pay bill and the workforce. We noted that our match fitness, as an board, would be judged on our ability to deliver enhanced patient experiences, ever safer services and improved clinical outcomes while managing the future well.

Easier said than done in a world of constant uncertainties.

One of our board members quoted Dante - “The hottest places in hell are reserved for those who, in a period of crisis, maintain their neutrality” - which rather apocalyptically summed up the mood.

I wouldn’t want anyone to assume that we are in some sort of Gaderene charge towards Armageddon; but the next few years are going to be challenging to say the least.

So if you accept the premise that one of the main roles of the board is to manage the future, then how should it be approached?

The starting point is to make sure the board performs effectively as a corporate team. The recipe is simple:

• ensure a clear understanding of roles and responsibilities;
• share a common vision and goals, be clear about how these goals are to be achieved;
• regularly review how the board is working;
• resolve conflicts between each other;
• make sure there is the right mix of skills, experience and time to do the job well.

Poor performance in any of these areas can lead to too much time being spent on operational issues, inappropriate items drifting up to the board, a reactive approach to agenda setting and thus a lack of focus on the main event. You can’t effectively steward and steer an organisation through choppy waters if you are unable to get these basics right.

Successful management of the future assumes that your strike rate in predicting future events is good. However, research suggests that the ability of organisations to predict the future is often illusory. Nobody, apart from some lonely voices out in the wilderness of the financial industry, predicted the scale and nature of the banking collapse and the subsequent economic crisis. So I would suggest that the major challenge for boards is to plan scenarios, always have a plan B and systematically review risk.

Board level risk management should be more about evaluating the impact of major events and taking steps to mitigate them before they occur rather than trying to forecast how cataclysmic the events might be. In our case we know we need to concentrate on strengthening our position as a local provider of healthcare services. We must thoroughly analyse and assess the strengths and weaknesses of all of our clinical services and planned investment decisions while managing the transition involved in delivering more care at less cost and in new and different settings. As one of our non-executives said: “We will be well served if we abide by the old adage that turnover is vanity, profit (in our case viable services) is sanity”.

There really is no substitute for informed face to face discussion. Without it you can’t expect the engagement and commitment of staff. Don’t be tempted to withhold or massage difficult messages or you will forego an open exchange about the issues and crucially how staff can contribute to finding solutions. So boards need to construct communication plans that set the vision and allow for bottom-up influence. And constantly review the effectiveness of communications and the quality of the message.

Most important of all perhaps is to keep your nerve and keep everything in perspective. Under pressure, or in times of difficulty, it is easy to panic or lose sight of the main goal. Even boards can go into panic mode at times, so when this happens it is always helpful to temper this with planning ahead. Striking the balance between strategic focus and operational demands is never straightforward but, if you’re not careful, you may not spend enough time on future-gazing and this can cost, especially when the heat is on.

Managing the present is tough enough, and NHS boards are held to account in many ways for this, but the accolades will come for those boards that can demonstrate to stakeholders and staff that they have steered a course towards a secure and sustainable longer term position.

So the lesson is to make sure you have processes and mechanisms in place to manage unforeseen events or as in the words of Mark Twain: “Plan for the future because that’s where you are going to spend the rest of your life…”