Do successful NHS managers have skill or luck to thank? Blair McPherson takes a closer look at what really determines which organisations sink and which swim
In today's performance-driven public sector, managers are judged by results. Senior managers are expected to deliver improved performance and star ratings, but is success really based on the actions of a few or is it down to the efforts of many? Do senior managers take too much credit when things go well and too much blame when they do not? How much difference can a senior manager make, and to what extent is success a matter of having the right people - or even luck?
League tables and judgement by results feed a macho management culture that encourages the belief that one charismatic leader can, by sheer force of personality, dramatically improve performance and public perception. Such leaders try to convince everyone they are in control. But are the most successful senior managers simply those who inherit the best staff and a growth budget? Or do some just get lucky?
Managers with a strong, dynamic and experienced team have a good chance of success, all the more so if they have the budget to fund new services and pilot innovative projects. This could explain why ambitious senior managers often choose to work for a poorly performing organisation over a coasting one. The former is more likely to accept the need for strengthening the management team and provide the money to fund new posts and new service initiatives.
Roll of the dice
They will never admit it on MBA courses, but success may be as much to do with luck as skill. For every scandal, there are a thousand senior managers thinking "there but for the grace of God".
For example, a small change in the government's funding formula can benefit some organisations at the expense of others. Lucky managers may suddenly find that they do not have to cut services, close facilities or increase charges. Instead, they have capital for refurbishment, money for new initiatives and good news stories in the press.
A good or bad inspection could also be down to luck. Managers who face a major inspection in the middle of a reorganisation will be vulnerable. A slight change of timing could allow the same managers to show their service in the best possible light. The timing could be decided by a high-profile complaint or a critical article in the local press - luck.
But this is not the whole story. While elements of chance are involved, senior managers can and do make a difference. They influence the culture of an organisation, set priorities and articulate the vision. They describe how things will look in the future. They inspire. However, they sometimes take too much blame for poor performance and too much credit for improved results because they have only a limited influence on the day-to-day activities of the organisation.
As the health service's focus shifts from a preoccupation with a narrow range of performance indicators to co-ordinated efforts to promote economic development, social inclusion and community cohesion, success will be determined by collaboration rather than competition, by integrity rather than manipulation and by empowering and coaching rather than demanding and controlling.
This requires a different type of leadership: one where all managers take responsibility by seeking to influence and shape the service across organisational boundaries and by being effective people managers.
Whether an organisation is a good place to work, a place where service user satisfaction is high and performance is improving is down to the leadership of managers at all levels, the commitment and skill of staff and, no doubt, a little luck.