comment: Management teams should heed insights into failing organisations

Published: 15/01/2004, Volume II4, No. 5888 Page 15

It was perhaps inevitable that franchising appears to have more or less disappeared from the Department of Health's improvement toolbox. The controversial measure has been greeted with both suspicion from the NHS and a lack of interest from most potential franchisers.

One man with unhappy experiences of the franchise process is Jan Filochowski, who last year bid unsuccessfully to take on Royal United Hospital Bath trust. This week he begins a five-week series on why trusts fail and how to save them (pages 28-30).

Mr Filochowski draws on powerful lessons from his time at Bath and Medway trust.

A key argument is that those tasked with monitoring trusts too often get a distorted, overly optimistic view of performance, with the true and awful picture suddenly emerging far too late. A sense of failure then engulfs the trust, wounding the morale of patients, clinicians and managers, and in fact clings to it even when performance begins to improve. The reality of this will be familiar to many zero-star trusts.

Mr Filochowski holds up a number of lessons relevant to the franchising debate. First, although senior managers may need to be changed, those departing should be supported and not heaped with blame.

Second, new managers must dig quickly through confusion to get a true picture of the fundamental problems and their real extent. The most visible problems may not be the biggest.

Third, open communication with all staff - but particularly clinicians - must be prioritised as a route to allowing them the space and tools to solve their own problems.

If the government is to return to franchising, these lessons - applicable to both NHS or private sector management teams - would be well learned and might give the policy a better name. l