Published: 02/09/2004, Volume II4, No. 5921 Page 12 13

Management strategies are big business - and the gurus who preach the latest techniques could be in a rare position to mould and influence the NHS. Mark Gould investigates who they are, how they operate and whether they work

The perma-tanned smoothness and glinting smiles of US inspirational speakers, the poetry and drama of Shakespeare and the sheer toe-curling embarrassment of David Brent from the BBC smash The Office all have one thing in common. They are all helping make better NHS managers.

Management strategies have become a major world business, and the NHS has not escaped the creep of management gurus.

The BBC is now marketing David Brent, office manager and motivational doyen, as a corporate education and training tool, and the NHS, along with Bupa and the Royal National Institute for the Blind, is one organisation that has benefited from the pearls of wisdom from the man from Slough paper firm Wernham Hogg.

The BBC says a number of NHS trusts have bought The Office as it provides a 'poignant and funny metaphor for bad management' by heightening and exaggerating situations that are present in virtually every work environment. 'By showing trainees examples of bad management they can be motivated to learn the correct way'.

But the 'do as I do not' approach of David Brent couldn't be further from the techniques adopted by another leadership guru with famous connections.

Richard Olivier, the son of actor Sir Laurence, has worked with NHS managers at Tees and North East Yorkshire trust and the Modernisation Agency.

Olivier pioneered 'Mythodrama' using the plays of Shakespeare, such as Henry V, Hamlet and The Tempest, to educate and motivate.

The technique highlights the challenges faced by key characters and uses them to relate to modern day NHS dilemmas.

Olivier says Henry V is useful for leadership and uniting people around common goals, The Tempest for managing change and Julius Caesar for power and influence.

Around 300 managers, patients and advocates from across County Durham and Northumberland have been on courses paid for by TNEYT using Henry V to look at inspirational leadership and creating a united workforce.

He explains. 'We used the 'once more unto the breach' speech to explain a number of motivational buttons that Shakespeare is able to push to get people to think about the bigger picture; what they are doing it for; about friends who have gone before whose sacrifices you do not want to be in vain; what ties us together; what is our common endeavour.He touches on an incredible variety of motivational tools.'

Olivier sees managers as 'caught in the middle' between policy makers and clinicians, and so advocates good communication as key to their success. 'When Shakespeare writes about a particular issue or personal conundrum, he is giving you an emotional reality as well as a logical one.We find this ties in with NHS managers who have to reach peoples' hearts and minds to move them forward.'

He illustrates the constant NHS refrain of managing change by focusing on The Tempest, summed up by Gonzalo in Act V Scene I: 'O rejoice beyond a common joy: in one voyage all of us found ourselves, where no man was his own.'

He says: 'Unless people can get to a point where they enjoy the challenge of change and think of it as a continuous development then they are always going to be in that resistant or slightly resentful position.'

Olivier says the part of any major change that is managed least well is the emotional one.He says that, while structures, strategy and processes might be in place, the emotional reality of getting relationships working on the ground where they have to actually deliver, often gets the least amount of attention.

'That requires a bit of emotional intelligence, to understand what people are going through and being able to frame the change in a way they are able to comprehend. People involved in change at quite a senior level in the NHS have got all the strategy around change and their MBAs or MAs in organisational design, but they haven't necessarily got people management skills.'

And he argues that given the vulnerable position NHS managers are in - open to criticism from their political masters, the public and the media - praise is vital when managers do well.

'NHS managers know that on most of the occasions they are reported in the press they are going to be knocked. So It is important for leaders to be supportive and offer praise in order to counteract that demoralising, de-motivating effect.'

Wendy Cowie, head of organisational development at TNEYT, says the Shakespearean course elicited the best feedback they had received from any management training scheme, inspiring the trust's managers to find out more about leadership.

Management consultant Stephen G Baker, whose credits include Bank of Scotland/HBOS, says the trick to keeping sane and stress-free in the world of change that is the daily diet of NHS managers is devising your own personal NHS Plan.

'It is good management practice to tie in the overall plans for the business area to the day-to-day workflow, ' he says. 'This can be done by developing a three- or five-year plan - tied in with the overall 10-year NHS plan - clearly defining the strategic aims of the unit.

'This should be further broken down into annual objectives, three-month and monthly plans.

While this will mainly address wider issues, it should be expressly stated in the document why it exists and what needs to be done to fulfil that aim - such as day-today activities and service levels.'

He also suggests a master list of projects and activities, which should be selected from on a dayto-day basis. 'A classification system that rates tasks from urgent and important to non-urgent and non-important should be developed to keep things in perspective.'

Baker says family, holidays and time away from work to develop new skills should be factored into this classification, as they are just as important.

Lancaster University management school professor of organisational psychology and health, Cary Cooper says managers will lead happier lives if they clear their minds of peripheral goals and concentrate on the real issues that affect patients.

However, he feels the pressure on NHS managers is greater now than ever.

'NHS managers are highly visible people and It is worse for them now the government has pumped so much money into the system.

'In the old days the public would sort of shrug and say there are not enough resources, but now we have been told there are all these new billions in the NHS. They demand more now because they see the NHS as having all these extra resources.'

The way they have to cope, says Professor Cooper, is to prioritise, and that can mean determining their own aims, rather than always following government priorities.

'They make a mistake when doing that, what is really important in terms of patients is what counts.'

Does he feel the 'consumer-led NHS' has created greater demand?

'I do not have any problem with the NHS treating patients as customers. You see people as customers and realise there are better ways of doing things to satisfy those customers - that way you get fewer complaints in your face and fewer complaints and pressure from the government because patients have complained to their MPs or the media.'

However, Professor Cooper's final thoughts on a better life for NHS managers are only in the gift of the government itself: 'The Bank of England has been given the power to set interest rates. The government has said 'off you go - do it on your own without our influence'.

'Now if that is all right for finance why can't we have the same thing for the NHS and education? If you depoliticise the NHS then you will solve a lot of these management problems.' l Once upon a time, a guy walked into a bar. . .

Story-telling and humour are important weapons in the armoury of the motivational manager even when you are criticising your audience.Researchers from King's College London analysed the public performances of three big-name US gurus.

They found that all three could say something uncomfortable to the audience if they 'wrap it up as a joke'either by laughing themselves or using ironic or exaggerated comedic gestures.

One of the researchers, Dr David Greatbatch, says: 'Our research clearly shows that gurus deploy humour at those points in their presentation where they face possible dissent.

'Because they package their ideas in a non-offensive way, the world's leading gurus are never booed from the stage and typically generate very positive audience reaction and a high feel-good factor.

'Anyone can learn the techniques they use.Public speakers from politicians to trainers could benefit from having a greater range of presentation techniques to employ when necessary.'