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Published: 27/06/2002, Volume II2, No. 5811 Page 33

Chief executives may aspire to the coveted three stars, but success has serious pitfalls, warns Sarah Fraser

Are there any disadvantages to being rated a three-star organisation? Does success have a downside? Being signalled three-star has a number of positive aspects, but those who wrap themselves in the glory of success may have nasty surprises in store. Canny leaders will spot that these gifts are Trojan horses. They will be marshalling their defences in preparation.

Success is not a stable state, especially in a system where only a set number of organisations can be three star. Unfortunately, evidence suggests that few organisations manage to maintain their cloak of success in rapidly changing environments.

1Even worse, they tend not to slip back incrementally, but rather suffer collapses - straight to no stars.


Because one of the greatest dangers of successful organisations is their inability to continue to learn.

After the champagne has gone flat, leaders and top teams of these privileged organisations might like to do some reflection.

They may have reached three-star status through tried and tested methods.Now they have received recognition for their achievements, will they want to change anything? What motivation will they have to test out innovative activities to sustain their status?

Will they persist in maintaining the status quo at the expense of continually adapting to ongoing and unplanned pressures? Research suggests the majority will work to sustain what has worked and avoid modifying to new and uncertain forces.

3Complacency about success can increase risk aversion. Three-star organisations will be in the limelight. No doubt the vultures will be standing by waiting for something to go wrong so they can move in and feast off the riches.When something does go awry in an award-winning organisation, and by the nature of evolving and changing systems it will do, the temptation is strong to blame people for any variation or indiscretion.

Despite rhetoric about developing a blameless culture, the NHS does not have a good track record in this respect. There is a significant difference between losing your job through sustained incompetence and being sacked for an unexpected event hyped up by the media. If chief executives can be ousted for minor failures and not be given the chance, along with the rest of their organisation, to learn from such incidents, then three-star organisations are in for a challenging time.

Individuals and teams may start to hold back from reporting minor failures, for fear of letting down the organisation, or of personal shame.Yet without feedback, information and understanding of these near misses, problems and errors, organisations will be unable to learn and grow.

With satisfaction comes a lack of attention to small details. In the behavioural and complex nature of the NHS, small things can have large effects. For example, an agency nurse may not be aware of the hospital infection policy and procedures. She does not receive any induction and unwittingly contributes to an outbreak of methicillin-resistant Staphylococcus aureus.An orthopaedic ward is closed.

Elective operations are cancelled.The waiting lists and times increase.All for the lack of a 15-minute induction process.

The top teams of successful organisations may be tempted by the offer to run other 'failing' organisations, at the expense of losing touch with their own organisation.Will the takeover team work with the new organisation or will it impose its own formulae? There is no guarantee that what works in one place will work in another.We do know that good practices are adopted by others only when there is a chance to participate and re-invent the ideas to fit the local context.

4Success can bestow overconfidence and prove a barrier to learning.

5The first test of a three-star organisation's capability to learn will come when the something unexpected, and not altogether pleasant, happens.The temptation to dismiss an 'incident' as a one-off due to a special set of random events will be strong.

Sustained success comes from resilience and the ability to respond quickly. It requires a culture in which feedback is valued and issues addressed with solutions that can be applied directly, without excuse.Adapting with grace and appropriateness is a characteristic of agile organisations.

Some three-star organisations will occupy their pedestal through luck, but most will do so through wisdom, learning and relationship-building.They will need as much care, attention and support as no-star organisations, though of a different variety.

They need to grow their learning capacity, and be given the space and privacy to experiment without fear of judgement by others.The first test of the policies and rhetoric of the Department of Health and myriad NHS agencies is to avoid the knee-jerk reaction of blame when something unexpected happens in a three-star organisation.

Sarah Fraser is an independent consultant and visiting professor, Middlesex University.


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Massachusetts: Fellows of Harvard College, 1998.

3March JG. Decision and organisation. Blackwell, 1998.

4Rogers EM. The diffusion of innovations. New York: The Free Press, 1995.

5Hedberg B. How organisations learn and unlearn. In: Nystrom PC, Starbuck WH (Eds) Handbook for Organizational Design (vol 1). New York: Oxford University Press, 1981.