Published: 02/06/2005, Volume II5, No. 5958 Page 24

All businesses need a strategy that provides a common agreement on the overall direction for an organisation or service to achieve a set of objectives or a 'vision'. This provides the focus for any business plan. It is important because everyone working in the organisation needs to understand what they are working towards.

Writing the strategy and keeping the business on course is the main role of the board.

Strategies used to be five or 10year plans, laying out where the business was going and how it intended to get there. Businesses now prefer strategic thinking, with the focus on innovation and challenging existing methods of creating customer value to keep up with newly emerging customer needs and changes in technology.

Rapid change or environmental turbulence is the norm, and businesses accept they can no longer predict the future. Instead, they must constantly adapt and test what they provide to build on success and find new ways of working.

The NHS, once committed to five, eight and 10-year plans to determine its future direction, has also recognised the need to change.

NHS chief executive Sir Nigel Crisp wrote in his preface to National Standards, Local Action in 2004: 'The NHS improvement plan... sets a vision of 21st century healthcare and improved health. . .

that should take precedence over old ways of doing things and institutional barriers, where these stand in the way of improving services to people. Organisations are expected to challenge the past, and use innovation and creativity to determine new local solutions, and set new horizons for local services.' The national standards are designed to create a shift towards strategic thinking in the NHS. They focus on whole healthcare systems designed to meet the needs and aspirations of local communities, while guaranteeing immutable values that define quality for the delivery of healthcare.

In the NHS, services can be provided by different staff in various locations, but in a total healthcare system there is a guarantee that all staff work with the same regard for safety, professionalism and personal service.

Ideas from the private sector on implementing strategic thinking are the same as those required to implement the developmental standards:

'Integrating diversity' - a phrase used by Jack Welch, former chair and chief executive of General Electric, who claimed businesses must eliminate boundaries within organisations so they can share ideas and make faster and better decisions.

'Battling bureaucracy' by using flatter management structures, which encourage employees to come up with new ideas and solutions to problems.

'Creating a learning culture' by cultivating leaders and putting values (such as standards) before numbers.

Having a limited number of targets that stretch staff to strive to improve services.

Thinking outside the box - getting all staff to free up their thinking to come up with different service designs and solutions.

You can get some more ideas from www.1000ventures. com/ business_guide/mgmt_new-model_ 25lessons-welch. html#Bureaucracy

HCSU is running a board-level programme for NHS organisations on developing strategic thinking using the Standards for Better Health published last year, which trusts must take into account in providing and commissioning services. HCSU is responsible for developing and maintaining the standards.

www. hcsu. org. uk

Ellie Scrivens is professor of health policy at Keele University and director of the Health Care Standards Unit.