There's often no holding back. I got short shrift once from the cardiac nurses over agency staff policy.

The 'external affairs' side of the acute chief executive job has always been a sizeable chunk. And it seems to be constantly growing. There's plenty of policy about - choice, payment by results, foundation trust applications, for instance. For the university hospitals you can also include changing research and development and education strategies and new concepts like academic health science centres.

All this has added to the amount of time spent away from King's. Some of this is about giving views on policy at the formative stages. Some of it is about pointing out the consequences. Some of it is done in civilised fashion - over dinner, at breakfast. But all of it adds to the working day and makes me reflect on how much I know about the organisation I'm representing.

King's employs over 5,000 people spread across a very wide portfolio of services from very local to national and international levels. I speak about them constantly but my guess is I know barely 10 per cent of what they're doing at any particular time. Of course, we have a management team which connects the shop floor to the corporate centre. But health service professionals are also strongly connected to their royal colleges, professional associations, chartered societies, trade unions, and so on, all of which will influence how they think and feel.

Meeting the citizens of the workplace

They are citizens of King's but also of orthopaedic surgery, gastroenterology, physiotherapy, nursing and midwifery and so on. They may also be citizens of the local workplace more than the whole organisation. One of my illustrious predecessors used to describe hospitals as 'a series of corner shops connected by the steam main'.

Am I alone among chief executives in grappling with this? I suspect not. In the last 10 years I have both been asked for and sought advice from chief executive colleagues on how to stay tuned to the shop floor. There doesn't seem to be a single answer. It's a never-ending struggle but one we shouldn't stop.

An obvious place to start has been to apply the GOYA (get off your ass) principle and see for yourself. At King's this is structured and unstructured. Spending a bit of time wandering about helps me pick up the thoughts of staff and patients in unguarded mode.

This tells me what I need to hear (and like Don Corleone I like to hear bad news immediately). If I actually ask someone in a formal situation if everything's OK there's a strong chance they will say yes automatically.

Wandering about is also a chance to get frank views from opinion formers all over acute hospitals and at all levels. At King's we do some structured information gathering through our First Choice King's programme. We have a 'go and see' task for executives to understand for themselves key elements of workplace transformation.

This ranges from a new approach to managing the ward environment to watching the new performance management system in operation in pathology. We also run a 'back to the floor' scheme for executives and senior managers.

Watching the medical director as receptionist resolving telephone queries while directing visitors, you can learn about less well-reported workplace stresses and remind yourself what the King's experience is like in other parts of the trust.

So far I've been a healthcare assistant and a member of the ophthalmology outpatient team. I've seen things that work very well, worked with great people who sometimes bailed out the processes that worked less well, and I've picked up a raft of ideas for improving the staff and patient experience. If only we could bring these into play straight away.

One of my favourite ways of transmitting and receiving is to engage with specific professional and work groups. It's very helpful to sit in with the matrons from time to time to hear how they're getting on with the facility management service provider.

Executive resource

I stress to people at King's that they should see their executives as a resource. If they need us to talk about strategy or explain how foundation status changes our world then that's an excellent use of our time.

And there's often no holding back. I got short shrift once from the cardiac nurses over agency staff policy. The ophthalmologists were equally unimpressed with my views on increasing the number of operations per list, though by the end of the discussion we were moving on that one.

By the time this article goes to press we will have completed a session with the neurosciences care group, getting their ideas on how to approach service transformation. Apart from their ambitions, I very much doubt they'll be reluctant to describe the challenges.

Is this second guessing the line management process? Not at all. Many of the execs work a bit like this. Complaints about someone else's decision are rare and when they happen we put them back into the management process, and point out the available lines of remedy.

It's about maintaining our body of understanding and helping others with theirs. I know that quite a few chief executives do these sorts of things for the very same reasons. The challenge for us all is getting the time to actually do it.

'Socialising' staff into King's is another way to find new perspectives on old issues. Like others we have our induction programmes, our new consultant groups, professional development groups, programmes for change leaders and so on.

These help us keep people in touch with the trust's overall direction. We also get some pretty sharp questions about that direction. We learn about changes in professional outlook (work-life balance is a novel concept for many of their forbears). You can read about that, but it's much better to hear and feel it.

Malcolm Lowe-Lauri is chief executive of King's College Hospital Foundation trust.