At a recent dinner I found myself sitting next to the worldwide chief operating officer of Cirque du Soleil.
Once I had swallowed my surprise that such a creative - verging on anarchic - band of artistes should even have a chief operating officer, we got to talking about how it has grown from an impoverished group of Montreal street performers to a global brand with an audience of 70 million.
It is an incredible story. Founded in 1984 by a busker cum fire-eater whose only previous job was three days' work at a hydroelectric plant, the group got its first leg-up with a handout from the Quebec government.
This was followed by a series of gambles, even when their backs were against the wall - including buying one way air tickets to performance venues in the hope that they would then earn enough for their next onward plane journey.
In those early days they had to contend with their big top collapsing after the central mast snapped under the weight of heavy rain. These days they perform in custom designed theatres, such as a 1.5 million gallon water tank in Las Vegas. In every sense, they have come a long way.
As we talked more, it struck me that there were certain - albeit indirect I grant you - parallels with a large NHS hospital. Cirque du Soleil employs about 3,500 people. It is a multidisciplinary workforce, though in their case it contains trapeze artists, knife jugglers, acrobats and musicians rather than junior doctors, speech therapists, mortuary assistants and porters. As in a typical hospital, their employees come from many countries - more than 40 at the last count. And Cirque's annual revenues are probably in the£500m-£700m range: not too different from a large NHS teaching hospital.
But unlike many hospitals, Cirque may have managed to transcend several traditional managerial dichotomies.
First, it has found a way of combining a strong culture of experimentation and innovation with consistent quality in its established activities. So at the same time that Cirque has innovated new productions and acts drawing in new audiences and venues, it has offered its existing repertoire to a consistently high quality across multiple locations, even as new cast members join shows that have been running for many years.
Second, it balances autocracy with decentralisation. On the one hand founder and chief executive Guy Laliberté personally views and critiques each and every new production before it is allowed to launch. His commitment to - and personal involvement in - the excellence of every aspect of Cirque's output is total. On the other hand, each producer of a new show - who is typically self employed - may be required to work with local teams they didn't personally recruit, to stimulate their mutual creativity.
Third, Cirque has carefully juxtaposed its own intuitions about what audiences want with a systematic approach to audience feedback. Staff mingle incognito with audiences leaving the shows, to overhear their comments on what they liked and what they didn't. (When was the last time you did that in an outpatient clinic?)
But fourth, and perhaps most interestingly, Cirque is highly reliant on outstanding individual performers who nevertheless have to function exceptionally well in teams. That is a combination that has frequently eluded the grasp of various hospitals, not to mention City financial institutions, football clubs and British cabinet ministers. So how, I wondered, does it manage to pull it off?
In large part it seems to be due to the attention it pays to recruitment. In fact you could go so far as to say that Cirque's most important competitive advantage stems from its systematic approach to scouting out, assessing and recruiting world class talent. So for most weeks of the year, Cirque talent scouts are to be found somewhere across the world, whether it be visiting Chinese academies, Eastern Europe gymnasiums or Brazilian barrios.
Several aspects of what happens next are particularly interesting.
For instance, Cirque would never hire someone on the basis of a one hour interview. Often the prospective employee will face an extended audition and a 16 week trial run is not uncommon, with no guarantee of a job at the end of it.
And my dinner companion told me that Cirque has evolved from a street performer (anarchic) culture, to an athletic (individual performance) culture, to an acrobatic (team performance) culture. So these days a candidate's superlative performance skills are absolutely necessary, but entirely insufficient. Attitude has to be right too. Prima donnas don't make it. Only those who can work well with others do. No individual is the star; "the show is the star".
When the talent scouts do find performers who meet their exacting requirements, they will often contract with them even if there is no immediate vacancy. At any one time, Cirque reportedly has 30,000 active artist files in its talent database who it will reach out to as opportunities arise.
So this is an organisation that emphasises both individual excellence and superb teamworking, and it does so by selecting on the basis of character and attitude alongside expertise and skill.
Now I admit that it would be stretching it a bit to say these various Cirque-like attributes are "the" route map for success as a hospital manager or clinical director. But they do provide some food for thought. How good is your organisation on each of these dimensions?
And next time you are sitting on an interview panel for that new consultant or senior nurse, at least fleetingly consider asking one of Cirque's typical candidate questions: "Please now mime for us what you do when you're alone in the bathroom."