We are entering a different phase of NHS management that to be successful will have to be characterised by a stronger emphasis on management than leadership, more process and communication, and more perspiration than inspiration. The reason is the recession.


Strange for me to say as a leadership consultant but we have placed too much emphasis on leadership and insufficient on developing good quality management and administration.  It is the latter that makes organisations work and deliver services to patients. I recall a story I am over fond of telling about my time as chief executive of a London hospital some years ago. I had been appointed to sort out the finances and strategy. After three months of beavering away I was approached by a consultant who said he and his colleagues thought I was doing a good job. Excellent I thought, must be the financial and strategic development work. Not a bit of it. He said it was because I always answered their letters and when they wanted to see me, I always made the effort to go to their office.


This was a valuable lesson. If managers are going to take difficult decisions then process, particularly communication with staff and stakeholders, will be crucial. It was also a good lesson in that much-hyped conference generating process called clinical engagement. Isn’t clinical engagement really about getting out and about talking and listening to doctors and other clinical staff?


Another example of process was in the mid-1990s when I led a difficult public consultation to establish a new children’s hospital for Greater Manchester. At the end of the extensive multi-stage process that lasted almost 12 months, I was approached by the then community health council who said that although they disagreed with the decision they could not fault the process. They had had ample opportunity, they said, to put across their views. The new hospital opened a few months ago.


Just in case you think I’m now sounding rather smug I messed up big time, also in the mid-1990s, when consulting on merging three neuroscience centres to create a single centre. The first consultation produced the wrong result because I had paid insufficient attention to process and been unduly influenced – against my better judgement – by a few powerful stakeholders. The consultation had to be run again to produce the right result. Embarrassing for me but right for the service. The new centre opened a few years later, which I promptly experienced as a patient. I guess it’s not every manager who not only sees the results of their strategic efforts but also experiences them too!


Finally, something about perspiration. It’s tempting when pursuing development activities to search for inspiration, for perfection. Leadership development is a good example. It’s easy to spend inordinate amounts of time, money and process on the search for the perfect model – believe me it doesn’t exist. Far better to get stuck in with something that best fits local context and tweak it in the light of experience. The majority of development activities are systematic processes not events. In other words, more perspiration than inspiration.