Leadership in the NHS and why it may be looking in the wrong direction.

There should be a thought at the heart of every organisation; are we doing good or ill? In Microsoft we worried about a new found monopoly and we engaged with this through responsible leadership. We understood that our role as managers had to change, we had a responsibility to our partners and customers beyond just making money for our shareholders. And over a number of years we became a better group of leaders.

In the NHS I am not sure we have yet to fully understand the constraints and opportunities afforded to us by our health and social care monopoly in England. Monopolies nearly always display a number of traits:

  • A lack of transparency
  • Poor levels of service.
  • No or low consumer power.
  • high prices for low quality goods and services.
  • out dated goods and services with little or no innovation.

I believe that these ought to be leadership concerns of NHS England.

Despite rises in medical legal costs through greater insurance payouts and premiums, the Francis Report and the Institute of Customer Service Report 2014,that shows lower and lower levels of customer satisfaction within the NHS, the NHS has yet to focus managers in the same way as those of the commercial sector near monopolies.

It may that the NHS has never really developed, in organisational terms, beyond the passive aggressive org that Neilson so graphically describes in his Harvard Business Review article.

It’s time we all demanded more of NHS leadership, the call for privatisation is the wrong way of tackling the issues of lack of competition. NHS Leaders should address the monopoly traits. This could be achieved through greater transparency, and by commissioning services for improvements in public, patient and professional experience.

There is some light at the end of the tunnel, the Kings Fund paper Reforming the NHS… is a very good place to start. But until the traits are on the agenda of every NHS leader we are not going to make progress.

Governments and Information

I was sitting in a meeting a couple of years ago discussing how governments used personal data,in the room were high panjandrums from every department of state plus a few people from civil liberty and allied organisations.

We came to the point when someone suggested that truly joined up personal information available to all government departments would be a real benefit for the citizen.

The libertarians were horrified. They were worried that Healthcare data could be cross matched with welfare payments and when discrepancies were found the citizen could be tried, convicted, a prison space made available and the Police would snatch the person from home and take them directly there.

I pointed out that it would be worse than that. The reality would be that data would be wrong and before we knew it the Government would be correcting us instead of the data. In my case I presume some surgical operation would be conducted to remove 10inches from my height to make sure it matched the “Official Data.” I can think of worse errors!

Governments think they know so much about us but in reality the real danger comes from companies like BT and Google. This TED talk explains the concern.

Public Service Marketing and the terrible cost of not doing it!

Marketing is not popular in the corridors of Whitehall, it is seen as a waste of money, often confused with advertising and thought of as only relevant to commercial organisations. As a result the management processes of marketing are avoided and never discussed. Programmes and outcomes are defined in technical and economic terms. As a result the citizen is rarely thought of or given a voice.

Commissioners of public sector health and social care services put in place the standards and values of the outcomes they want to achieve. It’s important to understand that the frameworks leaders use to define programmes effect those outcomes directly. Set things up as Information Communication and Technology programmes and you get ICT led outcomes, set things up like Comms and PR and you get those. By being internally focussed and organisationally constrained a commissioner can miss the point.

Public Service Marketing is the management process to avoid such pratfalls , leaders need to listen to the requirements of the citizens, patients and professionals. Then, they should build and test cost effective offers to map to those requirements. In that way the offer/response is understood by the target population. In this way the chances of a successful outcome are great enhanced.

Recent marketing failures in health and social care services mean that we now need a tough conversation about the reintroduction of a set of tools that are designed to create cost effective outcomes. Rather than costing too much money the lack of public service marketing has cost the public, patients and professionals far more.

People before Technology

The National Audit Office has been pretty scathing about NHS ICT systems. My charge is more serious. The NHS National ICT organisations have over the last 20 years, the current one is called the Health and Social Care Information Centre, failed to put people and patients at the heart of their systems and products.

By focussing on the technical and economic justification for programs and ignoring the requirements of the public, patients and NHS professionals, HSCIC haven been delivering technical and economic solutions. Sometimes this focus leaks out in public. Here is an example spotted on a bus in Chiswick last week.

IMG 20140228 205152

It is not hard to put people at the heart of what you do. In the NHS it is easier when you have read the NHS Constitution. By understanding the promises at the heart of the document you have a check list to make sure your ICT ticks off all of the requirements.

More importantly if you don’t take care to meet the needs of the Constitution then Commissioners and auditors are likely to find your delivery inadequate.