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.

Leadership.. Slim was right

There has been some discussion of leadership in Microsoft lately.

Shackleton or Slim.

Shackleton Leadership… not one I would follow, he was a leader we studied at Sandhurst when we looked at the dark arts of leadership, coercion, peer pressure and religious intolerance.

Undoubtedly once in the boat he did an amazing job of keeping people alive and navigating the small craft across a huge expanse of open water… the key is don’t prepare so badly that you have to get into the boat in the first place.

Our leader of choice was Lord Slim…he had 3 elements to his leadership:

1. Spiritual

(a) There must be a great and noble object.

(b) Its achievement must be vital.

(c) The method of achievement must be active, aggressive.

(d) The man must feel that what he is and what he does matters directly towards the attainment of the object.

2. Intellectual

(a) He must be convinced that the object can be attained; that it is not out of reach

(b) He must see, too, that the organization to which he belongs and which is striving to attain the object is an efficient one.

(c) He must have confidence in his leaders and know that whatever dangers and hardships he is called upon to suffer, his life will not be lightly flung away.

3. Material

(a) The man must feel that he will get a fair deal from his commanders and from the army generally.

(b) He must, as far as humanly possible, be given the best weapons and equipment for his task.

(c) His living and working conditions must be made as good as they can be.

I think there is much we can do with Slim’s simple outline.