Managing at Scale
As part of our ‘What If’ series on change in the NHS, we spoke to Turnaround Director and Consultant Chris Huckle and asked him: “Putting all politics aside, if you could change one thing about the NHS, what would it be?”
If I could change one thing…
It would be with management structures. The great companies have one thing in common: a world-class management system. One that cascades from top to bottom of the organisation, allowing management of their business at all levels and a clear line of sight from board to shop floor. One that links organisational, operational and individual performance. One that looks forward, allowing management to intervene with support where risks are emerging rather than after they have hit.
One such great company is the IBM Corporation. IBM and the NHS are of a similar nature: the NHS runs with a budget of around £125bn, IBM one of $80bn. IBM has 380,000 employees, the NHS one million plus. The NHS has an inherent complexity with the separation of purchaser and provider and a plethora of separate organisations and arms-length bodies. IBM meanwhile has the challenge of operating, managing and reporting from 170 countries. Most importantly, both rely on and value immensely intellectual capital. Both have management systems in place that combine people, organisation and management information in a series of defined meetings and reports. Both bring great good to the world. However, they manage themselves very differently.
At IBM the management system is the very heart beat of the organisation. Its supportive and ubiquitous nature ensures that economics is a balancing consideration in all they say and do. Senior development engineers understand that a commercial focus ensures that more can be reinvested in primary, world-changing research and development. Account managers understand that less spent on airfares is more invested in developing customeroriented solutions. This powerful blend of culture and system is achieved through excellence in leadership, management and information. Executives ensure that quality and economics are both at the heart of every discussion.
The majority of management meetings are one to-one ensuring that both parties know their business intimately. Management understands they’re accountable for delivery and that their primary role is to help their report be successful. The system is supported by up-to-date accurate information structured so that current performance and likely outcomes are balanced with risk highlighting areas that the management team need to focus on. Meetings focus on how risks can be mitigated, and performance is improved with both parties contributing.
The NHS manages very differently. The reliance on committees and general meetings, many of which are statutory and limit individual accountability, creates a permafrost layer between senior management teams and operations, as well as limiting the essential transfer of knowledge and values that one-to-one meetings bring, a learning approach that is deeply embedded in its clinical approach. Locally developed solutions result in poor information and weak management reports that make it hard to manage and break the essential top to bottom management cascade. Lack of management training and experience allows the debate to gravitate to the crisis of the moment with few discussions focusing on the operational economics of the organisation. The solution is to establish a national management system that covers the length and breadth of the NHS, allowing global roll up and down. The defining of standard approaches for similar units, such as Trusts, would allow the adoption of best practice and make management transfers more effective.
National standard formats for management information and reports, with the necessary investment in management information systems, would have the added benefit of improving management line of sight. Great training for all line managers, with a focus on work-place coaching, is essential. As part of this programme all managers would be encouraged to meet one to one with their direct reports on a weekly, monthly and quarterly cycle. Also encouraging cross-industry learning through secondments and ‘teach first’ types of initiatives would greatly enhance the development of the management system.
Resource for health care will always be limited. Having a management system that can make the right economic and quality based decisions is essential if we are to have a thriving world class health care system.
Chris is a turnaround and transformation senior executive who has worked across the NHS and Independent Healthcare. He specialises in helping organisations in difficult situations to achieve transformation, stability and success, whether it’s an NHS Trust or a £2bn turnover corporate.
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