The Changing NHS

How do non –executive directors add value to strategy making in the NHS? Last week I heard two quite contrary views about this, both expressed by senior NHS managers.

1. Constructive Critics

In the first view, strategy making is seen very largely as the responsibility of executive teams. Non-execs don’t have the time or knowledge to engage in this process. Instead they can best add value by reviewing and constructively questioning the strategy (once largely formed). They might help the executives to ‘fine-tune’ around the edges but it's unlikely that they would push for a strategy that the executives were unwilling or reluctant to contemplate and in any event, by the time they are involved it's too late to have a fundamental rethink!

2. Active Shapers

In the second view, non execs are seen as central to the strategy forming process. Because they come, largely, from ‘beyond’ the NHS they can often challenge assumptions and values-led suppositions about what the strategic intent ought to be. This is especially true for non-execs who have spent time in customer facing large private businesses. In short, they can help executives to think way beyond their 'comfort zones’ and encourage the crafting of new strategies that enables the NHS to more fully enagage with the world as it is rather than how it ought to be.

So, here we have 2 quite different views about how non-executives can help NHS organisations form far-sighted and effective strategies. I suspect the first view holds sway in most places but perhaps the second is the one which holds out the prospect of creating most value.

Do you recognise the two roles I've described and what are your non-execs, constructive critics or active shapers?

nhs

non-executives

strategy