The Changing NHS

I’m about to start some work on helping people craft and use scenarios regarding the future of the NHS.

It’s a crowded space – Mission, Vision, Values, Policy, Strategy, Tactics, Transformation, Improvement etc.

In preparation I’ve been lucky enough to have lots of interesting conversations, especially with Tony Hodgson of Decision Integrity who is acting as an Adviser to the work.

My head is swimming and so far I’ve just got a bunch of questions:

Mission

• Why is Mission so rarely talked about in the NHS?
• Is it simply understood and accepted at an implicit level?
• Do local NHS managers feel they have no influence on shaping it and therefore don’t see it as having any real relevance to their day-to-day decision making?

Vision

• Why is Vision almost always reduced to and communicated as a series of short-term operational challenges (more choice, greater plurality of providers, reduced waiting times etc?)  

Strategy

• In the NHS, what’s the difference between strategy and policy?
• Is strategy irrelevant if you are leading an organisation that is focused almost exclusively on demonstrating operational improvements within the next 18 months?
• Why do managers act as if they believe that only successful implementation of current policy/strategy will lead to intended desirable outcomes being achieved?
• Why don’t they more openly consider alternative strategies, that may be more likely to achieve desired results?
• In forming strategies, do managers focus too much attention on the political context at the expense of due consideration of trends in the social, economic, technological and environmental domains?

Innovation and Improvement

• Can a focus on improving operational processes successfully co-exist with attempts to transform organisations and systems? 
• Does a pre-occupation with operational /process improvement only prolong the 'slow death' of outdated organisational entities that are better off being blown apart?

Answers on a postcard gratefully received.

Steve

www.stevepashley.co.uk

nhs

change management

strategy