The Changing NHS

If Foundation Trusts are to thrive then they need to be capable of building and sustaining a culture where clinicians and managers are confident, ambitious, competent and action-orientated. One aspect of this challenge is the extent to which Trusts can excel at spotting and nurturing potential future leaders from within their own ranks.

If a NHS hospital Trust employs, say, 4000 staff, then surely at least 100 future leaders are there somewhere? After all, that’s just 2.5% of current staff.

Does your Trust do this and if it does, do the Trust Chief Executive and the HR Director meet regularly to review how people in the ´group of 100´ are doing?, to plan what opportunities to offer people next? and to identify succession paths? 

If your Trust does invest in growing its’ own future leadership, what criteria is used to identify people? Perhaps your organisation uses the Leadership Qualities Framework, promoted by the NHS Institute for Innovation and Improvement?

Skip from Be Excellent™ has posted a list of eleven criteria for spotting future leaders, drawn from Ram Charan’s book: Know-How: The Eight Skills that Separate People Who Perform From Those Who Don’t

1. They consistently deliver ambitious results.
2. They continuously demonstrate personal growth, adaptability, and learning better and faster than their peers .
3. They seize the opportunity for challenging, bigger assignments, thereby expanding capability and capacity and improving judgment.
4. They have the ability to think through the business and take leaps of imagination to grow the business.
5. They are driven to take things to the next level.
6. Their powers of observation are very acute, forming judgments of people by focusing on their decisions, behaviors, and actions, rather than relying on initial reactions and gut instincts; they can mentally detect and construct the “DNA” of a person.
7. They come to the point succinctly, are clear thinkers, and have the courage to state a point-of-view even though listeners may react adversely.
8. They ask incisive questions that open minds and incite the imagination.
9. They perceptively judge their own direct reports, have the courage to give them honest feedback so the direct reports grow; they dig into cause and effect if a direct report is failing.
10. They know the non-negotiable criteria of the job of their direct reports and match the job with the person; or if there is a mismatch they deal with it promptly.
11. They are able to spot talent and see the “God’s gift” of other individuals.

Personally I think a list of eleven criteria is too many to ‘operationalise´ successfully. Instead I would focus on the five criteria that I’ve put in bold font. Also I’d add a sixth, along the lines of:

• They consistently demonstrate a strong sense of wanting to serve others, especially patients.

What do you think to this list? Does your Trust have a way of identifying and nurturing potential future leaders? Does it draw equally from clinical and managerial ‘gene’ pools?

Thanks to George Ambler at The Practice of Leadership for drawing my attention to this issue.

Steve

nhs

leadership

The Healthcare Commission recently released the results of its’ annual survey of 128,000 NHS staff across England.  According to the Guardian Society,only 42% would be happy with standards at their own establishment. A quarter said they would be definitely unhappy and 34% did not have a view. Just under half the staff in hospitals said care of patients was their trust's top priority, but 25% said it was not.
 
However, job satisfaction levels, although slightly lower than last year, remain relatively high. 68% of acute trust staff and 75% of staff in primary care trusts reporting that they were generally satisfied with their jobs.

On a related note, I recently attended a seminar where the CEO of a USA based not for profit healthcare system explained that his organisation’s mission was to ‘delight’ patients.  He claimed that a key reason why his organisation was successful in this regard was because his pay, to quite a large extent, was dependant on the Board judging that the organisation had achieved a key metric concerning patient satisfaction.  Basically every in-patient is surveyed, after discharge, and asked whether they would recommend the hospital to a friend.

That got me thinking. Currently, according to the Department of Health’s Pay Framework, (download from here) it seems English PCT Chief Executives earn a basic salary between £100k - £142k pa and have the possibility of an annual  performance bonus payment if the organisation is deemed to have met its’ financial control target and the CEO is judged to have performed above satisfactory in a four point scale. I couldn’t find the corresponding figures for Acute Trust Chief Executives – have you ever tried to search the DH website! -  though in 2005 the BBC reported on an IDS survey that claimed the average English Acute Trust Chief Executive was earning a basic salary 18% higher than a PCT Chief Executive.

Given the general direction of NHS policy, more market power in the hands of patients and more non-price related competition amongst providers, perhaps we ought to see the focus of these incentive schemes shift, away from financial control and general CEO performance, towards something more tightly focused on ‘delighting’ patients?

1. Would NHS Trusts really focus more attention and energy on ‘delighting’ patients if their CEOs had this kind of arrangement in their contracts?
2. Are CEOs sufficiently influential internally and capable of resisting other, potentially competing priorities that are externally proposed?
3. Are Chairs of Foundation Trusts likely to have more of an appetite to introduce such incentives as part of their duty to manage the performance of their CEOs?
4. If, yes, would a scheme be more effective if it meant a CEO might lose a percentage of their basic salary rather than gain a additional amount over and above a guaranteed minimal and if yes, what % of salary would need to be ‘at risk’ in-order for CEOs to make delighting all patients their number one priority? 2%, 5%? 10%?
5. Could a simple, measurable and meaningful patient-focused metric be identified, stuck with and used?
6. Should we consider introducing a similar scheme for Medical Directors?  Alan Maynard, Professor of Health Economics at York University has recently floated this idea for all GPs and Consultants.
   

You manage what you measure – hmm - you manage what you get paid for might be more accurate?

Steve
www.stevepashley.co.uk

paynhschief executives

You can write what I know about the details of NHS IT / Connecting for Health on the back of a postage stamp, but I do know one thing - that the NHS is wasting massive opportunities to transform how care is delivered by not taking full advantage of the knowledge and skills held by IT and informatics professionals already working within the NHS.

When almost every other industry you can think of is or already has exploited the potential of IT to re-inventing business models and offer more value to consumers we are stuck in the black hole of Connecting for Health.

I have recently spent a fair bit of time with senior IT people and have been amazed at how disconnected they feel from local strategy making processes. They seem to have allowed themselves to become labelled as the ‘techies over there’ – to be kept at bay from the strategy makers on the Trust Boards at all costs, preferably by the Finance Director.

Yes, a large part of the responsibility for changing this situation rests with IT people themselves – they need to become more proactive, seeking opportunities to show how IT can help support and even reshape local delivery strategies. To do this they need to begin to see themselves as a central part of the general management community and get much better at personal skills such as building relationships, communicating in ways that hit the right buttons and exerting influence without formal authority.

BUT, surely, Trust Boards and CEs need to help by inviting them to the party. Far too many CEs behave as if they see IT as being about ‘connecting grey boxes’ rather than what it really is - the power to remake relationships in ways that lead to more value being created for customers. Spotting and nurturing talented IT professionals and helping them to become influential members of the Board must be a key task for any Chief Executive.

If we are to succeed in remaking the relationship the NHS has with patients, carers and local publics then we will do so by changing how people experience the 80% of care that is offered and delivered at a micro level in what we currently call Primary Care and this, in large part, means getting much better at spotting and then realising the potential that mobile technology and web-based software offers.

There are lots of IT people out there who understand this, loads of them, but they are stuck in their professional silo, watching as missed opportunities flow past the window.

Steve

www.stevepashley.co.uk

I have been haunted for several weeks now by a news report I saw in the Times from April 25th.

Titled “Ericsson Offers To Pay Off Older Staff" the report basically says that Ericsson has offered a redundancy package to about 1,000 of its 21,000 employees in Sweden. The unusual thing is that the offer is only open to people aged between 35 and 50. Not because they want to downsize but, get this, because they want to replace this cohort with younger workers – i.e people under 30. Ericsson believes mobiles are a young person’s game and people under 30 will be much more likely to be in touch with Ericsson’s market place and the products they offer to it.

Please don’t shout at me - but how if the NHS did something similar? - but instead of replacing middle-aged managers with younger ones, we replaced them (you?) with people aged over 65...in fact, the older the better! 

We are, after all, already moving in this direction with nurses and other groups of clinical staff (albeit by default as younger people / women in particular get excited about careers outside the public sector).

This way we’d have our organisations run by people who:

a) are likely to have much more empathy or indeed, first hand experience of having to cope with chronic conditions as well as acute health problems (Is it better to have younger, perhaps more energetic managers keen to make a mark and further their careers by helping to transform the NHS or to have much older managers, who have first hand experience of coping with illnesses and receiving services from the NHS and it's contracted suppliers?)

b) are not moving jobs and geographical location every 3 years and thereby much more likely to stick around to help with the implementation of policy (You can have all the brilliant policy you want but it’s no good at all if you can't implement it because all the mangers who got the ball rolling have moved elsewhere);

c) have much more collective wisdom and corporate memory than we currently tend to have within our management teams. (Quite frequently these days I see new management teams making the same mistakes that their predecessors did, becasue they are not able to learn from previous initiatives they undertook together); and

d) have already secured their pension entitlements and are therefore more inclined to 'push back' and exert more collective influence where policy proposals are thought to be ill advised.  (The Sven Goran Eriksson syndrome if you like!) 

I know this all sounds very old fashioned but maybe it would make a real difference to how we run services, prioritise developments and engage with the politicians? Perhaps, as my Grandma likes to tell me, "Where B&Q goes the NHS should follow"!

Steve

www.stevepashley.co.uk

P.S. If you’re worried about all the 30-45 year olds that are displaced, fear not. They will all earn a fortune being re-hired as management consultants and at least they’d have more of a clue about how to use their Blackberries than the older folk we would have re-hired after they all took early retirement.