A lot of you have written about the plight of Whipp's Cross. Many as kindred spirits. It is easy to forget it is a local hospital for a large slice of London and the place where people, many of whom don't have much choice, go to work every day.

You are right; it has cast a shadow over the NHS; 3/4s of Trusts have given up trying to balance the books and as regulators stomp about looking for more problems to heap on the existing compost of troubles, everyone is nervous.

Whipp's got themselves on a losing streak. One of the symptoms of a losing streak is a turnover of top bosses. A sure sign that we see replicated in other places right across the NHS.

Management guru Prof Rosabeth Moss Kanter describes, perfectly, the mechanics of a classic and predictable decline. So familiar in the NHS:

"... as losses mount, pressure goes up. Stress makes it easier to panic. Panic makes it easier to lose. Losing increases neglect. Signs of failure cause people to dislike and avoid one another; hide information and disclaim responsibility; key elements of denial. All of this makes the cornerstones of confidence crumble. People doubt themselves, feel they cannot count on others and do not trust the system around them. The climate of expectations turns negative and everyone begins to feel powerless to change anything..."

There you have the story of Whipp's and I suspect many other Trusts.

Nine well recognised and predictable pathologies emerge: Communication decreases; Blame increases; Respect decreases; Isolation increases; Focus turns inwards; Rifts widen and inequities grow; Aspirations diminish; Initiative decreases; Negativity spreads.

The NHS response; inspection, more criticism and make things worse. The NHS could not manage struggling Trusts and health economies in decline more wrong, more bad, more 'orrible... if it tried.

What about a turn-around? Can it be done? Yes. But not the way the NHS does it. 'Special Measures' with its desperately negative connotations amplifies the problems, tells the world 'this is a bad place' and makes recruitment and change even more difficult.

How about applying to become a 'Fresh Start Trust'?  An entirely different proposition?

No two turnarounds are the same but the basics are. Rebuilding confidence and leadership. Not heroic leadership but the kind of leadership that involves people.

Generally struggling organisations will need structural changes and to find savings. Dumping them on an unsuspecting, mistrustful workforce is madness and makes matters worse.

Timing and phasing are important. More immediately there will be scores of low-cost, high impact simple changes that can be done quickly, regularly and systematically. Ask the front-line what they are and do them.

This captures imagination, builds trust and galvanises confidence. 'Things are getting better around here...' can set the scene for things getting better everywhere. Small wins make huge differences and pave the way to big changes.

Rebuilding trust and confidence helps to get accountability back into the organisation. People who feel confident and safe take on responsibility and accountability. When that happens people start to respect each other and that is the key to teamwork. Once you have teamwork you have a chance to foster innovation, initiative and new ways of working.

Moss Kanter writes:

"Leaders who guide winning streaks make a different set of choices, towards positive, inclusive, empowering actions that build confidence. By believing in other people, they make it possible for others to believe in them. Working together, they increase the likelihood of success and of continuing to succeed."

The NHS is facing a critical time yet is stuck with the inertia of regulation and processes that have got it into this mess. The NHS is close to losing its confidence; quality has become someone else's business, success isn't what happens here and my job is all it is.... a job.

We know failure is contagious but confidence is infectious. The most important task of a turnaround is to give the organisation its confidence back. Confidence isn't optimism, or a character, or attitude; it is the belief that good things can happen.

Why wait for a turnaround? Go and make good things happen.  

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What exactly does the Health Ombudsman do?

Find out - I'll be talking with the

Health Ombudsman Dame Julie Mellor - details here 

Book Now

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Have a look at the  

Academy of Fabulous Stuff;

Problems looking for solutions - solutions looking for problems.

Make a note; be a sharer this week. 

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