My Christmas ended as two Hyundai's and a Volkswagen rolled into the blinding 90 Fahrenheit heat of an Afghan morning. Their planned route was blocked by traffic, construction and the general hubbub of 9am local time.
The drivers adjusted. They knew their business. They took different routes but arrived at the civic opening of the new sewage plant, right on time. Before them, local politicians were expounding on economic revitalisation, locals applauded, children played at the outer ring of the crowd.
The drivers paused for a moment, floored their accelerators, ploughed into the crowd and simultaneously squeezed the detonators in the palm of their hands. The propane tanks in the vehicles exploded and the scene was turned into a mosaic of shrapnel, remains and blood. Thirty five children lay dead, 10 Americans and 140 Iraqis wounded.
The El Amel Sewage Plant Bombing, 2004.
I've just finished reading a book. Not an airport thriller but probably one of the cleverest management books I have read in a long time. Thank you Sam for recommending it. The Book is Teams of Teams by McChrystal, Collins, Silverman and Fussell.
The authors are senior US military, Navy Seal, Harvard types. Their purpose; to demonstrate how utterly unprepared we are, in our management practices and understanding, to cope with the changing world we face.
With respect and deference they use the sewage plant bombing to make graphic how one of the most advanced military countries in the world, that had invested millions on equipment and men and women, trained to a razor's edge... were impotent against a ragged, under resourced but utterly dedicated enemy.
An enemy that could flex, when the US military could only reorganise. An enemy with no structure, versus the US military with chains of command. An enemy that had leaders when the US military had chiefs.
Nimble versus, flat foot. Incisive, rapier like, versus blunderbuss and bigger bombs. An enemy that could move, change and adapt in seconds; when the US military could only reappraise, restrategize and take months to start again.
The US military perfectly equipped and trained to fight the wrong enemy; anyone with access to the internet, some cleaning products and ball bearings was the new enemy.
How the US Army went about solving its problems has resonance for the NHS. Worlds apart in their mission, yet a mirror image of botched attempts to resolve the future.
The military perfectly organised to fight in a world where battalions lined up against each other; fire power was everything, aimed at an enemy you could see and count.
The NHS perfectly organised to treat a population where working men went home for lunch, lived until they were 69yrs and died in hospital, after a short illness.
The military, struggling with an enemy that is invisible, plays by, not new rules, but no rules; swept on a tide of terrorism it neither understood nor was equipped to deal with.
The NHS, struggling with long-term conditions and an ageing population, being swept on a tide of demand it cannot control or predict nor is equipped to deal with.
Solutions for both? A redesigned workforce; groups of cross-trained, nimble, open people. Self-managed teams. A system built on resilience, decisions taken as fast and as close as possible to where the issues are. A place where strategy gives way to tactics and techniques.
Somewhere people share data, understand the issues, are shown the total picture, draw their own conclusions and paint their own solutions. Empowered because they have enough context to make good decisions.
For the NHS this would mean; vertical integration, services that start with the patient and work backwards, Operation Onion (remember that) in every work-place.
Redesigning workforce training to reflect the cross functional needs of complex patients. Ending the futility of commissioning. Instead, a fanatical focus on outcomes, investing in whole systems of integrated care.
Leaders who can drive the rhythm of disparate organisations with a shared purpose, a common vision and an organisational wide understanding of what is expected.
The NHS is in its own war, battling demand and austerity. Some would say, fighting for its future.
The US Army found empowerment was its strongest ally but it seems to me, for the NHS, it remains the partner of last resort.
