19th July 2016

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Ed Smith
Chair of Not-Monitor, or whatever it's called.  In conversation with Roy L
Good conversation, networking and a glass of wine.  What's not to like!
News and Comment from Roy Lilley
The IHM have done a survey on leadership.  It's an ice bath.
They say; "aspiration to top-level positions remains high among... leadership trainees..."
... but; " [aspiring leaders] are  deterred by... unrealistic demands placed on health and care service delivery within currently available resources."
... and despite; "high turnover and vacancy rates for senior positions... few trainee managers see a clear career pathway to the top level."
It's a good read! I make the upshot; 'I'd quite like to be the boss but not if I'm gonna get killed by unrealistic demands.  The view from the top maybe great but I've no idea how to get there, so I'll give it a miss.'
The sub-text is; being the CEO of an NHS Trust is a dog's job.  Unless you have been in post for ten years or more, have a solid management cadre around you and a set of accounts that looks like it is close to balancing... you're dead.
Even then, the lunacy of the CQC or a wholly unforeseen serious incident can finish you off.
Fortunately, there are enough heroes willing to give it a try! 
About 20% of trusts have no permanent CEO.  Why would you do it?  A second-tier senior management post puts you around the top of the pay-scales without the aggro and intrusion into your life.
The report's findings are drawn from a desk-based-Googlie thing, a focus group of half a dozen post-grad management students from a business school and an on-line survey of 111 students.
It's a snap-shot that makes grim reading; gender and ethnic discrimination, unrealistic demands, hostile media and political environment and a third of leadership trainees who don't aspire to top-jobs.
The IHM, whose members know a thing or two about managing hospitals, go to great lengths to paint a picture of the healthcare environment... monochrome.  

It's made me think about the future of NHS leadership.
First question; what's the Leadership Academy doing?  I always enjoy spending time with the students but if things are as dire as the IHM says, is the £44m a year they spend, well spent?  Are we doing the right kind of training?
Are we training the wrong people, to be the wrong leaders, doing the wrong job?
We are muddling through in the worst period of NHS history I can remember and it's not working.  Should we stop training people to make decisions and start training them to enable decisions to be made?
From deciding to enabling, from directing to empowering.  Declaration to distribution.  Pointing to providing.  Shifting the power from board meetings to ward meetings.   
We need leaders but a different kind of leader; door-openers, engineers, brokers, opportunists.
Is it still a good idea to focus so much power and responsibility into the hands of one person? 
What would an NHS, without 'leaders,' look like?
The famous Buurtzorg community care people, in the Netherlands, give us a clue.  Their whole organisation is run by one inspired chief executive, Jos de Blok and an FD; the rest are self-directed teams.
Nurses are perfectly capable of taking on a joint responsibility.  A sense of interdependence is likely to encourage openness and trust.  Identifying a common purpose.  Once empowered to 'get on with it' a huge chunk of conventional structure could become redundant.
The Academy of Fabulous Stuff has three examples of SDTs here, here and here.
In some US states nurse-councils decide patient ratios and other key policy issues.
I see no reason why our hospitals couldn't become a network of self-directed teams, coming together in a 'grand council' under the chair-ship of an independent person.
There are additional benefits; teams will settle into natural work groups.  That doesn't mean just nurses; it means the full cast of care-givers involved, leading work and redesign.
Business Week reported that self-directed work teams are, on average, 30 to 50% more productive than conventional counterparts; reductions in costs, nimbleness, increased commitment, faster adoption of technologies.
Social media is transparent and can involve everyone; real time polling, outcomes analysis, decision making and operational performance.
Heroic leaders are committing career suicide, is it any wonder no one wants the job. 
Flatter organisational structures; people highly networked with open communications, everyone connected. 
Do we dare to move on from the pyramid diagram?
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News and Stuff
News boy
26th Sept Kings Fund  5.30pm.
Ed Smith 
Chair of Not-Monitor 
(I must find out what they are called!)
Great evening in prospect.  He has a huge experience and a raconteur 
Plus the usual wine and networking. 
Special ticket prices
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - a leaked copy of the childhood obesity strategy waters-down advert watershed, salt content, junkfood at checkouts... all gone.  Sugar content reduction of 20% not 50%.  Hardly worth the bother, is it?  Or, better than nothing? 
>>  I'm hearing - nothing about the famous Reset letter from the Reaper and Tarzan.  This is the second week we've been hanging on.  I wonder if it's being Tinkered with?  I wouldn't bother with it myself.  Everyone knows there is no money and the Treasury wants to hear the pips-squeak.  Just get on with it, please.  We are all in for a whack from the headmaster.  Just stuff a magazine down yer trousers and take yer punishment. 
>>  I'm hearing - Stephen Dalton will not be taking on the full-time role at the Confed.  Perhaps he could run a Trust.  We have St David Dalton... they could get together and run a chain?
>>  I'm hearing - a report is due out this week pointing to the under funding of primary care; calm down, everyone is underfunded.
Need inspiration, a good idea or solve a problem
Dr Rodney Jones
Does it again.  This time with a fascinating analysis of 
bed occupancy and hospital mortality.