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18th October 2016
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HealthChat
Matthew Syed - author of 'Black Box Thinking'
Special half-price deal for IHM members 
Last Ten Tickets Left.
In conversation with Roy Lilley
25th October 2016 - King's Fund - tickets here. Hurry they are whizzing out of the door!
Shared purpose
News and Comment from Roy Lilley
The history of management is complex and contradictory.  Managing situations, delivering results, grip, bullying... a familiar and evolving tale.  

Middle managers, often cut-off from what really matters in the boardroom and dislocated from the front line of care, where everything that matters, matters.
 
'Just do it'... 'get it done'... 'don't bring me bad news'... 'no excuses'.  The ludicrous management style of Alan Sugar in his 'how-not-to-run-a-company' comedy show.  The vocabulary of the worst kind of management.  Management by fear and firing; square them or squash them. 
 
It is in the middle of the organisation that the corrosive effects of bad management start to eat into the establishment's infrastructure.
 
Bullying-down, managing up.  No bad news, all messages massaged and distorted.
 
For a time Attila the Hun got things done.  And who is going to say 'no' to a 700 pound gorilla with a Kalashnikov.  But, the day the organisation finds itself facing a crisis... management by dread is a death-knell. 
 
It is easy for staff to disengage and that is where the trouble starts.
 
Organisations have to be managed.  In the interests of the board, the shareholders, the taxpayers, the customers, the patients, organisations have to to have a structure, a shape, a form.  People have to know what is expected of them and how they must go about their work. 
 
This requires a consensus.  Buy-in.  A common belief in a shared purpose. 
 
Yesterday, the HSJ reported three more Trusts are to be put into 'special measures'.  Between them they look like they are likely to miss their financial obligations by a margin of around one third.
 
Does it matter?  No.  It might have done once.  Not anymore.  Now it's a relief.  
 
It doesn't matter to the people who will be arriving for their treatment.  They want it and that's that.  They may wait longer.  They are already doing that.
 
What about the front-line staff?  They will still deliver.  There may be fewer of them.  They will work harder.  Some might leave or decide working for an agency is a better option but not a lot will happen.  The BMA discovered there is no appetite for anything else.
 
In the Board room and upper echelons of management... do they care?  Probably not.  There was a time when they might have.  The disgrace of 'special measures' might have been career threatening.  Some senior people did throw in the towel, persuaded the predicament was of their own making.  It seldom was.

Now they can expect a ritual rollicking, some management help they don't have to pay for and a quiet bung.
 
We know something like three-quarters of the NHS can't balance its books.  Does this mean three quarters of NHS management is daft or does it signal system failure?  If all the Trust bosses with financial problems we fired there would be no one left.  We need to look after the people who are brave enough to stick to the task.
 
The financial problems are manufactured by the politicians and compounded by the Treasury.  People have withdrawn consent to play their game.  They'll just come to work, soldier on.  Oblivious to the shrill from Number 10.
 
The deficit is too big for them to imagine, never mind do something about.  The NHS has arrived in a state of... 'Whatever....'
 
Mostly people want four things:
  • to be given a clear idea what the job is; 
  • to be given the credit for doing the job well; 
  • to be protected if they make an honest effort and don't quite succeed;
  • to have the opportunity to grow and do the job better.
The four cornerstones of good management and the four founding pillars of Change Day.
 
Change Day is tomorrow; Wednesday.  I am not saying by Thursday all the problems will have disappeared.  What I am saying is tomorrow marks the opportunity for a year of change.
 
Tomorrow; 
  • we can give people the credit for the job they do; 
  • we can give them permission to try something new, better and innovative; 
  • we can show them what good looks like
  • we can define their work in the context of how it's done in other places... where they might just have a better way...
Tomorrow is the day we create the time and space for good people to do great things.
 
Tomorrow is a chance for us to re-boot management, re-establish consensus and reengage a shared purpose. 

--oOo--

Find out about Change Day, powered by IMS Maxims, collected, collated and counted by KPMG and evrything made to work by Coloplast.
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Know something I don't - email me in confidence.
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Medicine for Managers

Dr Paul Lambden
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HealthChat
Matthew Syed
Former Commonwealth Table Tennis Champion and author of Black Box Thinking
Half price tickets for IHM members
25th October
King's Fund
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Gossip
shh
This is what I'm hearing;
if you know different,
tell me here
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>>  I'm hearing - fierce gossip about the departure of the Bart's chair.  It was very quick wasn't it.  There'll be more on this in the coming days.  Bound to be.
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Need inspiration, a good idea or solve a problem
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NEW HEALTHCHAT
Dr Sir Sam Everington
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Barrister, doctor, leader.
In conversation with 
Roy Lilley
He's been a 'rough-sleeper' and charged with making fraudulent job applications to highlight discrimination.  
The first medic on the scene after the 7/7 bombings.
This will be a really interesting evening.  Medico-politics, the future of Primary Care.
Tickets for IHM members half price.
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Change Day

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Trial 
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