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Jonathan Straight

Member Article

Transforming healthcare for a better world

Around the time I was exiting my role at Straight plc, mid 2014, I was approached by Becky Malby, director of the Centre for Innovation in Health Management (CIHM) at the University of Leeds to see if I was interested to take part in a programme. This was called the Leadership Indaba and it would consist of four sessions spread through the following year.

According to Wikipedia, an indaba is an important conference held by the principal men of the Zulu or Xhosa peoples of South Africa. This particular indaba aimed to bring together experienced leaders into a thinking space to do good work, and at the same time make an academic contribution. The ultimate goal being to support large scale change that would leave the world a better place.

CIHM seeks to reduce the focus on “reductionist asset stripping approaches to management” within the NHS and social care, instead finding solutions with the people that deliver and use its services.

The programme consisted of discussions where we would share our knowledge and try to come up with ideas to improve matters. At some of the meetings there were speakers who would set the scene for the discussions to follow. Of the nine participants, eight were from the health sector in various different capacities. Then there was me, an entrepreneur with no formal training of any kind but with many years of experience in running a dynamic and rapidly expanding commercial organisation beset with numerous challenges.

Initially, I was not sure why I was there. But gradually I began to see the value of my involvement. In many ways I was from a different world to the rest and my perspective could therefore be fresh and challenging.

My observations over the several sessions was that the health sector delivers some excellent outcomes but is beset with big problems which the current system seems unable or unwilling to deal with. I met fundamentally good people doing great jobs in their own spaces but I got the impression that they were all up against something bigger and somehow alien to their way of thinking or working that did not help them in their daily activities.

All of our discussions were confidential and am not at liberty to share specifics. However, much of the conversation was around the perceived difficulty in repairing a system universally considered to be broken and both the terminology used and the apparent sense of powerlessness that senior leaders feel they possess would probably not be accepted in the private sector.

My observations lead me to some conclusions. These are the views of an outsider but they reflect what I learned in the short few hours I spent on this project.

Firstly, managers need to get real. This is difficult because the NHS is not just a heath system but a political system too. I think this is fundamentally wrong and dangerous for patients who end up being the pawns in the actives of politicians. Having a clear remit of what needs to be achieved over a long term would be helpful. Ministers do not add value in this respect in my view. Where there is a bullying culture (and I believe that this comes from the very top) it needs to be dealt with.

Next, the sector needs to understand why it exists and what are its desired outcomes. Too much focus is on attempting to deliver a cure, not enough focus is on prevention - which intuitively sounds like it would save a lot of money in the long run. Using big data, entrepreneurial management and incentives along with radical, qualitative-based procurement of goods and services will help to deliver a better service at a lower cost.

As an example, in Leeds, Age Concern is delivering an exercise programme to reduce the risk of elderly people falling and needing hip replacements. Using data they know how many people in their target group are admitted to hospital each year and they know that they will save the NHS money through this programme. This is not the job of the charity sector unless the public purse is directly funding it. The NHS itself should be seeking to deliver such interventions, saving money in the process. But could such an intervention cause a problem? Idle surgeons, empty wards … you see why this may not be quite so simple.

Thirdly, I have understood that the most senior managers interfere with the work of their subordinates in such a manner that it impacts on their ability to do their jobs properly. Some of those managers who are succeeding are playing a game where they focus on what they need to do for their line managers and take little notice of the rest. Some of these areas are thriving. Senior managers and Board members should allow the professionals in their teams to work towards agreed outcomes in their own way as would be the case in any well-managed company. I am talking about effective delegation, not abdication of responsibility. The wider NHS could do well to learn from the places where a bit of rule bending is achieving great results.

The patient must come first always and without exception. We have all seen what can happen with micro management and a focus on the wrong goals as was the case in Mid Staffordshire. The life of a patient must be the most important factor in any health professional’s thinking and if rules need to be broken to save a life they should be. I would go further and say there is actually an obligation to break the rules if a life can be saved.

Finally, we should remember that the patient is a human being with the potential to transform his or herself given the right direction and teaching. I was told of people living in desperate communities with few facilities, no jobs and little contact with nearby population centres. This is sad and no doubt difficult for those afflicted. However, we must remember that these people are not destitute, nor are they hungry. They have the blessing of time to pursue whatever they want, something that many might be grateful for a little more of. In many cases they have a choice whether to be healthy or not. Somehow providing the key to self fulfilment would be the best investment that could be made in such people rather than waiting for them to become ill through poor diet, drink and smoking and then treating them for the resulting diseases. I remain an outsider to this sector but I have learned a great deal about its workings and its challenges. I see a problem at the top and a confused agenda as to what exactly should be delivered. This is not easy to solve but not impossible, Hopefully, those who can push an agenda of change forward will take note of what all of us on this programme have learned and have published in order to allow us to deliver our goal of leaving the word a better place.

This was posted in Bdaily's Members' News section by Jonathan Straight .

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