In the latest great NHS re-organisation let the form take care of itself

Managing Director, Tom Amos, on approaching NHS re-organisation. 


Legendary San Francisco 49ers coach Bill Walsh had a philosophy best captured in the title of his book: The Score Takes Care of Itself. At the core of this philosophy is the idea that if you focus an organisation around a clear set of values and beliefs, and cultivate a corresponding culture of performance at every level, the results will follow.

Taking the 49ers from the worst performing team in the NFL to being at the top of the league in just two seasons shows how powerful this approach can be.

As the NHS goes through another round of re-organisation it can take something from Bill Walsh.

The NHS is fundamentally an economy of organisations. Whether foundation trusts or community and primary care organisations, form dominates. It is set to continue to do so as organisations within STP regions jockey for position within new structures: Multi-specialty Community Providers (MCPs) or Primary and Acute Care Systems (PACS) operating as or within Accountable Care Organisations (ACOs) or Accountable Care Systems (ACSs) – organisational form within organisational form.

The great risk in all of this is that the people at the heart of the NHS – its patients and staff – are forgotten as organisational interest starts to trump everything else.

To get this right we suggest a different approach for this re-organisation.

1. Be clear on the problem(s) you are trying to solve. Think about this not from the narrow organisational perspective but from a broader standpoint. What are the problems facing patients, staff and other key stakeholders in your region?

2. Agree on your shared values and beliefs. In tackling these challenges, what are the values and beliefs you are going to galvanise behind? This enables leaders to transcend organisational form and reconnect with why they got into healthcare in the first place. Some of the values and beliefs we have come across in client discussions include:
Being people centric
Being open and honest with the public
Enabling empowerment
Removing barriers from patient perspective
Taking a long-term strategic view as opposed to a short-term reactive approach

3. Work as one team, even when working across several organisations. Identify the skills needed to deliver on your approach. Rather than then competing for which organisation delivers on these skills, leaders should work at being objective on how best to use the strengths of all those around the table. To take the sporting analogy a little further, and as one of our clients pointed out, rather than acting like competing Premier League teams, this is about selecting the England team and then working as one.

4. The form will then emerge. Once you are clear on the problem you are trying to solve, your values and beliefs and the skills needed, you can then work out the best structures to bring this together – be it MCP or PACS and the associated configuration.
Critically though form should be an aspect of execution and not the driving force behind the process.

Ultimately the NHS has always been values-driven. However, over many years, organisational form has come to dominate. This is a real opportunity to come together around values again, to find common ground and really drive collaboration.

For the 49ers it delivered 3 Super Bowls, a record that speaks for itself.

For more info, get in touch tom.davis@baxendale.co.uk

Tom Amos

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