Disappointment

These days, before Covid, BC, seems to be the modern punctuation mark in our timelines.

So…

… BC in a brief window, when it looked like the world could be a better place, I went, with others, to Tehran…

… to look at the management of their diabetes problems.

Roughly, 14% of adults, aged 20-79 have diabetes.
Total cases adding up to ~7.5m adults.
Almost one-in-three people with diabetes in Iran are unaware of their condition and
an additional 9 million Iranians are estimated to have pre-diabetes.
Nearly 500,000 new cases are added annually.

It’s a lot.

The Iranians shepherding our group were; educated, informed, open minded and the people we met; cautious in speaking about ‘the west’, but curious.

They were just like everyone else; they wanted a job, a safe place to live and to be with the person they loved.

If you were born where they were born, you’d be like them.

Keeping in touch became impossible… but I can imagine they’re sitting on the edge of their seats. Glued to the telly. Hoping ‘something might happen’.

That’s the point, isn’t it? What ‘something’. What happens next?

Iran might slip back into the way things were. Or, perhaps, this time a new world will emerge. Iranian families reunited, young people experience the world beyond their world, and…

… there are 395 people from Iran working in the NHS… we might give a thought to them, this morning.

They’ll be thinking; what happens next?

In management it is a simple but often neglected question…

… what happens next?

Paul Schoemaker, a Dutch academic built on scenario planning and took it to peripheral vision. He argued;

‘Leaders fail because they focus on the present crisis and ignore weak signals of what might follow.’

A decision is announced, the policy launched… collides with reality and the effect of the whiplash, never considered (see Reality, when plans hit the real world).

Peter Drucker warned decades ago that organisations frequently mistake decisions for results.

Planning is misunderstood as making future decisions, but the reality; decisions exist only in the present.

Results are not produced within the organisation, it’s the customer, making the decision.

In our case, patients insisting on using A&E because they are not satisfied with the alternatives we’ve planned (the NHS front door problem in a nutshell).

We slip back into the way things were

Just as nation-building comes after a war, the real work of management begins after the policy announcement, meets the complexity of the real world.

Never clearer than what’s happening now, in the NHS is…

… the drive to reduce management numbers. A policy was presented as cash releasing, to be invested elsewhere, crashes into systems that are simultaneously expected to…

recover waiting times,
redesign services,
implement digital programmes,
manage industrial relations and
deliver a ten-year transformation plan…

… what a ridiculous word that is… transformational.

Anyway… all of that requires leadership, coordination and operational grip. Remove half the people? You know all about that. We’ve discussed it ad nauseam (and it’s already dawned on plenty of people).

What we don’t know is; what happens next?

The 8⅜ year plan…

… promises transformation, (ugh), prevention, neighbourhood services, and a shift of care closer to home. The next question hangs in the air: who’s gonna go it?

The workforce is already stretched, recruitment pipelines are fragile, structures underdeveloped, and there’s no credible long-term workforce strategy that aligns staffing with the plan.

A strategy without the workforce is only an aspiration (or just a brochure).

These aren’t technical failures. The NHS has thousands of skilled managers and clinicians who understand the system intimately. They know the pressures, the constraints and the consequences.

The problem lies elsewhere.

Political systems, reward announcements.

Bureaucratic systems, reward compliance.

Neither rewards careful thinking about the second and third-order effects of decisions.

The policy becomes the headline. Looking busy becomes the measure of success. The operational consequences are left to play out later.

Military planners learned winning the battle is not enough; the peace that follows must be planned for.

Without that, victory simply creates the conditions for the next crisis.

The NHS faces a similar dilemma. It doesn’t lack plans, strategies or initiatives. What it lacks is disciplined thinking about the whiplash…

… what happens after the plan meets reality.

Management, is not about making announcements. It is about managing consequences.

Until systems begin asking simple, unfashionable questions, like…

… what next…

… we’ll continue with the cycle of initiative, disruption and disappointment.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.