Thinking. Management by thinking. We’re going to have to do more of that. Right now, we react.

Management by reacting. This pops-up… so we do that. Events occur… we respond. Reaction-time, once measured in months, now measured in days, even hours.

Why? Partly the environment is so quick to change and partly data and information tempts us into fast-twitch responses.

All this, putting pressure on traditional structures.

Once we were content with power, centred at the top, intermediate and front-facing, functional-units, focussed on out-puts.

Today, the pressure for outputs drags us to a place where only good-news gets reported up and anything bad gets bullied out of sight.

Management by pretending everything is OK.

All the basic concepts of management are under pressure.

There are three types.

Strategic management.

Focussed on the next, not the now. When the now and the next don’t mesh, there’s hell to pay.

The big factor working against strategic management is that it is based on planning. We can only plan for what we know, or think we know.

No one planned for the banking crisis… no one saw it coming. No one saw Brexit coming. Babylon never featured in our strategic plans.

At the heart of strategy… what’s coming… and as the cycle of change gets quicker, technology gets smarter, strategy has to give way to catch-up, tactics and techniques.

We persist with strategy and wonder why it fails.

Entrepreneurial management.

Conventional management takes inputs and tries to make the outputs sharper, cheaper, more efficient.

Entrepreneurial management takes the same inputs and tries to turn them into something else.

We have cars, let’s see what we can do without a driver.

We have patients, what can we do without a doctor?

We self check-out at the supermarket; that’s the customer adding value to the business.

Can patients add value to the NHS? What can they safely do, so that we don’t have to?

The conservative climate of healthcare, vested interests and reimbursement mechanisms turns entrepreneurial change into a battle.

Traditional management.

Income goes down, cut operating costs. Workforce problems, recruit. Demand goes up, make more. Making a loss, stop doing what’s loss-making.

It doesn’t work for the NHS. We can’t stop doing things and the only way we can cope with demand is to make people wait.

Last year the wider economy increased productivity by 0.2%. The NHS did 1.2%. We are already squeezing the pips.

None of this is any good for our NHS. We have to try something different; How about management by T.H.I.N.K.

Team working; a cliché but it’s important.

There’s no room for the heroic leader. We are realising that modern healthcare is the sum of its parts.

Moving to integrated working can’t be done unless leaders are able to build trust, keep their word, be inclusive and share decision making.

Help people get better at what they do; the workforce crisis won’t be solved overnight.

Working better together, is only half the story. Getting the best out of people, creating the time and space for good people to achieve great things, is fundamental.

Investing in training the people we are lucky to have. Trusting them to do more. Self managed teams.

Few people work to the extent of their capability and training potential.

Involvement; no more can anyone manage anything sitting behind a desk.

Leaders who are visible, have a vision and share it often are leaders who are credible and trusted.

Accessible leaders learn more.

Nimble; nimble leaders step forward and listen, ask for feedback, ideas and get helpful answers to, ‘How can we fix this by spending petty cash…’

Nimble leaders are happy to respond to events, make changes, have clear unambiguous communication and hold themselves accountable for what needs to be done.

Nimble leaders have conversations with people.

Knowledge; treasure it.

Thinking managers always hire people who are better than them. They are not afraid to say; ‘I don’t know.’

They understand they can’t do everything and surround themselves with people, who together, can do anything.

As the NHS enters its next phase, expect it to be challenging.

Managers who THINK will come through better than you might think…

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Reproduced at by kind permission of Roy Lilley.