For as long as I can remember there’s been a debate about the NHS and business.
The NHS should be more business like. The NHS is too much like a business. The NHS should do more business, with business.
What can the NHS learn from business?
The tools of business are essential to the management of the NHS but the objectives are often an uncomfortable fit.
Business managers are under pressure to deliver better profits for their shareholders.
NHS managers are under pressure to deliver better outcomes for the public.
Business managers must deliver more, for less.
NHS managers must deliver more, with less.
Business managers use data to implement key steps, drive profits. In the NHS using data to forecast and plan services is still in the era of the Ford Cortina and the Kenwood Chef.
However, there is one business phenomenon we have in common.
Performance. However it’s defined.
Businesses have to push for better performance. It comes from investment, training and an understanding and expectation, that the company, and how it works, will not be the same as it was in the last five years and…
… certainly won’t be anything like the same, in the next five.
The NHS, so dependent on personal interactions, the scope for performance improvement is different.
Maybe we should talk about performance enhancement.
Business performance might be about software, robotics, AI… driven by the single goal of reducing costs.
That means only one thing…
… how do we do what we do, with fewer people doing it?
We can’t replace health workers with machines.
We could make work easier. Enhance performance by reducing repetitive bureaucracy and help decision making… but face it… we can’t publish a workforce plan because of the costs implied by safe staffing…
… so fat chance.
This is a well trodden path. It leads to an interesting tendency, in business and dare I say the NHS, first identified by US psychologist Edward Thorndike… in 1920.
He told us about, ‘The Halo Effect’;
‘… imagine a company that’s doing well; increasing sales, rising profits, and a healthy share price… the tendency is to infer that the company has a sound strategy, a visionary leader, motivated employees, an excellent customer orientation, a vibrant culture…
… if that same company suffers a decline, sales and profits fall… market analysts may conclude that the company’s strategy went wrong, its people became complacent, it neglected its customers, its culture became stodgy, and more….’
Thorndike warns; these things may not have changed much, if at all.
An organisation’s performance, good or bad, shapes perceptions and an impression… its ‘halo’… and it’s dangerous.
Think of Virgin. There was a time when it thought it could do no wrong. It pitched up in the NHS, to tell us how to do it.
It’s gone… along with; Virgin Cola, Virgin Vodka, Cosmetics, Brides, Clothing, Virginware (knickers), Cars, the New York Mega Store, Virgin Pulse and Digital, Virgin Express, Little Red, Virgin Facebook, Virgin Lottery, Games… and we all know what happened to the trains, the airline and ventures into space.
Virgin had a halo of entrepreneurialism, customer service and an aura of ‘we can do anything’… turns out, they couldn’t!
John Lewis, their halo was shone on the NHS… their partnership approach to HR.
Politicians talked of mutualising the NHS workforce.
JL have since scrapped their staff bonus, warned of job cuts, suffered three years of losses and property write-downs pushed the company to a £517m loss.
There is little doubt, in public service iconography, the NHS has a ‘halo’.
Despite strikes, waiting and all the aggravation the public has. The NHS halo, far from being the ‘uncreated light of grace’ is more like a tin hat.
Thorndike points out, copying a formula doesn’t ensure success.
The failure to think about culture, execution and customer orientation has seen plenty of ‘halo’ companies fail.
Managers of halo companies make judgments that reflect assumptions, the assurance and predictability of success.
Their logic becomes circular.
When rivals improve at a faster rate and they always do… the halo slips.
Rather than the light of the halo illuminating the dark corners of performance, they dazzle and blind even the most experienced…
… with the illusion of everlasting success.
What is there to learn from all that?
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.
