Being a manager and leader in the ‘new’ NHS will be different. To work, the views of three parties will need to be reconciled into one plan; that of local authorities on the health of their population; the local clinical community on commissioning for outcomes; and the NHS Commissioning Board on delivering the mandate. And all will need to be done by listening to the voice of patients and public.
In the first paper in the NHS Confederation’s new series on leadership in the new architecture, myself and my fellow contributors present what we have learned from other sectors in which matrix organisations and coalitions play a major role.
Two major lessons are worth highlighting. The first is that organisations that work in a multi-dimensional environment actively invest in the process of alignment and conflict-resolution. To benefit from creativity and flexibility, these environments must be managed. It will not happen on its own.
The second lesson is that process is not enough. Skill is required. And like in the rest of life, we can decide that we hope managers and leaders will intuitively know the right thing to do, or we can invest in the development of their skills and capabilities.
The good news is that this has all been done before. In our paper, Simon Dingemans from GlaxoSmithKline shares his experience from a multinational perspective, Mike Standing from the Monitor Company (not to be confused with a certain economic regulator), gives the view from a professional services firm, and Ed Smith provides his reflections, having been an audit partner in regulated environments.
My own view is that, given the IQ available in the components of the system, there is no reason that, with good will and a concerted effort to develop the skills required, the new world will not work. But I would add two caveats. We need to be consciously competent at it, and invest accordingly. Also, we need to make sure that the legitimate points of view of others are built into the plans we ultimately deliver. It is when the priorities of the patient, the clinician and the manager are addressed that the plan is a good one.
After all, we are all in this together, as someone might have said.
Read Ciarán Devane’s paper Leadership in a matrix