THE BIG STRATEGIC GAP BETWEEN THINK AND DO AND DO AND DON'T THINK

The biggest issue in new under resourced businesses is the large gap between "think and do" and that goes both ways to "do and don't think" as well. People who spend their valuable time doing "don't think" about their business, and people who think about their businesses, don't have the time or resource to implement that thinking. The problem is "I know what to do but I don't know when I am going to do it" the most common cry in any young business and the biggest reason for them failing in the first three years. In any business there are things that have to be done, things that need to be done, things to do, things it would be good to do and things that don't need to be done. The problem is most people focus on the wrong things, whilst those that have to be done, are done, those that need to be done aren't because we are doing things that don't need to be done. How do we focus on the right things in the haze of our business environment?

In the Royal Marines a colour sergeant said to me "Sir, you are not clever enough to think of more than ten things, so just make sure they are the right ten things" extremely wise counsel that has held me in good stead ever since. The solution is simple its called STRATEGY, by planning and identifying what all our issues are and where we want to get to, we can identify our big issues and focusing on the top ten of them  as we develop disciplines and processes that keep our businesses on track.

Strategy for me starts with identifying the purpose of the business, why does the business exist. Then the destination needs to be identified and shared. It is the head mark showing where the business needs to get to through the identification of a vision. The vision becomes reality through dividing it into missions, from which plans are drawn up, to achieve each mission milestone. Risks need to be identified and contingencies prepared for before the allocation of resources are considered, both in terms of the talent required and the priority of allocation.

Strategy has to be simple and effective and need not be an over complicated difficult and challenging process. Strategy needs to be empathic with a business and not prescriptive. It is a matter of the simpler the better but it also provides a guide to getting to where you want to be and not a fixed route to the destination. To be effective strategy has to adapt to circumstances and the environment in an organic way. It is far more like a sat nav than it is a printed route map description to a destination.

LEADERSHIP AND THE NHS

I find it interesting that the Keogh Report found failures in care at 14 hospitals, 11 of which have been put into special measures. We now know none of the 14 has been given a clean bill of health and that then raises the possibility that there are other failing hospitals out there. The 14 investigated in this review were a snapshot of poor performers chosen because they had the worst death rates for the past two years.

The key question for me being how was this allowed to happen given the role of the Care Quality Commission (CQC) and the leadership within each of the hospitals and their associated trusts? For me there is a fundamental dilemma between care and business. Basically the NHS will spend as much as it is given on caring if it were allowed to do so. However it is seen as a bottomless pit by the Treasury and those responsible for funding it. The clash of the two cultures, care and frugality, needs to be addressed by strong and decisive leadership to maintain the necessary and somewhat precarious balance in an affordable and efficient way. The issue being exposed in the media at the present is the current lack of balance with either one of the two cultures gaining supremacy. If the care side wins Trusts go broke if the business side does people die unnecessarily.

The real leadership dilemma is how does the government maintain standards at an affordable level? It has tried to do this from without using the CQC to maintain the standards and this has now been proven to be a flawed process although the government will maintain and enhance that philosophy with the appointment of Sir Michael Richards and his army of inspectors.

The real problem is not going to be changed from without, the problem is a cultural one and the clash of cultures within the NHS and culture can only be transformed through strong leadership throughout an organisation and a clear and unambiguous strategy that is understood and bought into by those who work within it. This cultural change has to be driven internally by great leaders. Cultural change cannot be driven from without the organisation. I believe the government should be investing in the leadership within the NHS rather than repeating its previous error of unsuccessfully imposing change from outside an organisation. Culture is after all "how people do things round here when no one is looking" and during inspections someone is looking.

The challenge now for the NHS and those in charge of monitoring it - the regulators, NHS England and the government - is to identify exactly how widespread poor performance is and how they can then deliver the necessary cultural balance to drive the required improvement in standards in an affordable way through strong and effective internal leadership.