Interesting to see that of the 14 Hospitals in the UK recently named as participants in the Keogh Review that many if not all had been subject to a large scale “Turnaround” Programme.
For many in the sector, it is probably not a surprise that the Blueprint Turnaround Strategy in Healthcare is starting to unravel.
Most Turnaround Teams adopt the same sales mantra as the core of their turnaround strategy, “This is how we did it at Hospital A” or, “That isn’t how we did it at Hospital B“.
As recent well-sourced experiences on Turnaround Programmes suggest, this strategy isn’t working when faced with a Hospital that needs to fundamentally transform their operating model, improve its service performance and recover balance in its financial profile.
Hospital Turnaround Programmes are not working. A period of shock and awe, the publication of a recovery plan and 6 months of programme management support will not transform the fortunes of a Hospital and the reasons why are clear.
- They are Counterproductive:When trying to turn around a struggling underperforming Hospital, one thing is a precursor to everything else: creating a robust, growing and healthy alignment in the whole organization. In other words, getting a formerly beaten-down, low-morale workforce to face forward and commit to the organization’s success.Telling clinical staff that they have major performance issues, and that only you and your handpicked lieutenants understand the true path forward, which is the heart of the ‘arriving hero’ strategy, achieves precisely the opposite — however dressed up in PR-speak the message is. It alienates and frustrates those who are on the receiving end of it, and guarantees that the organization will start its new journey by moving backward, not forward.On top of that, when you need to build local ownership and accountability, a Programme Management Office will be created, bringing accountability to the very few in the centre, rather than the many in the frontline operating and providing the services that need changing the most.
- They are Almost Always Wrong:Assuming that what worked in one Hospital in 2011 will work in another in 2013 is not just lazy, but almost always wrong. Hospitals are sprawling, complex entities with large numbers of professional interests at work. They can’t be altered in 10 weeks — and certainly not simply because a Turnaround Team says so.Elements of past success in previous organizations can be incredibly helpful in shaping strategy in a new organisation, but the default mind set needs to be ‘what’s new and different here that requires new and different solutions?’, not ‘what can I copy wholesale from my last job?’.Turnaround is as much about “engagement” and “strategic clarity” as it is about “grip” and “pace”.
- They Stifle Debate:“Their Partner told me to do it” has long been an effective way to shut down rational debate about the legitimacy of a specific action, and the “look how well it worked for me at Trust A” argument does much the same in the turnaround world.When you’ve got turnaround credentials and have been placed in position by the Regulator who’s going to argue with you?It takes a brave person — or one truly committed to lasting success — to withhold playing their ‘God card’ in the interest of healthy robust debate, but in both cases, the success of their Hospital depends on them doing precisely that.
- They Eradicate True Innovation:The most telling, pointed flaw in the hero-with-a-blueprint strategy?It’s rarely, if ever, how the hero’s initial jaw-slackening success was achieved.But now, armed with “here’s how I did it at…”, there’s little or no room for zero-based thinking; and with a blueprint, determinedly imposed from the top down, there’s little or no room for real and much-needed innovation.
The saddest aspect of all this is that just about every one of us have at some point witnessed the arrival of a Turnaround team, and many NHS teams will get to see them in the next 5 years . And we’ve all seen what happens when they start every sentence with ‘Well, here’s what we did at Trust A…”
It doesn’t work. Turnaround Teams seem to believe they’re exempt from the same dynamic. Except they are not. Not even heroes with a blueprint.