CEOs in the UK’s National Health Service are increasingly constrained and isolated.
If you thought managing your company’s multiple stakeholders in the social media spotlight was bad enough, spare a thought for CEOs in the UK’s National Health Service (NHS). They have all the challenges you have, plus increasing regulatory attention, and the pressure of knowing that lives are literally at stake.
A little over 35 years ago, the late Roy Griffiths, then deputy chair and managing director of supermarket company Sainsbury’s delivered his report into the management of the NHS. The report called for the wholesale introduction of general managers to oversee 'planning, implementation, and the control of performance.'
He wrote, famously, 'If Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge.'
Indeed, successive governments were convinced that importing management principles from business and finance would make the NHS more efficient and more effective. The introduction of general managers was followed by the creation of an internal market and numerous organisational changes, including the shift to budget-holding Foundation Trusts, intended to increase autonomy and responsibility.
More recently, however, you would be forgiven for thinking that the establishment of professional management was intended only to supply an army of scapegoats to shoulder the blame when the inevitable disconnect between available funds and demand for treatment became apparent. In 2016 the then Health Secretary, Jeremy Hunt, said 'We should today ask whether the NHS made a historic mistake in the 1980s by deliberately creating a manager class who were not clinicians rather than making more effort to nurture and develop the management skills of those who are.' Even Prime Minister Theresa May’s 2018 announcement of £20bn per year of extra funding has been accompanied by a chorus of warnings about the likelihood that this money will be wasted on management consultants, agency staff and general ‘mismanagement.’
So what is it like to be on the sharp end of these criticisms as a CEO in today’s NHS? Warwick Business School associate professor Dr Maja Korica, whose research focuses on the dynamics of complex and rarely seen organisational settings, describes the job as ‘uniquely difficult.’ With her research collaborator, Professor Davide Nicolini, she has likened it to managing 'in a glass cage.'