You might hope the answer to that question is self-evident. Whatever your long-term goal, you need a plan for how you’re going to get there, particularly if you work in a complex, dynamic environment like the health service. And particularly if you’re relying upon multiple organisations to help you achieve that goal.
So why does strategy sometimes get a bad name, particularly when developed at national level? Partly, I suspect, because some so-called strategies tend towards a mere assertion of policy goals, rather than providing a convincing account of how those goals are going to be achieved. And partly because of a tendency for set-piece publications that feel like they’re trying to have the last word on an issue that’s crying out for a more agile approach – for a living, adaptive strategy.
But I think most fundamentally because we too often reach for shiny levers – national strategy becomes a sort of painting by numbers where (whatever the problem) we announce we’re going to amend (say) the NHS standard contract, or the Quality and Outcomes Framework, or a training curriculum – rather than considering what will actually motivate people to behave differently. Any strategy that doesn’t begin by creating shared goals – and agreeing how different organisations will contribute to those goals – is unlikely to survive first contact with the system it’s trying to influence.
A significant part of my current role is spent working with local health systems and with NHS England and other national partners to turn ‘accountable care’ into a new way of managing resources (workforce, estates, technology, information, wider community assets) to improve quality of care and health outcomes for local people.
"Any strategy that doesn’t begin by creating shared goals – and agreeing how different organisations will contribute to those goals – is unlikely to survive first contact with the system it’s trying to influence."
This work has a number of key features. It’s essentially bottom-up: it relies on commissioners, providers and local authorities having the determination to come together and act as one, agreeing how to use their collective resources more effectively. It relies on agreeing with these emerging accountable care systems the national changes that will enable them to make a success of this new approach, whether that’s devolved transformation funding, more streamlined forms of regulatory oversight, new financial flexibilities, or support in developing new payment models. It seeks to be highly agile: we take those proposed national changes and work on them rapidly but iteratively with local systems.
Perhaps most importantly, though, there’s an increasingly strong focus on organisational development, or rather cross-organisational development – investing time and energy in seeing the world through other people’s eyes, challenging our own (and each other’s) mindsets and learned behaviours, developing relationships through working on tough, practical issues together. All the stuff that no one taught me when I started working in this business some 25 years ago.
I’m excited by what’s starting to happen in these emerging accountable care systems and our relationship with them. And it’s happening without a 100-page strategy document, but rather through an agile, shared work programme, founded on a shared conviction of how the health service needs to evolve.
Ben Dyson is Executive Director of Strategy at NHS Improvement.