Dr Peter Bibawy NHS NE Hampshire and Farnham Clinical Commissioning Group
How can the NHS learn from other sectors? And when our to-do lists are full to bursting, how do we make the time to do so? Over the last two years I’ve had the privilege to be part of the first cohort of fellows with the Forward Institute. Bringing together 65 emerging leaders from across the public, private and social sectors, my cohort included fellows from the British Army, Metropolitan Police, Bank of England among many other organisations.
Such a diversity of people gave fascinating insights into what leadership should mean today.
The programme is focused around values-driven leadership, particularly weaving social responsibility, innovation, purpose and diversity in all that we do. Using a blend of inspirational and practical examples, skills development, discussion and experiential learning, the programme aims to support Fellows to grapple with the major societal forces shaping the environment in which their organisations must compete.
The last 18 months has changed my perspective on everything from understanding complex issues to the wider challenges in society that are directly and indirectly linked to health and social care, as well as develop a deep understanding of what responsible leadership means. It has been an emotional journey of unlocking barriers, applying waves of influence and showing courage at all times.
The fellowship has underlined how much benefit there is for all of us – not just in the NHS – in peeking over the walls of our own particular silos to see how others do things. For example, the Army hosted our last residential at Sandhurst – conveniently for me, right on the doorsteps of my local health system of Frimley Health. What stood out was the Army’s approach to dealing with complexity, and the role of leadership in doing so. Sandhurst’s geography (buildings spread across three counties) resembled the complexity of our health system (three commissioning organisations, two foundation trusts, multiple other providers). But the nature of the Army’s problems was also similar to that faced by us in the NHS.
"In a complex world, as the Army had realised, there’s no linear solution, nor is one person’s viewpoint – regardless of how many medals on their chest – supreme"
Let’s take a step back. Problems which are complicated are those which are hard, but can be solved given sufficient brain-power, planning and expertise. Think landing on the moon, or building a hospital. Gantt charts and tightly controlled processes come to the fore.
Complex problems however are characterised by unpredictability, and scores of interdependent relationships all set within an ever-changing environment. Think dealing with the Taliban in Afghanistan, or reducing childhood obesity. Trying to predict how complex problems will play out doesn’t particularly help; what matters is how well you can adapt, and how fast.
In a complex world, as the Army had realised, there’s no linear solution, nor is one person’s viewpoint – regardless of how many medals on their chest – supreme. The role of the leader isn’t to be always right, but to create an open system where all views are accepted, allowing individuals, organisations and systems to evolve and transform.
This approach to leadership is seen within the Army’s approach to commanding operations. Their philosophy of “Mission Command” is centred on the exercise of direction by the commander using mission orders to enable disciplined initiative, but all within a broader intent to empower adaptive leaders in delivering their operations.
An amazing, simple (but not easy - I have been told it is a challenge to always get this right, especially at times of peace!) concept, “Mission Command” continues to be a core principle for the Army. It’s centre-stage in the Army’s leadership doctrine too, which is organised around three framework components:
What leaders are: champions of values and standards, leading by example, influential and responsible
What leaders know: professional competence, decision making and communications
What leaders do: develop self and others, build teams (empower, cohesiveness, set direction, raise standards) and achieve the task.
It’s fashionable in health care to talk about complexity, but hearing about the Army’s approach made me wonder how we compare in the NHS, and how we can empower our front-line staff to innovate and deliver in an autonomous, empowered and energised way.
While we were there, General James Bashall spoke about “how excellence is not a single act but the need to do the right thing all of the time”. It strikes me that we are only going to make excellence universal across the NHS if we fundamentally change our approach to what leaders are there to do, and how we support them to support others.
Had I been 20 years younger I would have seriously thought about joining the Army, what an inspirational British Institution! I recognise how great a privilege it was to be part of the Fellowship, and to spend three days at Sandhurst - obviously, it might stretch the NHS’s budget a bit far to do likewise for all 1.3 million NHS staff. However, we won’t find the answers to all our problems from within the NHS – we need to find new ways to look outside and bring back ideas, insights and inspiration.
Peter is a GP and Medical Director of NHS North East Hampshire and Farnham Clinical Commissioning Group @peterbibawy