Thoughts from Andrew
Hi, Hello & Welcome
Not-so-brief insight into our thoughts, mindset and the challenges we all face
A warm welcome to anyone with the interest or desire to discover more about me, why I feel so strongly about what we are doing and other thoughts that I think need sharing.
I am absolutely passionate about really making healthcare work because it has to, for all our sakes. Health is our most precious condition, and it is reliant on the combination of our own stewardship of ourselves coupled to a well-functioning, sustainable health system.
Our health system is breaking (some might say broken, which is disingenuous to the amazing work it does under extremely difficult circumstances) under the pressure of a multitude of converging ‘bigger picture’ issues, most of which are not of its own making. However, our healthcare system must be restored to sustainable health and this is something that is not happening. Most would agree, on the whole, that it is declining and many services are finding themselves in either acute distress or delivering healthcare they are increasingly worried about. I believe this doesn’t have to be so but that what we do and how we do it are absolutely fundamental to changing this picture. It is not only very possible but everything we need to know is available but not understood, used or applied. I am passionate about changing that.
I choose to do what I do using a ‘company’ as the platform predominantly because this is a good way of funding the work to be done and an excellent way of holding me to account in ensuring what I do is useful and valuable. If it is, we grow and if it isn’t, then we are in trouble. However, please understand it’s a means to a more important end, not the end itself. With this in mind, you will start to see a step change in how we do what we are doing, far more closely aligned to my underlying beliefs and sense of purpose. It will certainly dispel any myths that we’re ‘in it for the cash’, a perception that has not sat well with me for a long time, despite my own recognition that this is sometimes how we have behaved, even if not intentionally.
A Sense of Responsibility
I believe strongly that healthcare is a responsibility requiring stewardship from all who act in it, preside over it or rely on it. Consequently, I also feel that career, business or political success should be a function of successful stewardship, never at the selfish, career- or profit-motivated expense of it. However, we do see this all around us:
- Managerial decisions motivated by short term outcome that careers rely on, instead of longer term stewardship that the system would benefit from
- Individuals undermining progress because it doesn’t suit them personally
- Conference or training companies ‘milking’ individuals (and therefore healthcare) because a topic is particularly topical
- Literally hundreds of thousands engaged in things they don’t believe in, almost ‘ordered’ to by others that probably don’t either (a system-wide failure in authenticity)
- Denial and defensive reasoning allowing the real problems to persist, unaddressed, whilst wasteful, white elephant solutions consume valuable and scarce resources
These examples are not stewardship over something so vitally important to us all. But neither is an uninformed rejection of change, new ways of doing things or attempts to address the problems we face, in the absence of suggesting an informed alternative. Good stewardship is being maximally informed on the complexity of the issues and holding everyone to account in finding better solutions. Nothing less.
The Need for a Difficult but Adult Conversation
Healthcare faces the most immense set of emerging challenges, the facts and figures of which only a tiny fraction are genuinely informed about. I believe this is not helpful to an adult debate about how we face our future in healthcare.
I spend a great deal of my time speaking on the complexity of the emerging challenges but the more I understand, the more I realise how few grasp the magnitude, the breadth or the implications of these complex, interrelated challenges. I strongly suspect that Government does but then does not act with stewardship. So healthcare policy is driven by these challenges but does not address these challenges. That has implications for everyone. I believe:
- Population changes (which we have very little influence over) will transform society as we know it and we must be ready for it and contribute to ensuring it isn’t a catastrophic transformation (which it has the potential to be)
- We are unlikely to ‘solve’ all of the issues we face (if you know the figures, I doubt you disagree) over the timescale in which we face them but we must learn to cope and survive regardless, doing the right thing i.e. act with stewardship
- Government does understand the reality but doesn’t know what to do or how to do it (it has distinct, carefully crafted policies but they are almost certainly not motivated by ‘solving’ the underlying issues) and will behave, I believe, increasingly erratically, unintelligently or with political motivation (shocker…) at a time when we genuinely need the opposite
- Services really have very little idea how to operate in their new environment but must learn to, fast & positively, to act with stewardship for their patients, their service and the system as a whole
- Commissioners are mostly blind to the real job to be done, or just how much of a curved ball they have been given – this does not help them, us or the system
I am an advocate for an adult, selfless, intelligent debate about the problems we face, underpinned by ensuring those contributing to it are armed with the true facts in all their complexity. It is only in this way that we can move from moaning about something we don’t like to designing, collectively, something that we believe in that genuinely addresses the future reality of the NHS and UK society as a whole.
A Responsibility Shared – Distributed Leadership
Our approach to leading is wrong. The people feel it, the evidence says so and you only have to look around and ask yourself a question you may have heard me ask “how well is this turning out for you?” I have spent 10+ years, alongside others who know far more than me, calling for and advocating a different approach.
If healthcare is a collective responsibility requiring collective stewardship, then leadership is a collective activity or set of behaviours too. We are organised so that the people at the top (of anything) carry disproportionate authority but not accountability. Leaders rule, others comply or passively resist and it doesn’t work. I believe this must change to a more distributed model, where all who act in healthcare, preside over it or rely on it genuinely share the responsibility for how it turns out. Consequently the answers to our deepest problems must be built as:
“An agreed solution to a commonly understood problem”
I believe passionately that collectively we have the intellect and mindset to come up with the answers but our approach to leadership undermines this. Good leadership values an alternative view, recognises the people best placed to devise solutions and selflessly defers to those that act with good judgement, demonstrate unwavering stewardship and produce ideas or innovations that can change healthcare for the better. I still believe predominantly that clinical professionals are best placed to do this. In healthcare, we have the planet’s highest collection of top tier intellects, highly motivated to do what is right and rigorously trained to overcome complex problems, collaboratively, whilst never forgetting you must act with good judgement even before you have all of answers you would like. This is what medicine is and why medicine has been so successful and this combination of mindset and intellect is where the answers will lie, enabled by those that can help them realise those answers. They just need an environment or conditions and leadership that helps this flourish productively, rather than viewing clinical behaviours as part of the problem.
I remain amazed (and distressed) that too often clinical professionals are suppressed and controlled, not encouraged, enabled and released. If you are worried what they will ‘do’ then it is because you do not lead them, develop them, support them and channel their abilities appropriately in a distributed leadership manner. If you did, you would not be worried. Look in the mirror before citing them as the problem.
I hope this has given you a small insight into the mind, beliefs and inner drivers that make me passionate about really making healthcare work. It’s why I do what I do, why I devote so much of my life to it, why I am so overtly passionate about the issues that need addressing and why I don’t or won’t give up.
I believe my purpose is to act as a catalyst, enabling the many committed professionals in healthcare (you) to create a strong, sustainable future for healthcare built on genuine solutions (ones that actually work) to the true, underlying problems. Of course, I am far from the only one on this mission but this was about me, personally, not about others with a similar drive or motivation. My work is centred on enabling you, collectively, to do what needs to be done and my contribution is focused on 5 key things (all parts of the same thing really):
- Continuing to gather, interpret and make available, as widely, usefully and cost-effectively as possible, the knowledge, insight and evidence necessary for us to commonly understand the future we face and how best to face it (in all its uncomfortable reality and complexity)
- Working with individuals, Services and Trusts to develop potent, impactful leadership, transformation & capability that ensures services are successful, adaptable and resilient in an increasingly distressed healthcare environment
- Re-igniting the fire or passion that led to the NHS becoming one of the world’s greatest institutions (with a truly noble cause) but encouraging its redirection towards making healthcare really work today and tomorrow
- Creating genuine solutions that enable people to learn more and achieve more (I see it as unsticking the stuck) in spite of the austerity we all face
- Doing the above in a way that models the things I have discovered or come to believe and, particularly, leaves them better off than before
This is not pie in the sky, profit-driven or unactionable rhetoric. Those that have taken the time to join me in developing the deep understanding that underpins what we do know this only too well. This is me, what I do and more importantly, why I do it. If you’re reading this line, I hugely admire your persistence and resilience! If it also happens to resonate with you then I’d really like to know. Get in touch! I’m not blind to the magnitude of the challenges we face but I do know they require a very different approach. If you feel the same way too, I’d love to work with you or support what you do.
My best wishes and continued efforts.
Partner, Academyst LLP
Director, Insights Leadership Ltd