Sir David Nicholson announced yesterday, a major review of NHS strategy in England. Thank goodness !
While some will argue that the review could lead to more uncertainty about objectives, this is of course true.
One of the key outputs from the review will be to decide if those objectives are still relevant to the NHS in England as it approaches its 65th birthday.
In an interview with HSJ, Sir David said that “the idea you could have one model in a sort of Stalinist way driven from the centre seems out of kilter really with the kind of NHS we want to create.”
Having been involved in strategy development in the NHS in England and elsewhere, here are my initial thoughts on how the revised NHS strategy can help to ensure that the NHS in England moves into a better place after the results of the review are implemented.
The revised NHS strategy needs simplicity.
Take for example, the story that is often told about a day when President John F Kennedy visited NASA at Cape Canaveral. While he was being guided around the site, he met a Domestic. “Good morning Ma’am” said the President. “Good morning Mr. President” said the Cleaner. “What do you do ma’am”. “I’m helping to put a man on the Moon”.
It would be helpful if everyone working in the NHS could give an equally succinct response to the simple question, “what do you do?”.
Nicholas Burroughs helps to explain simplicity. He is credited for saying “simplicity should be found in the execution, not the meaning”. In the NASA example, the vision was to put a man on the moon. In terms of simplicity, the NASA strategy was all about making sure that man walked on the moon.
Reviewing the NHS strategy will inevitably be a design process. Burrough’s quotation is well-regarded in the design community and I believe that after the NHS vision is revisited, simplicity can helpfully be one of the cornerstone of the NHS strategy review.
So that the revised strategy achieves simplicity, it would also be helpful to have just one strategy, instead of the many (sometimes conflicting) strategies that we have at national, local area team, CCG and provider levels.
Having just one strategy will help to discourage the instincts of writing intricate and beautiful complexities that are likely to make things unnecessarily complex and not particularly understood.
“Trust the results, not the conclusions”. This quotation comes from Linus Pauling, the only person to single-handedly win two Nobel Prizes. Pauling discovered that his colleagues tended to base their conclusions on their own belief-biases rather on the results. There are examples in the NHS and elsewhere, of individuals and groups who have a tendency towards developing conclusions rather than putting their efforts into improving results.
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