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Why NHS Leaders Lack Vision

I predict that the 5 year visions that each local health economy must produce next year will in fact be far from visionary.  Great visions should be memorable, motivating and measurable, and I predict that the majority of those produced will fail all of these tests.  I am confident in my prediction because we are operating in a system that is not designed to produce great visions.

Seth Godin (in ‘The Icarus Deception’) tells the story that when a world class violinist visited the Juillard School in New York to give a speech and a performance, only 15 of the students attended.  But at the same time every practice room was booked solid.  This is because what got the students into the prestigious school was the ability to play music as it is written, to produce the notes and to follow instructions.

The dilemma these student violinists face is that what got them into the school is not going to help them when they leave.  The world is not short of good violin players.  What the world wants is original art: violin players that play music in ways that no one expects.  And this is what the young students have been culturally encouraged to avoid.

The parallel with leaders in the NHS is clear.  The Hay Group survey of the ‘top leaders’ in the NHS demonstrated that the vast majority have pacesetting as a predominant style.  Leaders in the NHS are good at getting things done.  They have become leaders because in the past when they have been asked to make things happen, they have made them happen.

But once they become a leader, following instructions is no longer sufficient.  The job now is to make the rules, not to follow them.  And we have not been trained for this.  There is no ‘what I should be doing’ because there is no ‘should’.  Now leaders must create a vision, develop the rules and make original art.

But the system of the NHS is not designed for this type of leader.  Is the NHS one organisation or multiple organisations?  Does it require one vision or hundreds?  The reforms were designed to shift the responsibility to the bottom.  To take away even the possibility of another ‘NHS Plan’.  So in the absence of a single grand plan each local health economy is asked to produce their own.

But what this means is that the NHS system as a whole should be supporting local leaders to create great visions.  In the new world, in the absence of a single plan, this has to be the priority.  But of course it isn’t.  The system is trying to find new ways to drive conformity and delivery – urgent care, finance, hospital inspections etc.  Leaders need to be immersed in the here and now.  The NHS does not want its leaders spending their time looking at other industries or other healthcare systems in other countries; what it wants is the crisis of the day to be tackled.

So with a set of leaders with no track record of producing great visions, who are busy playing the violin in the practice rooms, and with no support in place for them to produce one now, I am confident that most of the 5 year visions submitted next year will be neither memorable, motivating nor measurable.


3 Responses to “Why NHS Leaders Lack Vision”

  1. November 27th, 2013 at 10:54 | #1

    Spot on Ben. Let’s be honest and call these what they are, five year plans, thinking straight out of the Soviet era. Visions will come from leaders, and where are the leaders?

  2. November 28th, 2013 at 10:28 | #2

    Hi Ben,

    Whilst there are clearly going to be failings in an organisation as large, complex and politically important as the NHS I think it’s important to realise that in the Seth Godin story there were 15 students who did attend the speech and performance.

    My advice is to get yourself informed enough so that you’ll be identify who these key individuals are and then use your column to champion their work and the practices that are supporting them.

    A clinical leader in the NHS that I think is balancing his efforts between the practice room and executing on visions would be Dr Amir Hannan:


  3. Ben Gowland
    December 7th, 2013 at 16:20 | #3

    Hi David

    Don’t misunderstand me – I think there are some great individual leaders in the NHS. My point is that they are the exception not the rule, and in a system that requires somewhere between 150 and 200 local visions that leaves us with a significant problem, that I dont see being addressed.

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