The issue:
A remote and rural Health Board’s new Chief Executive Officer was the fifth such appointment in five years, during which time the Medical, Finance and Public Health Directors and the Chief Operating Officer had also been replaced three or four times. Only two Directors in the Corporate Management Team had more than two years experience of the organisation.
The new CEO commissioned a Business Planning Workshop for the entire CMT to:
- Review the strategic issues relating to the impact of the NHS national strategy on the local delivery of an integrated strategic local health plan
- Compile a list of agreed corporate strategic priorities
- Determine strategic priority portfolios of responsibility for each member of the CMT
- Identify middle management structures and support systems for delivery
- Agree on the CMT values and behaviours to adopt and rolemodel in order to delivery the strategy
My intervention:
The workshop was essentially an inquiry into the need for change and the options to take forward the business of the CMT differently.
Each Director was given time to prepare a flipchart presentation of the national health strategy for their functional area of responsibility in relation to the local delivery plan by looking at both through three lenses:
Competence
- What are the statutory requirements for which the Local Health Board will be held accountable, and what is its power and influence to deliver at the local level?
Capability
- What is the Local Health Board’s current capacity and capability to project, forecast and monitor resource allocation and planning, and its ability to adapt current plans or mitigate against the worst aspects of external drivers of change
Process
- Does the Local Health Board deliver the local plan because of or despite its power and resources; how does it include the needs, wants and values of local healthcare delivery partners and stakeholders; and how does it evaluate the signs of local and internal dissatisfaction and agitation that would trigger adaptation or mitigation of plans?
The strategic issues relating to each Director’s authorised remit, resource allocation and implementation process were then drawn from the presentations, clustered by the participants into significant issues in common, and then identified as corporate strategic priorities through my facilitation of two 4-box decision-making tools, firstly:
And, secondly, with regard to prioritising any one issue over another:
- What will happen… if you do?
- What will happen… if you don’t?
- What won’t happen… if you do?
- What won’t happen… if you don’t?
Each Director was then asked to prepare a further flipchart presentation by drilling down under each strategic priority to identify the programmes, initiatives or interventions within their functional area that could be included in their portfolio of responsibility. These presentations surfaced a number of simultaneously conflicting aspects where agreed:
- Roles and responsibilities
- Policies and procedures
- Objectives and performance management indicators
- Workflow and customer care needs
are likely to be comprised by the reality of the cross-cutting themes of:
Timescale — and the balance between being reactive to what’s already in the system and proactive to what can be put in place
Affordability — and perceived value for money
Proportionality — of resource expended in relation to benefit gained
Access — within the constraints of a remote and rural strategic health plan
Quality — that is acceptable as fit for purpose, and not necessarily ideal
Engagement — the quality of compliance or commitment from what is known, understood, accepted, and taken forward in partnership with the internal workforce, strategic partners, external stakeholders, local communities and individual patients.
The ensuing discussion resulted in agreed portfolio responsibilities for each Director that were comprised of core (must have) and discretionary (nice to have) elements.
Each Director then drew up an organogram for his or her Directorate and considered whether the middle management structure and monitoring systems was adequate to support the expanded portfolio. The need for reorganisation or additional resources was then discussed by the group.
I concluded the workshop with a process that allowed participants to reflect on what behaviours they had shown and experienced from others that had been supportive, cohesive and productive, and any that had been difficult, challenging and limiting. They identified clear, open and honest communication and the opportunity to do good work together as the two most important behaviours to adopt and rolemodel in taking forward their new strategy.
