Seizing leadership opportunities in the NHS

Hearing Jeremy Hunt read from his speech notes in a packed conference hall last month I had only one thought on my mind: how did he land the most senior health job in the UK?

‘We need to embrace randomness and adapt our behaviour to it, shifting our focus to advance ourselves and our organisations’

Chance must have played a role, I decided. Luck; serendipity. Call it what you will, but its role in driving the success of leaders and their organisations is the topic of author Frans Johansson’s book The Click Moment − Seizing Opportunity in an Unpredictable World.

I have always been intrigued by the question of how much luck shapes achievement. I had a sense that talent and experience were required but what really drives success beyond that point?

The premise of Mr Johansson’s book is simple but challenging. In an increasingly complex world, planning and analysis no longer guarantee strong performance.

For NHS leaders this premise sits even less comfortably. Acknowledging such a thing in public could be “career limiting”. However, I believe this does not take away our control over our destinies or the success of our organisations. On the contrary, a random world creates moments of opportunity: “click moments” as Mr Johansson describes them.

We need to embrace this randomness and adapt our behaviour to it, shifting our focus on to creating, seizing and exploiting these moments to advance ourselves and our organisations.

The role of luck

For those who have read journalist Malcolm Gladwell’s book the Outliers, it will come as a surprise that success can be random. Mr Gladwell argues through examples such as The Beatles and Venus and Serena Williams that the key to success depends on practice − at least 10,000 hours of it.

However, the 10,000 hour rule only works in a limited range of circumstances where a specific skill is being developed that can be uniformly repeated in a stable environment, such as playing tennis. But running a successful business is not like playing tennis.

The rules are not fixed in perpetuity. There is no ever-present umpire. While we are willing to look back over our private lives and acknowledge the role luck has played in being in the right place at the right time and with the right people, we find it less comfortable to be as open about our work lives.

‘The key is action. Not in a specific direction, just action’

Think forward three years. Which party will be in government? How will they reorganise the NHS? What will the tariff be for each of the services you provide or commission? What technology will be affecting healthcare? What role will the private sector play?

The combination of scale, politics, bureaucracy, public interest and managed competition makes the NHS more, not less, random than the world around it.

Mr Johansson writes in The Click Moment: “Some of us need a plan that makes sense, some of us need a plan that emotionally grips us, others need a plan to coordinate activities and keep our schedule straight. The reason behind the plan is not especially important because you will be wrong anyway. Whatever you need to make the case to act is fair game.”

The key is action. Not in a specific direction, just action. In doing so, we will create opportunities that can be seized and exploited.

Here is how Mr Johansson says to do it: “You have an easier time creating click moments if you connect with more people. You have a simpler time making a successful bet if you try a lot of them… And you are more likely to get caught up in complex forces if you are out in the world doing stuff, which is easier if you know how to do something well.”

Small bets, big wins

External networking is something NHS leaders do not tend to do enough of. Attend a conference or event outside of your field of everyday interest. Resist the pressure to only “focus on the day job”. In a recent study by Brunel University of HSJ Awards winners, one of the three keys to success was identified as “taking a risk”.

Placing bets means acknowledging you don’t know the best answer at the outset. Be open and honest about it. This requires a significant cultural change in many of our NHS organisations.

‘Use passion as fuel. This is where the NHS has an advantage. The workforce is passionate about the work it does’

“Making many small, purposeful bets, fuelled by passion and calibrated by affordable loss, is the second out of three ways to channel the randomness in this world,” says Mr Johansson.

While acknowledging we don’t know the answer allows more bets to be placed, this does not make them any more affordable.

Explore ways to split investment between several smaller pilots. One way to achieve this would be to co-invest with other local NHS providers and commissioners or with the private sector.

Use passion as fuel. This is where the NHS has an advantage. The workforce is intrinsically passionate about the work it does.

Complex forces

The challenge is to harness this energy and understand that placing many bets will lead to many failures, but ultimately this is in the best interests of patients.

“You must actually do something, even if you are not sure where it will lead,” writes Mr Johansson. “Once you start executing, whether or not the bet actually works in your favour, you are exposed to complex forces that can pave the way for future success.”

The message here is straightforward. It is all well and good placing bets, but once signs of success begin to show act on them; “double down” on the bet. This means investing in those bets that look to be paying off and stopping those that don’t. Remember these are bets, not investments; some will stop and others will receive additional investment.

So next time that pilot project you invested in looks like it just will not deliver the benefits you hoped for, stop it. Take the resources and plant a few different seeds in new and diverse projects. Watch for early shoots and double down on them. This is innovation. You never know, one day you could become secretary of state for health.

Craig Barratt is a principal at AT Kearney