Barts Health Trust has been put into special measures after a damning report by the health service regulator. But what is meant by special measures, and what does this mean for the East London Hospitals that are run by Barts?
In a previous article we spoke about the need for a systematic improvement in management capability across the NHS. This is a long term, gradual but comprehensive change over a number of years - the antithesis of special measures. Special measures requires a different kind of management, for special measures we need someone reactionary, a fire-fighter, a hero.
The hero is a manager that puts the 'special' in special measures. They will be parachuted into a crisis with little understanding of the situation into which they have been dropped. But no matter, through their years of crisis management experience they will be able to seize the bull by the horns, wrestle it into submission and the problem will be solved. This is quite an achievement - the ability to turn around failing organisations is not something to be sniffed at and in no way should we belittle the achievements of these talented individuals. But dealing with the NHS in this fashion is like spinning plates, it will work only until the next crisis.
The hero is a short-term solution to a serious, long-term problem that screams immature management. Just a glance at the report on Whipps Cross University Hospital in Leytonstone demonstrates the need for cultivating mature management throughout the NHS. Low staff morale, bullying, failure to meet waiting time targets are all clear indicators that current management is not sufficiently mature.
According to the BBC "One of the first steps at Whipps Cross is strengthening the leadership team - the hospital will have a dedicated managing director and a director of nursing, as well as a medical director to oversee its day-to-day running"
This strengthening of the leadership team may be a temporary fix to this immediate problem, but it is not a solution to the much larger problem of why these crises occur at all. Why is the NHS a constant blaze that must be managed by continued fire-fighting? The answer may lie in our focus. Perhaps it is because we care about the results, but not where they come from.
We hope to deliver a better product, but what we fail to realise is that the quality of the product is only as good as the process that delivered it. Under performing management across the NHS delivers under performing hospitals. Relying on heroes will, at best, cope with one crisis at a time and only in the short-term. If we can focus on improving management capability throughout the NHS the systemic culture it creates will sustainably improve results and the need to crisis manage will be over.
Barts Health Trust may well need to be put on special measures and in the short term, crisis management is likely to be an immediate remedy for the current crisis. However if in future we were to move away from crisis management towards measurable mature management that takes a systemic approach, we might just find ourselves with fewer plates to spin.