Saturday, 11 May 2013

NHS managers could learn a thing or two from Sir Alex Ferguson

As Manchester United fans across the globe prepare themselves for the ‘end of an era’ and mourn the retirement of Sir Alex Ferguson, it is worth reflecting on why he has been one of the greatest football managers of all time.

Regular followers of this blog will be familiar with my penchant for combining two of my great passions – football and health - so of course this landmark is just too significant to go without comment.

Non-believers may wonder why a football related subject should dominate headlines worldwide but Ferguson has his hands on the rudder of a 1 to 2 billion dollar enterprise, equally beloved by the stock market and football fans alike. Why has he been so influential and why have so many column inches been dedicated to this recent news? Because Ferguson is not only a great manager, he’s also a great leader and it’s quite rare to have both in one package.

Much has been reported about the lack of leadership and management in the NHS, both from a macro and micro perspective. Progress, service improvement and high quality care CAN be achieved in our hospitals and primary care facilities, if the teams have some decent leadership. And I’m not just talking about the boardroom, I’m talking about the doctor’s surgery, the bedside, and even the operating theatre – each department needs strong management. So NHS managers and leaders, please read the list below and take note.

Why was Sir Alex Ferguson so successful in managing a diverse group of individuals, each with their own agenda, but with, in theory, a common goal?

Discipline: I’m not suggesting that the hairdryer technique (where Ferguson blasts anyone who displeases him with a nose to nose tirade) but teams do need to play by the rules. Boundaries should be clear, rules well defined and bad behaviour should be noted and censured.

Reward good performance, address bad performance. The two golden words that could go a long way to fixing the NHS – performance management. Many have seen examples of incredible commitment and dedicated care alongside laziness, complacency and cruelty. For every individual failure there was a manager who either missed or ignored bad behaviour and practice. Performance management requires integrity and courage.

Instil pride in the brand and the team. Ferguson made it clear that when a player behaved badly on or off the pitch, he was damaging the Manchester United brand. The NHS has a fantastic brand and yet so many managers ignore this fact. I have seen brand loyalty (to almost a pathetic degree) in workers within the private sector which benefits customers, staff and the organisation in equal measure. Staff should wear their uniform with pride and be encouraged to honour their own teams.

Manage egos and personalities bigger than the brand. Cantona, Keane, Ronaldo – Ferguson had a knack for channelling genius and is probably responsible for saving the career of many an upstart. His controversial sale of David Beckham still smarts, but maybe he was probably right in recognising that the Beckham circus could have unbalanced the team dynamics. One of the biggest challenges facing NHS leaders is how to manage clinical teams. The clinical card is often produced to win a work stream argument. These days, I have found that the big egos aren’t just the consultants (historically the most difficult to manage, especially orthopods and heart surgeons) but therapists, GPs and nurses sometimes inappropriately use their clinical qualifications as a type of diplomatic immunity. Their clinical concerns must be heard and carefully balanced with the harsh reality of health economics.

Earn your stripes. Ferguson worked his way up and was a player himself. The best NHS managers either have a clinical qualification or at least worked within a clinical environment. Jeremy Hunt, the Health secretary, is suggesting that prospective nurses spend more time on the ward before embarking on their training but I think it would be more effective to insist that every manager spends some time either observing or assisting patient care so they really understand the stress and pressure that clinical teams face.

Lead by example and encourage a healthy work ethic. Even at the age of 71, Ferguson is first at the training ground for early morning sessions. Too many NHS managers stay in their ivory towers and should spend more time in committee than at the coalface.

Celebrate success! Ferguson’s ‘dad dance’ at every goal leaves something to be desired, but no-one could doubt his pleasure. There is so much good in the NHS and it should be celebrated.

For senior leaders only – manage the press. Ferguson was criticised for blacklisting several organisations and reporters during his career. But he is a canny Scot and he knew that he needed to control the message. I was at a launch of a new joint NHS/private venture on cancer research the other day. It is potentially a fabulous collaboration, and I shall be writing about it soon. But there was one reporter there, from a newspaper that famously overdramatises health stories and so often gets the facts wrong. She kept chipping away at the potential negative elements of the venture, and even her questions demonstrated that she didn’t quite get it – but these bad news stories dominate the UK press and undermine improvement efforts. Yes, it’s important that the public know about catastrophic events such as the unnecessary deaths at Mid Staffs and flaws in government reforms but the NHS PR machine needs to work harder in sharing the good news too.

I wish you every happiness and good health in your retirement and many many thanks for the hours of pleasure you have given millions Manchester United fans for over a quarter of a century.

Just one thing – could you consider postponing your retirement and replacing Sir David Nicholson as Chief Executive of NHS England? It’s about time the NHS had a premier league manager.


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