Our Shared Agenda

Although we're each under pressure to become and remain expert in our field, today’s challenges also call for us to contribute to an agenda much wider than that of our function or unit. But, all too often, as we specialise and know more about less, our perspective seems to narrow and a form of institutional 'glaucoma' sets in. 

​

Consequently, one of the most difficult challenges for those leading large multi-functional enterprises is to encourage the specialists to find time to consider the 'bigger picture' and to contribute to the planning and management processes.

​

Most professions now acknowledge, however begrudgingly, that the management and leadership of their enterprise requires the combined attentions of those directly involved with the delivery of the service plus others with the requisite management skills and time to focus on the key business issues. 

​

The professions have been quick to respond to this new imperative. In the not-too-distant past, it might well have been a surgeon who managed a hospital (perhaps modelled along the lines of the eponymous Sir Lancelot Spratt). When not performing heart transplants, teaching junior doctors, undertaking research and seeing private patients, s/he would have provided the everyday management and strategic vision for a costly and expert enterprise caring for entire communities. 

​

Today that very same surgeon will still be involved in surgery, teaching, research and private medicine. But now s/he will share the leadership and management role with general management colleagues who can bring to bear the weight of their business skills in finance, personnel, marketing, service delivery, etc and turn the vision into reality. 

​

Law is another example. Traditionally, barristers appointed an individual from within their ranks who, when not defending a serial murderer in the High Court, provided the overall leadership and management to chambers. However, in recent years, greater competition from solicitors and pressures from Europe have prompted barristers to employ a generalist to assist them with the increasingly complex management agenda. Those in other professions might recognise certain similarities. 

​

Over the years, a number of new management tools or processes have appeared on the scene, each with the promise that it can help bring some order out of chaos. Most have stumbled 'out of the blocks' as I saw first-hand in two large mergers in which enterprises were ripped apart by internal division, parochialism and the demands of the most powerful professional cabals, e.g. finance, marketing, etc or in the case of the NHS, the consultants, junior doctors, nurses, managers, etc.

​

Today’s highly functional, segmented and professional enterprise needs something more - a process that focuses the minds of all the key players on all the major issues and allocates and balances effort and resources across the entire agenda.

 

I don't claim to offer the only solution, but I believe that at Guys & Tommies, my colleagues and I came close to the Holy Grail when we developed a planning and performance process that we named 'The Shared Agenda'.

 

As one of the UK’s leading hospitals born out of the merger of two very distinctly different London teaching hospitals - Guy's and St. Thomas' - we faced a number of challenges:

​

• develop improved links with Primary Care;

• reconfigure services across both sites (Guy's and St. Thomas');

• create the UK’s leading Planned Care Centre;

• cope with reduced resources and increased demand;

• improve standards of care and service delivery;

• be at the 'leading edge' in both research and practice;

• train the healthcare professionals of tomorrow.

 

Our success - both in achieving our mission and in responding to more immediate challenges - depended on our ability to translate our mission into action.  

 

As we employed over 7,000 staff in a huge range of functions across two separate sites, a key question was who was going to focus their attention and energy on the key priorities and ensure that we achieved our stated mission.  

 

Clearly that was too great a challenge for the Board on its own. Yes, we could and should continue to provide leadership and direction for the whole of the Trust but we needed the support and commitment of many others.  To this end, we created a distinct group - named the Senior Cadre - drawn from the following groups:

 

• professional heads of service;

• clinical directors;

• departmental managers;

• senior specialists in their field of expertise.

 

This group brought together some of the finest minds and most dedicated professionals with whom I had the good fortune to work. Each was one of the UK's leading experts in their field. Combined, they would play a key role in translating the Trust's overall objectives into actions that ‘made it happen’.  

 

In the paper 'The Shared Agenda - the process',  I write about the process we designed to make this possible.