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04.05.2016

NEXT GENERATION: 3 Big Lessons for Business from the NHS

By Yasmin Crowther

At the end of last September, I was unexpectedly a guest of the Royal Devon and Exeter Hospital when my baby arrived six weeks early. We were in hospital for nearly a month as my little boy gained weight, strength and the basic reflexes to feed. I stayed in hospital with him the whole time and will be eternally grateful to the neonatal nurses who held my hand through the process of becoming a mother to a tiny baby when days before I’d been immersed in my busy career.

Going into hospital six weeks ahead of plan feels a bit like walking off a cliff edge. One minute I’d been occupied with corporate problem-solving and the next I was sitting in a hospital bed waiting for my baby to arrive and then waiting until we could all go home. The experience was challenging and enlightening. From hardly any exposure to the NHS other than via the news, I was suddenly immersed in a system of consultants, junior doctors, midwives, nurses, matrons, cleaners, security and catering. Gone midnight, I often wandered the labour ward corridors, helping myself to cereal from the canteen to keep me going through the night as my new baby wriggled awake in my arms.

A month in hospital, treading the corridors, is a long time - time enough to become good friends with other expectant and new Mums and time enough to get to know the doctors and midwives and greet them by their first names as you pass like ships at midnight.  It was time enough for me to observe my own particular corner of the NHS unmediated by media or politicians and – given my background – time enough to think about what the NHS might teach business. 

1.     Business as unusual is business as usual – or not leaving the patient out in the cold

Few industries or organisations exist to perform in the midst of chaos - but this is exactly what a ‘normal’ day in the NHS comprises. My experience of a busy labour ward and neonatal unit taught me that the NHS works constantly to manage an ever-changing quota and spectrum of patient needs. Limited resources have to be prioritised to deliver care according to the severity and urgency of needs that are constantly changing as patients come and go. There is no steady state. 

The image of resource management that developed in my mind was akin to the holding pattern of planes over Heathrow – that mothers may be expecting to land (be induced, have a caesarean etc) at a certain time, but often get postponed or delayed (sometimes for days) as more urgent cases get prioritised. It may be extremely frustrating for individuals, but the point is the system has an unprecedented volume of extremely serious risks – life or death – to manage and does so largely with success, day in and day out.  While the NHS is frequently criticised for waiting times and for postponing operations, we largely treasure the overall service it delivers perhaps because we recognise how exceptional it is to deliver business as unusual as a norm.

The NHS routinely deals with the types of hazard that most businesses would rank amidst their highest and potentially most catastrophic risks. It also manages those risks to deliver optimal outcomes – not for itself as an organisation (as it may be more profitable to turn certain types of ailment away), but for all those patients it exists to serve. This patient-centred ethos would be akin to companies focusing on delivering what’s best for their stakeholders’ well-being (beverage companies supporting a sugar tax?), rather than seeking to protect and enhance their bottom line at all costs. The contrary reality is that many shareholders prize those very companies that manage risk to safeguard business as usual – even when it is the equivalent of leaving patients out in the cold.

Where the NHS does its best to deal with the unexpected and profoundly challenging, business often seeks to do exactly what it needs to circumvent challenge – be it in relation to fossil fuels, tax avoidance or executive bonuses. Surely more trust and higher regard would be won by those businesses that better addressed the messy reality and risks with which the rest of the world has to contend rather than clinging to – and often reinforcing – a ring-fenced artifice of business as usual.

Which brings me to the next reflection: when faced with events beyond one’s control – especially those with high stakes and high consequences (from the arrival of a baby to the nudging forward of climate change) – no amount of clever positioning or adjusting at the margins can change the basic truth of the situation, and no single person or institution can hold all the answers.

2.     Intelligent decisions are collaborative and emergent – not command and control

When I first went into hospital, I longed for some decisive insight and advice about what was happening and what I could do and when I could go home. For the first few days – before my baby actually arrived – I received different nuances of advice from a variety of midwives, junior doctors and finally my consultant. But it all added up to one simple unavoidable conclusion: I was staying put – in holding pattern, as it were.

At the time, I found it infuriating. It was a beautiful Indian summer outside and I imagined all the things I could be doing at home to prepare for when the baby actually arrived. But I did stay put and later, when I was able to reflect on it, I valued the prismatic truths contained in all the different perspectives and insights. My challenge had been to understand the kaleidoscope of rationales and possible outcomes and do my best in a dynamic situation, rather than seek out a definitive forecast and single solution and stick to plan, as so often seems the case in corporate strategies.

In the business world, many difficult decisions – often to do with internalising external costs and impacts, whether environmental or social – tend to get booted down the road to other decision-makers, be it regulators, this or that country, this or that institution. The buck gets passed with little insight coming to the fore. Some companies may seek to engage in stakeholder dialogue to surface options and solutions, but then often freeze when faced with the scale of challenge and demand played back to them by those real world voices, with the end result being a tendency to position themselves as having ‘listened’ while – you guessed it -  still pursuing business as usual.

Such companies effectively opt for selective deafness while hoping their corporate weight simply works to push internal ambitions to fruition and inconvenient truths to one side. This is akin to an NHS practitioner ignoring a patient’s expressed symptoms, complaints and suggestions with the intention of delivering a healthy diagnosis and outcome on the basis of medical text books and assertiveness alone. However bright such a medical professional might be, one would not seek them out. The nurses, doctors and consultants we admire are those who listen and who present treatment options for discussion, with clear recommendations, but no imposition, in a spirit of partnership with the patient – the most important stakeholder. How many businesses fulfil this ethos? Which hospitals would remain open – let alone be bailed out - if they neglected their core stakeholders as spectacularly as our banks?  And what might leading doctors teach bankers about risk management and value creation for society, as opposed to the one way track of investors and consultants seeking to teach the NHS about markets that have so spectacularly failed.

3.     Sweating the small stuff – or reframing mindsets to deliver big outcomes

After my baby arrived, we spent days in the neonatal unit involved in the minutiae of caring for a tiny life, along with a host of other parents who had been catapulted into the exceptionally quiet, tender and semi-Caribbean climate required of the next generation who arrive a little too early or unwell. From thinking about corporate challenges and strategic issues, I was occupied with feed times, expressing breast milk, and weight gain measured in grams. For weeks, I scarcely left the low dependency unit cubicle where my baby was looked after and I will treasure the matron who, sometimes seeing me near overwhelmed, would say: ‘You are doing really important work now – nothing is more important’, and while I felt myself falling off the cliff edge of all I’d known before, I knew she was right.

Which brings me back to the big stuff of tackling inequality, ensuring fair tax and the like – which is often treated by business as small stuff or too-difficult, discussed on the edge of meetings or amongst special-interest groups, but rarely incorporated into core business models or strategies. But what would a business look like that sought to pay fair tax and understood the value of addressing widening inequalities.  What sort of reputation and market presence might such a business achieve for making the effort and taking a lead, and what sort of world would we be living in?

Some talk of a future of cognitive capitalism or post-capitalism, where those things we undervalue today – from data to creative free time and ‘the sharing economy’ – are appropriately valued with all the redistribution of ownership and wealth that implies: no more corporate monopolies and privatisation of assets that are essentially the property of individuals (my data) and society (our intelligence). The promise is a new type of networked and collaborative capitalism with society’s well-being and development valued as core, rather than as a secondary benefit of conventional market-economics. If so, then the NHS - with its capacity to manage a massive volume of high risks, be stakeholder-centric and focused on macro and micro challenges to deliver critical value for society (its health) - might be an imperfect signpost to the future, as much as the troubled bureaucracy so often painted.

Nourishing the next generation – just do it!

After nearly a month, my husband and I walked out of hospital and brought our son home. Over the subsequent weeks, he put on weight exponentially and become robust, resilient and noisy as any small child. Soon it will be time for me to return to the world of work and I find myself wondering how the experience of becoming a mother will influence me. A dear friend told me that, for her, having a child delivered a renewed sense of urgency – that there are only so many hours in the day and that we don’t have the luxury of cosmetic exercises, small ‘p’ politics and kicking the can down the road – and I agree. I am determined to hold onto the lessons I learned from the NHS: to help business look beyond self-circumscribed comfort zones; to challenge self-serving strategies that kick inconvenient issues into the long grass; and to encourage even the smallest steps towards genuine collaboration in tackling the many messy challenges facing society and our next generation.