Five lessons from ten years of NHS strategy

It may appear somewhat strange to start a blog in praise of Matt Hancock, but here goes. In 2018 I was at the NHS Providers annual conference, listening to the future I’m a Celebrity contestant in his first months as Health Secretary. He set out three priorities for the health service. When pushed to name more, he refused. His logic: start adding to the list and everything becomes a priority, which means nothing is.

Whatever you make of the rest of his time in office (and jungle), that discipline has stayed with me. Naming priorities is easy. Stopping at three is hard.

At Kaleidoscope we have spent ten years helping NHS organisations develop strategy. When we recently asked a group of NHS leaders how strategy is seen in their organisation, the same words kept popping up: essential and necessary, but also disconnected and reactive. And 97% agreed with the statement that NHS strategies promise more than they deliver. (To the 3% who disagreed: do get in touch. We would love to study you.)

We are drawn to strategy because it matters, and let down by it far too often. Here are five lessons from a decade of trying to close that gap.

You can have another priority… but it’ll cost you

Adding a priority always feels free. It never is. One trust we worked with told us: “our superpower is saying yes, and it’s killing us.” Leaders tell us they want to be brave and decisive, but without upsetting anyone. You cannot have both. If you are making real choices, you are prioritising some things and deprioritising others, and people will feel it. Good strategy brings the trade-off into the open, as Lewisham and Greenwich NHS Trust did in committing to “long-term improvement even over short-term fixes”.

What’s said in the corridor, stays in the corridor (unless you stop it)

The conversation in the boardroom is usually very different from the conversation in the corridor. Every organisation has truths that everyone knows and nobody writes down. Early on in our process we ask: what do we need to know that we will never find in a document? The answer usually starts with “how long have you got?” It is what we call collecting the brutal truths: experiences of today, said out loud, before any talk of the future. The best technique we know is peer to peer: representative groups of staff leading big chunks of the process, so the conversations happen between colleagues rather than with outside consultants. The insight is always richer.

Does your strategy mean anything at 3am?

Look at the evidence on why major change fails and staff resistance sits near the top. Not because staff are malicious. Usually the strategy is simply unknown, unconnected and irrelevant to daily reality. So here is a test. If your organisation runs a night shift, does your strategy mean anything at 3am? If people cannot remember it, they are not following it. A good strategy can be summarised in a sentence, on a night shift. Too many strategies are, as we put it in our ‘Little guide to strategy’, written for robots, not people.

You’re writing the document for you

Most strategy documents are skimmed once and filed. That is fine. The document matters, but as a signpost rather than a sacred text. It gives you a record of what you actually decided. The real change happens through the process of deciding it, and through getting that substance and direction into the lifeblood of the organisation. Nobody was ever transformed by being pointed at a 40-page PDF.

Strategy never stops

Launching is the easy bit. The test comes around month four, when the launch energy has faded and the day job has crowded back in. Much of successful strategy is boring, relentless discipline: keeping it as the thing people talk about, decide against and return to, long after launch. Our guide describes strategy as a continuous cycle of learning, adaptation and conversation, never a one-off exercise. That means ownership spreading well beyond those with strategy in their job title, from the board to the night shift.

Ten years in, we are still learning these lessons ourselves, and the first one still bites hardest. Saying no is as difficult for a consultancy as it is for a health secretary. But strategy remains one of the most powerful tools an organisation has, and every one of these lessons is within reach.

Kaleidoscope has supported strategy development across the NHS for ten years. For a copy of our ‘Little guide to strategy’, or a conversation about your own, email hello@kscopehealth.org.uk.