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According to The Telegraph, Mr Jeremy Hunt, Health Secretary of Her Majesty’s British Government has declared that doctors and nurses should run the National Health Service as opposed to ‘managers with no front line experience’. According to him, the creation of management layers in the 80s was a mistake.

Very popular, perhaps, but bonkers.

Front line experience does not give anybody managerial or leadership capacity. If we were to apply the Hunt Bonkers Rule 1, many CEOs of companies would be declared unsuitable. Many of them come from a finance background, or R&D, or strategy, and, equally, not many of them have been salesmen of first line marketers. There are entire multinational corporate affiliates run by ex-manufacturing people and global commercial pharmaceuticals run by ex-heads of R&D. Whoever is skilled and qualified, is the right one, whether a doctor or not, a nurse or not, plus any of the unnamed, physiotherapists, clinical psychologists, HR heads and Chief Porters.

That was Bonkers 1. Bonkers 2 reads ‘An MBA is to be created so clinicians can study leadership’. MBA is the last place in the world to ‘study’ leadership. The Health Secretary can send anybody to do an MBA and I am sure they will benefit from what an MBA can give. But this will be equally valuable, or not, to clinicians, procurement administrators, dentists, ambulance services directors and accountants. MBAs are not the main source of leadership.

Bonkers 3 is ‘Doctors and nurses will be sent to universities, including Yale, to prepare them for management positions’. Very good luck to all. The idea that universities prepare for management positions at that level is naive to say the least. OK, more than that, it is bonkers. Also, if I were the head of UK universities (I realize there isn’t one, but let’s pretend) I would be very annoyed with the ‘including Yale’. Somebody has been selling something to him.

And probably all of that will be unchallenged because it will be popular. Managers are bad, poor doctors and nurses, if they could just be given the keys of the kingdom. Speaking as somebody who holds both an MD and an MBA, I would argue that the logic of banking on these ‘front line professions’ is, well, bonkers. Some doctors have no managerial ability, nor they want one. Some specialists work in a rather isolated world. An excellent ‘front line’ cardiologist may be both a Nobel Prize candidate and the last person you’d like to see in charge of a hospital. Some physicians are delightfully sensitive to the human condition, others have the emotional intelligence of a fish cake. And fish cake is not a condition of leadership. You don’t have be a psychiatrist to run a psychiatric hospital, nor the asylum should be run by inmates. You do not need to have led a platoon in Afghanistan to be Defense Minister.

I would prefer hundred times a brilliant leader with zero front line experience than a mediocre leader with hundred points of frontline stuff. Nurses and doctors have a trust advantage over all other possible professions  in the country. Some of them may be excellent formal leaders (I think Mr Hunt is thinking  administrators, though), others would be excellent role models and high influencers over the entire workforce and the public. The trust advantage does nor necessarily lead to administrative and managerial advantage.

And yet, it would take very little for Mr Hunt to look deeper inside the shop. The NHS has incredible hidden and un-used capacities. Some hospitals run in a incredibly innovative way, but not well publicized because ‘good’ does not make headlines in the British Daily Mail. Internal, central Transformation groups in the NHS are state of the art in people mobilization. There is a myriad of other pockets of excellence. Let them do, flourish, lead, scale. Led by nurses, doctors, physiotherapists, psychologists, accountants or porters if any can lead. Mr Hunt should perhaps look inside, not in Yale.  ‘Straitjacket Removal’ is the key competence, if you want one.

By the way, the NHS ‘problem’ is a wicked problem, and no amount of managerial training for  ‘front line’ people, or anybody in isolation,  will solve it per se.

Mr Hunt’s Bonkers Idea summary is that Manichean, populist, naïve, uncritical thinking, and intellectual flawed one of ‘managers are bad, doctors are good’. How smart to alienate your entire managerial population.

The problem is that one gets used to Bonkers Ideology. It’s the new black. In the era of post-truth, the world is flat, and trumpism logic, anything goes and rationale would remain unchallenged. And I am afraid Mr Hunt’s (Bonkers) prescriptions will be incredibly popular. Maybe not as a Mexican wall, but, hey, who knows.

If politicians could have some critical thinking and common sense, we would have a better health service in the UK. I am not optimistic on that assumption.

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  1. Susan

    Brilliant post. Many organisational problems are wicked problems with no easy answers. And the idea that MBAs prepare people to be leaders has been thoroughly argued against by Henry Mintzberg. The sad thing is that people seem to think complex problems are solved by simple solutions.

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