The Changing Role of the CEO in the NHS

1
The Changing Role of the CEO in the NHS
Presentation to the International Forum on
Quality and Safety in Healthcare 2008 Paris,
France
Stephen Ramsden, CEO, Luton Dunstable Hospital
NHS Foundation Trust
2
NHS managers A tradition of men in grey suits?

• Rather then being given the scope to help lead
  the reform of the NHS, Chief Executives were
  treated as little more than conduits for the
  policies of the Centre
• Frank Blackler, 2006

3
The Creation of a Performance Management Approach
in the 21st Century NHS

• Performance targets centrally determined
• Structures to implement and performance manage
  SHA
• Command Control
• Macho management style
• High turnover of NHS CEOs

4
Some CEOs like the operational stuff ? ? ? ? ?
5
2007A Year of Personal Challenge Opportunity

• 2nd year of NHS Foundation Trust Freedoms ?
  Liberation
• NHS initiatives Delivering Through Improvement
  Transformational Stories/Change
• Participate in Monitors Service Line Management
  pilot ? Devolution of autonomy Strategic
  Business Units
• New personal coach and strengthened Executive Team

6
First Change Myself

• Line accountability of Clinical Directors ?
  Medical Director
• Weekly Executive Team meetings move from CEO to
  Deputy
• Executives become more independent and more
  inter-dependent
• Time management (Productive Leaders)

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First Change Myself

• Focus on Transformational agenda
• Used story telling
• Vision to lead the NHS in Patient Safety,
  supported by improving patient and staff
  experience, fit for the 21st century NHS,
  improving delivery through SBUs
• Requires/allows
• Visibility - internal - Walkabouts - Big
  dots e.g. HSMR - external - Leading the NHS in
  Patient Safety

8
Results

• Executive Team more empowered ? next step to help
  them devolve autonomy to SBUs
• CEO more visible internally
• Being on the balcony and on the dance floor
• Not yet converting the CEO in touch into
  tangible changes in culture e.g. inertia often
  evident
• CEO more strategic Accelerating the
  transformation of Patient Safety at the L D

9
Adverse events 70 reduction
HMSR From 11 worse to 10 better
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A word on Style

• Level 5 Leaders
• Executive leaders build enduring greatness
  through a paradoxical blend of personal humility
  and professional will Jim Collins, Good to Great
• Not a macho larger than life approach perhaps
  more commonly associated with NHS leadership

From The Definitive Book of Body LanguageThe
Crotch Display, Allan and Barbara Pease write,
is used by macho men and tough guys. The
posture can show dominance or team solidarity.
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A Word on Stability

• Recently celebrated 10 years as CEO at the Luton
  Dunstable Hospital NHS Foundation Trust
• General Electric has had 12 CEOs in 123 year
  history!
• A recent study tour of USA e.g. Bellin Health CEO
  since 1992 (and Deputy together almost 30 years)
• .And in the NHS ?

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Can the NHS Change?

• Darzi Review leadership and leadership
  development
• NHS Reform moving to transformation phase and
  locally set targets
• System changes, including Foundation Trust
  movement
• NHS Institute programmes such as Delivering
  Through Improvement and Productive Leader
• Growth in Patient Safety /Transformational
  leadership challenge

13
Transform, inspire and lead

• If the CEO isnt leading transform-ational
  change, theres a good chance no one is