Ken is a personal friend (he was best man for my marriage to Annie) and has been a professional management colleague in healthcare for over 25 years. In 1983 I moved 300 miles from my home locality as a (relatively) young and inexperienced manager to a big challenge in a new job in the National Health Service (NHS). I found myself in Torbay, Devon, England – a place where I knew no one.
The first person to make me feel welcome at work in Devon was Ken who at the time was the Administrator (which in those days (all but) meant CEO) of Torbay Hospital which has over 500 beds. Ken was very helpful to me from day one in all sorts of ways. He gave me great support and advice in a completely new locality where frankly, I felt completely lost.
I unashamedly ‘used’ Ken as my 'informal mentor' in those days and actually I still do.
As far as I’m concerned Ken is the best Chief Executive the NHS has never had.
Hundreds – possibly thousands - of people in the NHS have influenced me during my long healthcare management career. Ken – through his wisdom, guidance, experience and kindness has influenced more than most.
I hope you enjoy reading the interview and please respond with questions and/or comments for Ken.
Ken: Very boring and conventional I'm afraid. I joined the Bath Hospitals straight from school on their local training scheme for administration back in the swinging sixties. We were expected and encouraged to obtain the Institute of Hospital Administrators qualification and leave for higher things. This I did, working in Wiltshire before coming to Devon 36 years ago. I have been rooted to this delightful spot ever since but fortunate to have enjoyed a variety of jobs including planning, HR, and operational management both within the hospital setting and in the community. I retired four years ago but returned on a part time basis. Work is now my hobby.
Trevor: Can you pick a couple of excellent leaders you have worked for and tell me what it was that made them better leaders than the average manager?
Ken: Unfortunately I can only think of one that I have worked for (perhaps that says something more about me than them!) but there are several others that I have worked with who I would single out. The qualities that stand out are integrity; good communication skills; vision; a pragmatic approach and ability to secure alliances; and the personal credibility (ability/knowledge/understanding/judgment/objectiveness) that breeds confidence in colleagues.
Trevor: I’m interested to hear your opinions about the UK National Health Service particularly in the light of the current debate regarding universal healthcare in the US.
Ken: I've lived in the States for short periods and what stood out for me was the number of people working well into their old age, some of them very frail, in order to pay their healthcare bills. The anxiety that was generated was palpable. For a civilised society with top class acute facilities it is barbaric. The NHS offers free at point of delivery, comprehensive, cradle to grave, non judgmental care. But those strengths are also its main weakness in that it tries to do everything for everybody (often backed up by legal action) and thereby creates an impossible funding and ethical dilemma. It seems to me that the ideal system would be the best bits of both-one with minimum bureaucracy, that incentivises innovation, encourages self help and reliance, and is explicit in what it services it provides.
Trevor: What’s your opinion of doctors being involved in management?
Ken: The first thing to say is that not all doctors want to be involved in management. I can understand that because it’s not what they trained for and doctoring is tough enough without any further distractions. However they can't then complain if issues are not addressed to their satisfaction. The second thing to say is that a common misconception of doctors is that management is about sitting behind a desk, dealing with finances or commanding a bunch of recalcitrant staff. Its not. It’s about shaping the strategy; establishing the agenda; setting priorities; keeping maverick colleagues on side; and advancing the clinical capacity and skills of the organisation. It is vital that doctors play a full and leading role.
Healthcare is a dynamic business, there is a political dimension (both local and national) and teamwork is essential to reconcile the many and various competing demands. Without clinical leadership the organisation will flounder.
Trevor: Can a manager from any organisation manage a large hospital? – What are the unique issues in hospital management?
Ken: I see no reason why managers should not be recruited from outside the NHS provided they have the personal attributes necessary. However, there is a steep learning curve that needs to be climbed very rapidly. There is a multiplicity of professions, specialist interests and power bases. Understanding the connections, motivations and dynamics is quite tricky. Learning who the movers and shakers are, both people and positions, is crucial. Taking advice from seasoned operators and tapping into the organisational memory is a key skill.
As with any new recruit the early, honeymoon period is crucial in gaining credibility and it is even more important for external appointees.
Trevor: Looking back on your career can you identify some of the big differences in management say 30 years ago compared to 2009?
Ken: Looking back some of the decision making processes were pathetic. On the other hand we were much more liberated from the vast weight of rules/regulations/legislation that there is today. Thirty years ago there was more thinking-on-ones-feet and initiative. These days the NHS is far more risk averse and there seems to be a written protocol to follow for every little issue. Management can easily deteriorate into a tick box culture and this drives increasing specialisation.
Gone are the days when a young manager could be a jack-of-all-trades (master of none) and learn by taking a chance and making mistakes.
Gone are also the days of the "public service" ethic. There are still pockets of altruism but society has changed. The other obvious difference is that there is no longer a defined career ladder to climb. These days it is more of a flexible climbing frame to scramble across both within and outside the service. Trevor:
What advice would you give to young managers just entering their management career?
Ken: Healthcare is a fascinating subject so:
*Take a professional pride in all that you do.
*Respect, and learn from, all other professions.
*Seize opportunities to develop.
*Listen to what patients, their carers and front line staff are saying.
Trevor: Are you optimistic about the future of healthcare management here in the UK?
Ken: I am a natural optimist. I am confident that the NHS has a future and there will therefore always be a need for good management. The top guys though will need a much tougher skin, have to be more politically and publicly astute and find a way of imposing that public service ethic on an increasingly strident audience.
Trevor: Brilliant - thanks Ken – keep taking the pills my friend!