Today I have immense pleasure in publishing my latest ‘Friend of Simplicity’ interview with Ken Dainton.
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.
Trevor: Welcome Ken - Please give a brief history of your career.
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!
This is the 1000th posting I have written on Simplicity Blog andI have responded personally to every comment. We have created a bit of a community.
Simplicity Blog has become an important part of my life.
I would be fascinated to hear your reflections regarding Simplicity Blog – does it still hit the right spots for, at least, some folks?
As for me, I still love writing the Blog and find it a great way to get my views and feelings ‘out there’ about leadership and management. Thanks to all readers and commenters for your terrific support over the last 999 postings – you are my teachers - and here’s to the next 1000!!!
Best wishes – always keep it simple.
Below is what I wrote in the very early days and I don’t think my views have changed at all in the (almost) five years since I started my Blog. ------------------------------------------------
Post Number 1 on 22 January 2005
I love communicating and blogging is the latest way of doing it.
Isn't it wonderful how we can now share thoughts instantly with like minded people from all over the world about how organisations are led and how things need to change?
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Post Number 3 on 24 January
My passion is to dispel the myth of complexity in management and leadership.
After all, complexity is merely the sum of simple parts. Management is not complicated at all ….we just love to make it complicated.
I also love lists.
This is a list of 17 things I believe. Yes 17 is a strange number. There is no mystery or significance in 17 - that is as far as I got!
So here goes .....things I believe with a passion - not in priority order 1. Staff at the front line know all the answers all the time 2. The words “managing people” should be exorcised from the workplace. Nobody “manages” people any more - people manage themselves. 3. If a manager has any job at all in 2005 it is to move heaven and earth to make it easier for front line staff to do neat work 4. Get other people to do bits of your job - they usually do it better than you 5. Management is simple 6. Leadership is not - it is an art form 7. The basics are the new cutting edge 8. I’m not convinced leadership can be taught 9. Give all the budget to front line staff ….yes I did say all the budget 10. Complexity is merely the sum of simple parts 11. Forget MBA think MST (Masters in Story Telling) 12. We are all Chief Executives of our own future 13. “Powerlessness is a state of mind - not a state of reality” Tom Peters 14. I don’t know what “a big organisation” means in 2004 15. I would take a pay cut for some leaders ….I would not follow some leaders if they doubled my wages 16. Our greatest motivation is always from within 17. The older I get the more I like words like “difference” and “diversity” …and the less I like words like “right” and “wrong
I realise I run the risk of losing all credibility and friendship with my many US friends in publishing the following. It was a letter written by comedy actor John Cleese in his character Basil Fawlty from the classic British TV Sitcom "Fawlty Towers." It was first published at the time of the election for the second time of George W Bush - hence the reference to Tony Blair.
I promise my friends on the left hand side of the pond this is meant to be funny - hope the Brit humour travels.
JOHN CLEESE LETTER TO THE USA
To the citizens of the United States of America:
In light of your failure to elect a competent President of the USA and thus to govern yourselves, we hereby give notice of the revocation of your independence, effective today.
Her Sovereign Majesty Queen Elizabeth II resumes monarchical duties over all states, commonwealths and other territories. Except Utah, which she does not fancy.
Your new prime minister (The Right Honourable Tony Blair, MP for the 97.8% of you who have, until now, been unaware there's a world outside your borders) will appoint a Minister for America. Congress and the Senate are disbanded. A questionnaire circulated next year will determine whether any of you noticed.
To aid your transition to a British Crown Dependency, the following rules are introduced with immediate effect:
1. Look up "revocation" in the Oxford English Dictionary. Check "aluminium" in the pronunciation guide. You will be amazed at just how wrongly you pronounce it. The letter 'U' will be reinstated in words such as 'favour' and 'neighbour'. Likewise you will learn to spell 'doughnut' without skipping half the letters. Generally, you should raise your vocabulary to acceptable levels. Look up "vocabulary."
Using the same twenty seven words interspersed with filler noises such as "like" and "you know" is an unacceptable and inefficient form of communication. Look up "interspersed." There will be no more 'bleeps' in the Jerry Springer show. If you're not old enough to cope with bad language then you should not have chat shows.
2. There is no such thing as "U.S. English." We'll let Microsoft know on your behalf. The Microsoft spell-checker will be adjusted to take account of the reinstated letter 'u'.
3. You should learn to distinguish English and Australian accents. It really isn't that hard. English accents are not limited to cockney, upper-class twit or Mancunian (Daphne in Frasier). Scottish dramas such as 'Taggart' will no longer be broadcast with subtitles.You must learn that there is no such place as Devonshire in England. The name of the county is "Devon." If you persist in calling it Devonshire, all American States will become "shires" e.g. Texasshire Floridashire, Louisianashire.
4. You should relearn your original national anthem, "God Save The Queen", but only after fully carrying out task 1.
5. You should stop playing American "football." There's only one kind of football. What you call American "football" is not a very good game. The 2.1% of you aware there is a world outside your borders may have noticed no one else plays "American" football. You should instead play proper football. Initially, it would be best if you played with the girls.
Those of you brave enough will, in time, be allowed to play rugby (which is similar to American "football", but does not involve stopping for a rest every twenty seconds or wearing full kevlar body armour like nancies).
You should stop playing baseball. It's not reasonable to host an event called the 'World Series' for a game which is not played outside of America. Instead of baseball, you will be allowed to play a girls' game called "rounders," which is baseball without fancy team stripe, oversized gloves, collector cards or hotdogs.
6. You will no longer be allowed to own or carry guns, or anything more dangerous in public than a vegetable peeler. Because you are not sensible enough to handle potentially dangerous items, you need a permit to carry a vegetable peeler.
7. July 4th is no longer a public holiday. November 2nd will be a new national holiday. It will be called "Indecisive Day."
8. All American cars are hereby banned. They are crap and it is for your own good. When we show you German cars, you will understand what we mean. All road intersections will be replaced with roundabouts, and you will start driving on the left. At the same time, you will go metric without the benefit of conversion tables. Roundabouts and metrication will help you understand the British sense of humour.
9. Learn to make real chips. Those things you call French fries are not real chips. Fries aren't French, they're Belgian though 97.8% of you (including the guy who discovered fries while in Europe) are not aware of a country called Belgium. Potato chips are properly called "crisps." Real chips are thick cut and fried in animal fat. The traditional accompaniment to chips is beer which should be served warm and flat.
10. The cold tasteless stuff you call beer is actually lager. Only proper British Bitter will be referred to as "beer." Substances once known as "American Beer" will henceforth be referred to as "Near-Frozen Gnat's Urine," except for the product of the American Budweiser company which will be called "Weak Near-Frozen Gnat's Urine." This will allow true Budweiser (as manufactured for the last 1000 years in Pilsen, Czech Republic) to be sold without risk of confusion.
11. The UK will harmonise petrol prices (or "Gasoline," as you will be permitted to keep calling it) for those of the former USA, adopting UK petrol prices (roughly $6/US gallon, get used to it).
12. Learn to resolve personal issues without guns, lawyers or therapists. That you need many lawyers and therapists shows you're not adult enough to be independent. If you're not adult enough to sort things out without suing someone or speaking to a therapist, you're not grown up enough to handle a gun.
13. Please tell us who killed JFK. It's been driving us crazy.
14. Tax collectors from Her Majesty's Government will be with you shortly to ensure the acquisition of all revenues due (backdated to 1776).
Thank you for your co-operation.
* John Cleese [Basil Fawlty, Fawlty Towers, Torquay, Devon, England]
For me its really important – always has been – always will be. I think it's partly to do with my late beloved Dad’s strong work ethic and the example he set. It was drummed into me from my earliest days. Dad always said “you get nothing for nothing.” He always told me to work hard in whatever I did.
I’ve always taken work seriously and I have to say a few years ago, far too seriously and at the expense of my health.
That brings me to a really tricky discussion and I would be fascinated to hear from you about this topic.
I began thinking about this last night when I was listening (yet again) to some of my favourite Eagles tracks and came across the Don Henley classic “New York Minute.”
The lyrics of this song always send shivers down my spine:
“Harry got up Dressed all in black Went down to the station And he never came back They found his clothing Scattered somewhere down the track And he won’t be down on wall street In the morning
In a New York minute Everything can change In a New York minute Things can get pretty strange In a New York minute Everything can change”
The song is a story of a New York City Wall Street worker who lost his way somehow and decided to end it all in front of a train.
Now I’m older I can say I agree 100% with my Dad’s philosophy. Work is good for our physical and mental health. The problem starts when work becomes too important, relative to other parts of our life.
Work gives us a sense of belonging; a sense of achievement; and it boosts our self esteem. Never under-estimate the importance of work in our total make up.
Having said all that, work should not be allowed to become such a controlling factor that it drives us to the edge of despair and sadly in some cases such as 'Harry' - over that edge.
It’s a fragile line and as Don sings those haunting words .... “In a New York minute, everything can change”
In my career I've had to re-assess my position regarding career choices on a number of occasions - we all do that. I am not for a nanosecond suggesting we shouldn’t worry about work – worrying about it keeps us performing to some degree. When worries about work turn into clinical depression we need to look for help and talk about how we feel. My great guru and life supervisor Professor George Giarchi often uses the expression “This too will pass”
Speaking from personal experience I would say George is right.
I can't help thinking managers don’t spend enough time getting alongside their front line staff.
The more front liners I meet – around 1000 in the last year - the more ‘disconnect’ I find between managers and front line employees.
Front line folks who REALLY rate their managers tell me their manager spends time with them. The front line employees who are critical of their manager invariably see one of the biggest problems that their manager spends far too much time behind their office door away from front line action.
This is not a surprise to me – it’s what I’ve been saying for more than 30 years.
When I started one of my healthcare jobs in 1989 I spent the first month of the job doing nothing but meeting people who worked on the front line interacting with patients. This was brilliant education for me and it felt like the employees enjoyed the experience of showing this ‘new guy’ the ropes about what they actually do.
I wrote up my feelings about that month and submitted it to my bosses in the form of a report called ‘I’m Pleased I Asked the Questions.” One of the bosses I respected most –sadly now deceased - wrote me a letter in reply that I wish I had kept.
He said this:
‘Trevor – As a manager you have undoubtedly chosen the most difficult route to lead and manage. The most difficult, but the most rewarding. Too many managers take the simple option – they sit behind the comfort of the office door and let the system take the strain. Good luck in your career.’
So here we are in 2009 – 20 years later - nothing changes it seems to me.
Why do some managers not get themselves off their backside – out of the office and talk to their front line folks? They are your greatest teachers.
Maybe it’s just me but this stuff is really simple.
Without a doubt one of the greatest joys of my professional life is that I now meet ‘virtually’ many people from all over the world. I would not have had the opportunity to ‘meet’ these people without the aid of the internet, email, blogging and the myriad of other modern communication methods at the fingertips of all of us.
In addition I've spent all my working life meeting and working with thousands of wonderful colleagues from all over the world in my healthcare management career.
Some of the challenges this brings include creating a common language and understanding the subtle (and often not so subtle) differences we have, depending on our nationality, our upbringing and our work experiences – in other words, the culture we live and work in.
It has become clear to me – often through mistakes I’ve made - that we are all different; generalisations are not helpful; and what make us tick is as different sometimes as chalk and cheese. Failure to recognise and respect those differences is a huge deficit. Like most managers, I imagine, I’ve learned mainly through experience about these things. I have delivered training workshops on the joys of diversity and I’ve read a few articles on the subject. But I've not found an easy to read guide about all this … until now.
For anyone whose work involves understanding cultural diversity and the nuances of different cultures (by the way - that means ALL of us) I recommend with great enthusiasm a book I’ve just finished reading;
This book by Charlene M Solomon and Michael S Schell is crammed with practical ideas and suggestions of how to work in a multi-cultural business world. It gives the reader an opportunity to assess one’s own cultural position on each of the seven dimensions considered by the authors as the key planks in recognising and working in a multi-cultural business world.
The book includes real world scenarios where ‘missing the trick’ of recognising, and more importantly, respecting cultural differences is not just an unfortunate oversight that can cause offence. It can also mean failure on the bottom line financially in a big way and result in missed business expansion opportunities.
As I read the book I found myself saying that this stuff is actually more than about how to manage across cultures. It is in fact about managing - full stop. I suggest the kind of respect and awareness called for in this book is as applicable working within a single culture population.
I congratulate the authors for such an insightful and brilliant reference book that will be regularly used by this trainer/consultant in my work.
The world is becoming a very small place. I often say that I now have more friends that I don’t know and may never meet than those I have met. “Managing Across Cultures” is a book I highly recommend.
It is written in an 'easy to read' style that I suggest ‘travels’ across cultures which of course means the authors are also 'walking their own talk.'
Today I have immense pleasure in publishing my latest ‘Friend of Simplicity’ interview with Ken Dainton.
