I spent a big chunk of yesterday in an internal workshop with the senior leadership team of the area I work in. The aim - ostensibly - was to work out how we could make faster progress. Failing that, how could we make it look like we were making better progress to the senior execs of the organisation? It was branded as a "Velocity Workshop".
The fact this latter point was clearly stated speaks volumes: this was as much an exercise in 'spin strategy' as it was an attempt to identify actual blockers and action that could be taken to resolve them.
In reality, most of the things making progress slow relate to the wider corporate environment, particularly extreme levels of bureaucracy which infect everything.
For example, it can take more than 3 months to gain approval for a new Statement of Work (SOW) - essentially a time-boxed piece of work for a specific team - for an on-going project which already has a full business case, financing and approvals.
The SOW needs multiple approvals within the organisation (from the budget holder, finance, senior management, digital assurance team etc etc) but then also needs wider government approvals from the Department of Health & Social Care, from the Government Digital Service (GDS) and now from a cross-government system called GAtS (Getting Approval to Spend).
This represents a massive overhead and a huge brake on progress. But, as well as these practical constraints that soak up time and effort in a completely unproductive way, prioritisation is also a major problem. By this I mean an almost total lack of prioritisation.
Generally if you really want to get something done, you need a laser-like focus on the most important thing, and a gearing of as many resources as possible to move this forward. Back in the real world of NHS England, there is almost no attempt to do this. Often this leaves individual teams competing against each other for resources and for priority in 'bottleneck' areas, in what is effectively a succession of zero-sum games.
Some of this derives from NHSE's business model, whereby new work and priorities are not always managed into the organisation from the top or in any kind of systematic way. Instead, individual ministers often develop their own projects or areas of interest working directly with the teams concerned, effectively leap-frogging NHSE's hierarchy.
Add to that the tendency for individual teams - sometimes lobbied or led by external contractors - to push projects for their own interests, and you get layers of management who have no effective control over the organisation's portfolio of work. The only levers they have are those that enable them to prevent work happening or at least slow it down.
Moving from the specific to the general, we can see several organisational traits emerging:
- An organisational leadership and hierarchy that does not fully control its business or priorities, resulting in unrealistic and unachievable expectations
- Organisational leaders who are never likely to fulfil the unrealistic expectations heaped on them, so must constantly decide who they can afford to disappoint
- An organisational leadership whose main levers are negative ones exercised through bureaucratic constraints (often just the weight of 'process')
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