Developing strategy in the NHS - mission impossible or essential leadership task?

I’m rarely stuck for words, but recently I found myself struggling when a friend of mine (a director in an NHS foundation trust) asked, ‘How can we possibly plan for the next few years?’ We had been talking about how the health sector can best respond to the quality and financial challenges it is facing. Her frustration was evident and, I imagine, shared by thousands across the sector.

So, just how can the sector plan ahead for an uncertain future?

At Monitor, I regularly speak with people in health care at all levels about their work, how it relates to patients and their organisation’s strategy. However, I notice that people can easily articulate the first two subjects, but not always the last and how it enables the delivery of safe and effective care.

At its simplest, strategy is a set of choices and principles to support the achievement of long-term goals, drawing on evidence and setting challenging but realistic timescales for achieving them. The best strategies draw upon expertise from staff, patients and other partners to guide and inform them.

However, developing organisational strategy is a demanding task – especially for senior leaders – whatever the sector. But does the complexity of health care make it a hard, if not impossible task? 

The answer is no. Or, at least it shouldn’t do.

Last year, Monitor commissioned independent research to assess the quality of strategic plans and planning capabilities at foundation trusts. While the review identified some clear examples of good practice, it also revealed that there was significant variation in capabilities across the sector.

In fact, only a small proportion of the sector was able to perform the full range of planning tasks to a high enough standard to produce well-articulated, evidence-based plans – plans aimed at enhancing patient outcomes, ensuring sustainability of local services and addressing underperformance.

By contrast, a large number of trusts struggled with some of the most important planning tasks and, in a limited number of cases, plans continued to overlook long-standing problems.

The easy conclusion to draw from these findings is that something needs to be done to improve this situation, but what, exactly? Improved strategy development and planning is within the sphere of influence of foundation trusts and other providers, but it needs to be unlocked.

This summer, Monitor worked with five trusts to learn from their experiences of developing strategy in order to develop guidance and a toolkit to help leaders and their teams to improve how they plan. Each trust faces different challenges in delivering care and has different opportunities in their local health economies or beyond. However, for all involved, having/developing a robust strategy is vital in either overcoming those challenges or maximising opportunities.

But strategy isn’t just about the future, it's also about supporting boards to manage the present. Professor Michael West conducted a study into prevailing culture and behaviours in the NHS which showed how a lack of clearly defined goals and highly variable support for staff are stifling the ability to provide high quality care.

Dealing with uncertainty is core to strategy development and should offer an opportunity for innovation and challenging ‘the way we’ve always done things around here’. Board members have to use their skill and judgement to lead these discussions and make clear and explicit decisions based on evidence, both to address the challenges facing the NHS and to deliver safe and effective care.

The role of leadership is critical in developing effective strategies that benefit patients. The five trusts I worked with show that developing these strategies is both possible and an essential leadership task, requiring head, heart, courage and, ultimately, great teamwork. 

Suzie is Development Director at Monitor and is a Health Foundation GenerationQ Fellow, www.twitter.com/bailey_suzie