Professor Henry Mintzberg

Henry Mintzberg, OC OQ FRSC (born September 2, 1939) is an internationally renowned academic and author on business and management. He is currently the Cleghorn Professor of Management Studies at the Desautels Faculty of Management of McGill University in Montreal, Quebec, Canada, where he has been teaching since 1968

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Evening, Prof….

Ok – that’s the WikiPedia background.  Now onto meeting and listening to the man himself:

They say you should never meet your heroes, for fear of disappointment. I met Henry Mintzberg, erstwhile management thinker and writer during my OU MBA course, in print, and was always fascinated by his thinking. I was lucky enough to meet him in person at two meetings at The Kings Fund in London.  The first was under the auspices of The Institute of Healthcare Management – an intimate affair with lots of question space. The second meeting was an NHS Health Chat, with Roy Lilley interviewing Henry. (Film of the meeting available here)

I wasn’t disappointed.

Much of the Profs work has started out very simply. “All I did was get down on the ground and saw what was going on. Then just wrote that up.  My findings were always just the patently obvious, but no-one was doing that”.

Healthcare has always been part of his research interest.  His latest book “Managing the Myths of Health Care” is as provocative as the title suggests. Anything that says after just a few preliminary pages, that Health Care is not failing, but succeeding, expensively, and we don’t want to pay for it. So the administrations, public and private alike, intervene to cut costs., and therein lies the failure”.

His thinking is always nuanced, not in extreme ideological positions.  There is great debate on Globalisation in the worldwide political sphere as we speak.  It is black and white, good or bad, as far as most report their views.  Henry?  “I’m for and against it”. I needed to listen more closely ( and as with all my summary blogs of talks, I may miss things that you would hear differently. And I will allow my opinions to the fore. So, this is not a report, it is a view…).

The myths were discussed a lot in this chat. Especially the ‘not failing’ view, but just succeeding expensively. The chat then veered into how organised or not organised health care is.  With the rejoinder that it is very easy to reorganise for short term patch up of problems.  Anyone can do that.  The book then goes onto how do we reframe the whole.

John Stephens and Henry Mintzberg

Henry with Simon Stevens, NHS England

His stories and observations drive his thinking and opinions.  More than for most of us. And he is still learning. Outsiders can give some ideas, but insiders need to drive change.  Budget constraints provide focus, sometimes.  Those in middle management can feel constrained and demoralised (ain’t that the truth!). Quotes abounded too.  “If you have responsibility, you don’t need accountability”.  He made the case for looking for causes (whether problems in an institution, or a health care issue), rather than cure.  In the main, I agree.  We still have a National Sickness Service in the UK.  Health promotion is in the mix, of course, but always feels like the poor relative.

Fascinating tangent on measurement: in his hometown of Montreal he asked his local hospital chief why they measured so much?

“What else do you do when you don’t know what’s going on?”.

We’ve all heard paralysis by analysis…and Henry’s line was a chapter title “Analysis:analyse thyself”. My line is “You can disappear up your own analysis”. And, another favourite, “you don’t fatten a pig by weighing it”.

What is efficiency? As soon as you use a word like that, it isn’t neutral.  We measure what is measurable.  I think we measure what is easy to measure, distorting what is not measurable.  It may mean we cheapen what is really important.

Good enough, or World Class? Best, in a competitive situation, may not be good enough. Too low a standard, as prof said! Good may be your best.  Every person to be their best? Is that how we get to being more than good enough?

And what vehicle to make that happen? Collaboration, versus self interest, may be easy to say.  He talked of Communityship, a refocus on society.

In the evening session, softly interrogated by Roy Lilley, we learnt a bit more about why Prof Mintzberg was so against ordinary MBA programmes.  (A show of hands proved a good 25% of his audience were MBA graduates). “Wrong people taught the wrong things at the wrong time.  You don’t learn to swim in a classroom”. Most of the grads there were mature students originally, so that takes care of wrong people wrong time.  But I agree with the supposition that function expertise can be learnt – marketing, strategic planning, finance – but not hands on people skills.  University of life for that, I feel. His triangle of Art, Science and Craft, standing for people and soft skills, analysis, and expertise, rang true for many. To improve the selection of managers, he suggested those they have managed before should input into the process.  Blindingly obvious, but rarely done?

Simplifying the message was a core theme repeated often by the Prof.  So I will do the same:

  1. Why do we obsess about data and analysis? We only measure what is easy to measure, not what is truly important.
  2. Stories and anecdotes are your company culture
  3. Remote control management fails, every time, over hands on, getting down on the floor
  4. Management is what we do. He is not a fan of leadership (Hurrah….I always fell out with the writings of Warren Bennett over this.  We all do both.  One isn’t better than the other).
  5. Everyone has something to input. Hierarchy can stifle that.

Finally he said that Healthcare is a calling, not a business.  If we can just do that, with everyone aiming to think how can I get better at my job today, and keep the crass business models out of Health, then we can let Communityship flourish.

Just a final thought.  US healthcare costs 11.5% of GDP.  U.K. is 6.3% – and is universal.  Just experienced the NHS at its best at a minor injuries unit in Tewkesbury, on a Sunday. Triaged and fixed in 45 minutes.

I know where I’d rather live.

Helen Stokes Lampard, Chair RCGP

Helen Stokes Lampard

“It was a fair fight for the position. Four candidates. I won.”  We expect Roy Lilley’s chats to be rather more combative than fireside, but that was a fairly typical response from Helen.

Not only chair of the Royal College of General Practitioners, but one day a week partner in General Practice in Lichfield, And in her spare time, Governor of the Birmingham Women’s NHS Trust.

Where did it start? A penchant for science, led by role model who was dad, in Swansea who taught science. Excited by Dentistry, through another role model who she stayed with one long vacation. She made the job sound very enticing. (Funny how a lot of role models and influencers are passionate about their work…). Salutary first underachieving at A levels was a useful life lesson, and St Georges beckoned after the second attempt. “Why not Welsh medical school?” “Family would have loved it, but as a teenager, I wanted to be far away!” House jobs through a swap, back in Wales.  Then a fun serendipitous turn of events….a penchant for research led to a PhD (so a proper Doctor!), which changed gynaecological screening in the UK. This led to joining an unusual (but shouldn’t be?) training scheme.  Half GP trainee, half academic research.  Then later in Birmingham, added in learning to teach soon.

I only give all the background because it does inform the view of the person, and how they have got there.  Although this is always my personal opinion, you can watch the whole interview free, clicking on here for the NHS Managers.net YouTube channel.  But I really got Helen’s passion, drive, intelligence and vision. Motto of the RCGP was repeated a few times. “Scientific knowledge applied with compassion”. Anyone can trot out platitudes, but I got the feeling she not only meant it, she lived it.

As ever, we learnt as much about Mr Lilley’s foibles as the chatee…”Why women’s hospital…we don’t have men’s….”  “What about getting me an old geezer GP – I’m not seeing a woman!”.  Then a bit more banter level “You fell out with the builders at the new office, 30 Euston Square?” “And we won the dispute”. I was really enjoying the instant replies.  NHS was castigated as a non family friendly employer.  Crèche spaces as rare as rocking horse droppings.  This moved us nicely onto that nights publication of the RCGP manifesto – out long before the political parties have managed theirs for the election.

The theme and main thrust of the evening was around is General Practice about to wither away? A simplified 6 part plan to save the NHS loomed over the audience (embargoed until midnight that night, but we kept getting sight of it as Roy continued to be naughty!).

(You can see the Manifesto here)

The election should not just be about Brexit.  The entire population needs healthcare. And everyone has a story, opinion and bias about “our NHS”. Here’s my notes on the 6 steps to save the NHS.

  1. Fund primary care so the GP 5 year forward view can be delivered
  2. Support euro and overseas employees, healthcare and allied professions.
  3. Extend GP training to 4 years from 3. They are “expert medical generalists”, and the job is more complex than ever. Cheaper in long term.
  4. 5000 more GPS by 2020
  5. A new return to work initiative for nurses, mental health professionals and pharmacists to join the multi faceted teams needed for evolving general practices
  6. Sort out the spiraling costs of GP indemnity insurance – yes, if mistakes happen, sort it, but not ambulance chasing.

See the whole here, but I like the simplifying.

70% of NHS costs are people.  We cannot just make the savings asked for from efficiency of the 30%.

What else for the future?  More remote consultations? Maybe it has to be “good enough” for some situations? I do feel one size doesn’t fit all.  And we all have different needs for different conditions  ( notwithstanding maggots in the scrotum, which Roy quoted twice, from Mormon a west end musical…don’t ask…). Maybe Skype, or apps like Babylon, or Face Time, or just the mobile phone, or near patient testing can help some people sometimes? Best quote of the night ? Roy: “There’s no silver bullet here, but maybe there is silver buckshot”. Primary Care Home is being successful in some places.  Sustainability and Transformation Plans (STPs) occasionally left GPS out of the solution – until hospitals told some of the local planners not to be daft. We do need to grow the wider GP team.  We do need the holistic approach of Primary led, secondary fixers and social care support to become fully dovetailed and smoothly transitioned. There need to be more new ways of working, and GPs tend to be active early adopters.  It feels like Helens vision around recruiting, retaining and returning of all the allied healthcare professional teams will help drive it all forward rather than over a cliff.

Some other great ideas about social prescribing, the tripod of social care, primary and secondary care, GP in A & E, other folk appropriate to the patient need (paramedic in out of hours triage, for example).

It was an evening full of hard hitting practical do-able ideas that were not scary or mad or just talk.  It feels like we just need the powers of persuasion to make the talk stop and the action start.  Helen Stokes Lampard is highly persuasive innovative and very hard to ignore.

Whoever wins the election, please be aware she will come knocking…and won’t take no for an answer.