Queen’s Medical Centre, Nottingham University Hospital
I read an inspiring interview in Health Service Journal last week with the fairly recently appointed chief executive of a large NHS Trust facing a massive turnaround challenge. Anthony May, recruited last year to Nottingham University Hospital following many years as a successful chief executive of a large local authority spoke of the importance of providing the organisation with “hope” and of his visibility throughout the Trust. He also commented that the problems faced by the organisation had resulted in it spending too much time looking inwards and that it now had to rebuild relationships with its stakeholders. This resonated with my experience chairing to two NHS organisations through turnaround where I worked in support of two outstanding chief executives. A sense of hope and what I recall describing to colleagues as “something to believe in” is part of the “Dark Matter” that makes organisations more than the sum of their parts. And these are things that can only be created and communicated by a leadership team who are highly visible.
It has taken a few days for me to find time to blog about the interview. Returning to the on-line interview, I discover that it is now accompanied by a dozen or so comments from May’s colleagues. They are all anonymous (which enhances rather than diminishes their credibility) and all clearly come from within NUH. Some are very supportive. All confirm the scale of the task confronting May and the Trust. Some more sceptical, although they suggest an impatience in the delivery of the turnaround – but, as another comment points out, given the toxicity of the culture that May has come into it seems unreasonable to expect a turnaround to be completed overnight. Other comments have descended into a mudslinging between front-line and support services staff, only confirming the cultural challenge. Others display a degree of cynicism: one expresses this in a constructive tone, remarking “Always conscious a few quotes could be taken out of context but CEO needs to be careful here he doesn’t look to subscribe to the ‘great man/heroic leader’ school of management. Always implodes in due course.”
The commentators also remark on the intrinsic challenges that NUH faces because of its size, its spread across multiple sites, and its complexity. They also comment on the distraction provided by past M&A activity, regrettably something that has been, and continues to be in fashion in the NHS (many years ago I undertook an analysis that suggested an inverse correlation between NHS trust size and both financial performance and quality of care), and is consistent with most of the work undertaken in the private sector suggesting value destruction from M&A).
The delay in writing this blog piece is fortuitous. My enthusiasm for Anthony May’s comments is undiminished, but the comments highlight the challenge he faces and the need for him to sustain his effort and commitment as he has a long, hard road ahead. I wish him well.
Patrick Nash, author of Creating Social Enterprise[1]I knew very little about Patrick Nash when he joined me in 2019 as an angel investor and advisor at Tranquiliti, a start-up providing an innovative mobile phone app mental wellbeing tool for school students and their teachers. I didn’t know much more when we were bought out in August last year by Tes Investments[2], other than what I gleaned from our monthly video call with George and Aaron, Tranquiliti’s founders, which was essentially that Patrick knows a thing or two about social enterprises. He proved a source of sound advice to them and had a similar appetite for risk and the level of investment as me.
A couple of weeks ago, he invited me to a book launch in November. I explained that I would be travelling to New York but promised to buy the book and read it on the plane. Amazon already had “Creating Social Enterprise” in stock and a train journey created the opportunity to get stuck into it right away. It proved hard to put down and I quickly concluded that it deserves the “If you read only one business book this year, read this” accolade. Scrutiny of the spine shows the publisher to be Patrick’s own company[3], so I doubt whether it will get the push (although it would from any self-respecting business book publisher) in the direction of the shortlisting for FT Book of the Year 2024 that it deserves .
While I was studying for an MBA at the Stanford University Graduate School of Business and serving my apprenticeship at McKinsey, Patrick was doing alternative stuff and getting his first taste of commercial life at Nova[4], a whole food co-operative in Bristol. He drove the company van, turned the handle on the trail-mix mixer, learnt a range of valuable lessons about people, customers, marketing, margin management, cash-flow, risk, systems implementation – loads that you have still to learn when you graduate from Harvard, Wharton or LBS – and, importantly for his own development, undertook a crash course in double entry book-keeping (something I did learn in the first term at the GSB) from his father when the founder’s ill-health meant he had to step back from the business at short notice.
Scarred by the experience of putting Nova’s stock system onto computer (Patrick’s Learning#8 in the book is “Never Trust ‘should’” as in “This should work” or “It should be ready by then”) and burnt out by three years without a holiday, he took a spell away from work. A few months later, he discovered the Findhorn Community. Most people are drawn to Findhorn in the search for a more spiritual focus to their lives but Patrick was sufficiently intrigued by a conversation with its finance director that he joined it to work in its accounting and finance department. Rather than finding himself spiritually, he stayed on to lead the project to develop its Ecovillage (the first homes were built from giant whisky barrels), where he “learned much of the complexity of running organisations, raising funds, creating multiple corporate structures and leading teams”. During his ten years with Findhorn, Patrick learned a lot more about running a successful business, not least about managing external and internal stakeholders. He describes this time as a “significant phase in my social enterprise journey. Many of the skills I have deployed as a social entrepreneur were developed there”. But lessons and consequent skills are not just for the social entrepreneur, most of them translate into any enterprise, public or private, large or small, and independent of industrial sector.
Although Patrick has established twelve social enterprises, charities and values-driven businesses in all, his greatest achievement was establishing Connect Assist, a specialised 24/7, outsourced call centre supporting multiple clients from the public, private and third sectors (including Versus Arthritis where I spent 8 years as a trustee), employing over 450 people in a part of south Wales where employment has still not recovered from the demise of coal mining. The third part of Creating Social Enterprise tells how Patrick developed a string of businesses that evolved into Connect Assist after first joining the Teachers’ Benevolent Fund, a charity operated for the teaching unions. In this role he took the lead in some tough decisions, including closing TBF’s legacy residential homes for retired teachers (he is the first to call out the case for closing businesses that are loss making and no longer fulfil their purpose) and pivoting the organisation to become a telephone counselling service, setting him on the path towards establishing Connect Assist.
Patrick has great stories to tell, including how, along the way, he had the Dalai Llama as his boss when, for a few years in between the big projects that are the meat of Creating Social Enterprise, he was CEO of the Tibetan Relief Fund. He tells tales of scrapes with the law as a twenty-something driving a whole-foods van around the country, when the grass roof of a house in the Ecovillage bursting into flames, and the thrill and relief at securing financing for assorted projects at the eleventh hour. These come across with a freshness as though they only happened yesterday rather than ten, twenty, thirty or even forty years ago.
He has built the account of his career around no fewer than 44 learnings, drawn out at the end of each chapter and recapped at the end of each of the three major sections of Creating Social Enterprise. Most, if not all, are relevant to anyone who picks up the book. As someone who preaches the importance of purpose and values to a business (as part of the Dark Matter that makes organisations more than the sum of their parts) I turned the page corner down at Learning#3: Align values and commercial interests. I did the same at Learning#38: Empathy is the new superpower, as I have no doubt that being able “to understand another person’s thoughts and feeling is a situation from their point of view, rather than your own” is essential to effective leadership based on trust. And his observance of the final sign-off learning, Learning#44: Moving on when it’s time to leave was the one that positioned Patrick for life after Connect Assist where, from the comfort of home on the Pembrokeshire coast, he could join me in our support to the young founders of Tranquiliti and find time to write Creating Social Enterprise.
Much of my working life moved on-line when Covid-19 hit. From time to time, I still go into the office although it feels as though a neutron bomb has hit: the building is there, but it is largely empty and most of those normally there are working from home. All the meetings that were conducted face to face before mid March now take place on video conferencing platforms (although half the time my colleagues have cameras switched off or their on-screen presence has frozen). Research appears to suggests that the productivity of most of the people now working remotely is higher than before. I miss my commute because it provided a welcome opportunity for exercise and included a delightful bike ride along the Grand Union Canal, but I am sure that I am in a small minority.
I miss the serendipitous conversations that take place in the corridor, making coffee, in the margins of formal meetings, and in the course of visits that I make as chairman to the front-line units and staff of my organisation. I have recruited a couple of new colleagues during the Covid-19 lockdown and we have had to manage their induction remotely, which clearly has its drawbacks. But other than these examples, I don’t get the feeling that the way that we do business has suffered much so far. However, is this sustainable?
David Robson has written an article in New Scientist[1], suggesting that “the coronavirus pandemic may be dismantling your social network without your realising it”. This echoes a concern of mine that the way most of us, and most organisations, have coped through the changes enforced Covid-19 has been only been possible as a result of the accumulated investment in relationships built up face-to-face. My board know each other well, know how to interpret each other’s contributions, will make allowances for each other and can generally anticipate how others will react to what they have to say. This has helped carry us through the past five months and will continue to assist through the next few months as, we all hope, we emerge from the crisis. This will apply to all sorts of established relationships around any organisation, will underpin day to day conversations and routine business, and will inform the diplomacy and political manoeuvring around the more tricky transactions. Assets on our balance sheet are liable to decay and, in our accounts for our business, we apply depreciation to them to reflect this. The intangible assets that are our social capital and which have carried us through new pattern of remote working are no different.
Robson’s article led me to a New York Times interview with Satya Nadella (personally heavily invested in video-conferencing, and consequently other people’s remote working, as CEO of the organisation that owns MS Teams and Skype). “Mr. Nadella said that raw productivity stats for many of Microsoft’s workers have gone up, but that isn’t something to ‘overcelebrate.’ More meetings start and end on time, but ‘what I miss is when you walk into a physical meeting, you are talking to the person that is next to you, you’re able to connect with them for the two minutes before and after.’ That’s tough to replicate virtually, as are other soft skills crucial to managing and mentoring.”[2]
Robson continues his article by summarising a wide range of research around social contact, and highlighting its value to us in terms of mental wellbeing and importance dimensions such as trust. In a sidebar to his main article, he quotes Peter Drucker writing in 1993 “It is now infinitely easier, cheaper and faster to do what the 19th century could not do: move information, and with it office work, to where the people are. The tools to do so are already here: the telephone, two-way video, electronic mail, the fax machine, the personal computer, the modem, and so on.” Robson notes that it has taken the pandemic for people to realise that they can work with less face time and discusses why it has taken a crisis to realise the potential for more people to work remotely. But while he concludes that “the relative success of new ways of working in the pandemic would certainly suggest that we can get by with less face time” he acknowledges that it would be unwise to scrap it entirely.
I worked remotely for much of the 1990s (with a dial up modem and Compuserve email address that consisted of numbers alone). Consequently, the revelations about the productivity of people working from home come as no surprise. However, I was working as a consultant and on private equity projects at the time. The work from home was interspersed with face to face activity with clients, selling projects and ideas, negotiating deals and persuading investors to back me. I was operating on my own or in small teams rather than a large organisation that was creating a greater value than could be achieved by a series of discrete market transactions and with the benefit of what I have described elsewhere as organisational “Dark Matter”. Having moved in and out of varied working arrangements and organisations differing in size over the past forty years, I know the importance of face to face contact in building relationships that are strong enough to be effectively maintained at a distance.
The large, global consultancy firm where I worked in the early 1980s employed a variety of devices to build relationships within the local office and the world-wide firm: consultants were expected to return to the office on a Friday to lunch together and receive a short presentation about a colleague’s project and piece of training; at each stage in your career development you attended residential courses with your peer group; practice groups would hold regional conferences to share learning; and the international partner group would meet for an annual conference. All this contributed to building a shared set of values, common approaches to solving client problems, and the ability to work remotely while remaining part of the firm.
It is important to recognise the corollary of Robson’s thesis: with remote working there is a risk that the quality of relationships will decay over time, particularly if the context in which the relationships were developed changes, if you don’t make this sort of investment. The “new normal” may involve much more remote working, but organisations need to recognise that the success of this approach over the past five months has been made possible by years of investment in social capital by having people working together previously. They will need to invest in “maintenance social capital” by getting people to getting people together sufficiently frequently to address the depreciation in this asset if they want to continue remote working in the longer term.
[1] New Scientist, 20th August 2020, pp32-36. “Missed Connections”
[2] New York Times, Dealbook Newsletter, 14th May 2020
Over forty years ago, I attended a four session seminar at the Graduate School of Business at Stanford with George Schultz, then moonlighting as a part-time professor while serving as President of Bechtel Corporation. By that stage in his career he had already been a professor at MIT, dean of the Chicago University Graduate School of Business, and served in the US government as both Secretary of Labor and Secretary of the Treasury. Two years later, the Economist’s leading article gave a warm welcome to his appointment as Ronald Reagan’s second Secretary of State, after the disastrous Alexander Haig when the Cold War showed dangerous signs of overheating. The Economist reeled of a list of the world leaders with whom Schultz had built a close relationship over many years, which contributed the dialling down of threats to world peace during and following Schultz’s term of office.
Among the unexpected benefits of the Covid-19 pandemic has been the efforts of organisations to reach out to audiences with webcasts and webinars. My Stanford connections mean that I am on a mailing list for the Hoover Institution where Schultz remains, at age 99, a senior fellow, and to judge by the unmissable half hour session on Monday evening, a very active one.
I recall being put down in 1980 by Schultz when I made a case, the details of which I have long forgotten, for government intervention of some sort and he responded arguing against the approach I’d suggested and made the case for the use of economic, and specifically market levers. It was striking in this week’s interview how wide is the range of areas in which he now argues for intervention in relation to domestic policy, albeit still using economic levers, and international co-operation to address the range of threats to the future of our society, not least climate change and inequality.
As one of the architects of détente in the 1980s, and more recently an advocate for continued international collaboration (arguing for example that Britain should remain in the European Union), it was no surprise that he contrasted both the current deterioration in the relations between the superpowers and the America First foreign policy of the Trump administration with the post World War 2 settlement. He opened his talk by citing the vision both of those who gathered at Bretton Woods in July 1944 to establish a new international monetary and financial order and of the European leaders who met in Paris in 1951 to surrender sovereignty to establish the Europe Coal and Steel Community and thereby laid the foundations of the European Union.
He presented a depressing outlook for the world, given the scale of the climate change crisis and the apparent lack of reason in the approach of too many world leaders. However, I am not sure that I buy all the arguments that he made. In particular, he argued that the ageing of the populations of North America, Europe, China and the more developed countries of Asian (and given the need for population decline to reduce pressure on the environment and address global warming, the inevitability of an ageing of the global population), create the potential for an end to economic growth and squeeze on living standards, which seemed to take little account of the potential for extending productive lives.
But, however interesting his view of the global outlook and whatever the pleasure for me of this trip down memory lane, what justifies including an account of Schultz’s webinar in this blog? The “takeaway” is his account of the importance of personal relationships and human interaction. It is clear from his anecdotes that his ability to rub along with people made a huge difference to the resolution of problems in the United States’ relationship with the rest of the world both when he was Treasury Secretary and, most critically, Secretary of State. The Economist was right in 1982 to hail the appointment of this massively networked figure. Interpersonal skills are important to the management of the interface between organisations, right up to the size of superpowers. They are also critical to the effectiveness of internal operations. In answer to a question about the dysfunctionality of US government and politics today, he observed that the key figures in both executive and legislative branches all lived in Washington for most of the year, and he would regularly meet over dinner with congressmen from both sides of the aisle, in contrast to the situation today. A glimpse perhaps of the Dark Matter that makes organisations work?
My recollection from our encounters in 1980 is of a solidly build man in late middle age (at least from the perspective of a 24 year old) with a gravelly baritone, a contrast with the smaller man of today with a voice pitched an octave higher. There is only so much we can do to hold back physical ageing, but it is inspiring to see that there is every reason for remaining engaged and committed to public debate. Schultz’s recipe for a long and active life was revealed in answer to the final question addressed to him: “Don’t stop working on the things that interest you.” There is no sign that George Schultz intends stopping soon.
My NHS Trust has an annual “Lessons Learned” conference, for sharing the lessons that teams have drawn out from incidents that have taken place in the previous twelve months. Don’t waste a crisis by failing to learn from the experience. This book is about lessons learned from a crisis, but is much more than just another business book.
Louai Al Roumani was the fairly newly appointed CFO of the leading retail bank in Syria when the Arab Spring turned into the Syrian civil war. Most of his family fled to the safety of Kuwait as conditions turned nasty (ironically, they had been living in Kuwait when Saddam Hussein invaded in 1990, but missed the occupation because they were on vacation in what was then a very safe Damascus), but Al Roumani chose to remain, loyal to his home city and his company.
“Lessons from a Warzone: How to Be a Resilient Leader in Times of Crisis” recounts the lessons learned by Al Roumani over the next five years. In this time, despite mortar bombs falling in Damascus and ISIS reaching the outskirts, his bank, BBFS, didn’t just survive but thrived. It did this by doing things that when explained by Al Roumani, and you should already have realised if only you thought about them for moment, make lots of sense even if they fly in the face of what many less insightful managers and directors might do (and, indeed, was evidence by departure of the two directors appointed the one of the major investors).
The lessons include going the extra mile to look after customers (airlifting safe deposit boxes out of a local branch as ISIS overran a provincial town), providing them with reassurance (displaying piles of cash when they queued up to withdraw their deposits and not restricting the amount they could withdraw), looking after staff and avoiding redundancies and cost-cutting around workplace hygiene factors ,and robust systems testing and disaster planning.
He draws on his heritage as a Syrian, living in a city that claims to have been longest continuously inhabited community in the world (a claim of Damascus that Aleppo contests), but also sharing the nomadic transitions of hospitality and reciprocity of Arabi culture. There are great insights relating to thinking about the long term health of the company, informed in part by a different “concept of time” from the one that he had been exposed to during his Harvard MBA. He argues that you should not treat profitability as a critical success factor but that if you see your objective the long term wealth of your shareholders you will from time to time have to sacrifice short term profitability. Although his bank was a creation only of the 1990s, he argues for playing “the long game as a third generation family business does.” He tells a charming anecdote of a large purchase from a shop in the Damascus souq where, in contrast the lady ahead of him who haggled hard and secured no discount, the old gentleman who been silently observing the young man serving Al Roumani gave the instruction that Al Roumani should receive a discount to reward him for not haggling. The account provided by Al Roumani explains why BBFS displayed such resilience through the Syrian civil war that it both maintained sustainable positions in relation to the marketplaces it deals with and also built the corporate and social capital inside the organisation not just to survive but the thrive.
Don’t read this book just for the business lessons. It is a powerful tale of the resilience of a man and a society in the face of enormous threat and massive upheaval. You will learn about the experience of a slice of Syrian society during the last decade and about the cultural hinterland that supports it. It is also a human tale, which keeps resurfacing through the book and continues right through to the acknowledgements at the back – just for once, make the effort to read these as the book keeps on giving right up to the final page.
We are in lockdown with Covid-19. Large parts of the economy are in suspended animation. Other businesses are operating on a hugely reduced scale. Others have recognised that their sales have dried up but have redeployed that assets and staff to help address the pandemic. The Chancellor of the Exchequer has become the “employer of last resort”, funding 80% of staff wages as an inducement for companies to keep people on their payrolls.
How should we interpret the reshaping of businesses through the lens of the Escondido Framework? In particular, what does it do those market interfaces that define the firm as visualised in a simple form by the Reuleaux Tetrahedron?
Are companies in the same business now that they were last month, before lockdown? In some cases, it easy to say that, at least temporarily, they are: the Lymington sail maker who has turned over his computer fabric cutting capability to turning out fabric pieces for others to sew up as scrubs for NHS front line staff and the university engineering departments that have deployed their 3D printers to make components for surgical masks. These companies have moved from one market into completely different one. Their staff, capital, and suppliers are relatively unchanged, but they have exchanged the customer market with which they usually interface with a completely different one.
Others have been transformed into agents of the state: temporary distributors of transfers by a government that has banned their businesses (particularly those in consumer services: retail, hospitality, entertainment) from operating. In their cases, the regulatory interface (not displayed in the 4 market interfaces of the Reuleaux Tetrahedron that describes the simplest companies, but has to be imagined in a multi-dimensional context) has moved inwards to the degree that the company is no longer creating value other than as a channel for transfer payments.
Another way of looking at the interpretation is that the company exists only in a shadow form, some ghost of what the company could become once again. I suspect there is a quantum analogy here – the locked down company with furloughed staff as Schodinger’s Cat. Certainly, the physical assets remain present, the staff remain employed, the wiring of the corporate structure remains in place, and the Dark Matter of the soft things such as relationships, corporate memory, social glue, shared assumptions, implicit operational and communication protocols continue – albeit that they may be vulnerable the longer that the lockdown continues. Zoom and its competitors keep some of the Dark Matter alive. The efforts that the investor, directors, and managers make in supporting and communicating with their staff will help, but the longer the uncertainty remains, or if the companies scrimp on their effort and investment in maintain this soft stuff, the greater the risk that the Dark Matter will leak away.
Bryan Magee, philosopher, broadcaster, and sometime Labour Party and SDP MP, died just over a month ago, prompting me to return to “Ultimate Questions”, his profoundly satisfying meditation on the enigma of human existence.
It contains a splendid passage that describes the undefinable qualities that is present in organisations working at the highest level, which I describe elsewhere as “dark matter“.
“I contend that our knowledge and understanding of other people, and our relations with one another, cannot be explained by the observable exchanges we make with one another. Something else is going on as well. A particular and extreme – and for that reason clear-cut and useful – example of this is provided by orchestral conducting. Many music lovers are able to hear the difference between two recordings of the same work conducted by, shall say, Toscanini and Sir Thomas Beecham, but no one seems to be able to explain how each of these is arrived at, ranging as they do from the unity of the overall architecture down to each individual detail and its integration into the whole. Such things cannot be fully explained in terms of what the conductor says at rehearsals (which often is not much) plus the way he looks at the musicians and wave his arms about. An immense amount that we cannot account for is being communicated by one person to dozens of others who carry out his wishes in subtle detail. I have long been fascinated by this, and have discussed it across the years with orchestral players and conductors. Players agree immediately, and without question, that they play differently for different conductors, but they cannot account for why, still less for how the what that is required of them is communicated to them. Conductors know what they are doing, and can do it at will, but they can no more explain how they do it than I can explain how I move my fingers, though I can do that at will too. Here we have a highlighted example of something that, it seems to me, is going on amongst us human beings all the time. It is impossible to account for the warm, capacious, deep, detailed, sophisticated and rich understanding that we have of one another in terms of our attention to another’s words plus our observations of other’s bodily movement. Something else, of a different order is going on.”
I attended the launch of “Collaboration Strategy: How to Get What You Want from Employees, Suppliers and Business Partners”, the new book by Felix Barber and Michael Goold of the Ashridge Strategy Management Centre. The book contains plenty of good material on structuring terms with the parties who you work with and aligning incentives. Reflecting the past service of both authors with the Boston Consulting Group, it has plenty to say about focusing on those activities in which you enjoy competitive advantage and outsourcing the others.
Publisher’s glass in hand, I was listening to Felix deliver a short lecture providing a synopsis of the themes of the book when someone¹ muttered in my ear: “they’re talking entirely about markets and financial incentives, but in reality it’s 80% Dark Matter”. This is a powerful metaphor and an important insight: we need to recognise that there is lot of dark matter out there in the economy and without it nothing works. Market forces and financial incentives alone do not explain how organisations, partnerships and collaborations operate and why we need them. Barber and Goold do acknowledge, buried deep in their text, that there may be more going on by commenting that they “don’t wish to downplay the importance of other approaches to motivating employees and other partners”. But, possibly reflecting lifetimes as consultants and academics, they convey in the book the impression that they don’t recognise the amount of Dark Matter that the system needs.
¹ David Pitt Watson, sometime managing director of BCG rivals Braxton Associates, Labour Party Finance Director, boss of the activist investment fund Hermes Focus and now social entrepreneur and responsible investment guru.
