I’m guessing everyone spotted the slight-of-hand the UK government demonstrated when they hi-jacked the “clapping for our NHS heroes” campaign, but when it comes to transforming national health they have a few lessons to learn.

I’m not talking about the way they used the weekly ritual to deflect our attention from their pathetic response to the pandemic. No, I’m referring to how they somehow managed to redirect the gratitude and admiration it engendered, probably quite rightly, for the front-line NHS staff, onto the National Health Service as a whole. Never was praise so undeserved, yet they managed to leave us with the feeling that the wonderful stories of individual dedication were somehow representative of the wonder of the service itself. 

The truth is the NHS was coming under increasingly close scrutiny and our politicians feared it was about to be revealed for the lame duck it really is. Not a good thing when you know you are about to have to dump fantastic amounts of money into the same old sticking plaster solutions in order to avoid being accused of killing what is probably the UK’s most sacred cow.

I think most people will agree that the the world isn’t in a good place right now. Most countries have their problems and a plethora of global issues are negatively impacting different countries in different ways. There are common traits and causes though and when you drill into them you’ll discover most stem from a general pre-occupation with self-interest.

For mankind to move forward we have to re-establish a feeling of community. In the UK the National Health Service, should be an exemplar. In fact, right now, the NHS is more an example of how to get it wrong.

I’m reading (Lord) Michael Ashcroft and Isabel Oakeshott’s new book “Life Support” with the extreme glee reserved for a situation where you find yourself shouting aloud “I told you so!”. I’m sure it is going to inspire me to write a few posts and articles, so watch out for them. Meanwhile, transforming the NHS has to be the first step in transforming national health.

I’ve been saying for years that we need to stop kidding ourselves that our NHS is OK and start the complete rebuild it has already desperately needed for so long. If we don’t, either it will collapse entirely or we would have no alternative but to forever throw vast sums of money into the black hole it has become. Meanwhile it will continue to be the absolute antithesis of what it was originally intended to be.

This is way past the sticking-plaster stage. In fact, it’s probably a little late even for major surgery. The reason the prognosis is so poor is that the people in control are way out of their depth and have been for decades. They are medical people, politicians and politically palatable fake consultants, none of which carries with them the skills or know-how to affect the transformation that’s really needed. 

They are all also exhibiting the classic traits of legacy leaders who got to where they were by means of connections and experience that was never appropriate, but which proved adequate in another, less competitive era. They are now either in denial, clinging on to their positions like grim death, burying their heads in the sand and hoping it all goes away, or praying that it doesn’t all blow up before they are retired on their golden pensions and well out of the range of fall-out.

This isn’t just about the NHS though. Organisations everywhere, that are close to being irredeemable, appear to be turned to stone and incapable of making the changes that might possibly save them. I gave this phenomenon a name — “transforminertia” — and I’ve spoken about it many times to different audiences around the world.

The problem is that a large proportion of employees in organisations like the NHS are miss-motivated. This is what happens when you fail to build a brand — that community of like-minded individuals that enables organisations to achieve what they must to stay in business inn the digital age. Great managers know how to take a cohesive brand community and leverage it to achieve great things in pursuit of their common objective — quickly, efficiently, less expensively and less painfully. 

The main problem with the NHS and organisations like it, is that neither the brand nor the objective is defined, so stakeholders have all assumed their own, self-gratifying alternatives. Some are in it for the money, others because the NHS is now largely a box-ticking organisation and that makes it a soft option for free-loaders. There are those too, who are in it for the glory or sense of power. Only a minority — and all gratitude to them — are really trying to do what’s right for patients or the UK population who invest in it. It’s not just about employees though. I have identified the six stakeholder segments that comprise every brand community. The NHS is no exception and without the brand, PPE salesmen, drugs companies and others are able to exploit the situation for their personal gain, unchallenged.

If this were a commercial business, it would have folded decades ago. The difference with the NHS is that when it’s leaders fail, as they do every day, tax-payers have no choice but to pick up the bill for their incompetence and we all forget it and move on to the next critical case.

It doesn’t have to be like this, but it’s going to take more than first aid to resuscitate this patient. 

Why has nobody had the balls to do what’s needed?

We continue to fool ourselves with the belief that our NHS is something special. It may have been the first of a kind, but, come on, get real, most countries these days have better, cheaper, more effective heath services. Questioning yourself and asking the hard questions of your organisation are an essential early step in any transformation process and I hold the hand of senior executives every day, as they take on this touch challenge. You can’t fix a problem until you accept it exists.

The NHS is out of date, inefficient, politically exploited and ineffective and the sooner we accept that, the greater the possibility that we can come up with a solution. However, this time a nip-and-tuck isn’t going to do it. Transforming national health means real transformation.

What’s more, the longer we procrastinate the longer the odds of success and therefore the fewer individuals there will be willing to take on the task. It’s no fun being associated with failure and when a nation’s most cherished institution is on the operating table, most candidates will consider it’s probably safest to sew them up again and hope you can get out of the door before anyone notices they’re dead!

The process of transforming national health would follow the same logical steps as the transformation of any other organisation.

It starts by aligning all the stakeholders behind a single objective. 

When things get as bad as they have at the NHS it’s inevitable that, in the absence of a strong brand, an “every-man-for-himself” culture will emerge. Before you tackle that though you have to establish what your community is all about. The communities of business are brands and we define them with a “brand model”. This is a document that pin-points the coordinates or characteristics of the brand. I have a programme that helps organisations discover their real self and I run it with my clients. I call it “brand discovery”.

Brands are communities of people who share values and beliefs. That doesn’t mean the people are clones, far from it, but that they share principles. Among other things, your brand model will establish what these are.

Next you get everyone on board

In fact it won’t be everyone. Especially in the case of the NHS. Most business consultants I know, recognise three employee groups in every pre-transformation organisation. You could call them …

  • The “Love it’s” — those who are enthusiastic about what their brand community represents and think it represents clarity they should have had well before hand.
  • The “show me what you got’s” — those that need convincing, aren’t sure they get it, but are wiling to listen.
  • The “forget it’s” — those you will never relate to, who are there for themselves alone and are never going to adhere to community principles.

Most consultants I know believe the split is roughly equal. I’m not so sure and again the NHS is in such a sorry state I don’t believe it is typical. The generally held belief is that as you progress through the transformation process, you will secure group one, retain half of group two and lose most, if not all of group three.

The first group are the foundations of your new community. In fact, research shows you don’t need anything like a third of your employees to buy into your brand. As little as fifteen percent will suffice to make your transformation viable. Once they are committed to the brand, you will have the traction you need to drive the kind of radical change represented by any worthwhile transformation. Nevertheless it is a case of “the more, the better” and a large cohort generally means faster progress.

Group two will need some encouragement, but if you have your group one, critical mass of 15% on-board group two will come along provided you devote some time and effort to encouraging them. 

Group three are where your problems lie. These people have a vested interest in the status quo and will do whatever it takes to scupper your project. As Greg Satell tells us in his great book Cascades, they’ll lie, cheat and generally dig holes for you to fall into. Your job, in the words of the song, is to pick yourself up, dust yourself off and start all over again! Eventually they will leave, because the prevailing culture of the business will be alien to them.

The role of internal marketing

You must never forget that your brand community comprises six stakeholder groups and you need them all to be on-board. Achieving this is what “internal marketing” is all about. Unless you establish this solid foundation, you’ll never do the difficult things you must to realise your transformation.

Once you have a community the real work can start. This is where you re-construct your organisation to deliver it’s objective (defined by your brand model) in the most efficient manner. In all cases “efficient” means doing “more with less” — fewer people, lower cost, less pain and, above all, a better outcome.

This means throwing out a lot of the old resources — plant, processes, people and thinking — and replacing them with modern day, often digital tools that allow you to do things you probably have never thought possible, but which, in the digital age are considered table stakes if you want to be competitive. It doesn’t have to mean throwing out everything though. One of my go-to Ikigai experts Saori Okada reminded me this week of the Japanese concept, Kaizen.

The Kaizen principle

While there is generally a need to push business leaders into the uncomfortable reality of throwing out stuff they have become attached to, many get scared that it might mean throwing out everything. Business transformation is a matter of rebuilding a business from the ground up, so that can happen, but it’s rare and even in the case of transforming national health, I’m sure there are things worth keeping. Kaizen represents the middle way. In the case of business transformation that dictates a straightforward marketing strategy process:

  • Define your objective
  • Establish how you achieve it
  • Determine what resources you need
  • Identify those you already have
  • Reveal the gaps
  • Make a plan to fill them — people, skills, equipment, technology … etc.

You may have a lot of what you need, even if you are currently applying it in a different way. Kaizen isn’t compromise though. It represents a state of mind that constantly seeks to improve, sure, but that sometimes means working better with the tools you have. The trick is to spot how existing resources can be utilised in your new model, without jeopardising overall effectiveness. In the digital age you simply can’t afford to start building a business aiming for second best.

You’ll appreciate how much easier, quicker and inexpensive transformation will be if you have a community that, to a man or woman, is committed to making it work. This is what you should be aiming for. The ability to make this a reality is the ace transformational leaders have up their sleeve.

Like any Brit I guess I have some emotional attachment to our NHS, but it’s also a bit of an embarrassment. More embarrassing though are the people who, despite overwhelming evidence to the contrary, continue to insist it needs only a nip and tuck. This kind of delusion is typical of chronic transforminertia.

If we approach the task of transforming national health correctly, our NHS could become the cornerstone of a new invigorated and fit-for-action “Brand Britain”. Get it wrong and you have to ask whether the money pit it has become is at all sustainable or viable.

Phil Darby
March 10, 2022

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