The safety of every patient, the value of every penny

When I graduated in 1990, I went to work for the Department of Health as a professional statistician. One of my friends asked me:

 “What do you actually do all day? Do they give you some ‘rock-hard sums’ to do in the morning and you get to leave when you have finished them?”

I politely told him that it was a bit different than that (in the usual robust and Anglo-Saxon way that young men do). The job did entail doing a lot of “rock-hard sums” as I was arguing about multi-dimensional scaling and logarithmic regression models with the British Dental Association’s advisor. He was the president of the Royal Statistical Society and very kindly tolerated dealing with a young upstart 22-year-old me. I am sure he could have demolished me quickly in any debate – yet we agreed on a lot and he was supportive. Looking back, this was an early lesson for me in power and how to use it.

I was reminded of that this week. I have been asked about the day-to-day role of a Trust Chief Executive by Alex, a graduate trainee who was shadowing me, and a front-line colleague at the curry club. “So what do you actually do each day?”.

Here is what the rules say the role of the Chief Executive is in my Trust [adapted from national guidance and agreed by our Board]

As Chief Executive I will…
  • Be accountable to the chair and  to the board of directors directly.
  • All members of the management structure report either directly or indirectly, to the Chief Executive.
  • Run the trust’s business.
  • Be responsible for proposing  and developing the trust’s strategy and overall objectives.
  • Implement the decisions of the board of directors and its committees.
  • Provide information and support  to the board of directors and council of governors and ensure that board of directors’ decisions are implemented.
  • Facilitate and support effective joint working between the board of directors and council of governors.
  • Provide input to the board of  directors’ agenda from themselves and other members of the executive team.
  • Ensure the chair is aware of the important issues facing the trust and propose agendas which reflect these.
  • Ensure that the executive team provides reports to the board of directors which contain accurate, timely and clear information.
  • Ensure that they and the  executive team comply with the board of directors’ approved governance procedures.
  • Ensure that the chair is  alerted to forthcoming complex, contentious or sensitive issues affecting the trust.
  • Provide input on appropriate  changes to the schedule of matters reserved to the board of directors and committee terms of reference.
  • Support the chair in their tasks of facilitating effective contributions and sustaining constructive  relations between executive and non-executive members of the board of directors, elected and appointed members of the council of  governors and between the board of directors and the council of        governors.
  • Provide information and advice on succession planning to the chair, the nominations and remuneration  committee, and other members of the board of directors, particularly in        respect of executive directors.
  • If so appointed by the board of  directors, serve on any committee.
  • Lead the communication  programme with members and stakeholders.
  • Contribute to induction programmes for new directors and ensure that appropriate management time is made available for the process.
  • Ensure that the development needs of the executive directors and other senior management reporting  to him/her are identified and met.
  • Ensure the provision of appropriate development, training and information.
  • Ensure that performance reviews  are carried out at least once a year for each of the executive directors. Provide input to the wider board of directors and council of governors evaluation process.
  • Promote and conduct the affairs  of the trust with the highest standards of integrity, probity and corporate governance.
  • Ensure the provision of effective information and communication systems.
  • Lead the delivery of good and effective partnerships, agreeing with the Chair the appropriate lead on key stakeholders.

This is a big list – and each of them covers a broad scope. For example – “Run the Trust’s business”, “lead the delivery of good and effective partnerships” and “promote and conduct the affairs of the trust with the highest standards of integrity, probity and corporate governance” each have depth and breadth.

In practice you can get a good sense of what this means through looking at the CEO Diary Blogs of people like Jonathan Fagge of NHS Norwich Clinical Commissioning Group and Dr Mark Newbold of Heart of England NHS Foundation Trust.

Screen Shot 2014-01-19 at 11.24.33

Difficult choices, public accountability and a focus on leadership, strategy and delivery are highlighted in every one of these. It is clear that, whether you run a commissioning or a provider organisation, these are system and organisation roles….and both Mark and Jonathan present examples of excellent leadership in both. So this is helpful at explaining about what a CEO does in the NHS. And as a former statistician, I would say it is all “necessary but not sufficient”. I would add two really important additions for emphasis.

When describing my role, I say that I am here to:

1. Be accountable – for two things only. The safety of every patient we care for and the value of every penny we spend. By “Value” I mean impact, quality, effectiveness and value for money. As the Chief Executive I carry this accountability 24 hours a day, seven days a week. It is like a coat that I never take off and one I wear gladly when the culture and systems are right and one that can feel incredibly heavy if they are not.

HQC4

2. Create the culture where others can succeed. This is one where people feel able to take responsibility and use the authority that they have been given to act. I have written about this elsewhere (“Some things are just too heavy for Superman to lift”) and will not repeat myself here.

HQC5

So what does a Chief Executive do all day? Everything required in the list of bullets above and, more importantly, balances keeping the accountability while ceding authority to others. It is never easy – I often get it wrong – but it is an essential part of everything we do, each and every day.

HQC6

One thought on “The safety of every patient, the value of every penny

  1. Pingback: The safety of every patient, the value of every...

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s