I grew up as a clinician during an era when evidence-based medicine, as a concept, penetrated the consciousness of the professions. Nowadays, one of my favourite meetings, which I chair, is PACEF (a pan health community Prescribing and Clinical Effectiveness Forum). It is regularly attended by clinicians, including GPs and consultants, to dissect, debate and agree therapeutics, protocols and pathways. We have a public representative who is never shy of contributing, usually in a way which stops everyone in their tracks. It is evidence-based medicine in action at grass-roots level and is, mostly, respected across the health community. More importantly, its decisions are accepted and complied with.
Which got me thinking: Is there such a thing as evidence-based management? Having evolved into NHS management, I am struck by how often it is subject to fashion. Every year or two a new craze sweeps from the central catwalk onto the high streets across the nation. From ISIP (Integrated Service Improvement Programme) to WCC (World Class Commissioning) to, now, QIPP (Quality Innovation Productivity and Prevention). However, beneath all these fashions in management, which purport to be the magical solution to all ills, I have gradually learnt that there is a core set of principles, based on accumulated evidence as to what really works. Some years ago, a friend recommended that I read Scholtes, The Leader’s Handbook. If anyone wants a book of evidence-based management, then this should be top of the list. The principles it sets out are, too often, woefully ignored.
One thing I have learnt, both in theory and in practice, is that the best way to implement change is through the discipline of programme and project management. I have worked with a colleague who has taught me that this does not need to be a mess of bureaucratic templates, but an exciting process of human engagement and involvement, leading to tangible results.
Going into any big change, however, I have also learnt to always think of the formula, as applicable as a law of physics, which states; ‘for any project there are three variables: fix two and the third becomes defined’. The three variables are: the resource you dedicate to the project, the time to complete the project, and the quality of the outcome.
By 2013, we must have GP consortia up and running whilst slashing management support by 45%. The time-scale seems fixed, the resource allocated seems apparent; the big question is – what does that bode for the quality of the outcome?
Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning
for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.