Separate worlds?

The Chief Executive of King’s College Hospital NHS Foundation Trust on the transferability of private sector experiences into the NHS

Separate worlds?

In 2008 Lord Darzi published the Next Stage Review, which was all about putting quality and safety at the centre of the NHS. That same year I left a private sector career and the position of Managing Director of BT Global services UK to join the NHS as Chief Executive of King’s College Hospital NHS Foundation Trust – the first appointed from the private sector. I felt empowered. Having been in sales and general management positions for 20 years, putting the customer first had long been a mantra.

There were some obviously transferable experiences, but with key differences. Running global data networks for banks requires a focus on quality and resilience. Failures need to be few and far between, and recovery needs to be fast and effective. Businesses would suffer, and my customer’s customers would be inconvenienced. But when you are running a hospital, mistakes have to be avoided at pretty much all costs, for obvious reasons. Overheads need to be kept to the absolute bare bones so that 90% of income can be dedicated to patient care and supporting those on the frontline.

This explains why adjustments must be made for the slower pace of change in the NHS – you can’t afford to make mistakes, quality needs to be high, and so due time and care must be taken. The real challenge is to manage clinical change at the frontline and ensure the utmost quality in all patient services, while preserving a more radical approach to changes in the back offices, where perhaps more risk can be taken.

The cost of recovery is immense, and a terrible distraction

Regulation is essential in healthcare, and very sophisticated. You fail a Care Quality Commission or Monitor target at your peril. The cost of recovery is immense, and a terrible distraction. So making the trade-off between staff in wards and staff in back office ‘overhead’ positions can mean the difference between success and failure. Obviously, those decisions were important in BT too. We were not inefficient, but we had far more overhead, and I couldn’t have imagined running my part of the business with the lean levels of finance, HR and regulatory compliance resources I do at King’s. Innovation is required to survive. Management information systems are very sophisticated here, and there is a culture of sharing best practice across the NHS. There is competition between hospitals – we all want to be the best – but we all share the same problems, and the underlying ethos of openness and transparency means there is an acceptance that the diffusion of innovation from elsewhere is just as important as inventing something new locally.

There is also the whole question of short-term profits versus long-term sustainability, a subject much in the news today. Closing a private-sector deal this quarter to keep the numbers good for the share price is of a different order of magnitude to closing national health inequality gaps that have been systemic for decades.

Clinicians are a vital part of our workforce. The general public holds doctors in high esteem, but nurses make up the majority of those who work in hospitals. They are there 24/7, along with healthcare assistants, catering assistants, cleaners and porters. The best heart surgeons need a world-class team to deliver outstanding care. For six hours they, along with their anaesthetists and theatre team, have your life in their hands. But for the next ten days before you go home, it is the ward-based team that determines your quality of life. And none of these people – intelligent, caring and highly qualified – earn as much as a decent sales manager in a global technology company or management consultancy.

People in the NHS don’t get off on being part of an organisation that wins awards

Why do they do it? The key difference is that they genuinely care, not because a big bonus rides on a customer satisfaction survey, but because they value each patient as an individual. They don’t get off on being part of an organisation that wins awards – they celebrate reducing mortality rates below that of their peer group and seeing that their discoveries are being copied elsewhere in the NHS. They love having letters from grateful patients.

The real learning after three years here is that ‘quality and safety’ mean something very different in healthcare and are core values, as is ‘inclusion’. Yes, equality and diversity are important CSR considerations in the private sector. But you can choose your customers. Everyone at King’s will treat all patients in the same way. We have patients with an incredible diversity of lifestyles, languages, cultures and behaviours, and we must do our best for them without regard to personal feelings. I would say that inclusion is right at the top of my priorities, alongside putting the patient at the centre of the organisation, and of course, balancing the books. I didn’t know about that when I came here, and I feel that I am a better person because of it.

Further reading

Tim Smart

Tim Smart is the Chief Executive of King’s College Hospital NHS Foundation Trust.

1 comment

  • Sir I would like to thank you for your appreciation of our workforce in King's and what struck me the most is that you talk about the "ward base team" and gave recognition to those who really work hard and give their 100% towards patient care and meeting trust expectations. After reading your article I felt that I made the right choice to move to King's as now I know that there is someone who care and value our hardwork.

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