The Click Moment - Seizing the NHS Leadership Opportunity

As I sat in my Board meeting earlier this week, sandwiched between Professor Heather Tierney-Moore OBE and Professor Max Marshall, I naturally wondered how a kid from Morecambe (officially the UK’s 3rd most crap town) made the journey from there to here. Chance must have played a role, I decided. Luck; serendipity. Call it what you will, its role in driving the success of leaders and their organisations is the topic of author Frans Johansson’s book ‘The Click Moment − Seizing Opportunity in an Unpredictable World’.

The question of how much luck shapes achievement has always intrigued me. I had a sense that talent and experience were required but what drives success beyond that point?

The premise of Johansson’s book is simple but challenging. In an increasingly complex world, planning and analysis no longer guarantee strong performance.

For NHS leaders this premise sits uncomfortably. Acknowledging such a thing could be “career limiting”. However, accepting this theory need not remove our sense of control over our destinies or the success of our organisations. On the contrary, a random world creates moments of opportunity: “click moments” as Johansson describes them.

We need to embrace this randomness and adapt to it, to shift our focus to creating, seizing and exploiting these moments to advance our organisations and ourselves.

The role of luck

For those who have read journalist Malcolm Gladwell’s book Outliers, it will be a surprise that success can be random. Gladwell argues through examples such as Venus and Serena Williams that the key to success depends on practice − at least 10,000 hours of it.

However, the 10,000 hour rule only works in a limited range of circumstances where a specific skill can be repeated in a stable environment, like playing tennis. But running a successful business is not like playing tennis.

The rules are not fixed in perpetuity. There is no ever-present umpire. While we are willing to look back at our private lives and acknowledge the role luck has played in putting us in the right place at the right time, we find it less comfortable to do the same with our work lives.

Think forward. Which party will govern us next? How will they re-organise the NHS? What will the tariff be for each of the services you provide or commission? What technology will be affecting healthcare? What role will the private sector play? Will the public step forward and genuinely accept the need for greater self-care?

The combination of scale, politics, bureaucracy, public interest and managed competition makes the NHS more, not less, random than the world around it.

Johansson writes in The Click Moment: “Some of us need a plan that makes sense, or a plan that emotionally grips us, or a plan to coordinate activities and keep schedules straight. The reason behind the plan is not especially important because you will be wrong anyway. Whatever you need to spur you into action is fair game.”

The key is action. Not in a specific direction, just action. In acting we will create and see opportunities that can be seized and exploited.

Johansson says: “You have an easier time creating click moments if you connect with more people. You have a better chance of making a successful bet if you try a lot of them… And you are more likely to get caught up in complex forces if you are out in the world doing stuff, which is easier if you know how to do something well.”

Small bets, big wins

External networking is something NHS leaders do not tend to do enough of – so attend a conference or event outside your field of interest. Resist the pressure to only “focus on the day job”. In a recent study by Brunel University of HSJ Awards winners, one of the three keys to success was identified as “taking a risk”.

Placing bets means acknowledging you don’t know the best answer at the outset. Be open and honest about it. This would require a significant cultural change in many of our NHS organisations.

“Making many small, purposeful bets, fuelled by passion and calibrated by affordable loss, is the second out of three ways to channel the randomness in this world,” says Johansson.

While acknowledging we don’t know the answer allows more bets to be placed, this does not make them any more affordable.

Explore ways to split investment between several smaller pilots. One way would be to co-invest with other local NHS providers and commissioners or with the private sector.

Use passion as fuel. This is where the NHS has an advantage. The workforce is intrinsically passionate about the work it does.

Complex forces

The challenge is to harness this energy and understand that placing many bets will lead to many failures, but ultimately it is in the best interests of patients.

“You must actually do something, even if you are not sure where it will lead,” writes Johansson. “Once you start executing, whether or not the bet actually works in your favour, you are exposed to complex forces that can pave the way for future success.”

The message here is straightforward. It is all well and good placing bets, but once signs of success begin to show we need to act on them; “double down” on the bet. This means investing in those bets that seem to be winners and stopping those that don’t. Remember these are bets, not investments; some will stop and others will receive additional investment.

So next time that pilot project you invested in looks like it is not going to deliver the benefits you hoped for, stop. Take those resources and plant a few different seeds in new diverse projects. Watch for early shoots and double down on them. This is innovation. In rare cases it can take you all the way from Morecambe to Preston.

This is a blog-size, adapted and updated version of a piece originally published in the Health Service Journal (HSJ).