Martin McShane: Consciously unconscious

Martin McShaneI was in a meeting last week with the seven chairs of the new consortia, two other executives from the new PCT cluster, and an external consultant who was giving an independent overview of the context and the challenges, and how they might be jointly and severally addressed. The content and debate was engaging and enlightening. As one of the chairs said, “I am ever more conscious of my incompetence and realise I am unconsciously incompetent as well. I want to address both those areas.”  His comment was in part, I think, shaped by our shared experience of participating in a simulation.

The best learning, I have found, comes from making mistakes. We all make mistakes, especially if we want to really innovate in such a complex system. The problem is that the consequences of making mistakes in the NHS can be fearsome; personally and for the system. We inhabit a prevalent, although not universal, blame culture. Participating in a simulation gives people the chance to experience “what if,” make mistakes, fail, and learn without the fear of any personal consequences or real damage to the system.  Having previously participated in a simulation myself and working with a Chief Executive who was experienced in both running and participating in simulations we decided to run one back in November as part of our development programme for GP commissioning.  It was a lot of hard work to secure the presence of so many key participants in the health and social care system as well as inviting skilled and experienced people from elsewhere to contribute and observe.  The event has been written up with the King’s Fund and has, I would say, useful lessons and insights into issues which have appeared or are appearing in reality.

I also learnt something. I was in charge of a newly formed commissioning support organisation, formed from the relics of a PCT. I met the consortia and agreed the support they needed and what that would cost. A couple of months later (about 40 minutes simulation time) I noticed they were talking to a private organisation. Within the month I had not only lost my team, who had decided to work with a provider as it was more secure, I had also lost the contract and was selling the Big Issue. I made enquiries and discovered the reason was that the consortia had decided to buy their support from the private sector at 10% of the cost I was charging! Puzzled, I asked the private sector provider how they had managed to provide the support the consortia needed at that cost? “I didn’t give them what they needed, Martin,” was the reply, “I gave them what they wanted.”

A big lesson for me, which I share ruefully but gratefully – after all, it was only a simulation, wasn’t it?

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.