Davide Nicolini, Maja Korica and John Powell HSRN Managing the unmanageable? 5 December 2013 This project was funded by the National Institute for Health.

Davide Nicolini, Maja Korica and John PowellHSRN Managing the unmanageable?5 December 2013

This project was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 09/1002/36 ).

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.

The organisational practices of knowledge mobilisation at top manager level in the NHS

About the project

• 2 year NIHR HS&DR-funded project• Research questions

- How do NHS chief executives source and use knowledge and ‘evidence’?

- What does being a chief executive in today’s NHS practically entail?

• Method: • Qualitative, in-depth study• Shadowing of daily activity, min. 5 weeks each

• Sample: 7 CEOs of NHS acute and MH trusts• Aim: Provide nuanced, rich accounts, not judgments or

recipes wbs.ac.uk 2

FINDINGS

wbs.ac.uk 3

Knowledge mobilisation in theory

wbs.ac.uk 4

Knowledge mobilization in practice“The CEO has been in the office since 7.25 am, listening to the news on the radio. By the time I arrived, he had checked the local press, dealt with emails and [social media], and read the documents for the afternoon meeting… By 08.35, he had 3 corridor meetings. He worked on and off for about 20 minutes on the presentation for the LET B meeting. At 08.50 there was a fire alarm. We stood outside for a good 15 minutes, during which the CE had four friendly business exchanges with different people, which allowed him, among other things to collect information on the Safety

5

Month initiative. He also spoke to the Director of Public Affairs, the Chief Nurse and the deputy Chief Nurse, and told them about [a certain] meeting, repeating what he had told others, and developing further the rationale for new acquisitions…”

Warwick Business School

Mobilizing knowledge as work• Traditional’, by-the-

book instances of K mobilisation rare

• K mobilisation as part of everyday CEO work and by-product of other activities

• Main practical concern: “am I knowledgeable enough to stay on top of the things that matter?”

6

Warwick Business School 7

Four modes of making oneself knowledgeable in practice

Intentional problem -

driven seeking

Deliberate monitoring

Heedful /non-directed monitoring

Unanticipated finding

Individual issue-specific search (rare). Mostly through delegating and establishing contacts with experts /friends

Meetings, monitoring key performance indicators, monitoring conversations

Impromptu conversations, open door, creating expectations, events, visits , walkabouts

Unplanned by-product of doing other things

CEO’s perceived knowledge-ability

needsPerceived

organisational conditions

Demands of the job

Understanding of the institutional context

Personal style

Self-narrative (‘What makes a good CEO?’)

Nature of the specific task at hand

What orients the attention of CEOs

wbs.ac.uk 8

From information to intelligence to actionable evidence

• What counts as actionable evidence constructed through work with the help of others

wbs.ac.uk 9

Sharing, circulating and ‘allocating’ information

Testing (and co-constructing) emerging sense

Weaving conversations via repetition to develop frames and narratives

Connecting the dots and checking for accuracy

LESSONS

10

From knowledge mobilisation to knowledgeability

• From seeking information or mobilizing ‘evidence’ to becoming knowledgeable: staying on top of the things that matter

• What sources they use = red herring• A doing mostly accomplished with and

through other people• A competence that can and should be

developed and refined

wbs.ac.uk 11

Personal Knowledgeability Infrastructure

wbs.ac.uk 12

What manager should/do I want to be?What is my task at hand?

What else is happening at the moment?

Warwick Business School

PKI in practice: An example of a new acute CEO

PERSONAL KNOWLEDGE INFRASTRUCTURE

RELATIONSHIPS HABITUAL PRACTICES ‘TOOLS OF THE TRADE’

• One-to-ones with exec team members• External links to support key strategic tasks• Informal ‘networks’• Management consultants as supporting ‘cast’• Mentoring

• Open door policy, with constant pop-ins• Walks to execs’ offices• ‘Gossip’ emails• Monthly informal meetings with PCT CEO• Area CEO and SHA meetings

•Large, operationally-focused weekly TMT meetings • Paper-heavy (“she feels naked not carrying them”)• Skimming• Train pile• Conferences• Regular ward/unit visits

Pathologies of the PKI

• Knowledgeability horizon like water for fish: you do not see what you do not see– Information inadequacy– Mismatch with the work to be done– Disconnect with wider context– Clash between structures and personal style

• Importance of inner conversational circle

wbs.ac.uk 14

Developing knowledgeability

wbs.ac.uk 15

What kind of a manager/CEO do I wish

or need to be?

What is the nature of the

broader competitive and

regulatory context?

Do I have the right combination of people and

tools in place to allow me to stay on top of things and

accomplish what I feel I need to do?

Where do I want my organization to

go?

What tools and ways of doing

am I more comfortable

with?

Where is my organization right now? What are the

opportunities and challenges ?

A reflective ‘roadmap’ for developing your knowledgeability

• Take stock and look at what you do now • Get a coach to observe you, and then help you observe

yourself and reflect• Use a trusted peer group and share how you operate• Assess (in partnership) whether your PKI is fit for purpose• Develop a personal plan to rebuild and enhance your PKI

– What do you need to know? How do you know what this should be? Who or what will tell you when that may be wrong?

• Set yourself the goal of continuous learning. Tie these to set dates in the diary to work toward on a structured and consistent basis.

wbs.ac.uk 16