Monday 15 April 2013

Naval strategy lessons for the NHS

It is the evening of 1 August 1798, in a sticky Mediterranean dusk, and Horatio Nelson’s Mediterranean Fleet has finally tracked down their French opponents at anchor in Aboukir Bay on the Egyptian coast. He is determined to bring them to action, even in the gathering gloom.

The British gun crews are crouching by their cannon while their French counterparts heave their heavy armaments onto the seaward side where the British will come.  The Battle of the Nile is about to begin.

Nelson had prepared for this battle by setting out clear rules of engagement, discussed with his captains evening after evening around his table on the Vanguard. That was the broad plan; the details would have to take care of themselves as circumstances arose, and he trusted his captains to interpret the plan effectively.

Nelson was no disciplinarian, and he had already gained a reputation for disobeying orders during the Battle of St Vincent. He steered out of line because he saw the chance to cut off a group of Spanish ships from the rest, and managed to capture them. Even if this wasn’t explicit, his captains knew this was his style and it was what he expected of them – not slavish obedience to detail, but enthusiastic commitment to the objective.

These regular dinners were the beginning of the trusting collegiate atmosphere he managed to instil among his commanders, which gave rise to the idea of a ‘band of brothers’. 

Captain Thomas Foley in the Goliath happened to be leading the line when the French came into sight, he ordered his men to get the battle sails ready, so that he could stay in front when the order came to get into line of battle. 

So it was Foley, standing next to his helmsman, the battle ensigns flying behind him, who saw the emerging opportunity as the disposition of the French ships became clear. There they were anchored along the shore, and he realised there might just be enough space to squeeze along their undefended side, between the French line and the shore itself.

It was a risky decision. Thinking fast as the battle got ever nearer, Foley realised that Bruey’s ships must have anchored with enough space to swing round at anchor as the tide changed, so there would almost certainly be enough sea to avoid running aground. But there was no time to consult anyone else. Foley steered between the French ships and the shore leading the British line after him. Foley was rightly hailed as the hero of the victory at Aboukir Bay of which Nelson had been the architect.

So although Nelson laid down the framework for the battle, with regular dinners for his captains, making sure his intentions became second nature to them, Foley knew he was allowed to do something entirely different if he saw an opportunity. He was able to break with conventional thinking, and the apparent drift of his orders, and use his intuition. Would he have managed to win the battle if he had been governed by the management culture from British public services two centuries later? Hard to know, but probably not.

The point was that he knew he had to take the decision, knew he was expected to, felt confident to do so, and did so in style.

Fast forward nearly a century to 22 June 1893, but again to the British Mediterranean Fleet, by then the decisive force in global military affairs. By that time, the Royal Navy revered the name of Nelson and paid lip service to his cult of structured disobedience – the telescope to the blind eye and everything that went with it – but had rather forgotten what it meant.

Nelson’s successor as commander was Admiral Sir George Tryon, charming on the dinner party circuit but known as a dictatorial martinet when he was at sea. He tried to keep his intentions hidden from his subordinates to help them practice in unpredictable situations but, the day before this fatal incident, he had actually told his captains what he wanted to do. 

He was going to turn his two columns of ironclads towards each other before they anchored for the night. It was a risky manoeuvre. Some brave captains suggested that, given the turning circles of the ships, the columns ought to be at least 1,600 yards apart when they started to turn. It wasn’t quite clear whether Tryon had agreed.

When the time came, off the coast of what is now Lebanon, Tryon unexpectedly ordered the two columns to start turning when they were only 1,000 yards apart. Two officers queried the order, but he snapped at them to get on with it. Admiral Hastings Markham, leading the other column, was confused by the dangerous signal and delayed his acknowledgement. “What are you waiting for?” signalled Tryon.

What was going to happen seemed horribly apparent to everyone except Tryon, but nobody acted to prevent it. Three times, the flag captain of his flagship Victoria asked for permission to go astern as the two leading ships hurtled towards each other, but did nothing. Only at the last minute, as Markham’s flagship Camperdown hurtled towards the Victoria with its ram below the waterline, Tryon shouted ‘Go astern, go astern!”

It was too late. There was a grinding crash as the Camperdown’s ram buried itself in the flagship. Victoria capsized and sank thirteen minutes later. As many as 358 sailors lost their lives. One of them was Tryon, who was said to have appeared mysteriously to his wife and guests at a dinner party in Eaton Square at his moment of departure.

These two stories, both about the commanders of the British Mediterranean Fleet, provide a blueprint for different organisational styles. Hospitals are not quite the same as fleets but, even so, organisations run by Nelsons tend to work, and those run by Tryons tend not to. Tryon organisations can get by, but never quite in the brilliant ways that the Nelson organisations do. 

Ironically, the ill-fated Tryon was always known as a brilliant and innovative strategist. His fatal flaw was his authoritarian style of leadership, which left those who would have been in his band of brothers – if he had been Nelson – fatally in the dark. They could see the details of what they were supposed to do, but not the big picture. There they were, flailing around, not daring to act to avoid disaster even though they could see it coming.

The situation was extreme, one ironclad with a ram bearing down on another, but it is also familiar. We have all worked for organisations where a similar culture prevails, where disaster looms and most people decide it is probably best to say nothing. 

We could say things that would improve services or performance or avoid accidents or disasters, but it is less risky to keep quiet. Maybe this doesn’t matter so much running fast food franchises or corner shops, but in hospitals it matters very much indeed.  And in the NHS as a whole.

I've set out these things in response to Roy Lilley's excellent blog on Letting-Go Management in the NHS.  He is absolutely right:

"Our-NHS is going to go through a tough time, instinctively some managers will think they have to become tough. They think tricky times and hard decisions call for tough management. Not true."

That is an urgent message for the NHS.  What it so badly needs, to find the creativity and innovation - and I may say, also the savings - is the maximum dose of flexibility, to set people free to solve problems in the best way that suits local people.  More about this naval parallel in my book The Human Element.

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