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

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Presentation on theme: "Davide Nicolini, Maja Korica and John Powell HSRN Managing the unmanageable? 5 December 2013 This project was funded by the National Institute for Health."— Presentation transcript:

1 Davide Nicolini, Maja Korica and John Powell HSRN 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.

2 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 2


4 Knowledge mobilisation in theory 4

5 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…”

6 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

7 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

8 CEO’s perceived knowledge-ability needs Perceived 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 8

9 From information to intelligence to actionable evidence What counts as actionable evidence constructed through work with the help of others 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


11 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 11

12 Personal Knowledgeability Infrastructure 12 What manager should/do I want to be? What is my task at hand? What else is happening at the moment?

13 Warwick Business School PKI in practice: An example of a new acute CEO PERSONAL KNOWLEDGE INFRASTRUCTURE RELATIONSHIPSHABITUAL 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

14 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 14

15 Developing knowledgeability 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 ?

16 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. 16

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