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8 November 2012
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Prepare Three Leadership Envelopes: an apocryphal tale retold

Mired in poor performance and bedevilled by dysfunctional teamworking, a large healthcare organisation hired in a new clinical leader to sort out the mess. Just before his official start date, the new leader met privately with his predecessor as he cleared his office. The departing incumbent fixed his successor with a gimlet eye and handed him three sealed envelopes. "It's tough at this hospital" remarked the soon-to-depart leader with monumental understatement, "and you might need these. Open them in order whenever you feel you've nowhere left to turn."

Heartened and enthused by the challenges of the role but not convinced things would really need a great deal of effort on his part, the new clinical leader quickly settled into post. As the days melded into weeks, he completely forgot about the three envelopes he'd chucked languidly into the bottom drawer. All this talk at his interview of the need for 'robust transformational change' seemed, now he was here, rather overblown. Sure, there were some problems - but nothing he couldn't fix. There didn't seem to be any major catastrophes, and he sooned came to believe was a fairly cushy number. But not long afterwards,  performance of the clinical teams started to dip markedly. Revalidation was still a dirty word and many staff remained unappraised and unmentored. The Deanery had been less than complimentary in a visit. He actually began to feel a bit of pressure. Sitting at his desk catching up on some emails, he suddenly remembered the envelopes. He reached down and opened the envelope marked "1".

Inside, it simply said, "Blame your predecessor."

Great advice, thought the senior leader! And it actually seemed to convince the Trust Board. The guy before hadn't grasped the true skills and dedication needed to get real change under way: he hadn't put the hours in. The new guy couldn't put right all those wrongs - there was more leadership required than he'd actually expected - it was going to take more time. He made a mental note to perhaps up his game a little. And to his delight, the Trust Board bought it. The heat was off; the Deanery criticisms were addressed through a lengthy action plan. Things weren't great, but they seemed to settle in his mind, and the new leader felt that perhaps he might be able to relax again and let others take the strain. But a rise in clinical complaints, some tricky issues around unresolved job plans and a further dip in hospital performance called his leadership into question once again. This time he went straight to the desk.

Inside envelope "2" it simply said, "Blame the other clinical staff."

Hmmm. Risky. But he gave it a go. The meeting with the Executive Team wasn't half as straightforward as the last one, but when they heard about how reluctant the other medical staff had been to get themselves sorted despite him writing to them twice - twice! - and how sluggish the nurses had been to come up with ideas about teamworking, well, it was only to be expected that things were quite bad. An action plan was drawn up - all it needed was more time. And, for a while, things once again settled. The now not-so-new leader was still able to get away on time every night, and although he'd definitely put more effort in since that initial Exec Team meeting, he was happy that things would sort themselves out if only everyone worked just that little bit harder. But a tricky CQC visit, some difficult questions from the Coroner about a seemingly straightforward surgical procedure which went awry and a further Deanery visit which identified unresolved outcomes from that initial action plan led him, within months, to receive an invitation from the Trust Board to swing by and see them in the comfort of their conference room.

He knew that this would be a difficult one. If only he'd put real effort into transformational change. If only he'd taken the time to understand the issues. If only - put simply - he'd led. With a heavy heart he sat in his office. But - wait! There was that third envelope. Perhaps all was not lost after all. Smiling, he reached down to the drawer, pulled it out, and opened it.

It said, "Prepare three envelopes."

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About the author

Darren Kilroy's picture

Darren Kilroy

Darren Kilroy FCEM M.Ed. Ph.D. is a Consultant in Emergency Medicine in Cheshire, and Director for Network Leadership and Development in Unscheduled Care. He is also Hon. Senior Lecturer in Emergency Care at Manchester Metropolitan University, and Clinical Lead for Unscheduled Care at NHS Stockport. His main areas of interest are the challenges of clinical and managerial engagement around emergent clinical commissioning models, and the role of clinical leadership within transformational change.



11 years 6 months ago

Interesting retelling

The original version I believe is Brezhnev talking to the dying Khrushchev . Indeed it has been "given" to me when leaving my last 2 main roles. Only 2 envelops in soviet Russia: blame your predecessor and write 2 envelops. Perhaps the NHS version is sadly too true - ie the step of blaming other clinical staff. A good New Years resolution might be for us all to remove blame and never to resort to more than 2 envelops?

11 years 6 months ago

Prepare Three Leadership Envelopes: an apocryphal tale retold

Great stuff. It reminds me of John Cotter's exhortation to leaders to "act with urgency every day". So easy for time to pass, and so much to get done!

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