'There isn't a single measure of failure', says Jan Filochowski, who has 20 years of experience as an NHS chief executive.For Jan Filochowski, failure is not the end. The chief executive of Great Ormond Street Hospital is trying to change a management culture where it is assumed there can be no return from failure. "I want failure to be a point and success to be a permanent long lasting state", he says. "If you get into that mindset, you approach things differently."
It is this message that permeates his recent book, Too Good to Fail?, and it is one that he wants more people to adopt.
Having managed organisations in all states from failing to world-leading, Filochowski was inspired to write about the patterns he identified which occur when things were going wrong. If left unchecked, his book argues, simple problems can multiply until they result in total failure. Too Good to Fail? covers the full spectrum of failure from minor mistakes to complete systemic collapse.
At a time when the NHS is perceived to be in crisis with negative stories hitting the headlines, Filochowski – who has 20 years' experience as an NHS chief executive and troubleshooter – wants to change the way people think about failing.
"[People ask] what's the perfect hospital? Who's the perfect manager?," he says. "I think that's wrong. One of the words I'm most suspicious of is 'best' or 'perfect' and words I like are better [are] 'good' because I don't think you can ever do anything well enough. And if you do, you've got a problem because things can only get worse.
"I don't think that's setting the bar too low," Filochowski adds. "It's setting the bar high enough so people have a chance at jumping over it. If no-one can, it's not the managers that are no good – it's the system that's misjudged how high it should be set."
But what is failure? According to Filochowski, "there isn't a single measure of failure". The parameters change depending on the views of patients, the government of the day or some intermediary body. But, he argues, there is a clear and predictable pattern to failure.
A clear warning sign is when management is convinced that they are right. Other indications of organisational collapse include misjudgement of the problems faced, a failure to respond to what customers are saying, blindness to the consequences of actions, and a lack of oversight of staff and skills.
Filochowski says that openness and listening are key to avoiding and overcoming failure. "If you know the answer already then you don't need to listen, but people rarely do," he says. "I think it's really important that people are consulted and able to give their view. That doesn't mean to say that people taking those decisions have to give way when someone disagrees with them, because you'd never take a decision."
Meanwhile, Filochowski thinks the culture of branding any problems as 'failure' must change. "I think individual organisations need to be able to own up to difficulties without that being seen as a failure. Owning up to problems is a mark of maturity and a real indicator that you are likely to make the best of things."
He recognises that NHS managers have an enormous task ahead of them. "You'll always make mistakes," he explains. "We're managing something incredibly complex and it's about seeing the mistake and correcting it before it becomes really big. I think a lot of the art of management is making the unpredictable, predictable."
As for the future of the NHS, Filochowski predicts a long and healthy life.
"I think the future holds an NHS that, with blips and ups and downs, will continue to improve. The fact that there are loads of things wrong with it doesn't mean it is in terminal failure. They can and will be put right. It will never be perfect. That's because it's good and it's getting better."
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.
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