Leading in the NHS is definitely challenging. I know from first hand experience just how tough it can. There are lots of issues to tackle, huge expectations internally and externally and of course things go wrong from time to time.
Sometimes it can feel that you are a like the hamster on the wheel running at 100 miles an hour and getting nowhere fast. There are always plenty of demands on your time and it is easy to think that just worker longer and harder is going to make the difference. 
But is working longer and harder really going to make a difference? From my own experience only partially. What really needs to happen is to stop, take stock and re-focus. The trouble is that few are willing to take the time out to do this.
As a result the problem just gets bigger and bigger. Tensions start to rise between people at the top of the organisation. Rather than working together people start to in-fight, respond less professionally than they should. This tone at the top starts to filter down the different levels of the organisation and becomes the norm
Before you know it you have bedlam on your hands. The snowball you were dealing with previously is now an avalanche. Stopping that avalanche is going to be near impossible.
On the other hand you can choose a different approach. The first step is to acknowledge that you need to take time out to review and reflect as a group. This requires the creation of a culture where people can talk openly and honestly about what’s working and what’s not.
Next you need to work out where leadership time needs to be invested. It should be on the areas that are strategically important or the real priorities of the organisation. The leadership resource is too valuable to waste on the wrong things.
It’s also vital to measure where leadership resource is being invested. We all know that 20% of our time delivers 80% of the results. Do you really know where leadership resource is being invested and even more importantly what impact it is having? The trouble with time is that it is limited and unlike computer memory you cannot buy additional time.
Be willing to stop doing things that you are doing out of habit rather than necessity. Do you really need to go to that meeting every month? Do you need to get involved in every e-mail discussion that you are copied in on?
Make productivity of the leadership team a QIPP initiative. You want your best talent being as productive as possible. Ultimately that means focusing on what matters and driving the organisation forward.
The Bottom Line: While leading in the NHS is hugely demanding, merely carrying on doing what you always did is really not going to cut it.
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