I have now described why failure happens, how to foresee it and how to avoid it. I have also described how to manage well, and the skills, behaviours and processes that are needed to do this in our uncertain world. But there are many intriguing questions left and I would like to finish the book by having a stab at a few of the questions that particularly intrigue me.

Is success down to the individual or the approach?

When I tell people about my approach to management, one of the most frequently asked questions is: ‘How much of the success of this is down to the approach and how much of it is down to the individual manager?’ My answer is the obvious one: it’s a combination of both. The late Steve Jobs was a great leader at Apple, a great innovator and a great reader of the environment. Jack Welch was a great ‘doing’ CEO at GE. Tiger Woods is a great golfer. Sir Alex Ferguson is a great football manager. Richard Branson is a great entrepreneur and innovator. Warren Buffett is a great investor. They are/were backed up by clearly thought-out approaches and considerable experience and learning, but they are/were also outstanding individuals. What even they haven’t done is make all the right decisions, or get everything right. Steve Jobs made mistakes in sending Apple down an excluding route, Alex Ferguson has lost key matches and key titles, Richard Branson has pursued some enterprises and ideas that have turned out to be duds. Hey, they are living in the real world, they are imperfect. They are also exceptionally good at what they do. They have learnt from these things and moved on to other successes. All this explains why they are enduringly successful.

Anyone who realistically and honestly calibrates what they are capable of can do the same. Neither my approach nor theirs can make anyone ‘great’, but absorption, internalisation and use of the ideas in this book can and will improve their effectiveness, performance and satisfaction with the job and the task, because it will help to make sense of them, to give them order, to clarify goals and to show that achievement is indeed possible. And this is another positive learning I want to convey. Knowing your own and your approach’s limits is the key to wisdom, success and successfulness. You will then get what you can out of them and yourself, but don’t delude yourself that they can do more. Imperfect managers do things imperfectly but they get things done. They manage optimally, whereas perfect managers don’t because they are a figment of the imagination.

This leads to a second set of key questions that people ask: ‘How enduring is this approach? Can it be embedded so that it survives changes of personnel? If so, how?’ Nothing is forever, but I believe that my approach can be hard-wired in and made a basic characteristic of any organisation’s operation. It works and it lasts.

Management or leadership?

The global edition of The New York Times of 28 April 2011 included a four-page advertising supplement prepared by China Daily of the People’s Republic of China. Headlined ‘Management Gap’, it focused on ‘the acute shortage of managers that is threatening the advance of its economy’ and it began by referring to a recent report by management consultants, McKinsey & Co., highlighting that China needed four million middle managers, 3,000 senior managers and a further 100 managers capable of leading Global 500 companies if its corporate sector is to succeed. China has leaders and leadership, both good as far as I can tell, but it also needs managers to succeed. Managers are crucial to success. But why?

At the heart of my own experience and learning about management is an increasing realisation that management is about specifics rather than generalities. You need to focus on specifics, you learn from specifics, you do specific things and you implement specific solutions. You divide, you focus, you concentrate, to coin a phrase, to make things manageable.

My counter-learning has been to become wary, though not dismissive, of broader ideas, theories and concepts, theories that laud aggregate concepts, most noticeably leadership, but also wisdom, transformation and quantum leaps. Leadership is unspecific. It covers the whole world, such a variety of situations, circumstances and requirements that the generalisations all too often mean dilution to the point of meaninglessness. The leadership qualities of Winston Churchill in the Second World War, Shackleton bringing his men safely back from the Antarctic when the ship broke up, the captain of a successful football or other sporting team (or the manager), the head of a research team trying to develop a life-saving drug, the head of any business enterprise (massive variations there too) – they are all leaders, presumably all needing to show leadership. To set that out indicates that leadership is the wrong place to start. It’s diffuse and indefinite and does not tell you what to do.

On the other hand, if you start with management requirements and tasks, you are likely to get onto something. The words I like, apart from those I have already mentioned, are do and do-ability, better, simpler, quicker, different. And look at the word ‘manage’ itself. Here is the dictionary definition, with comments, linking each part of the definition to what I have been saying in this book:

1. To bring about or succeed in accomplishing, sometimes despite difficulty or hardship [the whole subject of this book!]
2. To take charge or take care of [responsibility first, leadership second]
3. To dominate or influence a person by tact, flattery or artifice [influence rather than dominate, but communicate, communicate, communicate!]
4. To handle, direct, govern or control in action or use [make things happen]
5. To wield (a weapon, tool, etc.) [act, be a doer]

So that’s what ‘to manage’ means. It’s all about realism, coping, compromise, imperfection, but always anchored in achievement. ‘I’ll do what I can’. Stick with it!

Managing to lead

In the summer of 2012 I was asked to comment on a thought-provoking interview with Sir Hugh Orde, formerly Chief Constable of Northern Ireland and President of the Association of Chief Police Officers. It raised for me the obvious question: ‘How alike are the leadership and management challenges in healthcare and policing?’ I had had to think hard about healthcare leadership challenges then, as I had just applied for and been offered the job of CEO at Great Ormond Street Hospital (GOSH) for Sick Children, and was now getting reactions to my departure from West Hertfordshire Hospital.

First, GOSH is an example (extreme perhaps) of the NHS truth that the brand is an awful lot bigger than the leader. The leader’s role is about safeguarding and enhancing the brand; about quality, cohesiveness, competence and shared values; about being first among equals, a marshaller, enabler and catalyst. But you can only do that if you can make sense of the big picture and be a shaper of direction to match it. People want and expect you to understand the business. They are anxious that your expertise won’t be full or specific enough because they are having to – and they want to – trust you. To be a good leader you have to show them you are a capable manager.

So what have I felt and experienced as a leaving leader? Guilt in response to expressions of warmth, gratefulness and concern because as a hospital CEO you really do belong to the organisation and are a vital cementer of it. This is because management in the NHS, and leadership even more so, is centrally pitched in human values and personal relationships and interactions. Any manager who wants to endure and be enduringly successful, let alone any leader, needs to attend to these, to want them and to be respectful of them.

At this point of transition for me, the importance of openness and transparency also struck me. On the one hand, it was cheering to be told that you had done what you said you would, and, on the other, chastening to see the question written across everyone’s faces at GOSH, will you be who you say you are? Will you repay our trust?

Much that Sir Hugh Orde said about leading the police force aligned with my experience of being CEO of a large hospital, but two differences struck me: firstly, Sir Hugh’s emphasis on literal bravery, a characteristic that we all admire but which is needed in metaphorical terms in my world, where it is about support, understanding and empathy; and secondly, the NHS and healthcare generally is a business of unsurpassed complexity (hospitals, according to management guru Peter Drucker are ‘the most complex managed organisations in the world’) where leadership involves understanding, blending and orchestrating the incredibly varied skills, intelligences and motivations of the most heterogeneous of workforces.

So there is much in common between a police force and a hospital, which is absolutely worth finding out about and understanding, but I am forced to conclude that I couldn’t do Sir Hugh Orde’s job and I don’t think he could do mine. As for Sir Hugh and I, so I believe for most others. We can and should learn from each other. That way we both, we all, will do our jobs better. That’s the basis on which I am offering my book.

Good at being imperfect

Early on in this book I set out as one of its key guiding principles the fact that perfection is a delusion, likely to be the enemy not the friend; and also, very closely related to that, that there is no end point, that good management is about keeping going, about staying in the game. If that’s so, ending this book with a wrap-up message is problematic. My way of dealing with it is to say that the wrap-up message is that there is no wrap-up message, that there is no perfection, that there is no end point and that the key to enduring success is continuation – more of the same.

But you can, and you must, learn lessons. The way forward is to consolidate and embed the ways of working, the ways of management that are described in this book. These are ways of working that recognise the inevitability of error and the importance of error and its recognition. They are about creating strategies based upon recognising your own imperfections; fault tolerance strategies that enable us to achieve.

To sum up …

What then is the advice for making vitality, if not permanent, at least long lasting? If there is no magic wand, then what is the next best thing? Here are some simple concluding ideas, admittedly mainly recaps:

1. Remember the sequence that this book describes and sets out.
   • The sequence starts with imperfect.
   • It moves through relentless choosing and prioritising.
   • It communicates and shares and receives feedback as a result.
   • This enables problem resolution or issue improvement.
   • The communication and the sharing show achievements.
   • They also highlight remaining or new errors, mistakes, problems and imperfections.
   • Instead of seeing these as matters for despair, they are matters for positive attention, ground to work on, material for the next improvement and resolution.
   • They are about keeping in this virtuous circle that we have got into, looping upwards and improving performance as we go around.
   • This way the unbreakable triangle enables an unbroken and unbreaking cycle of improved performance.
2. Avoid complacency and never think you really have the solution: you won’t have. Be a permanent watcher, and ensure you have tall watchtowers to look out from. Look inside for signs of overheating. Look widely: check and evaluate what others think, even if you don’t accept what they say. Understanding why they say it and what is driving them will help you to respond better.
3. Remember the importance of contingencies. Always either have or be ready to flesh out a plan B. This is not necessarily about detail. It’s about readiness to change direction, being geared up for something different.
4. Don’t think you can create paradigm shifts, but look out for them happening, as they will, and often unexpectedly. Where these are radical enough:
   • You may have to reposition or realign your whole effort.
   • It is even possible that the shift will be such as to show you that your own task or your own contribution is over, that it may be time to hand over.
   • It may be time for things to be done differently from the way you have done them.
     If you foresee that, if you anticipate that change, then you can help your organisation, and you can certainly help yourself to move on smoothly to your own next challenge.
5. Search out luck. You can increase your chances of being lucky:
   • Learn from, generalise each success.
   • Do the converse: having found a failure and dealt with it, generalise your action by seeking out and eliminating anything like it elsewhere.
   • Learn from others. Steal ideas shamelessly but critically.
   • On the contrary, avoid the latest fad, the latest solution, the latest panacea, until you have evaluated just what it can and can’t do for you.
   • Keep asking yourself: what is the overriding metric? What is it here and now in the light of all I know, the priority, both in terms of what must be achieved and the time that must be given?
6. Think about the story you are experiencing, the story you are telling. Does it make sense? Does it look as though it will have a satisfactory ending? Think how you can shape one. Think about how the story won’t actually have an end but will move on again.
7. … and don’t panic!