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Taking the initiative

There is a time and place for looking after patients, but progress demands leadership and the job of the leader is to generate initiatives.

In a period of scarce resources, the one thing we can rely on is a constant supply of programmes, visions and strategies to spur us on to new heights of achievement.

The dictionary defines initiative as “the power to assess and initiate things independently” and “the power or opportunity to act or take charge before others do”.

As so often, the dictionary is simply wrong. Initiatives are not there to be taken on the spur of the moment: they require considerable thought and planning. Likewise the idea of people initiating things independently is a recipe for disaster.

It’s as daft as assuming that people can make a plan without being told what to put in it.

You will have seen that NHS England has just issued 90 pages of planning guidance. This is a sensible measure to ensure that plans are not simply made and executed in some haphazard way but are planned, consulted upon, reviewed, revised and published in time for the next planning cycle. By the time the plan is ready, revised planning guidance will be available to keep the planning process up to date. These things don’t simply stand still.

The planning guidance is also important for consistency. Because your plans will need checking, it helps if they are all the same. Of course you need the freedom to make local plans, but the approval process would grind to a halt if they were all different.

Telling people what to put in the plan and then leaving them to write it satisfies the need for local autonomy without compromising the overarching need for accountability. In a very real sense, what goes in the plan is completely up to you (see Appendix 4 of the guidance, which contains a list of the things that are completely up to you and some examples of things you are free to include if you want your plan approved).

Don’t let your five-year plans deter you from taking initiatives in the meantime. Your plans will be expected to include initiatives, but you can start planning your initiatives before you’ve finished initiating your plans.

There is plenty of advice available to help you develop eye-catching high-quality initiatives for any purpose. Here is a fine example, which you can use as a template for initiatives of your own.

The 6Cs – the building blocks of all great initiatives

  • Cliché – at the heart of all our initiatives
  • Coincidence – the odds against everything starting with the same letter
  • Cobble together – our methodology for this initiative
  • Care, compassion and culture change – the essential ingredients for all initiatives
  • Concrete – the one ingredient you won’t find in any of our proposals
  • Cost saving – any money saved by this initiative will be reinvested in new initiatives

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