Breaking bad news

GGI consultant Joe Roberts says GGI is a critical friend to our clients – and that sometimes means telling them things they don’t want to hear.

At GGI we pride ourselves on our objective, independent approach to reviews. Sometimes that means we have to deliver bad news to clients.

In some cases, boards already know that their organisation has a problem and that is why they have commissioned us. There may have been a serious incident, or regulators may have taken enforcement action. Leaders of these organisations are mentally prepared to face hard truths. However, in other organisations, shock, disappointment and even disbelief may greet critical review findings.

This is usually due to one of several reasons. One of the most common is that the organisation had problems of which it was aware, took prompt action and now believes that the issue has been resolved. But the actions they took were not sufficient to deal with the root cause, or are not yet embedded in practice.

Alternatively, the organisation may, until relatively recently, have been a high performer with inspection ratings to match, but has now become complacent, and gradually, sometimes almost imperceptibly, it has lost its way and fallen behind its counterparts.

Or, in a large organisation, there may be a very local but serious issue in an individual service which has never been escalated to senior management level or appeared on the board’s radar until now.

The human factor

When delivering bad news, it is important to consider the ‘human factor’. If we are honest with ourselves, none of us enjoys hearing critical feedback or disappointing news at work. Individuals will naturally be concerned about the impacts: what their regulators, non-executive directors or external stakeholders will think; the amount of extra work that will be required to put things right when everyone is already working under intense pressure; the financial cost to the organisation; and the personal and professional consequences for themselves.

These responses are entirely natural and understandable. Often, they do not last long and the temptation to shoot the messenger fades away as the facts of the matter are considered.

In a small minority of organisations, however, the pushback against an outsider’s critical judgement is more of a concern. Common themes of national reports about major service failures in healthcare include an excessive focus on the organisation’s own image and reputation which prevents it from acknowledging its own shortcomings, or a rigid and hierarchical leadership style which inhibits constructive professional challenge.

In such cases, people working inside the organisation may already have identified for themselves many of the issues highlighted by the reviewer but have been rebuffed when trying to raise them.

In these organisations, it is absolutely essential for reviewers to stick to their guns and provide robust, factual feedback and directions for change. GGI works to a strict code of ethical practice which requires us to escalate concerns we identify in the course of our work, including to external authorities where there is evidence of serious wrongdoing or service failures that put patients, employees or the public at risk.

Driving improvement

As management consultants specialising in governance and leadership of organisations, we see driving improvement as the primary objective of our work. Thus, we are open and direct with our clients, and we endeavour to deliver our findings and recommendations in such a way that they are more likely to be accepted and acted upon. There are four main elements to our approach.

1. No nasty surprises

During our reviews, we remain in continuous contact with the sponsors of our work within the client’s organisation. If we uncover an issue of potential concern, we share it as soon as we become aware so that the facts can be clarified and the client can take action if necessary. They will not find out about the issue for the first time when a draft report arrives in their inbox.

2. Solid evidence base

We triangulate evidence in different forms and from different sources to form our judgments. Intelligence gathered from one-to-one interviews with directors or focus groups with frontline staff is matched up with data in management reports and national performance statistics and, where appropriate, with the views of external stakeholders. Our findings are never based on just one piece of evidence and our reports always make clear how, and from where, our conclusions are drawn.

Also, our reviewers always work as part of a team, so the findings of our reviews represent a considered, collective view from a group of subject matter experts, rather than the opinion of an individual.

3. Constructive and developmental approach

We are consultants, not regulators or auditors. Rather than a ‘compliance’ approach of working through checklists and questionnaires to provide a yes / no answer, or red-amber-green rating of compliance with a standard, we seek to understand the organisation in order to set a baseline for improvement. This is about professional judgement and nuance. It is not about painting a simple black and white picture. As such, we will highlight both what works well and what doesn’t.

4. Realistic and practical suggestions to put things right

The greatest value of our reports lies in our recommendations. Critical feedback is more likely to be accepted and to result in positive change if it is accompanied by helpful advice about how to solve the problems described in the report. Sweeping, broad-brush recommendations to ‘embed a supportive culture’ or ‘encourage more open communication’ are likely to be of little help so we produce more granular and actionable recommendations covering not just the ‘what’ but also the ‘how’. Many of us come from backgrounds in the NHS or other parts of the public sector and we are under no illusions about the pressures our clients experience every day – and how difficult it can sometimes be for them to make change happen.

Critical friends

We see ourselves as critical friends to our clients and, like all good friends, we will tell our friends what they need to hear even when we suspect it might not be what they expected or wanted to hear.

In business and the public sector, just as in life more generally, problems rarely remain hidden forever. It is infinitely better for an organisation to identify a problem in its early stages and deal with it while it remains manageable, than for it to snowball into a crisis. Often, when that crisis comes to light, it is uncovered by regulators or the media amid a blaze of negative publicity. Very quickly, the organisation starts to feel micro-managed by its regulators and loses control of its own destiny.

By accepting and acting on critical but constructive feedback, leaders will have the peace of mind that comes from knowing what their risks are and how they are being managed, rather than worrying about unknown unknowns that could blow them off course at any moment.

Even if sharing difficult messages can sometimes feel uncomfortable for consultant and client alike, the benefit for clients of us doing so is priceless.

Any organisation would accept pushback from internal audit expressing a negative opinion and qualification of accounts. In exactly the same way, the value of our work is in its independence. It makes no sense, commercially or reputationally, for us merely to tell clients what they want to hear.