New chief executive officer of an acute foundation trust

First, in order to understand the particular personal knowledgeability infrastructure and approach to attaining knowledgeability developed and continuously maintained by a CEO, we suggested that understanding the particular context, nature of work and personal style is highly relevant. In particular, for a new CEO of a large acute trust, the particular context brought novel challenges of financial pressures, which were previously absent, not just in this organisation, but also in the CEO’s previous organisation to this extent. Practically, the challenging financial pressures meant not only a great focus on operations and securing the necessary savings, but it also brought significant regulatory attention to the trust, which the CEO as the accountable officer had to manage. In addition, the CEO had been in post for less than 1 year at the time of our observations, and this was also a larger organisation than the CEO’s previous one, which brought particular challenges of ‘scaling up’ the executive’s work to ‘fit’ the new environment.

In addition, the context contributed to a distinct nature of work for the CEO, which was characterised by a focus on leadership and ‘sharing the vision’, by spending significant time with staff in various parts of the organisation via ward visits and similar, but also organising staff events with a view to communicating the challenges, most notably financial ones, as part of a strategic narrative of ‘where we are going as an organisation’. More practically speaking, the work of this CEO involved a busy and constantly changing diary with many internal and external meetings, but also long working hours on and off site, which featured both many informal conversations on site, particularly in the evenings, but also reading, writing and administrative tasks worked on at home, which could not be done on site because meetings and other engagements took precedence. Finally, the personal style of this CEO tended towards a collaborative approach to working as a team, an action orientation towards addressing issues immediately and seeking out information and solutions proactively, and a focus on the detail, though this was always done with a view towards the ‘bigger picture’ for the organisation. Indeed, managing the detail to manage the big picture is a shorthand that could be employed to describe the particular orientation of this CEO to her work, which as we shall see was also reflected in the CEO’s particular approach to remaining knowledgeable in practice.

Notably, these three elements, namely context, nature of work and personal style, greatly informed the personal knowledgeability infrastructure of this CEO, which consisted of a particular configuration of relationships, practices and ‘tools of the trade’, as seen in Figure 11 below. For example, the collaborative team approach reflected itself in many informal and formal interactions with the executives, whereas the sense of leadership and ‘big picture’ thinking informed the engagements with external colleagues and networks as sources of insight and aids to making sense. Similarly, ‘sharing the vision’ was reflected in frequent visits to wards, and large operational TMT meetings, which also provided the opportunity for the CEO to make it clear (as she reported in her feedback session) that there was a new executive in post, with a new style and direction. Finally, a certain combination of ‘tools of the trade’ was employed by this CEO to make herself knowledgeable, which included informal visits, reading external publications on train journeys, attending conferences, such as those organised by the NHS Confederation, and participating in local CEO meetings, among others. Importantly, these were just some of the ‘tools’ brought to bear in daily accomplishments of work by this CEO.

FIGURE 11

Example of a personal knowledgeability infrastructure (new CEO of an acute FT).

This infrastructure then contributed to and was mutually informed by the particular approach this CEO took to maintaining knowledgeability in practice, which is to acquire knowledge largely as she goes along. For example, a ward visit was seen as crucial for visibility and staff communication purposes, but the CEO stressed that during such events helpful insights were also being gathered in order to be made sense out of, and current thinking was tested against what is happening on the ‘front lines’. In other words, knowledgeability for this CEO was a continuous process of interaction in an in-depth manner with various sources, all of which were considered and reflected on via additional engagements and conversations, with a view towards building a ‘big picture’ account of the world and how such information helps to inform it.

This mutually constitutive dialectic between context, nature of work and personal style, personal knowledge infrastructure and an individual orientation to knowledgeability can be seen in action in the case of the annual savings programme as a particular task towards which knowledgeability was employed by this CEO. In particular, the task involved roping in a number of elements or sources, both formal and informal, over time, namely an informal meeting with the management consultants hired to help facilitate the process, which itself included obtaining comparative insights to how this issue was being dealt with by other trusts; a meeting with the NHS Elect to gain similar insights; a detailed discussion of current status and associated figures with the trust lead on improvement, as well as other executives on multiple occasions; and finally a meeting of the trust management team, in which the managers were questioned in great detail concerning the work done so far, and encouraged to work together in order to bring forth a viable solution. This reflected again the reliance on multiple sources of insight, including both formal and informal, as a key part of the CEO’s personal infrastructure, but also the detail orientation and collaborative approach as key features of the CEO’s approach to working and maintaining knowledgeability as part of that.

Established chief executive officer of a mental health foundation trust

The second illustrative example, in turn, is that of an established CEO of a mental health FT. First, the particular context was that of a very successful financial year and a mature organisation, which the CEO was very familiar with after more than 5 years in post. This context was reflected in the nature of work during the time of our observations, which was characterised by the CEO as ‘managing a steady ship’: a steady pace of work, with a tightly scheduled diary, and only a few late evening events. This allowed the CEO sufficient time to engage in continuous informal reflection in conversation, which was a key component of her personal style, along with an emphasis on professionalism, and an orientation towards learning and evidence-informed practice. These three aspects subsequently informed, and were informed by, the personal knowledge infrastructure set up and maintained by the CEO, which consisted of a number of key relationships, structures and ‘tools of the trade’. For instance, the reflective approach to work and knowledgeability was maintained via close relationships with a smaller number of executives, who were regularly consulted and engaged in conversation in order to make sense of current tasks or future work. The CEO’s personal coach, who has been in a supportive role to the CEO for years, was similarly relied upon. In addition, external meetings were used purposefully to help make sense of emerging issues or strategic tasks, while large team meetings allowed the CEO to model her kind of professionalism to the rest of the organisation. Finally, the CEO had in place a number of ‘tools of the trade’, which she used in order to maintain the appropriate knowledgeability for everyday work in context. This included publications such as the HBR, for professional leadership practice, and NHSmanagers.net, for sector thinking, but also a long telephone call in the car each morning (and most evenings) with executives to discuss and reflect; frequent coaching, and added professional engagements, such as attendance at external conferences, not only in the health-care field.

FIGURE 12

Example of a personal knowledge infrastructure (established CEO of a mental health FT).

These could be collectively described as ‘managing in continuous reflection’ as a descriptive way of characterising the CEO’s posture or orientation towards work and thus also towards knowledgeability. As the CEO told the researcher, ‘this is basically how she works, so a stream of consciousness to the execs’ (excerpt from field diary). This can be seen in the example of a service manager appointment process, where the CEO found herself holding an opposite opinion to the rest of the panel about which candidate to hire, which prompted an extended process of information-sourcing, sense-making and reflection in order to arrive at a decision that was in line with the CEO’s professional and evidence-informed approach to work. In particular, following the meeting of the panel, where it became apparent the CEO was an outlier in her assessment, the CEO returned to the office and had an informal chat with a trusted executive, asking her what she thought about this situation, and stressing that the CEO could not understand the discrepancy. This was followed by more reflection, this time via a telephone conversation with another executive until 21.00 that evening, and an unprompted conversation several days later with another manager who offered her informal views on the candidate. Another component was a further meeting with a HR representative to review the scores from the day, which allowed the CEO to conclude that the original decision made was correct, as the scores of the different candidates across the panel members supported her assessment. Importantly, this reflected the evidence-informed approach by the CEO, where various sources were frequently taken into consideration during the iterative process of making sense, but ‘hard’ evidence was sought out where possible as a crucial component of the decision.