Team of Teams

General Stanley McChrystal, Portfolio Penguin, 2015

This book attempts to show how learning from failure in a military context can be applied to other contexts, e.g. business or medicine.  McChrystal found that simply doing more of a failing strategy produced more failure, and that radical change in structures was needed to effect success.  He moved his huge organisation from a highly-structured and efficient hierarchy to a less efficient but more flexible, highly-networked structure that could adapt quickly to changing circumstances.

He noticed that small teams were successful because of the cross-linkages between members, but didn’t easily ‘scale’ due to organisational design and culture.  So, he created multiple linkages between teams by empowering individuals to work outside their teams. He calls this ‘empowered execution’, and this led to the ‘team of teams’ concept.

Think about your own situation.  How often do you communicate with people outside your immediate team?  So, try it now!  If it makes you nervous, try the question, ‘what would you do if you weren’t afraid?’.  Pick up the phone, or send an email if too timid, and link to someone you think might be useful to talk to.  Don’t worry about ‘rank’ or ‘organisational chart’.

Keep in mind the higher purpose of why you work in the organisation you do.  Check its mission or vision statement if unsure!  If anyone asks why you’re contacting them, remind them of the purpose of the organisation.

The Next Level: what insiders know about executive success

  Scott Eblin, Davies-Black Publishing, 2006

There is often a feeling of vulnerability when you find yourself in a position of high authority in an organisation.  Many new executives fail to thrive in their new role and self-doubt is common.  Scott Eblin has analysed this transition and come up with characteristics for success.  His book is built around the notion that new executives must let go of previously successful tactics and pick up new ways of working at the higher level.  Simply doing more of the same is inadequate.  He quotes extensively from recognised high-performing executives.

The ideas and strategies suggested in ‘The Next Level’ are particularly pertinent for doctors in managerial/leadership positions, (or those who aspire to such positions).  For most of their careers, doctors have kept their ‘nose to the grindstone’ of clinical practice, studying for professional exams and perhaps engaging in some research of doubtful use.  They have not had to engage with non-clinical managers much, let alone executives or boards of organisations.  So when they achieve some sort of formal leadership role, say, Clinical Lead or Director, they usually don’t have the necessary skills to succeed.

Scott’s book has straightforward, practical advice drawn from real-life examples of success.  If you apply his advice you will astonish your colleagues and delight your board!

The Starbucks Experience: 5 principles for turning ordinary into extraordinary

Jospeh A Michelli, McGraw-Hill, New York

About 5:30 am in the waiting area of Liverpool airport, I was feeling dog-tired.  There was nearly an hour to kill before my flight and a Starbuck’s sign caught my eye.  I had never been to Starbucks before but I had in my mind an idea that that coffee was supposed to be good, certainly better than the usual airport fare.  I bought my espresso and was genuinely surprised by the local server asking if I wanted a glass of water with it.  I accepted, and sat down.  I was thinking, “Is that normal for Starbucks, or did this just happen to be an unusually friendly and insightful Scouser?”  Whatever, I was pleased; my expectations had been exceeded.

This really is the essence of the book.  Starbucks aims to turn an ordinary event (buying a cup of coffee) into an extraordinary experience for the customer.  This permits Starbucks to charge higher prices, and to ensure the customer comes back.  A ‘win-win’ situation.

This book was recommended to me by my old CEO at Nations Healthcare Ltd, a young, independent healthcare company trying to break into the NHS.  The idea was that what Starbucks could do for coffee-drinkers, we could do for patients.

It was a neat idea.  The NHS is ordinary, it’s OK, it’s mediocre1.  It could be great if the experience of the patient was taken seriously, i.e. enacted as opposed to espoused.  Starbucks takes the customer experience seriously, that is, it plans it, expends resources on it and ensures its implementation from the bottom of the organisation to the top.  Anyone who works in a service industry and genuinely wants to enhance the consumers’ experience should learn from this book.

Bear in mind the author and organisation are Americans, so for a British reader the style can be a bit cloying.  However, the central message is valid and certainly applicable to healthcare.

Here’s some brief thoughts I picked out from the 5 principles that can easily be applied to healthcare: 

Principle 1:  make it your own:

  • Be welcoming: hospitals are scary places, show hospitality!
  • Be genuine: connect, discover, respond
  • Be considerate:  mindful of the needs of others
  • Be knowledgeable:  love what you do and share that knowledge with others
  • Be involved: in your workplace, department, hospital, community 

Principle 2:  Everything matters:  small details can make all the difference, there really is no way to hide poor quality, ask patients what details they notice about us 

Principle 3:  Surprise and delight:  under-promise and over-deliver (how often the NHS gets it the opposite way round!  For example, think of how we send out appointments, then phone to say they’ve been cancelled).  Don’t be content with ‘satisfactory’ look for ‘delighted’.  Efforts to surprise and delight are contagious.  Patients can even be delighted by the way we make things right 

Principle 4:  Embrace resistance: don’t mind criticism.  If it is untrue, disregard it; if unfair, keep from irritation; if it is ignorant, smile; if it is justified, learn from it 

Principle 5:  Leave your mark:  “How wonderful it is that nobody need wait a single moment before starting to improve the world.” – Anne Frank

1          Health Consumer Powerhouse (2007).  Euro Health Consumer Index 2007, available at [accessed 14/02/08].  (The UK NHS ranks 17th out of 29 countries in Europe).

The 7 habits of highly effective people: powerful lessons in personal change




Stephen Covey.  Simon & Schuster UK Ltd, London

It’s hard to know where to start with a book as famous as this.  I had to read this book; I mean, literally!  It was mandatory reading prior to starting my MBA course.  I would never have normally read such a book, but I’m very glad I did.

It is the personal development book par excellence.  It is very easy to read and verbalises a lot of intuitive common sense.  But remember, common sense is not common practice!

I think that Stephen’s central theme is that there are certain truthful, absolutes in life.  Adhering to these principles will always lead to satisfaction, whether at work or in ones private life.  For me, it revolutionised the way I interact at work and, for anyone contemplating how to be an effective leader, this book is indispensable.  I have also seen Stephen’s video of how children can utilise the ‘7 Habits’, which is quite astonishing.  However, like many good ideas the principles need to be put into practice (made into habits) in order to work and, of course, that’s the difficult bit!

Change your questions, change your life: 7 powerful tools for life and work

I met Marilee at the Global Forum for executive development in Shanghai (great food!).   She enthusiastically told us about how we inhabit a world formed by the internal questions we ask.  She explained that if we increased the quantity and quality of our internal questions we would move from a negative Judger mentality to a positive, Learner one.  This would then lead to an ‘inquiring’ way to view the situations and circumstances we find ourselves in day-to-day.

Such an appreciative, inquiring way to see the world vastly improves our ability to function well as individuals, teams and organisations.  Her book, Change your questions, Change your life describes a fictional character who revolutionises his life and work by applying the principles of Marilee’s QuestionThinking.

I found this book very appealing and helpful.  It is simple (occasionally simplistic), but nevertheless, valid.  I have used it in situations where I felt dis-empowered or bemused.  It’s especially helpful in highly politicised situations as it forces openness and honesty in a non-threatening way.  I have also used it for groups who feel victimised or bullied.  Great for countering that learned helplessness!  Highly recommended.

Patients, Power and Responsibility: The first principles of consumer-driven reform.

 By John Spiers. Radcliffe Medical Press; 257 pages; £27.95

“Discontent is the beginning of the success of a nation.” So opines Oscar Wilde’s Lord Illingworth in A Woman of No Importance.  If this maxim, as quoted in ‘Patients, Power and Responsibility’, can be applied to the NHS then we are surely ready to succeed!

Everything is improved by consumer-driven reform of healthcare. This is the central argument of John Spiers’ wonderful book.  There will be better treatment – guaranteed – , prompt service, reward for high performance and, best of all, self-responsible patients.

His vision is one of unimaginable freedom in UK healthcare, where governments simply make the rules but the power is wielded by competing, independent care associations of patients who insist on outcome-based healthcare.  Ultimately,  fund-holding patients have “the ability and freedom…to be in charge of their own life and their own care.”

Spiers sets out his principles in a detailed and scholarly way, focussing on the real meanings behind emotive words, such as ‘equality’ and ‘choice’.  He exposes the impotence of patients ‘having a say’, when they have no financial muscle to flex.  Consumer-driven reform means informed and intelligent patients making choices not only about their care but also about their lifestyles.  There would be incentives for preventive care.

This is no ‘pie-in-the-sky’ wish list.  Practical solutions are described, based on evidence.  Think of the optics market in the UK, where there has been an explosion of choice, improved consumer satisfaction and still, many opticians offer free eye-tests!  This success could prove a model for other sectors.

But what of chronic expensive illnesses?  Spiers answers this with a basic, guaranteed ‘core’ package of care.  The middle class will still pay for the less well off, but individuals will be encouraged to top-up their provision.  International comparisons are made, with Switzerland and Canada mentioned favourably.  Indeed, the gap in total health spend between the UK and other developed nations is largely accounted for by the underdeveloped independent sector in the UK.

I thoroughly enjoyed John Spiers’ book, and continually found myself exclaiming things like, “That’s absolutely right!” and “See, isn’t that what I’ve always said?” 

I would encourage anyone involved with healthcare in the UK to read this book.  It provides an optimistic and realistic way forward, free from the stultifying effects of political dogma and out-dated paternalism.