The 5 things every Board needs to get right
Two and a half thousand years ago, Aristotle worked out why some arguments persuade and others fail. He gave us three words for it – Logos, Ethos and Pathos.
I’ve led Executive teams in the development of strategy several times during my career and those three words have always been at the forefront of my thinking. They helped us to land controversial strategic changes that commanded widespread support where previous attempts proposing similar things had failed.
I have since learnt that, despite this success, I missed something which, in the end, risked delaying implementation, despite the strong support. There was a fourth principle which Aristotle proposed elsewhere – Kairos – the right timing. I have also learnt that he united them all into an overarching idea, one that I believe is the rarest and most important quality in NHS leadership today. He called it phronesis I will come to it at the end of this piece
I am convinced that by learning these lessons set out over 2 millennia ago, organisations can vastly improve their chances of creating a strategy that sticks and can be delivered.
Logos
The evidence
Before anything else, you have to understand what is in front of you. Not the surface narrative the system has convinced itself is true, but what the data, the patient stories, the staff voice, the local context and the lived reality say.
Strategies founded on thin diagnostic foundations fail because you cannot appropriately redesign what you have not first understood. The Board that commissions a strategy before it has truly looked at its population is building on sand. So you discover, patiently and honestly before you design anything.
This sounds obvious but I know it is surprisingly hard. NHS strategy development processes tend to jump to solutions too soon or implicitly start with an answer and work backwards to assemble the evidence. Logos demands the courage to not know, before you can begin to know.
Ethos
The credibility to be in the room
People do not readily accept advice on its own, they must trust the message giver. For Boards that can be people who have done the job and who have themselves made the call when the choices were hard. For the public it takes people with authenticity, who they have gotten to know or by professionals who are held in high regard.
Building ethos takes time and continuous effort. It can be the difference between someone who can describe a Board’s anxiety and someone who has felt it themselves. Or it can be between leaders who are seen as detached from what staff and patients really experience and those who have done the leg work to be out, accessible and open to challenge.
Ethos is not simply about reputation. It is about whether people are predisposed to believe you when speak. That matters enormously in the NHS where people are frequently, and rightly, sceptical of those who observe from the outside and prescribe from a distance.
Pathos
The spark
Here is the part I have seen most strategy work miss. Solutions are poorer when developed in a back room and delivered to the organisation. They need the people who really understand services, those who provide them or receive them to be trusted to come up with new answers. I call them the architects.
When a belief has been ignited that this time it might be different, a sense that someone is finally listening, a glimpse of the version of their service they came into this work to build, it provides the emotional ballast to make strategy stick. Strategy that ignores this is weaker and more likely to fail before it ever impacts the real world.
The NHS is full of people with extraordinary reserves of purpose. They came into this work for a reason. Pathos, properly understood, is not emotional manipulation, it is the act of reconnecting people with why they are here and giving that energy somewhere to go.
Kairos
The right moment
This is the fourth element, the one I previously missed and the one most often left out of the classical account. It was present in Aristotle’s own work and developed more fully by the ancient Sophists who built on his thinking.
Kairos means the opportune moment “the right time”. Not just the right argument, the right credibility or the right emotional connection but the right conditions in which all of those things can land.
The Greeks depiction of Kairos as a god with wings on his feet and a single lock of hair at the front of his bald head makes the point that opportunity can only be seized head-on, as it approaches. Once it has passed, there is nothing left to grasp.
I can see now that, at times, I have fallen foul of this and as a result the organisation has missed the moment because the timing was off. This happens a lot across the NHS and we will all have examples — an engagement exercise launched in the middle of a financial crisis, a culture programme announced in the same week as a redundancy consultation, a transformation plan unveiled to a Board that was preoccupied with a turnaround crisis.
Kairos is not about waiting passively for conditions to improve. It is an active discipline which requires leaders to read the environment, understand what the organisation is ready for, and make the judgment about when to move. That judgment can only be developed through experience and careful attention to the human dynamics and the wider environment
Which brings me to the fifth idea that unites all the above.
Phronesis
The master virtue
Aristotle did not include phronesis in his rhetoric, he placed it in his Nicomachean Ethics. He described it as practical wisdom: the ability to make sound judgements in complex, uncertain, human situations where no universal rule applies.
He considered it the master virtue – the one that holds all the others together.
Phronesis is not the same as knowledge. You can know all the evidence and still misjudge what to do with it. Neither is it the same as skill because you can be technically capable and still miss what matters most. Rather, it is the capacity to perceive what a specific situation requires and to act accordingly. Aristotle is clear, Phronesis cannot be learned from books. It can only be developed through experience, through having been in enough situations, made enough decisions, lived through enough consequences, to develop a refined sense of what good judgment looks like.
The NHS has an abundance of knowledge and technical skill. With ever more rapid turnover of senior staff, what it has in increasingly short supply is the kind of seasoned, human judgment that phronesis describes. This loss is insidious and difficult to spot but its cumulative impact is a service increasingly lost in tactics and struggling to transform in a way that our fiscal and demographic challenges demand.