That was the question set to stimulate debate at The King's Fund's annual conference last Tuesday during a Dragons' Den-style session on investment for improvement.
The panel, trying to persuade the audience where to place their hypothetical cash, made their cases valiantly.
Paul Durrand of NHS South Central defended the many and varied uses of management consultancy in the NHS. Jean O'Callaghan, chief executive of Bedford Hospital NHS Trust, argued that the cultural and behavioural change needed to deliver productivity improvements required an organisation-wide and structured improvement programme such as Lean (pointing to a six per cent increase in productivity by the end of the first year of implementation at Bedford). Gareth Goodier, chief executive of Cambridge University Hospitals NHS Foundation Trust, made an impassioned call for leadership development as the most effective and long-lasting choice for investment.
Most NHS organisations will seek support from management consultants at some point – perhaps to kick start a programme or to bring specialist knowledge not present within their organisation, such as expert advice on major transactions. But there are differing opinions about the extent to which these consultants should be used.
The same applies to improvement programmes. There are evangelists for the different models around the health care system, but whether the choice is Lean or a home-grown approach there are few chief executives who have not committed, with varying degrees of success, to quality improvement programmes for their organisation.
What these two 'options' have in common is that they require the third choice, leadership development, to achieve their objectives.
Effective leadership on any major change programme requires clarity about objectives, effective and timely decision-making, commitment, passion and good communication – these skills must be identified and developed in any organisation committed to improvement.
The question posed at the event is an artificial one – under scrutiny our panel members all admitted to using at least two, if not all three, mechanisms for improvement. But the issues that underlie it are real. Leaders in the NHS are making increasingly tough decisions about how to get the most value from the programmes they put in place, especially as their spending is under public scrutiny.
The audience weren’t unanimous in supporting any of the three options, but two thirds reached the conclusion that they would throw their cash into the leadership development pot if forced to choose.
Faced with the same options, where would you place your money?