High hopes for healthcare
Published : October 2008
Poised to assume the mantle of CEO at King’s College Hospital, how does Tim Smart, currently CEO of BT Global Services UK, plan to make the leap from technology to healthcare – and how tough does he think life in the public sector will be? Becky Done went to meet him to find out.
It’s an unusual move. After a career spent entirely in the private sector – firstly at Shell, latterly at BT – Tim Smart is about to embark on something different altogether. In fact, he is about to become the first in history to move directly from the private sector to the role of CEO in an NHS foundation trust. Private to public sector career moves are not unheard of, but this is the first of its kind.
“I always had the ambition to do something in the public sector,” Smart explains. “I set myself the goal that when I got to 50, if the right opportunity came up, then that’s what I would do. It’s been in my head for 10 or 15 years.”
To those who might question the relevance of private sector experience to the NHS, Smart is quick to respond. “BT has a very strong management culture, ethos and values. It is also a relatively complex business – all of which is very transferable into the NHS. If I’d been running a small company things might be different, but the fact that I worked for Shell in the early part of my career and have spent the last 19 years with BT means that I possess a lot of transferable skills.”
It’s not long before Smart’s commercial aspirations for King’s become apparent. With a strong reputation for excellence in research, King’s is one of a group of trusts – including Guy’s and St Thomas’, and South London and Maudsley – aiming to create what Smart calls “a global brand for healthcare” in south east London. He hopes that his ability to collaborate and work with different organisations will impact positively on the trusts’ efforts to create an academic health science centre. “Strategically, that’s a big opportunity that I hope to add some value to,” he explains. “Maybe because I come from the private sector with a commercial background, I can provide that element to the equation.”
Smart hopes that this brand of excellence will enhance King’s ability to attract the world class talent to serve its diverse community base. This is another area in which the NHS has clearly identified his having useful knowledge, for he has been champion of BT’s equality and diversity initiatives. “If you look at the ethnic and gender mix at BT, it fairly equally matches society,” says Smart. “We win a lot of awards in equality and diversity; and in a hospital like King’s where the community served is extremely diverse, aving the ability to do that well means having an appropriately diverse workforce,” he explains. “I think the fact that I’ve been in BT and worked in this area helped my cause because I have the experience of working in an organisation that’s taking it very seriously.”
Smart admits he thinks the NHS has been “brave” in taking the decision to appoint a CEO whose background is entirely in the private sector, but he balances this assessment by drawing a further direct similarity between the NHS and BT. “Both BT and the NHS are part of the infrastructure of the UK – so there must be some transferability between the two. The qualities that both BT and Shell have imbued me with, and the way they have helped me develop, really fit in quite well to transfer into the public sector, because both those organisations do very important things, they’re very trustworthy and they have very high quality people,” he says.
That King’s is a foundation trust – patient-led, and with much of its decisionmaking decentralised – will allow Smart many of the commercial freedoms he is accustomed to. “I guess that makes my experience more relevant,” he says, “because of the opportunity to develop commercial operations from the hospital base. You can use that for the benefit of the hospital – if you’re a foundation trust and you make a surplus, you are allowed to re-invest it back into the hospital.”
Clearly, then, a commercial perspective will be an asset to hospital operations – but will this be welcomed by all, or is there a more sensitive balance to be struck?
Smart agrees that an appropriate approach is important, but is convinced that a commercial strategy will strengthen the service deliverable to the patient. “I can understand if the management is slightly nervous,” he says. “Public sector structure and the pace of change is undeniably different to what happens in the private sector, but the clinical community are certainly very optimistic about it. What they want me to do is use my commercial expertise and background to enable them to deliver valuable services to the atient.”
To illustrate this, Smart cites the four hour turnaround of A&E patients, a target which must be achieved 98 per cent of the time. “But if you’re a doctor, what you’re really interested in is making sure the patient’s okay,” he points out. “The four hour target isn’t what’s ringing the bell in your head. So I have to be able to create an environment whereby more resources become available. If, as management, you can run the place as efficiently as possible, reduce beaurocracy, and focus on the key things that make the place tick, you enable your people to serve patients better.”
With this in mind, engaging with his staff will clearly be a priority. “There is an incredible amount of talent amongst the staff and they’re very committed to what they do,” says Smart. “Finding the touch points with those people and understanding what makes them want to work with the institution, and what makes them want the institution to be more successful – I think that’s really quite an important challenge.”
Smart appreciates the immediacy of the environment he is about to enter and understands what implications this has on his own role. “At BT I have to make an appointment to go and see my customers – but you’re going to get pretty immediate feedback in a hospital,” he says. “I only have to walk out of my office, come down two flights of stairs and I’m in the middle of it.
“It already makes me feel re-energised because the challenges are significant, and they matter. I’m not saying that what I do with BT doesn’t matter – of course it does – but at King’s you can walk into the liver unit, for example, and meet people whose lives have been transformed. You can participate and contribute to something that makes such a difference in such an immediate way and just being a part of that will make everything worthwhile.”
As a career move, then, is Smart searching for something more rewarding? “This is a real goal in itself,” he replies. “I don’t necessarily see this as a career move; this is where I’d like to end up, and I’m really looking forward to it.”
Smart agrees that some CEOs, having enjoyed substantial remuneration in the private sector, are now in the position where they can ‘give something back’ to society by taking public or voluntary sector roles. “Maybe there will be more of them,” he suggests. “In fact, a lot of people have said to me, ‘I’ve always thought about doing something like that myself’. Of course you can’t avoid recognising the fact that public sector remuneration is not, on the whole, as good as private sector remuneration, but maybe now people become relatively wealthy at an early enough stage in their life to be able to go and do something while they’ve still got the energy and the enthusiasm to do it.” Substantial pay packages – including that of Ian Livingston, who took up the role of BT Group chief executive in May this year and was reportedly set to earn up to £7 million in his first 12 months – commonly come under fierce and intense criticism in the public eye. But Smart’s stance is unrepentant: “People who run large corporations put an enormous amount of themselves into what they do,” he says. “Francois Barrault [chief executive of BT Global Services] travels incessantly, works incessantly and is always available. He shows great leadership, thinks through where we want to go, takes risks and puts all the mitigation plans in place – and hopefully, he gets rewarded appropriately. The fact that his remuneration package is public information just makes it more interesting to people.
“I’d imagine a lot of people think that I’d be pretty well rewarded running a hospital as well, but you need people who are prepared to take a bit of a risk, and who have the leadership skills to move organisations forward. How much they are paid is just a consequence of whether they achieve the results. I think you have to look at yourself in the mirror in the morning and say, ‘Am I worth it?’ At the point you think you’re not worth it, you should ask yourself why you’re doing it.”
Self-reflection and personal development seem to be high on Smart’s personal agenda as he makes the move to King’s. Complacency, on the other hand, is not. “If you’re not learning something every day; if all you’re doing is repeating what you’ve done before, then you’re not making progress,” he insists. “Obviously, there’s a hell of a lot to learn. I’ve never been accountable to the public accounts committee before, for example, so I’ve had to learn all about that. I’m hoping over the next few months to go up the learning curve at King’s, so by the time I arrive there I actually know what’s required of me, rather than walk in on day one and ask some really stupid questions!”
Does Smart anticipate that a return to learning, coupled with a new working environment and its associated relationships, will generate some renewed thoughts on the subject of leadership? “Absolutely,” he replies. “In fact, I did once upon a time think of writing an essay on the subject. And I learnt an expression recently: ‘Hard on facts, fair on people’. I think that embodies good leadership.” What else does he think makes a good leader? “One thing that means a lot to me is integrity – being really trustworthy and true to your word. I also think empathy with the various stakeholder groups that you’re accountable to – customers, shareholders, employees, or in this case, the taxpayer, patients and employees – and understanding what makes them tick is very important, as is the willingness to take risks and put yourself out front.”
Putting himself “out front” and taking a risk is certainly what Tim Smart is doing right now. But he is quick to emphasise the positive reaction and support he’s received from colleagues at BT, future colleagues at King’s and contemporaries in the wider business world – suggesting that he may have helped to change perceptions about making the move to the public sector. “I guess people might previously have been nervous about doing it,” he suggests. “People in the private sector are worried about too much beaurocracy and about being exposed in the public domain, because it can be quite challenging in that sense if things don’t go according to plan.”
If this worries him, Smart doesn’t show it. “I’m optimistic about it,” he smiles. “Really. It makes me feel really good.”