Rule 2: Reach every rung on the ladder

Rule 2: Reach every rung on the ladder

The six rules of good healthcare management and leadership development.

Mark Britnell

Global Healthcare Expert, KPMG International; Senior Partner, KPMG in the UK

KPMG in the UK


One of the clearest lessons from health organizations that have maintained a consistent focus on improving their management and leadership is that very little can be changed by focusing only on the top-tier. Failure to invest properly in mid-lower management grades was the most common weakness in healthcare organizations’ strategies noted by interviewees.

This is an astonishing gap considering that a ‘mid-ranking’ hospital manager might routinely be responsible for a department of US$50 million turnover or more – the size of a medium-sized company.

Management and leadership are increasingly seen as collective endeavors, and those that reserve development initiatives for executive positions quickly encounter a number of serious limitations:

  • The organization becomes strong on strategy but weak on implementation. A layer of ‘corporate concrete’ forms which prevents corporate plans filtering down or innovation bubbling up.
  • Development is done in isolation from the real business, culture and operations of the organization.
  • Resources are focused on those that have already had the opportunities to develop these skills, rather than those that could benefit most. In many cases executives will have attended similar programs before anyway.
  • Staff morale, recruitment and retention, along with organizational performance and reputation, suffer as a result.

Instead, the best organizations develop comprehensive, lifecycle programs that instill a consistent and sustainable set of management and leadership behaviors spanning every level of the hierarchy. This means that change can be hardwired over a decade or more of employees’ careers rather than expecting transformational effects from one-off interventions. It also communicates to staff across the organization that everyone has a role in the management and leadership of the organization, whatever their grade.

If this comprehensive approach sounds expensive and daunting, it needn’t be. Organizations like Discovery (see below) show that some of this management development ‘ecosystem’ can be almost free to implement, by drawing on the resources and opportunities already in the business.

Symptoms of failure:

  • Organization is strong on strategy, but weak on implementation
  • Few senior leaders have risen up through more than three tiers of the hierarchy
  • Low ambition and morale among middle managers

Key action for boards:

Map your existing development activity against your organizational matrix – are resources being rationally distributed or are there major gaps?

Case study

A comprehensive, ecosystem approach, Discovery Health (South Africa)

Health insurers are not usually known for dynamic and innovative management practices, but then Discovery is no ordinary health insurer. The South African payer is one of the fastest growing in its sector globally, with a track record of innovative spin-offs, regular new product launches and rapid international expansion from its current base of 2.6 million members in South Africa to operations in more than nine countries over the past three years.

A comprehensive ecosystem of management and leadership development is an essential component in Discovery’s mission to become ‘the world’s best insurance organization and a powerful force for social good’. The philosophy behind this approach has seven important tenets:

  1. Invest in all levels of staff in the organization.
  2. Development should begin at onboarding stage and continue throughout an employee’s career.
  3. Participation should be driven by demand from individual staff members, not mandated upon them
  4. A rich mix of formal and informal development, to suit a broad palate of learning styles.
  5. All training is consistent with a single ideal – ‘The Discovery Person’ – who is optimistic, entrepreneurial, results driven, honest, has low ego and high intellect.
  6. An organizational rhythm of continuous opportunities to improve and put skills into practice, including biannual product launches and 90 day challenges.
  7. Regular contact time with the senior leadership team, so that staff can see these behaviors modelled in practice.

At the heart of Discovery’s ecosystem is the leadership development ‘starfish’, composed of more than 30 interventions for staff to choose from at varying points in their career. Among these is the ‘Inspiring Excellence’ program, whereby staff can present organizational, operational or product improvements directly to senior leadership. Staff that are accepted get direct support to develop themselves and their idea, including mentorship by a Discovery executive throughout the process.

For newly-promoted senior managers, an immersion program puts into practice the notion of thinking outside of departmental silos towards the whole organization. Their first three months are spent moving around all different parts of the business from front line services to back office functions. These are more than quick walkthroughs: they are required to spend substantial time engaging with the challenges of each area, and to be in a position to comment critically and appreciatively on their priorities and plans. Then they begin to focus on a project in which they will identify and analyze specific improvements across business units. As they work at this, they compile a personal learning log and portfolio of evidence to support their arguments. At the end of the three months, they present recommendations to the Executive Committee – so accountability and performance are a hard-edged requirement too.

For leaders with the potential to rise to the very top of the organization, Discovery’s Executive and Operational Committees have up to two rotating secondment positions each lasting six months. This is to give the most promising leaders a chance to see behaviors modelled at the most senior level and have all-important contact time with the executive teams.

The results of this developmental activity are plain to see throughout the organization, including at the very top. The organization’s COO Karren Sanderson, for example, started with Discovery in 1997 as a call center agent, working her way up through the hierarchy and drawing on many of the opportunities in the organization.

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