Towards the back end of last year myself and Alex Segrove were asked to take responsibility for a new business plan for the “digital bit” of adult screening in England.

I have been involved in the creation of a few business plans in my time. In each of those cases the motivation to create a plan in the first place has followed a familiar pattern, but the process of creating them, and the expectations for the final artefacts, has varied wildly.

With this experience in mind, my first question when set to task was: is there a template we are expected to follow? As it happens there was, it came with very little explanation of how to use it, and some rather troubling constraints.

It’s an Excel template

The highest level of abstraction in an NHS England business plan is a problem. This is a short written account (it has to fit into a single Excel cell) of the problem(s) your team is looking to address. A problem has a one to one relationship with an Outcome Based Objective (OBO) which is essentially an inversion of the problem. If the problem is people dumping mattresses on the side of the road, the outcome might be a future in which people can quickly dispose of mattresses in a cheap, convenient and sustainable way. Underneath a problem / OBO combination are outcome measures, deliverables and benefits. These three ideas represent:

• how you will measure your progress towards the OBO — outcome measures
• the things you will do during the time horizon of the business plan — deliverables
• and the financial benefits your work will release as defined by the Treasury’s Green Book

You might also be asked to include some “metadata” alongside each of these things, for example: organisational dependencies, the use of AI, or alignment to the 10 Year plan. But these things aren’t core and might vary with what is in fashion at the time.

As I have written before, a demand for in-year benefits incentivises the wrong kind of ideation for an organisation with the kind of systemic problems the NHS faces. However, if you put that to one side, what is left is reasonably sound. An examination of problems you face and the change you hope to create is the right place to start. Asking what measurable success looks like is right too. You might understand what a better future looks like, but how do we verify that future has arrived? Committing to delivering things also makes sense. And giving an entire quarter’s latitude in terms of a delivery date feels reasonable given the size of the organisation.

It is in the application of these concepts where things start to go wrong.

Predicting the future

NHS England seems to think those responsible for business planning are also able to predict the future. Deliverables are demanded, not just for the coming financial year, but, oftentimes, for many years after that too. This is the cardinal sin of any planning process and a tell tale sign of a digitally immature organisation. Problems and outcomes (along with their measures) should be sticky, deliverables should be loose. As product managers the world over will tell you: no good roadmap survives contact with reality, why would a business plan be any different?

To make matters worse, your plan will become a feature of upwards reporting. Dug up on a monthly or quarterly basis like some archaeological artefact on which the future was foretold. When it turns out, as it often does, that those predictions were wrong, the owner is chastised and the artefact returned to the ground (call it SharePoint), only for the process to be repeated again. It is not, as the cliche goes, a “living document”, which can be edited, in a non-judgemental way, as new information comes to light.

A business plan without a strategy?

While in the process of creating the Digital Screening business plan I was asked to revise the plan of an early stage startup on behalf of the CEO. What I was sent was a solid set of financial and operational targets that were both logical and ambitious. My main bit of feedback was: this is good, but how are you going to do it? What is your strategy?

You could ask this same question of an NHS England business plan. In fact, in both cases you have what veteran strategist Richard Rumelt calls fluff. Nice charts that go up and to the right and announceables that fit into a grid, but no substantive examination of how you are going to do the things you’ve set out.

A good strategy is an honest accounting of the constraints your organisation faces and the hard decisions you’ve had to make when it comes to deploying the resources you have. Most importantly, a good strategy is a story that can be told to others. Unlike a model, a strategy can be read (or presented) from start to finish. It can have holes poked in it. It can inspire.

Value in process

I have been thinking recently about value in outcome and value in process. Where the work itself creates value along with the final outcome. Creating a business plan has value in process. Finding time to think about the future, the change you want to see, the problems you’ll face, how you’ll measure change, and the things you’ll do along the way is really important.

You don’t need a formal business planning process to do this. Indeed, a formal process can create problems itself, for example, by squishing different parts of an organisation together, by setting arbitrary limits, or unrealistic time horizons. But never the less, a formal process is also a good forcing function, you are told to make the thing, and with that get value from the process.

And then there is the NHS England business planning process…

By focusing on in year benefits; by asking teams to predict the future, and reprimanding them when they are wrong; by failing to ask how goals will be achieved; the process has been corrupted to the point at which teams bristle at being involved, targets are sandbagged out of fear, and no one talks about strategy. If the real work of business planning is happening, it happens in the margins, rather than in the open where it belongs.

Freedom to fail

The notion of no roadmap surviving contact with reality (like many organisational adages) has origins in military doctrine. No plan survives contact with the enemy, and with that came the freedom to fail, as military leaders realised it was the deputies on the ground who could make the best decisions when the plan was suddenly faced with the gritty reality of warfare.

The freedom to fail, as Sarah Fisher points out, is probably a hallmark of a digitally mature organisation. Organisations that give teams the freedom to learn from their mistakes benefit from the greater depth of understanding they now have and ultimately move forward faster. Organisations that chastise failure, sweep it under the rug or plough on regardless due to their sunk cost bias will never achieve those outcomes.

And therein lies the real problem facing business planning within NHS England. We can certainly improve the process: shortening our time horizons, scenario modelling, and writing more strategies would be a good start. But without the deep cultural shift that encourages experimentation, and with that the freedom to fail, we may struggle to overcome the many challenges we face.