What can health boards, or any public service, learn from the battle of El Alamein?

‘Not much’ would have been my answer before Christmas, but Santa brought something that changed my mind. Alamein by Stephen Bungay (external link). A former management consultant turned historian, Bungay brings a fresh insight to history by applying modern management thinking.

Nominally focused on the 1942 El Alamein battles (external link), the book is really the story of how a high performing organisation (the Afrika Korps) and a poorly performing organisation (Italian Army) confronted a mediocre organisation (Commonwealth 8th Army). And lost.

Over 70 years later what relevance does this have for public services in Wales?

General Bernard L. Montgomery watches his tanks move up

How can General Montgomery help us think about health services in Wales? (Photo credit: U.S. National Archives)

Success comes from a well-functioning leadership

As part of our NHS structured assessment work we are looking at how well health boards lead and manage. This includes looking at how the board operates, the topics it considers and what information it uses to run the organisation. The executive and board of any organisation must have robust information, draw the right conclusions and implement a sensible strategy.

But that’s all a bit dry and dull isn’t it? The lively stuff in health boards (and armies) happens at the front line surely? Bungay tells us otherwise – what happens at board level can be life or death too.

What battle should we be fighting?

In 1941 and 1942, the Afrika Korps won a series of high-profile battles, but to no strategic advantage. The frontline in the desert was not the only fighting front. The outcome of the land fighting was determined by a supply war.

The Desert War was literal. Every bit of food and water, petrol, bomb and bullet had to be shipped in by each side. The scale was immense – the Afrika Korps alone needed over 3,000 tonnes of supplies each day. In today’s money that’s about 100 articulated lorry loads.

Getting the right stuff, to the right people, at the right time became a single point of failure.

The main front in the supply war was the Mediterranean Sea. Control of sea convoy routes, three main ports and the supply lines linking the ports to the front required control of the air. Central to all of this was Malta. Whoever possessed Malta would win the supply war and hence the overall battle.

Each side had the means to win – look at the data, see the big picture and decide where to concentrate their effort. This is not easy though – armies (and health boards) need to cut through the fog of war and determine where the real battle is. To do otherwise is just a waste of effort and resources.

Stethoscope on a graph

Have health boards picked the right battles?

The Italians failed miserably. They had chaotic leadership with initiative and responsibility discouraged at every level of rank. This meant upward delegation of most decisions. Bungay tells us that in 1942 most of the 300 General Staff meetings (ie ‘board meetings’) were devoted to the movements and unloading of individual ships. As a board they were focused on the right topic, but the wrong level of detail. They missed the big picture.

At the height of its success, the Afrika Korps was nearly 1400 miles from its base, the distance from Cardiff to Naples. It took one tonne of petrol to move 10 tonnes of supplies 300 miles from base to frontline. This distance lengthened with military success and the petrol consumption became more disproportionate. This was an inbuilt brake on military success – acting like a self-limiting organism.

The German General Staff were aware of this, but Rommel was a charismatic and influential CEO. He was also a brilliant tactical leader who thought logistics were dull and somebody else’s problem. He tried to devolve the problem upwards to head office in Berlin. As a board, the Germans had the right information, but focused on other more interesting issues. They too failed to develop a coherent strategy.

British and Commonwealth military practice was outdated, hence their lack of success at this point in the war. However their military curriculum emphasised logistics and they recognised that Malta was the key to success in the whole theatre of operations. The rest, as they say, is history.

And what of our health boards? In among a fog of targets, strategies and other pressures – do they know where they should be fighting?

About the author:

Tom Halsam standing in front of a planeTom Haslam is one of the WAO’s performance audit staff who focuses on issues of economy, efficiency and effectiveness. His 20 years’ experience includes audit, business development and methodology roles at the Audit Commission, New Zealand’s Office of the Auditor-General and the UK National Audit Office.

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