Given its failure to manage major change in the past half century, how well equipped are boards to run the most interactive and responsive mode of care yet attempted, anywhere in the world?<\/p>\n
First, some history. Brunel lived in an era of golden engineers who ran all aspects of the business. He knew when to build wooden bridges to complete a railway, so that the operators could launch the services that would fund better bridges later. He dealt directly with his backers and his father\u2019s spell in debtors\u2019 prison overshadowed his overworked and gilded career.<\/p>\n
This hands-on approach persisted a surprisingly long time. The Ocean Railway<\/em><\/a> (2004), for instance, tells how 19th century marine engineers drove the passenger experience with a hand on the technology and a seat on the board. They took financial risks and ran operations, building ships that would outpace the competition while carrying more passengers in ever greater luxury.<\/p>\n A rising corporatism isolated the working end \u2013 industry, innovation and integration \u2013 from the funding flows and strategy. By the \u201870s British Leyland epitomised how dangerously disconnected the two had become. Management and unions missed what was wrong, each focused on its part of the problem, and neither realising that build quality and process engineering were the new keys to success.<\/p>\n As this industrial scene disintegrated and the NHS was in its prime, a new breed of entrepreneurs \u2013 let\u2019s call them e-Titans \u2013 was emerging, with roots in computing instead of steel. With a hand on the keyboard and a seat on the board, Bill Gates and Steve Jobs became household names, and we soon adopted Google even if we didn\u2019t know who Sergey and Larry were.<\/p>\n The NHS is one of the 20th century\u2019s golden legacies, but it\u2019s not commercial, so what can it learn from this most commercially minded breed? First, it is notable that e-Titans are not focused on commerce alone but maintain a creative and active interest across society, including health and the environment. The NHS is all about knowledge, and so cannot neglect the e-Titans\u2019 discoveries.<\/p>\n So, how have e-Titans changed the world? David Edwards (I\u2019m feeling lucky<\/em><\/a>, 2012: p18) describes Google\u2019s CableFest \u201999 \u2013 when Larry Page and a few engineers played jigsaw puzzles with servers to squeeze 4 motherboards per tray, stacked into 8-foot high racks. It\u2019s not that this reverse-and-rebuild-engineering was extreme, it\u2019s that a CEO would dive in to find the highest packing density. This hunger for efficiency powered Google away from the pack.<\/p>\n e-Titans remain fanatical about detail. In some senses, their style is closer to the 19th century than the 20th, and they certainly don\u2019t believe you can leave innovation or process tuning to others.<\/p>\n Critically, and trillions of dollars of wealth creation later, e-Titans are rewriting the manuals. In Creativity Inc.<\/em><\/a> (2014), Ed Catmull shows how companies can harness ingenuity, while Reed Hastings and Erin Meyer (No Rules Rules<\/em><\/a>, 2020) are taking big investment decisions out of the boardroom to the fringes, where Netflix staff meet their clients.<\/p>\n Amazon\u2019s online books sales did not just threaten poorly run bookstores: it shook an entire sector. A third-party logistics MD recently complained to me that he must compete, on meagre resources, for customers whose expectations are shaped by Amazon\u2019s technology and processes.<\/p>\n