In NHS estates, we need to get brave at saying Yes. And we need to get much braver at saying No. Even when we don’t say No at all.
(Feeling muddled? Read on...)
Here’s some of my Monday morning Festival of Wrong Conversation musings.
Part 1: The case for ‘Yes, if…’
‘No, because...’
I sometimes think this 2 word phrase is where most transformative, or at least potential-filled, ideas in estates NHS go to die.
No, because we have no money. No, because we don’t have time to try something new. No, because of clinical risk. No, because of governance. No, because it’s not in the 100-page business case that was written 18 months ago.
It’s understandable. Risk is very real, and public funds are finite.
But when ‘No, because...’ becomes an semi-automatic response, it freezes creativity, alienates people who might be able to help, and puts all our attention back on the challenges and hurdles – rather than the opportunities.
What if we flipped the script? What if the more normal answer became ‘Yes, if...’?
Yes, if it starts small and we limit the time we spend.
Yes, if the governance and management are proportionate to the tiny idea we are trying to test.
Yes, if we trial it before committing (whilst not allowing it to be a perpetual pilot!)
Yes, if we can find a way to manage the risks rather than simply list them.
And so on…
Challenges aren't an excuse to do nothing – to the right people they are nothing more than conditions to design around. And by moving to ‘Yes, if...’, we replace a state of bureaucratic paralysis with one of creative pragmatism. That's a very different mindset.
Creative pragmatism starts with the belief that there is almost always something we can do.
In the battle between momentum forward and standing still: Yes > No.
But there's another side to this.
Part 2: The courageous Yes (and the No it forces)
A genuine Yes often requires us to say No to something else. And this is where things get interesting (to me, anyway…).
We so often think No is the word that closes possibilities. But sometimes the most difficult thing about saying Yes is accepting the doors it closes.
We cannot do everything. And every definitive Yes commits resources, time, attention and energy. It means choosing one direction over another. It can feel uncomfortable - especially when resources are so scarce.
So, to protect ourselves, we hedge. We setup another steering group. We commission more work on options and prioritisation. We refuse to commit to a hard Yes and No – so often because we don’t want to make the wrong choice.
Except that by refusing to make a - potentially - wrong choice, we fail to make any meaningful choice at all.
In a world where capital is scarce, attention is fragmented, and collective capacity is exhausted, a vague non-committal Yes is not really good enough. Why? Because if you try to be everything to everyone, you do very little for anyone at all.
Real strategy isn't deciding what to do - it's deciding what NOT to do. The real meaning behind the Yes is in the No - the No to the 5 other things we could have done.
Yes is an act of deliberate elimination. It says - we are backing this direction, right now, with these resources. Everything else waits.
So a courageous Yes is actually kind of a whole lot of No.
Are you following…?!
Part 3: The Synthesis (sort of)
So when are Yes and No the right or wrong answers?! It depends on the question!
The defensive No - Kills small, low-cost interventions before they've had a chance to live.
The vague, non-committal Yes - An agreement that keeps everyone (kind of) happy but really commits to nothing. Too many ‘priorities’, possibilities linger, and resource is spread way too thin.
The creative Yes - Makes small things, and new approaches, possible.
The courageous Yes and No - Makes a deliberate choice to back something – and let go of the rest.
So, what is creative pragmatism?
In the context of Yes and No?
I think it's the ability to hold two seemingly contradictory ideas at the same time - knowing when to challenge a No, and when to push for a Yes.
It’s not the art of finding a way to say Yes, or the act of knowing when to say No. It’s being a fluid navigator of Yes AND No - moving between the two in pursuit of something worthwhile.
Perhaps that's what creative pragmatism really is:
Knowing when to challenge the impossible, when to commit to the possible, and when to walk away from good ideas.
If you’re interested - I share more thoughts on visionary (or creative) pragmatism here in a past Loxie blog.
