Explore every episode of the podcast Delivery by Design

In this episode of Delivery by Design, Alastair Mitchell-Baker speaks with Dr. Andrew Murray, a GP and senior NHS leader, about the reality behind clinical leadership and operating models in NHS organisations.

What sounds like dry organisational jargon turns out to be deeply connected to frontline outcomes. Andrew breaks down how operating models influence decision-making, staff morale, and ultimately patient care.

• Operating Models Shape Real Outcomes: An operating model is not just structure on paper. It defines how decisions are made, how teams interact, and how quickly change can happen. Poor models create delays, frustration, and reduced quality of care.
• Clinical Leadership Drives Performance: Strong leadership is reflected in team morale, clarity, and effectiveness. When leaders align across disciplines, teams perform better and deliver safer, more efficient care.
• Hierarchy Can Limit Collaboration: Traditional medical hierarchies can discourage input from other professionals. A flatter, more inclusive leadership approach improves problem-solving and encourages people to speak up.
• Shared Responsibility Needs Clear Roles: High-performing teams balance shared ownership with clear accountability. Everyone feels responsible for outcomes, but roles and decisions remain clearly defined.
• Culture Is as Important as Structure: Even the best-designed operating model fails without the right culture. Psychological safety, trust, and open communication are critical to making systems work.
• Healthcare Must Move Beyond Hospital Walls: Future care models require stronger integration between hospitals and community services. Clinicians will need to think beyond departments and work across systems to improve patient outcomes.

[00:01:50] – What Is an Operating Model: Why the term often confuses clinicians and what it actually means in practice.

[00:03:50] – The Impact of Poor Systems: How bureaucracy and slow decision-making affect staff motivation and patient care.

[00:04:16] – What Effective Clinical Leadership Looks Like: Measuring leadership through team performance, morale, and outcomes.

[00:07:27] – Challenges in Medical Leadership Culture: Time constraints, training, and mindset barriers that affect collaboration.

[00:16:21] – Leadership at Different Levels of the System: How multidisciplinary leadership changes from ward level to board level.

[00:22:21] – Aligning Culture with Operating Models: The importance of connecting structural design with organisational culture.

[00:26:46] – Integration Between Hospital and Community Care: Why healthcare systems must shift toward more connected models of care.

[00:29:20] – The Future of Neighbourhood-Based Care: How roles and responsibilities will evolve beyond traditional hospital settings.

[00:31:15] – Rethinking Risk in Healthcare Delivery: Differences between hospital and community approaches to managing patient risk.

[00:36:18] – The Power of Relationships in Healthcare Systems: Why trust and time together matter more than over-engineered structures.

[00:37:12] – Final Thoughts on Simplicity and Leadership: Why simpler systems and empowered teams lead to better results.

Connect with the Guest Dr. Andrew Murray:

• LinkedIn: https://www.linkedin.com/in/andrew-murray-360a0b83/

Connect with the Host Alastair Mitchell-Baker:

• LinkedIn: https://www.linkedin.com/in/alastair-mitchell-baker-a01babb/

More from Tricordant:

• Website: https://www.tricordant.com/
• YouTube: https://www.youtube.com/channel/UCo2WP_UCnm-tszOIc87O36Q
• LinkedIn: https://www.linkedin.com/company/tricordant-ltd/
• Email: office@tricordant.com

Follow the Podcast:

• Apple Podcast: https://podcasts.apple.com/us/podcast/delivery-by-design/id1884004753
• Spotify: https://open.spotify.com/show/1FZ3DP0DcivWcXv8bJH3Hw?si=64f2414b3fbd44cc

In this episode of the Delivery by Design Podcast, host Alastair Mitchell-Baker is joined by John Deverell and Andrew Liles to discuss the "Operating Model" - the essential bridge between a strategy and its execution. They explore why many NHS organizations are stuck in a cycle of "firefighting" and how a well-designed model can empower clinicians and improve population health.

1. The "How" vs. The "What": Strategy is the destination, but the operating model is the machinery and culture that actually delivers the results.
2. Firefighting as a Symptom: Constant operational crises usually indicate that the staff doesn't believe in or understand the current operating model.
3. Post-COVID Shift: The NHS must transition from "command and control" recovery back to a model that empowers local providers and communities.
4. The Foundation Trust Blueprint: Reflecting on the "high point" of the first Foundation Trusts as a model for systemic strength and clinical leadership.
5. Clinical Design: For a model to work, clinicians must be architects of the system rather than just subjects of external targets.

1. [00:00:00] - Introduction - Defining the operating model as the "how" behind the strategy.
2. [00:02:10] - Guest Introductions - John Deverell and Andrew Liles’ backgrounds in NHS leadership.
3. [00:03:18] - John and Andrew discuss the meaning and importance of operating models in healthcare.
4. [00:12:34] -The need for NHS organizations to rethink their operating models post-Covid.
5. [00:18:10] - Focus on rebuilding operating models for long-term transformation in the NHS.
6. [00:44:10] - Max raises the question of creating citizen-centered operating models in healthcare.
7. [00:49:27] - Closing remarks and a preview of future webinars on operating model design

🔗 Connect with the Guests:

👉 John Deverill: https://www.linkedin.com/in/john-deverill-a04a7b1/

👉 Andrew Liles: https://www.linkedin.com/in/andrew-liles-282b1792/

🔗 Connect with the Host Alastair Mitchell-Baker:

👉 LinkedIn: https://www.linkedin.com/in/alastair-mitchell-baker-a01babb/

🔗 More from Tricordant:

👉 Website: https://www.tricordant.com/

👉 YouTube: https://www.youtube.com/channel/UCo2WP_UCnm-tszOIc87O36Q

👉 LinkedIn: https://www.linkedin.com/company/tricordant-ltd/

👉 Email: office@tricordant.com

🔗 Follow the Podcast:

👉 Apple Podcast: https://podcasts.apple.com/us/podcast/delivery-by-design/id1884004753

👉 Spotify: https://open.spotify.com/show/1FZ3DP0DcivWcXv8bJH3Hw?si=64f2414b3fbd44cc

#NHS #HealthcareLeadership #OperatingModels #Tricordant #HealthSystems #ClinicalLeadership #NHSStrategy #HealthManagement

Welcome to Delivery by Design, hosted by Alastair Mitchell-Baker, leadership consultant and director at Tricordant. This podcast explores how organisations turn strategy into meaningful results through thoughtful organisation design, strong leadership, and systems thinking.

In each episode, Alastair speaks with leaders, practitioners, and change-makers who are working inside complex organisations to improve how people, teams, and systems function together. The conversations look at the real challenges behind transformation, from aligning strategy with structure to building cultures that support long-term performance.

Drawing on Tricordant’s experience in organisational consulting, the podcast examines practical approaches to leadership development, organisational effectiveness, and navigating large-scale change. Guests share lessons from the field, offering perspectives that help leaders design organisations that deliver, adapt, and thrive in an increasingly complex world.

Whether you're leading transformation, managing organisational change, or exploring new ways to improve how your organisation works, Delivery by Design brings thoughtful conversations and practical insights from those shaping the future of leadership and organisational design.