Apart from the People’s Liberation Army in China, Britain’s National Health Service is the largest organisation in the world. Karen has become expert in helping the service to make change happen despite its size.

She’s coached numerous newly appointed NHS chief executives through the difficult transition from lieutenant to general. She’s guided an established chief executive through two promotions and a switch to the private sector. And she’s advised another on reshaping a directorate that was criticised as a ‘sleepy backwater’ into one that now has a national reputation for crackling efficiency.

Karen brings the same insightfulness to other clients as well – among them Amey Construction, Marconi and the consulting firm Accenture. For the head of an international technology firm, for example, she set up a leadership assessment and talent-management programme involving 200 managers from across Europe and the USA. The programme was described by one initially cynical manager as ‘revolutionary’ – and by the manager’s boss as transformational.