Moving Day

After 110 posts I’ve decided to take an official break from blogging and instead focus more on using Twitter.

Partly this is because as health2works demands more of my time and attention I’ve got less time to offer facilitation and change management consultancy. And partly , ok I admit it, it's because 140 characters is a lot easier to produce than 400 words (and often a lot more interesting I hear you say).

If you’ve been reading this blog regularly over the last couple of years then thank you. I hope you’ll consider following me on Twitter.

I have 2 Twitter accounts:

health2works – for tweets about what health2works is doing and how the web has the potential to change the NHS for the better (the picture is of my colleague Roger Marlow)

stevepashley  – for my personal tweets about change management and policy issues relating to the NHS 

I hope to see you ‘out there’

Steve

Video Interview with Mike Farrar - Web 2.0 and the NHS

I've been busy for the last 9 months setting up a new web technology company called health2works. H2W partners with NHS organisations to quickly identify ways to use the Web creatively and at low cost to offer benefits to patients, clinicians and NHS organisations.

Our first piece of work has been with NHS North West working on something called the NHS NW Web 2.0 Accelerator Initiative. We first generated 260 'raw' ideas via 8 brainstorming workshops with patients and clinicians. We then picked 20 of these ideas and brought them 'to life' in a series of prototypes (hopefully sufficiently well for people to see the potential). We hope to move into full build stage soon.

Anyway, my partner in health2works is a guy called Roger Marlow. As part of the Accelerator initative Roger interviewed Mike Farrar, Chief Exec of NHS North West about how he thinks the Web can help transform the NHS.

Here's the video interview.  

Mike Farrar Interview: Web 2.0 and the NHS from Steve Pashley on Vimeo.

Dirty NHS Wards, Patient Harm and Browsers

I've not blogged for a while because I've been busy setting up a new company with my colleague Roger Marlow.

It's called Health2Works and is now up and running. The aim is to create really useful, easy to use, low-cost web-based tools for patients and NHS clinicians. I won't give you the full monty sales patter. That's enough. 

Today the Guardian had a great article called "Why the NHS can't get it's browser act together". Well worth a quick read. I emailed the article to Roger and this was his instinctive reply. Some 'food for thought' at least.

So much to say about this.... Perhaps we should blog about it?

It's indicative of the extent to which the NHS doesn't see itself as a "web enabled" organisation - getting so far behind in such a crucial technology.

Also highlights how specious some of the "security" arguments are that we come across. Keeping your browser up to date is page-1 stuff. Unfortunately I expect the reaction might be in exactly the wrong direction - more lock-down.

On the positive side, if health2works gets its way, millions of ordinary people will be using the web much much more for their health related needs and issues like this will be seen in a similar light to dirty wards and patient harm.

Regards,
Roger

 Now that would be a real transformation in NHS IT culture. 

Strategic Facilitation and Web 2.0

Strategic  facilitation. That's what I think I do quite a lot of the time. Basically I try to help senior NHS managers and clinicians either a) to explore difficult and organisationally significant issues  or b) to identify new strategic possibilities and form useful leadership coalitions that can help these aspirations come to fruition.

All mildly interesting perhaps, but what's this got to do with Web 2.0?

Well, as people who know me are aware, I also am an enthusiast for Web 2.0 tools and applications and recently I've taken to blending the use of some of these tools into the facilitation work I do. Garlic bread, it's the future!

Two straightforward examples might help shed some light:

Example 1

A few month back I was asked to  facilitate a meeting of about 40 Health Economists, Finance and Public Health Directors. They were being pulled together to advise DH on whether a national support network ought to be formed to help PCTs make better revenue investment decisions - from both technical and allocative efficiency perspectives. I suggested that the organising group use SurveyMonkey to seek the group's views, in advance, about whether forming such a group was a good idea  (it was thought to be so surprise surprise) and, more importantly, what the key roles and responsibilities of such a group might be.

An online survey was duly run (at no cost!) and the subsequent 4 hour meeting was then focused on 3 things: a) Quickly sharing and clarifying the results; b) Exploring the 2 issues where significant differences of opinion within the group seemed to exist; and 3) Asking the group to  focus most of their time on providing detailed advice about how the top 5 roles, as voted in the survey, ought to be discharged in practice.

The point is that, without the free online survey, the group would have come together and spent alot of their time talking in generalities about the support network and what it might do. The survey 'cleared the decks' and allowed the face to face meeting to add more value to the proposed initiative.

Example 2

Currently I am helping a well established University research network to develop an accreditation re-submission bid to enable it to continue to receive a sizeable amount of research monies for biomedical research projects. We are using a tool called Ideascale to  invite stakeholders to suggest, refine and prioritise key questions that need to be addressed before the resubmission proposal gets written.  So instead of the  2 day workshop that was initially proposed, where everything is addressed in one go for better or worse,  we are now holding a half-day meeting to address the 10  most powerful questions , followed, 2 months later by a half-day session with stakeholders where a draft re-submission bid will be presented and modified.

In both examples, Web 2.0 tools (SurveyMonkey and Ideascale in these cases) are being blended into the development process, helping to create less time consuming and more focused face to face working.    Garlic bread, it's the future you know!

The Long Tail of Facilitation Questions

Image by Segozyme

Recently I was in a 5 hour meeting, planning a series of high profile workshops for civil servants and senior managers to explore the key features of a new Commissioning system. Don't worry, it wasn't in England! Two other professional facilitators/process designers were in the room, as were 4 or 5 policy people.

The meeting progressed quite smoothly. Time passed, with occasional bouts of tension and excitement and a few interesting design choices emerged. However, (and you may find this a little sad), energy levels went nuclear amongst the 3 facilitators when the question of whether or not to have appointed facilitators work with the 8 table-based groups popped up!

We (the facilitators) had different opinions and loved the debate. In fact we 'came alive'. Much better than discussing a boring old Commissioning system. The poor old policy people were bemused, perhaps rightly so? Eventually after 3 or 4 minutes of increasingly heated debate we came to our senses and suggested that we resolve our differences on this matter outside the meeting. The policy people signalled a huge sigh of relief.

For the record, three options were under discussion:

• Identify and brief competent 'table facilitators' from beyond the 40 invited participants in advance;

• Identify 8 people from the 40 participants in advance who we think would probably be competent as facilitators and ask them to do it, with a briefing before the workshop; and

• When the time for table facilitation comes, draw everyone's attention to a short list of facilitator responsibilities listed on the wall and ask each table group to  appoint someone from their table to act as facilitator.

 I was angling for option 3.  Which option do you prefer and why?

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Why is the NHS a Web-Free Zone?

photo by Jude

Guest post from Roger Marlow, Health2Works

Before I try and answer that question, let’s start with a few questions about you. Do you use IT at work, and if so is it any good? And next, do you use the web at home, and how does that compare with your experience at work? If like me you find what is available 24 hours a day, for free, on the web utterly amazing and what is available in the typical work place relatively stone age, then you are not alone.

The incredible story of the growth of the web isn’t news anymore but even the raw numbers are still staggering. You can search 2 billion web pages in a fraction of a second, read 3 million wikipedia articles, watch 9 million YouTube videos, subscribe to 175,000 new blogs every day and chat with 200 million people on Facebook. And it's not just the scale of these facilities that is amazing. They are available all day every day, never run out of space, they continually add new features, and there are literally thousands of new things to try out every day. And it all happens without any overarching management or grand-design; the web has no CIO, no mission statement and no management team. 

Compare that with the experience of IT in a typical NHS PCT or Trust. Here we have CIOs, mission statements, and management and project teams galore, but there isn’t the feeling of innovation, pace and sheer wonder that you get from the web. Why is that? Perhaps you feel like Blackadder trying to teach arithmetic to Baldrick, who gives up complaining “To you, Baldrick, the Renaissance was just something that happened to other people, wasn't it?”. Is the web just something that happens outside of healthcare?

Isn’t it time we put the web to work in the NHS? It has changed, largely for the better, key aspects of just about every other aspect of society. Perhaps it’s time to stop thinking that IT is something that happens ‘over there’, at huge expense and risk, by people with funny job titles, focused entirely on extremely complicated clinical integration projects. And what’s more we are at a crucial point in time. The web itself is going through a renaissance, creating so called Web2.0, supporting new social effects such as social networking, empowering the “long tail” and giving a global voice and power to even the smallest of minority groups. Which is all rather prescient for health. The NHS faces enormous increases in demand for more consumer friendly healthcare services and experiences at the same time as significant financial challenges. It can aid its own survival by taking advantage of some amazing technology.

Yes, the NHS has dabbled a bit with Web2.0 applications, but now is the time to embrace the full potential of Web2.0 and experiment like crazy. I and others are proposing ways of bringing, quickly and at low cost and risk, the amazing technology of the web, and in particular Web2.0, to healthcare. This is not just to give us all a better experience of IT in the workplace, but primarily to give better, more efficient care, to reach and connect with more people. 

Now is the time to act. Do you think the NHS is sufficiently curious? If you are interested in getting involved, please have a look at what Steve, Robin and I are up to at health2works and let me know what you think. 

Roger

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Summer Holiday Questions for Chief Execs

Most Chief Execs are going to be on holiday for a couple of weeks soon. Rest and relaxation hopefully, but also a chance to reflect on some deeper questions, away from the cut and thrust of day to day life in the NHS.

At the risk of ruining a few holidays, here’s my list of questions to mull on whilst lying on the beach or pottering along cobbled streets etc.

1.How can my organisation clearly demonstrate that it accepts a fair share of the responsibility for getting UK plc out of the mire?

2. How can we still keep a focus on creating our future whilst coping well with the financial uncertainties and challenges of the next few years?

3. Do I really care about quality?

4. How many staff want to work for my organisation more than any other and how can we get this number up next year?

5. If my organisation didn’t exist would local people demand that we be created exactly as we are now?

6. Am I still keenly interested in healthcare and serving people?

Got any better questions to pass the time on a sunny beach?

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The NHS and Local Communities

I met with some PCT people last week. The meeting was in a new Health Resource Centre, built under the Local Improvement Finance Trust scheme(the LIFT programme) for £7m.

The Centre is a wonderful building. It's light and airy, has 3 floors, a lovely atrium and even a half-decent car park. It houses a bunch of GP practices as well as a wide range of community services and a few specialist clinics, previously available only at the local DGH. I was so impressed I even took a couple of pictures.

But then I was taught an important lesson. Putting up a nice building and calling it a Health Resource Centre is not the same as acting as a Health Resource Centre. Whilst I was waiting at the Reception desk, a middle-aged, friendly woman came in and asked, politely, if she could leave a bunch of A5 leaflets alongside the lovely display boards promoting various local NHS services. Her leaflets were promoting a new local voluntary support group for people with Cancer. "I'm not sure let me check", said the Receptionist. A phone call ensued. Then came the reply "Oh dear, I'm sorry but we have a policy only to stock official NHS leaflets. Do your leaflets have an NHS logo on them by any chance? - No, I'm sorry then, but we can't take them".

I was reminded of this little story this morning when talking with my wife. For some reason, please don't ask why, my wife has decided to offer a home boarding service for dogs. She's produced some colourful posters and yesterday popped off to 3 local Vets to see if she could put the posters on their notice boards. All said yes, without hesitation, as did the 4 local shops, scattered around nearby villages, that she approached later the same day.

Apparantly vets and shop keepers consider themselves to be intergral parts of their local communities, but the NHS is still not sure.

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Wonky Teeth and NHS Inequalities

My son has 'wonky teeth'. My wife took him to the dentist (on the NHS). She, the dentist that is, suggested that a specialist should come and take a look at him, to decide if he needed braces . Wife and son agreed.

Six weeks later he went back to the dentist for his assessment. Turns out he could benefit from treatment but didn't qualify for free (NHS) treatment - "he's just on the wrong side of the access threshold". We would need to pay privately for the treatment. Wife asked how much. £2700 was the reply. Wife walked out in a daze.

Now I have a friend who is a dentist. I rang to ask for advice. "Who did the assessment?" he asked. "Mr X" I replied. " Well, he only does private work, why were you seeing him? You should go back to your dentist and insist on a proper NHS referral" he suggested. "I thought that was what we were having in the first place, thanks for the advice" I said.

We followed the advice. Last week my son went to the local DGH for another assessment. This time by someone who is employed by the NHS. He was still borderline but, after a bit of humming and harring, he was accepted for treatment. No charge.

My dentist friend saved me £2,500! Trouble is most people don't have a dentist for a friend, or a GP, cardiologist or social worker for that matter. What happens then?

Perhaps they might contact their local NHS PALS office? I didn't think of this, which is interesting in itself. I've just tried to contact them now, out of curiosity. According to the national PALS website, my local office is 'full-time staffed', but it only deals with written enquiries!

There must be tens of thousands of people who each day feel 'adrift' in the labyrinth that is the NHS, stoically or angrily accepting 'their lot'. Its mid 2009. We need to do better. Perhaps it's time for a professionally run national telephone and online patient agent service that can quickly source good, geographically relevant. sources of advice to help people already 'adrift' in the system review their situations,clarify options and become more assertive 'customers' ?

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New NHS 2.0 Not for Profit Start-Up - Interested?

Health 2.0 is part of the future for the NHS. The term, derived from Web 2.0, covers a large bucket of web-based applications, all designed to give patients, healthcare 'consumers' and communities more information, influence and/or control over their healthcare experience or health status.

The Health 2.0 'movement' started in the States, mostly West Coast. I went to the annual Health 2.0 Conferrence last October. About 1000 people (mostly application developers, clinicians and policy commentators) spent a lively 3 days in a Marriott hotel basement, reviewing over 100 health 2.0 applications and exploring where the 'movement' might go next.

To-date the potential of Web 2.0 has pretty much passed the NHS by. Partly because IT staff are largely preoccupied with trying to get NPfiT 'on track' and most managers aren't that familiar with net based appplications. That's going to change soon. The DH is formulating a new Digital Strategy that will, in part, embrace the experimentation with what is becoming thought of as NHS 2.0

I'm going to start a not for profit to work in this area. The basic idea is to help PCTs and Trusts to explore possibilities with talented application developers. Quick beta versions of NHS 2.0 applications can be generated and tested and those that prove to be most attractive to users can then be picked up and funded more fully. Let me know if you are interested in getting involved. It'd be good to find two or three partners who have something to offer. Also let me know if your organisaion is interested in being an early customer!

There is enormous potential here, (despite the digital divide) to help millions of people make their lives a bit easier by the use of relatively simple, very cheap and practical NHS 2.0 applications. Who knows, some may even turn out, as a by-product, to be useful in helping the NHS achieve some of it's key strategic objectives.

A few of my favourite applications showcased at the Health 2.0 Conference are:

Careflash

Limeade

The Prevention Plan

American Well

My Medlab

PatientsLikeMe

WeAre.Us

Sermo

Healthline

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