The Changing NHS

 

I've just finished working on a set of strategic scenarios that describe four 'edge of plausibility' possible futures for Health and Wellbeing systems. The work was commissioned by NHS North West and the detailed scenarios can be downloaded from their website.

The scenarios are titled; Corporate Cures, Community Cures, Shopping for Health and Living for Health. They have been developed, over the course of 12 months, involving nearly 400 NHS managers and clinicians, local authority senior officers and Councillors, MPs, 3^rd sector leaders, private healthcare leaders etc.

The rationale for the work, basically, is that NHS strategy making is sometimes too narrowly-focused and short-term in nature. Senior leaders (national and local) often assume that the NHS is sufficiently powerful to exert a dominant influence on its’ strategic operating environment. Unfortunately this assumption is proving less likely as a number of fundamental drivers bring stronger pressures to bear over the next 10-15 years. These drivers include:

1. Approaching the limits of the welfare state (expressed through a more solid public consensus about the ‘tax take ceiling’)
2. An explosion of new treatment and diagnostic possibilities
3. An ageing population; and
4. Increasingly sophisticated and demanding forms of consumerism

Building and using strategic scenarios is one way of helping leaders explore possible ways of coping/thriving in the light of these drivers. Hopefully NHS organisations can use the scenarios to help them improve the far-sightedness of their local strategies. Essentially by:

1) mentally immersing 'strategists' in the 4 future ‘worlds’ that depict, in differing ways, how English Healthcare and Wellbeing systems might evolve through to 2020; and

2) subsequently ‘returning to the present’ to discover a) new or sharper insights into what strategies might be appropriate over the next few years or b) new insights into how robust existing strategic intent is and what conditions might trigger it being re-thought. 

Anyway, we will see, as local Trusts and PCTs start to use them. 

nhs

strategic scenarios

Does your PCT/Trust have it's own brand or does it still hope to rely on the national NHS brand?

Brand tags is a great idea for a site. Just react to the brand and jot down the first word that comes into your head. Then see what other people have said.

If you're going to create a Trust/PCT micro brand what word might people jot down in the brands tag game....safe, modern, friendly, haphazard, innovative, caring, mistakes, compassionate, knowledgeable, paternalistic, informing, reassuring, helpful?

p.s. You can only have one!  

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brands

UK healthcare

As a rule I don't normally just pass on links to other posts but hey, it's Jan 2nd, outside it's grey and raining and yet another piece of Christmas Cake is daring me to eat it. 

Everything 2.0 has a post titled:  Health 2.0: 38 sites that can help you to stay healthy, or to improve your health, or to lighten your sickness.

Thanks to Matthew Holt at Health 2.0 for drawing this to my attention.

I haven't looked at all 38 sites yet, but I imagine they are all (currently at least) mainly focused on serving USA-based users/communities. I wonder which ones would work this side of the pond and what a more UK centric list of Web 2.0 health sites might look like? Please let me know which Web 2.0 health sites you know about. Maybe we can compile a little list and get the NHS's attention on this?

Happy 2008 to all.

nhs

web 2.0 health

Welcome to my 3rd Words of Wisdom post -  where I share favourite posts I've seen over the last couple of months or so. The first two WoW posts are here and here. 

I hope this selection provides some ‘food for thought’. In no particular order:

Mark Wilkinson is Chief Executive of Central Lancashire Primary Care Trust (PCT). That's Preston and nearby to you and me. Mark is a new blogger! It’s good to see NHS CEOs reaching out to people / their members in such an open way. Maybe Mark will start a trend? His blog is called Mark's Blog and Banter

PauLevy is CEO of Beth Israel Deaconness Medical Center in Boston Massachusetts. A recent post that caught my eye is this one – Teamwork Wins Against VAP (ventilator associated pneumonia). Teamwork saves 96 Lives might be a better title;

Charging money for things (even at a very low rate) really does change, quite dramatically, how people perceive services and products. Seth Godin relates how IKEA started charging 10 pence for shopping bags and consumption reduced by 95%. Maybe there is a useful future for co-pays in the NHS?

ScribeMedia have put together a fantastic short video chronicling A Brief History of Medicinefrom witches and leeches to Web 2.0. health communities. Produced to show at the recent Health 2.0 - User Generated Conference in San Francisco. Treat youself and watch four minutes and 30 seconds of brilliant stuff - and no I didn't go to San Fran either!

Susan Abbott at Customer Experience Crossroads gave me a ‘aha moment’ with her post about Curves , a new fitness centre franchise, designed and run for people who hate traditional gyms and fitness centres. Now maybe this is the sort of experience that GPs ought to be 'prescribing' for people who need to lose weight? Does this kind of fitness centre experience already exist in the UK?

RateMDs , DrScore and VIMO are all sites where Americans can rate their doctors. Now how long does it take for this stuff to travel over the pond! Thanks to David E Williams at The Health Business Blog for posting about this first time around;

David Maister has a great idea. If you want to be a more agile organisation then break out of the annual cycle and review plans on a 3 monthly basis. Read it here.  

Writing here last week about recent UK attempts to amplify consumer pressure on healthcare providers reminded me of an international seminar I attended in 2000 whilst working for a health care learning network called ODPN . A group of healthcare provider Chief Executives from the UK, USA, Spain, Germany and Australia spent a few days together in Spain, exploring the implications for them of the rise of the informed healthcare consumer.

Without getting bogged down in detail, the starting point was a simple conceptual framework (above) that depicted three key influences and pressures that all healthcare organisations face, to varying degrees, at any point in time.

The assumption being that the system was increasingly likely to become unstable and this, in turn, presented CEOs, as leaders of healthcare providers with some opportunities. For example they could choose, at certain times, to see themselves as:

i) Leader as Maintainer – helping their local system to remain as stable as possible, by seeking to keep these often competing sets of pressures in balance as much as possible. (Most of the the UK and Spanish CEOs felt this was their natural territory);

ii) Leader as Agent - actively seeking to bring about a new dynamic by encouraging an accumulation of power to points A and/or B and/or C. (Most appealing to the CEOs of Mental Health providers who supported the growth of pressure point B).

iii) Leader as Systems Architect – (represented below) encouraging alliances between various pressure points. For example, by encouraging the formation of an alliance between a national consumer group and local clinicians – where both groups (and the provider organisation itself) wants to see funders agree to pay for a new treatment modality. (The most appealing role for majority of USA CEOs).

Despite being quite simple, this framework served as a very useful reference point to help get conversations started. How might a provider CEO’s role within a system ebb and flow as healthcare consumerism growths in strength and technological possibilities become more available? This is sure to become a much bigger question - sometime soon.

Steve

www.stevepashley.co.uk

Attempts to encourage NHS providers to become more responsive to consumer pressure accelerated this week with the Secretary of State for Health announcing plans for a DoH supported website that offers patients a choice of more than 200 hospitals for their elective surgery from July 07. Interestingly according to E-Health Insider, this new site will also give patients an opportunity to rate their care experience. I wonder what the folks at Patient Opinion think of this development? The not-for-profit social enterprise has been collecting patient stories for well over a year. By the way, it looks like Revolution Health is trying to get something similar 'up and running' in the States.

Whilst it's true that writing this blog has helped turn me into a bit of a ‘tech nerd’, I still have enough Organisation Development genes left in me to realize that the most important thing here isn’t the technical collection of stories and feedback data per se, but how healthcare providers actually make use of this new information.

• Will they have a sufficiently receptive organisational culture to enable them to easily accept, or even celebrate, the feedback they receive?
• Will they be capable of successfully ‘fusing’ these new sources of feedback with more local ones that they possibly (hopefully) already orchestrate?
• Will the relevant clinicians and managers be given timely access to the information received?  and if yes
• Will they be sufficiently motivated and skilled to take quick action to address the sources of customer discontent, to learn whether the changes they have made are improving things and to try new ideas if the answer is no?

In short, can NHS Trusts become organisations that are sufficiently permeable to customer experience?

Steve

www.stevepashley.co.uk 

I’ve been saving posts from my favourite bloggers for a few months now and I thought it might be useful to share a few with you. They have all given me loads of ‘food for thought’ and I hope they do the same for you.

In no particular order:

+ Would you rather have customers rave about your services, your organisation or how using your services makes them feel great about themselves? See what Kathleen says in Creating Passionate Users;

+ David Maister writes about how best to offer advice when it's not been asked for. I've needed to know this for a very long time;

+ Ever wondered why it's so hard to get people motivated? The Chief Happiness Officer will enlighten you - if you're motivated enough to visit (groan). 

+ Rob Millard's The Adventure of Strategy blog draws attention to how "the folk at Visual Literacy have developed a monumental summary of graphics used in business management and strategy".

+ Seth Godin helps you to understand why switching strategy is harder than switching tactics.

+ Ever wondered what’s so hard about making those cash releasing efficiency savings? Tom Peters has a "1% No brainer" post. Do we overcomplicate things a tad?

+ Bob Sutton has some great diagnostic questions for designing or repairing a team on Work Matters.

+ Are you grappling with information overload? See Psych Centrals 5 top tips for coping. Thanks to George Ambler at The Practice of Leadership for the ‘heads up’.

+ Dr Crippen – the NHS Blog Doctor - talks about how he needs to grit his teeth and spend a few hours recording QoF data in-order to earn his practice £23,000. It's in the Monday 15th Jan section.

+ David Williams, author of the The Health Business Blog summarises a New York Times interview with Professor Clay Christensen where he talks about the lack of progress in shifting the practice of healthcare to lower cost, more accessible settings.

+ Michael McKinney’s Leadership blog introduces us to Marshall Goldsmith's idea of soliciting feedforward rather than feedback.

A couple of questions to end with:

Is this 'best of' post something you'd like to see every 3 month's or so?

Do you have any favourite posts to share?

Steve

www.stevepashley.co.uk

This is probably the most useful change ‘formula’ I’ve ever come across.

D = Dissatisfaction with the status quo

V = Attractiveness of the vision for the future

F = ease of taking the first steps and

R = the strength of resistance to the proposed change.

I’ve often found the formula a useful reference point when attempting to make sense of a change programme. Basically the sum of DVF needs to be greater than R. If it’s not you’ve got some work to do. You need to find ways to strengthen D, improve and/or better communicate the V, offer more and/or easier options for F, reduce the strength of R or any combination thereof.

I was reminded of DVF>R during the recent holidays.

On Christmas Eve I attended a Nativity service at a Church in my local town. At the beginning of the service the lay preacher announced that free Christmas cards were available at the back of the Church for people to sign and send to Tony Blair. The cards urged the PM to keep the A&E open at the local District General Hospital. Someone then jumped up and announced to the congregation of about 300 that there also was an option to sign an online petition on the No10 website if people were too rushed today to do it. The next day I took my 11 year old son and his friend to Asda for a hot chocolate (I know all right). Anyway, a stall in the busy lobby was staffed by the Save Our Hospital campaign with more Christmas cards for Tony. More impressively, every 5 minutes someone was using the supermarket tannoy system to draw attention, in a very friendly way, to the stall and the campaign!

Quite a lot of R building up there there don’t you think? There might be a document about the proposed changes to 'acute care in the County' on a website someplace, I'm not sure to be honest. Some NHS folks locally need to get working on D V and F - and quickly - or we'll be stuck with unsafe, inefficient healthcare for another 15 years.

Steve

www.stevepashley.co.uk

According to the Health Service Journal, David Nicholson, NHS Chief Executive, recently set out 5 priorities for Primary Care Trusts(registration required to view). These are:

1. Leadership and engagement in and with the local community
2. Accountability
3. Having a more business like approach (whatever that means- answers on a postcard please!)
4. Being data driven
5. Having an ambitious strategy

This little list could keep me in posts for a month, but I was particularly struck by the first priority, because it reminded me about Open Space. I first came across Open Space when Barbara Bunker and Billie Alban included it as one of eleven Large Group Event (LGE) methodologies described in their book Large Group Interventions: Engaging the Whole System for Rapid Change

Many NHS organisations have since used Open Space Technology to help them ‘engage with stakeholders’ – though usually via  one-off events rather than as a way of democratising decision making and getting work done on an ongoing basis. If you’re thinking of using Open Space read Open Space Technology: A Users Guide. Also go to Open Space World for great resources and tips.

Within the NHS, Open Space has become the most widely used of the LGE methods. Probably because:

a) It’s relatively easy to do – for example no content preparation is necessary;

b) Participants enjoy it – people enjoy the freedom to self-organise and the energy levels are usually very high; and

c) Managers see it as an ideal method for getting something started with a ‘bang’ (we do a lot of getting things started in the NHS!).

Last week I came across a really interesting development. Gabriela Ender has created a really clever online collaboration version of Open Space that can be 'rented’ by the hour!

Initially I was sceptical, but then I took the tour (available top left of page) and was very impressed. This online version could be great for international collaboration and for ongoing collaboration when community members already have good levels of trust established.

Perhaps the online version is a tool that NHS Foundation Trusts can use to keep engaged with their members?

Perhaps PCTs can use it to help managers engage on an ongoing basis with various public and clinical communities in-order to generate and implement ambitious strategies – addressing two of Mr Nicholson’s five priorities at the same time!

Steve

www.stevepashley.co.uk

It looks like NHS providers could have wide scope to promote themselves and their services. See the consultation document Code of Practice for Promotion of NHS services.This makes a great deal of sense given the increasing amount of real competition amongst Trusts and between NHS providers and private and independent sector providers. But are NHS Trusts going to be any good at it? A few thoughts spring to mind:

1. What are you promoting?

Traditionally NHS organisations, especially acute Trusts, have found it hard to take tough decisions about ‘what type of organisation are we trying to become?’, preferring instead to remain ‘Jack of all Trades and (arguably) Masters of None’. But comprehensiveness, although ideologically appealing to many is not easy to do well. In fact I can’t think of a single successful company that has earned success on the back of convincing customers that “we’re really good at everything”. If you’re not convinced try reading Focus by Al Ries;

2. What are potential customers interested in?

NHS culture is often best summarised as top-down bureaucratic managerialism. Although managers sometimes talk about customer focus, Trusts still find it incredibly hard to break free from rules based behaviour. Well so what? What’s this culture thing got to do with promotional activity? Take a few minutes to randomly browse a selection of Trust websites and you'll see. Far too many NHS Trust sites are designed to deliberately draw visitors' attention to links to The Top Team, Meet the Board, Trust Turnover etc. Is this what a potential customer really wants to see? By contrast take a close look at Sharp Healthcare’s Site. Sharp is a successful not for profit healthcare provider system in Southern California that is shifting it's culture -using the phrase "The Sharp Experience". Sharp won the best US healthcare website award in 2006 and that takes some doing when you operate in the world's most advanced consumerist society. If you want to start redesigning your website to better meet customer needs a good first step is to ask your communication staff to read Don't Make Me Think - the best web site design book I've seen. Also take a look at the recent DoH choice survey results to see what reasons NHS elective surgery patients give for choosing a provider.

3. Who are you competing with?

Much of the last 10 years of healthcare policy in England has been based on the belief that “a service just for the poor is a poor service”, so it will be interesting to see where promotional spend will be focused. What will be the balance between spending on competing with other NHS providers versus spending focused on differentiating trusts from private providers (and appealing to middle class professionals)? This latter act is a tricky thing for a Trust to do well if acting on its own. Perhaps we might see clusters of NHS trusts combining promotional budgets to compete with the bigger national private provider chains?

4. Where are you doing it?

I (together with millions of other website owners) am a member of Google’s Adsense program (where Google automatically places adverts on my site matched to my content and I get paid when people click through). My homepage has had a BUPA banner advert on the bottom, on and off now for about 2 months! Will NHS Trusts be allowed to promote themselves on the internet like this? The consultation document suggests that advertising on TV and Cinema will be unlikely but what about internet advertising, especially as this could be a much better way of reaching particular target groups and could be focused by geography as well?

5. Don’t forget the Shadows.

Finally, when all is said and done, local word of mouth promotion is still likely to be the most powerful method, but only if Trusts actively embrace it. How many Trusts routinely run patient follow-up programs to solicit feedback and, as a by-product, promote themselves further? Also how many Foundation Trusts have membership advocate programes underway? Thirteen thousand local people, singing from the same hymn-sheet sounds a powerful way to re-position and strengthen a Trusts place in a local market. This shadow marketing activity is likely to be increasingly important.

Steve

www.stevepashley.co.uk