The Changing NHS

Here’s a good 2 hour process for helping your department collectively review the year and celebrate and learn from successes. It’ll work, with a bit of tweaking, with up to about 40 people.

Set up’s very easy. You just need:

1. A bunch of post-it notes and nibbed marker pens;
2. A long wall chart, with 3 horizontal rows, about 30 cms apart. Divide the wall chart into 12 equal chunks (1 for each month of the year just gone).

The process is pretty easy too:

1. Put people in groups of 5 (as mixed as possible) and invite them to take 20 minutes to identify up to 10 key world events in 2007 and jot them down, each one on a different post-it note;
2. Get all the groups to post their ‘stickies’ at the same time on the wall chart, putting each one in the time slot in the bottom row – clearly labelled ‘World Events 2007’. Give people a few minutes to look at all the events the groups have identified;
3. Repeat the process, but this time ask the groups to identify up to 7 key work achievements in 2007. These can be achievements that people in the group feel they have been personally involved with or they can be achievements that others’ in the department have mainly brought about. Again, invite people to post in the appropriate row and give them everyone a few minutes to review all the new post-it notes;
4. Repeat the process yet again, but this time invite people to jot down one or two personal highlights each from the year, outside of work. e.g completed 10km run, moved house, son graduated etc.

Once all 3 rows of the wall-chart are populated with post-it notes, invite all groups to take 30 minutes to consider these 2 questions:

1. What, if anything, do our work achievements have in common? (Perhaps they have been led or initiated in a certain way? Maybe they all have clear deadlines? Maybe they were undertaken by teams that already existed or maybe by teams formed specifically for that purpose?).

2. How might we increse our chances of being even more successful in 2008?

Finally, have a 10 minute ‘shout-out’ where each group must make no more than 3 suggestions related only to the last question. Note the suggestions and agree how they are going to be considered further.

nhs

review process

learning

Endings are important. A bunch of people have spent several hours or maybe even a day or two together, working on important stuff. It’s important that, as a minimum, they leave with a shared sense of accomplishment and clarity on what happens next or on how next steps are too be agreed.

I sometimes spend too much time thinking about beginnings and not enough about endings. That's because I'm nervous. It's also because first impressions count and because endings depend on 'middles' - what's happenned in the workshop. Nevertheless, endings need thinking about beforehand. Mistakes I’ve made include:

1. The ‘Trickle Away Ending’

Here I scheduled a penultimate sesssion where participants were invited to place themselves into small groups that met outside the main meeting room, when the 24 hour workshop was finishing at lunchtime on day 2. Some of the break-out groups finished well before others and some people used the ‘free time’ as an opportunity to return to work rather than wait around for a final plenary to take us through to lunch;

2. The ‘We Aren’t Up for The Challenge Ending’

Here I encouraged people to volunteer, publicly, to be responsible for follow-up actions in the last session of a 2 day workshop when the work needing to be done (planning a new hospital) was really important and daunting. People were tired and overwhelmed with the scale of the challenge they had identified. Energy levels were low. Only a few people came forward, leaving everyone with the impression that their was no real appetite for ‘getting to grips’ with the challenges. It would have been much better to simply summarise the key challenges identified, get the groups’ assent to the summary and agree a process, to be undertaken within a week or so, for prioritising what happens next and who is to be involved etc;

3. The ‘It All Sounds the Same Ending’

Here 40 clinicians and managers worked in four groups for a day, sketching out possible futures for healthcare and wellbeing systems in 2020. All the groups produced interesting, plausible, rich stories but I made the mistake of inviting all groups to share their work in turn before seeking reactions from the rest of the group. By the time the 4th group had finished people couldn’t keep the stories apart in their heads. It would have been much better to seek reactions after each one in turn. Better still, I ought to have asked each group to finsh their feedback with a summary of 3 things they really liked about their story, to help listeners more easily grasp the distinctiveness of the material.

Oh well, live and learn I guess!

Have you either led or been a participant in a workshop with a bad ending? 

nhs

workshop design

facilitation

I thought I'd try out this new Sketchcast technology to show you an exercise that I sometimes use with groups of NHS managers and clinicians to open up discussion about what the future shape of healthcare might look like.

I hope it's useful to you.

nhs

change management

Here’s the Brief

A group of 20 people find themselves thrown together as a result of a merger of 3 Strategic Health Authorities. They have been working as one group for about 6 months and the leader thinks that now is a good time to agree some key work principles that will strongly influence how the group behaves with each other and with their 'customers'.

Rather than seek to impose some new work norms, the leader wants the group members to generate work principles for themselves, with him shaping the outcome by participating in the process and reserving the right to add or modify the outcome of the work if he thinks it necessary.

We have two and a half hours for the first 'get together'.

Here’s The Process

To get something useful 'into play' quickly I used a combination of World Cafe process (described in an earlier post here) and affinity clustering. The process was as follows:

1. World Cafe style dialogue process for an hour to give everyone an opportunity to explore the key question "What's really important about how we work with each other and with our customers?"

2. 20 minutes back in original groups to agree 4 key work principles, with at least two being about how the group works with external customers and agencies. The suggested principles are written on 20 sticky hexagons (much better than post-it notes) - You can get these from Teamtalk

3. 15 minute tea-break whilst the small tables are removed and chairs are re-arranged in a horseshoe facing a blank wall. When people return to the room everyone is asked to get hold of one sticky hexagon that contains a suggested key principle that came from their last group discussion

4. Each person takes turns to come out to the front, tell the whole group about what's written on their hexagon and why its' potentially an important work principle and then stick it to the wall. Here's the good bit. When sticking hexagons to the wall, ask each person, to affinity cluster their hexagon with others already on the wall which are thought to be very closely related

Note: you might need to invoke editorial privilege in the early stages of the affinity clustering as people tend to be quite polite and are reluctant to suggest that their idea is different from those already aired. But once you've intervened a couple of times they soon start to make better judgements about what ideas are really closely coupled with others and which ideas are better placed on their own.

The 20 suggested key principles were organised into 6 clusters:

1. Offer support and encouragement

2. Have clear roles and personal objectives

3. Be skilled at working in teams

4. Be seen by customers as change agents not technicians

5. Have a clear strategy that is well understood by group members and customers

6. Take pride in delivering on challenging work

The next step is to agree some statements that illustrate desireable behaviours congruent with each principle in action. After this the group can find ways to regularly and systematically reward/encourage people to exhibit these desirable behaviours more frequently.

What do you think about this simple process? It's not rocket science is it, but I'm amazed at how many new departments and teams don't make the time to do this kind of norm building work. Instead they hope that appropriate norms will somehow emerge over time. But, as I heard someone say last week - Hope is not a strategy!

Steve

nhs

culture

workshop design

Welcome to my second WoW post. The first one is here. 

Once again I’ve selected some of my favourite pieces over the last few months from bloggers I admire. I hope they provide some ‘food for thought’ for readers interested in improving or transforming the NHS. In no particular order:

Paul Levy is CEO of Boston’s Beth Israel Deaconess Medical Center. In Running a Hospital , Paul was brave enough to publish up-to-date ICU Infection Rates. This has caused quite a stir. See the original post here;

George Ambler’s wonderful post, The Practice of Facilitative Leadership  has 6 themes that will really 'ring bells' for anyone involved in leading people across boundaries;

Kathy Sierra at Creating Passionate Users has a bunch of posts I could include here – but as I have to choose one, I’ll go for the one about the need for organisations to enable staff to be passionate about their work rather than their employer. It's here;

What’s the point of articulating a strategy that your organisation has no hope of ever achieving? This is one of Rob Millard’s Three Unpalatable Truths. Curious about the other two?

As branding becomes more important in a more competitive NHS what might be a better balance between a national and local ‘look and feel’ for the NHS? Susan Abbott has a nice take on this question.

Rick Maurer, author of Beyond the Wall of Resistance draws attention to a Washington Post article where a reporter looked at all conflicts between UN Security Council members and weaker nations since the end of World War II. She found that in all 122 conflicts the stronger nation failed to win 39 percent of the time. Read Rick's take on it here.

Next up, an article by Mathew Holt, author of the US based The Health Care Blog  about new developments in social networking for healthcare. Read it here, you never know, there might be something in this internet thingy after all; 

Finally, Werner Kuper  draws attention to a great icebreaker exercise originally posted by Tom Heck on his TeachMeTeamWork.Com blog   

I hope you enjoy the selection.

Steve

nhsleadershipchangeOD

www.stevepashley.co.uk

About a year ago I posted 8 tips about workshop design. Quite a few people have since told me they like the more practical posts, so at the risk of invoking the law of diminishing returns, here are 4 more tips for running workshops:

Physical Space

1. Set up the room so that participants are seated as near as possible to the point where any set-piece contributors are going to be. Sounds obvious I know, but I’ve been in hundreds of events where people are too far away and therefore are encouraged to disengage.

2. Use a room that is at least twice the size you think you need. That way you always have the option of moving participants to a new location, with a different layout, if you need to signify a new phase of the workshop, or the need for a change of pace. For example, if I have lots of table groups working on similar questions and we need to move towards a consensus I like to move people into a more intimate, chairs-only horseshoe type arrangement. This way all participants are seated close together as one group, focused on a nearby wall where competing ideas can easily be shared and affinity clustered. This type of layout (together with the symbolic act of all participants getting up from seperate tables and walking to a new location together)really helps to signal shared purpose and the need for whole group collaboration.

Mix By Attitude

3. Clients often say they’d like table groups to be mixed. Usually this means forming groups by mixing people by levels of seniority or the type of organisation they work for or gender. However, it can sometimes be more useful to mix people by their attitude to a key issue that has relevance for the workshop. For example, if the workshop is about Becoming More Effective at Strategic Commissioning it might be a good idea to mix people with reference to their attitude towards a question such as: How Effective Are We Currently at Strategic Commissioning? You can easily do this by asking people to quickly arrange themselves in a line where one end represents the belief that ‘We Are Already Very Effective’ and the other represents the belief that ‘We Are Almost Completely Ineffective Currently’. Then if you want 8 tables simply walk the line giving people a number from 1-8 in turn.

More Effective Feedback from Groups 

4. Someone once told me that they’d never seen any workshop evaluation where participants rated any formal group feedback sessions as the high spot of the day! So if you need groups to feedback to each other try this. Ask groups to:

• Write the 5 key points they wish to make on flipchart paper
• Post the paper on walls around the room (and give everyone enough time to walk the room and review all the posts)
• Take 15 minutes to agree on 3 key points they have seen that really strike a chord
• Take 2 minutes to share these 3 key points with the whole room.

PS It’s also handy to have a bell or (if you have a laptop and speakers) a nice computer generated sound, like a drum roll, that can sound as each group approaches the last 15 seconds of their 2 minutes of feedback time.

What tips do you have?

Steve

www.stevepashley.co.uk

change management

nhs

facilitation

OD

I had a strange dream last night. I was at a dinner party and the person next to me asked me what I did for a living. For some reason I was compelled to say “I design learning events”. I’ve had this dream before and usually the conversation stops dead at this stage and the person spends the rest of the evening talking instead to whoever is seated on their other side. Sometimes this is because my new ‘friend’ hasn’t a clue what "designing learning events" actually involves and is not the slightest bit interested in finding out. Sometimes its’ because they think they do know and all they think it involves is scheduling a line-up of speakers to present for an hour each over a 6 hour period with occasional breaks for tea, coffee and catching up with real work! But last night something strange happened. My new best friend expressed some interest in my answer and asked me to give him some top practical tips. Hold the soup I thought:

1. Don’t squeeze time on Introductions. Use the introductions slot as an opportunity to get people focused on the theme of the day. For example, as well as saying hello to other people on their table ask people to share a quick story that is related to the theme of the day. For example, if the day’s about identifying more efficient working practices, ask people to tell a quick story about the most efficient service they have ever received.

2. Don’t start with set-piece speakers if you can help it. If people spend the first hour (or more) listening to ‘experts’ they are already in danger of slipping into passive mode.

3. Use lunch, tea and coffee breaks as part of the design logic. For example, if you have some group work that then needs synthesing have a slightly longer lunch break and invite one or two people from each group to meet with each other over lunch to do this and then present it back at the first session after lunch.

4. Try and avoid having a feedback session where small groups report back sequentially on what they have done/discovered. If you must do this at all then get the groups back into the room and give them a further 10 minutes to choose no more than 3 things they wish to tell the others. Their most important insights perhaps, or the 3 things we need to consider doing differently as a result of their discussion etc.

5. Break up the flow of the day. Different people will prefer and learn best from different processes. Try and put shorter sessions next to longer ones etc. Aim for a mixture of presentations (30 mins max), group exercises, reflection in pairs, whole group plenary conversations etc. If it’s a nice day, you are in a nice setting and people are working in pairs or threes, encourage them to talk while walking outside.

6. If you are facilitating, be true to yourself. Don’t get fixated on techniques per se. Be honest and tell people what you are thinking as the event progresses. If you are unsure what to do next then tell people and explain why. Ask them what they think. If you sense there's something 'in the room' that no one seems to want to address then say so and name it. Ask people if they think your interpretation is right or needs 'fine-tuning'.  You have a responsibility to push issues back to people even if they then choose to ignore them. 

7. Always always schedule a 30 min Review of the Day session as the last item. If you are slipping behind time during the day you can use some of this time to catch -up. There is nothing worse than having people start to 'drip away' before you get to an agreed conclusion or agree on some good next steps etc.

8. Use www.zoomerang.com (or some other e-survey tool) to seek feedback and further thoughts about how the work can best be pursued. People often have better ideas a few days later when they are not as tired and have had a chance to mull on what's been said.

Oh is that Minestrone, lovely……..my favourite…anyway what job do you do?..

Steve

www.stevepashley.co.uk