The Changing NHS

I'm running an Open Space training session next week for a group of mental health service users who are planning to run their own OS conference every 6 months or so.

In preparation, (yes i do prepare sometimes),  I thought I'd have a quick look on YouTube to see if anyone had posted an OS video that I could use to convey the essence of the process. Well, I found 3 great ones. What a great resource YouTube can be. Here they are:

1. 2 minute interview (in the back of a taxi) with Harrison Owen, the larger than life guy who thought up Open Space, talking about how he did it. 

2. 3min 30sec video of an Open Space process used by the Transisition Network at their inurgural conference in Stroud;

3. 30sec video showing a speeded up 1 day OS conference at the Tate Modern. Great fun to watch.

I think I'll use these next week.

Incidentally if you want to know more about OS, go to Open Space World

open space

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

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

Incidentally, I'm also struck about how many ‘weak signals’ about these new worlds already exist in the present. Normally, I at least, seem to just ‘tune these signals out’ on a day to day basis. But once you begin to hold future scenarios in your head you begin to see lots of ‘acorns’ all over the place.  But that’s another story.
 
Steve
scenariosnhspsychology

I used the World Cafe process for the first time recently as part of a one day workshop design. If you're not aware of it yet, World Cafe is basically a process for encouraging deeper, richer conversations. The originators have a strapline - Awakening and engaging collective intelligence through conversations about questions that matter.

In a nutshell you arrange the room as a cafe - small card tables, paper tablecloths that people can doodle on etc - and anything from 12 to several hundred people discuss a key question in groups of 4. After 20 mins or so just about everyone gets up and moves to a new table for a conversation with new people (apart from one person at each table who stays behind as a table host to welcome the new 'guests'). 

It works with groups that range from 16 up to several hundred. You run the small table conversation process 3 times, with the same question being addressed each time and then harvest the learning in a whole group plenary discussion. The idea is that people build and make links to what has been said before at the table rather than make new/separate points.
 
If you want more info you can download a good concise guide here.  More information can be acquired at the World Cafe site.

Btw, if you're curious about the magnitude of unnecessary variation that still exists in the NHS have a look at the stats collected as part of the NHS Institute's Better Care, Better Value initiative. The data is here

1. Spend some time with the group exploring what a key question might be, rather than presenting them with a suggested question and asking people if that sounded about right;
2. Have a 4th round of cafe conversations before the final plenary discussion, with a new question, something like "What have we discovered about how to make a more effective contribution?";
3. Ask table hosts, at the outset of each new table conversation, to invite new guests to add insights to 2 or 3 key issues that have surfaced in the previous discussion rather than asking them to summarise what has been said previously;

Anyway, what do you think? Does this sound like a process that could enrich some of your work with colleagues?

nhs

world cafe

learning

In Made to Stick, Dan and Chip Heath explain why some ideas take hold and others quickly fall by the wayside. In summary, they suggest adhering as much as possible to 6 principles help make ideas ‘sticky’. SUCCESs stands for Simplicity, Unexpectedness, Concreteness, Credibility, Emotions and Stories. The ‘stickier’ ideas reflect more of these principles. There’s quite a bit more to it than this but that is the 'gist'.

In an earlier post I wondered why NHS Mission or Vision statements have so little use as managerial tools for aligning and motivating staff. I think the Heath brothers have just helped me out.

Here’s a couple of Vision statements I found from two NHS Trust sites (picked at random, honestly) and two alternative versions that might be ‘stickier’.

Old Version

We will ensure the Leeds Teaching Hospitals NHS Trust is a locally, nationally and internationally renowned centre of excellence for patient care, education and research. We will deliver this vision by ensuring we attract the best possible staff and invest in their development.

New Version

The NHS employs 1.3 million people. Our 15,000 staff will be amongst the best there is and that's why Leeds Teaching Hospitals is talked about in 193 countries.

Old Version

To be the first choice for patients, offering access to high quality patient services. We will build on our success as an NHS Foundation Trust, continually developing services to meet the needs of our patients, working with partner organisations and staff to strive towards excellence. We aim to be an organisation that the community can be proud of, responding to the views of patients, members and staff.

New Version

People will choose to use our services more than 200,000 times every year. That’s because we make sure we know what local people want and we make sure we provide it.

I think these versions are simpler, more unexpected and more concrete and credible. What do you think? Are these newer versions 'stickier'? , More meaningful for staff? Would they be more useful in helping staff figure out what to do and how to behave?

Steve

nhs

vision

change management

Last week I sat in on a NHS senior management team meeting. It lasted 3.5 hours.This established team accomplished 80% of their business in the first 90 minutes then they allowed themselves to take two hours for the remaining items. This meant that eight people spent the equivalent of 16 hours discussing 4 agenda items. Two items couldn’t be resolved because the necessary information wasn’t available yet. They will be back on the table in a fortnight’s time. One item was something that someone not present needed to resolve and one item could have been dealt with by 2 of the people present, outside the meeting.

Why does this happen? Is it just a case of needing better meeting skills or is it something more deeply engrained within the culture of NHS management? If it’s the latter then the following ideas for spending less unnecessary time in meetings may not help:

1. Cap meetings at 60 minutes for the next 3 times you meet. Then, and only then, review whether meeting time needs to be extended in future. You might get to like this more action orientated way of working.
2. Work out the average number of agenda items your meeting has dealt with over the last 6 meetings. Now set an agenda item cap at half this number and reduce the time available by one third. Find other ways to deal with the displaced items, or maybe watch as they mysteriously disappear
3. Calculate how much money your meetings cost. Not the opportunity costs, just the actual costs - number of people x average salaries/pension costs per hour x number of hours in the meeting - At the start of the next meeting share the answer with colleagues and ask if there could be more effective way to get things done.
4. Start and stop meetings on time. Scott Berkun  has 5 great tips to help you do this.
5. If all else fails, take a more draconian approach. According to CIO Insight, Wallmart Stores Inc has introduced standing only meetings, with Blackberries left at the door – “to cut to the chase.”

Is time spent in meetings generally time well spent in your organisation? What tips do you have to help NHS managers use time in meetings more effectively?

Steve

www.stevepashley.co.uk

teams

nhs

meetings

A few months ago I facilitated an Open Space event as part of a week long international conference organised by the International Initiative for Mental Health Leadership.

One of the break-out sessions was led by Elspeth Murray, a Poet and in it, Shona Neil, Chief Executive of the Scottish Association for Mental Health, produced this wonderful poem.

SOUNDBITTEN

“I wish we could find a way

of getting beyond egos:

territorial rivalry

unintelligible meaningless

jargon

the turf battles

the competition

the inanity

it exhausts me.

 

I wish I could have a day

that’s not a groundhog one

Go to a conference where the

emperor IS wearing clothes

where the sultans of spin

are not weaving smoke in mirrors.

 

I get so tired of soundbites

I am fed up of getting soundbitten.

Just occasionally, usually at lunch

or in the bar, I stumble into a little glimmer

of authenticity

Or find a clutch of kindred souls

who aren’t full of self-promotion, speak warmly

and can listen too.

There is hope.

Hope that maybe we can shift

from soundbites

to soundhugs.”

Steve

www.stevepashley.co.uk

nhs

workshops

facilitation

A few weeks ago I wrote about DVF>R - a change formula that I often find helpful as a way of framing what’s going on and helping me find a focus for what needs attention.

On reflection, within the NHS, when seeking to bring about significant change, I think managers:

• tend to spend relatively too much time and energy on D and V - helping people to accept the need for change and painting a picture of a desirable future) and
• not nearly enough time and energy on F and R  - helping people take the first steps towards a new ‘state’ and seeking to reduce the strength of resistance to the changes being proposed.

The relative lack of attention to F is particularly puzzling to me because, as consumers, we are all bombarded with ‘ease of first steps’ offers. Take yesterday as an example for me:

First, a letter from Barclaycard offering me 0% for 3 months on balance transfers. Nothing unusual here but the letter goes on to say that the 0% rate will be extended to 9 months if I spend at least £50 per month for the first 3 months after taking up the offer. This very nearly worked. I nearly took the first step.

Second. A few hours later I’m working at my PC. I needed to insert a Venn diagram into a paper and I Google lots of drawing software that can help. One, Smart Draw, offers a free 7 day trial, so I download and use it. I almost buy it on the spot. Almost certainly I will buy this package when I feel I need regular access to this type of drawing software. I’m already a service user!

Some questions:

1. Does the NHS offer enough First Step moments when managing change?
2. Are First Step moments mainly focused internally, on making it easier for staff to take the first steps towards a new way of working?
3. If yes, is offering First Step moments to customers (patients, local communities etc) something that is counter-cultural?
4. Could more First Step moments be offered to NHS customers when managing service change programmes?

Steve

www.stevepashley.co.uk

nhs

change management

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