The Changing NHS

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.  

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

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

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

Over a hundred PCTs, ten SHAs and twelve Ambulance Trusts have or will very soon have new executive teams in place. Can these quickly become high performing, effective teams? Let’s hope so. The NHS needs to get back to focusing on maintaining and improving services. The new ‘top teams’ will have a better chance of being effective if the folks doing the hiring have paid attention to 3 things.

1. Technical Competence – Does this candidate have the skills and experience that mean they can perform their personal (functional ) responsibilities competently?

2. Group Compatibility - Will this person ‘fit well’ with the rest of the team? Does she hold similar attitudes, beliefs and values to other team members and will she readily accept the formal leader as legitimate? – Lots of research shows that as group tasks become more complex member compatibility becomes relatively more important

3. Role Diversity – Will this person play a useful role in helping the team make decisions and get work done? – Too often teams of competent, compatible people suffer from excessive ‘groupthink’ where they collectively hold a blinkered view of what’s going on ‘out there’ and consequently exercise poor collective judgement about what’s needed. The most effective teams avoid ‘groupthink’ by ensuring that members play particular roles within the team. Belbin’s eight team roles are a useful guide. Quite often, in my opinion, NHS 'top teams' have members playing too few roles.

But it’s not easy is it? We need our new executive teams to be comprised of competent, compatible members, but we also need them to avoid the blight of ‘groupthink’. In my experience the first 2 are usually taken directly into account in selection processes whilst the third needs urgent attention soon after the team starts working.

I wonder how well we’ve done?

Steve

www.stevepashley.co.uk

Productivity and OD. Bet you that’s a phrase you don’t hear very often!

Most OD practitioners would instinctively prefer to be engaged on issues around values-based working, empowerment, quality of working life, organisational sustainability and learning etc rather than the things that keep operational managers awake at night – productivity and process improvement etc. Might this have anything to do with the fact that lots of OD people are female? Anyway, leaving that thought to one side for now, given these very different sets of interests how do these worlds become intertwined? Perhaps they don’t. Perhaps managers see OD as increasingly irrelevant to the day-to-day preoccupations of the NHS. But if you are looking for a lifeline, perhaps the juncture both groups call team development is where we should be focusing.

It’s here, potentially, that the two groups can most easily see how they can usefully work together. Although even here I suspect there’s still some differences of interest that will need to be negotiated. For example, most OD people will be more inclined to want to work on helping teams feel more coherent, less conflict riddled and more democratic whereas most line managers will want help to be focused on how teams can be more productive – especially in toady’s climate where recent Office for National Statistics data suggest that NHS productivity may have actually fallen between 0.6 and 1.3 per cent each year between 1995 and 2003 – although this doesn’t take account of improvements in quality, a thorny issue to measure. See http://www.statistics.gov.uk/cci/article.asp?ID=1429

Teams are, in essence what our NHS organisations are composed of – they are our DNA. Hundreds of long-term and temporary teams, composed of multi-professional clinicians and managers. Sometimes working in relative isolation from each other but more likely to be working together in inter-related ways. Tempting as it might be for some OD people to quickly square the circle by asserting that teams will become more productive by becoming more coherent, less conflict ridden and more democratic, other things might make a more direct and significant difference. These include:

1. A clear, compelling and shared sense of purpose (p.s. If one member doesn’t share the rest of the teams’ sense of purpose please don’t automatically revise it – consider changing the team instead).
2. Crucially, a team leader who is both respected for their competence and is obsessed with defining, monitoring and rewarding outstanding performance
3. The right mix of team members (both in terms of professional abilities and required team roles)
4. An ability,as a team, to accurately assess ones level of performance and identify and action ways to improve this

Surely if we really focus on this we can improve the productivity of our teams by at least 5- 10% and if we can do this then surely we will markedly improve overall NHS productivity and “please stop calling me Shirley” – sorry I couldn’t resist.

Steve

www.stevepashley.co.uk