I've been out and about again. Legging it to catch trains and sitting in queues of traffic. Parked in airport lounges. If there is an upside it's the time it creates to think. This is what I've been thinking about.

We have to be mindful that NHS has all the disadvantages of being a state run bureaucracy. However, the benefits are universality, fairness and accessibility. It is only by being nimble, efficient, open to innovation and constantly asking 'is this the best we can do' that we can continue to make the advantages outweigh the disadvantages.

Bad policy has made the bureaucracy worse; fragmentation, complexity, diffuse leadership and no ownership. The vacuum creates a leadership opportunity. It is not about being in charge it is about creating time and space for good people to do great things. We can do that for each other.

It is the doubts that politicians have in their own ability to lead and inspire that makes them resort to regulation, inspection and targets; all of which are demoralising, encourage fear, gaming, cover up and waste. Don't use your energy on it. Focus on doing the best job you can. Ask yourself; if this person was my family is this what I'd do? If this was my money, is this how I'd spend it? We can all do that.

All healthcare systems have money, quality and demand issues. None of this is your fault. Life chances, happenstance, systems, policies and pressures to make it look-good for the boss are the real causes of problems and out of your control. Try and build alliances with like-minded people to focus on the patient, concentrate on learning and improving. Put all your efforts into encouraging the goodwill of the people around you. You are who you hang out with.

Understand, sometimes, the obvious things are the most difficult. It is obvious that keeping people healthy for longer is a good thing. Why is it so difficult? It is obvious getting people better and home, safely, as soon as you can, is a good thing. Why is it so difficult? Be curious about the difficult things. Don't back away from them. Ask why they are difficult. Difficult things take root, tackle them before they do and the rest will fall into place.

The NHS is quite unlike any other workplace with its low dependence on the management of information by the use of technology. This has to change. Being open-minded about innovative technologies and data analysis can give us the answer to 9 basic questions which, since 1948 have been too difficult to answer: who gets ill; with what; why; can we stop it; how did we fix them up; did it work; what did it cost; was the 'customer satisfied'; do we want to do it again.

Healthcare is dangerous, things can go wrong. It is the measure of the organisation and the individual how well and quickly things are put right and arrangements put in place to make sure it doesn't happen again.  Inspection, special measures, humiliation all create a fearful workforce who will never understand this. Ask; what can we do to make their work a pleasure, where they do it a good place to be and let them know it's OK to have fun at work?

There is not an example of poor care, a fiddle, a callousness, a corner cut that can exist without secrecy. Making it easy to speak frankly and to listen is more fruitful than waiting to hear the sound of a distant whistle being blown. Each one of us has to be an open source of what is happening, what we don't want and what we want more of. We protect ourselves from inconvenient truths. Would we buy an egg if, at the supermarket checkout, we saw a picture of the suffering of a battery hen? Why would we blow the whistle knowing the last person who did so ended up in tears with no job.

In the maelstrom of the day it's easy to get doing and forget thinking. Thinking takes time and space but we can't solve our problems using the same thinking that gave us the problems in the first place. 

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'What is the point of a select committee' come and join me in conversation with Dr Sarah Wollaston MP, chair of the Health Select Committee.

 Kings Fund 11th March - details here. 

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roy.lilley@nhsmanagers.net 

Know something I don't - email me in confidence.

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