3rd March 2015

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59 minutes to save the NHS - can they do it?

Dr Phil Hammond in conversation with Roy Lilley

RCN HQ, Cavendish Square, London 1st April   Details here.  Tickets are flying off the shelf.

The 6th quater
News and Comment from Roy Lilley

They are standing like soldiers in a sunny corner of my garden. Their more audacious relatives have been in the supermarkets for weeks. Spring is on the way; the daffodils have arrived.


Another year and another beginning. A life cycle. People, creatures even ideas and organisations have life cycles.


Organisations are interesting to study. Understanding where they are in their life-cycle is an important part of managing them for success.  If it's not too numerically challenging I think there are 5 quarters to the life cycle of any organisation.


The first 1/4r is the 'chaos' quarter. All organisations start in chaos. Think about the car industry.  The first car; bumping down a track made for a horse and cart. A bloke with a red flag out-front shouting; 'Get out of the way, here comes a car'. Everyone said 'Wow!' No one could figure out what it meant. Planes; the Wright Brothers did something spectacular but no one could see that string, wood and canvass could translate into a communications industry.


The second 1/4r, the infrastructure quarter. Someone realises the idea is a goer and puts things in place to make it work, properly. Cars got roads. Planes, airports. Trains; lines and railway stations. Technology, initially very chaotic, got the web.


The third 1/4r is 'technical improvements' and benefits realisation. As the product or service improves, more people can see the benefits, demand rockets, competition heats up and costs reduce. Technology is a good example. The better it gets, the cheaper it gets, the more accessible it gets.


The fourth 1/4r the realignment phase. It all gets 'too difficult'. Expect mergers, consolidation, regulation, job losses and reverting to core functions. Plenty of examples; banks grew and merged, things went wrong, regulation emerged. To survive they consolidated and job losses followed. M&S and Tesco's are learning about reverting to core functions. Care homes are starting to understand consolidation.


Then, the magic '5th quarter'!  Fragmentation (demergers), new technology based solutions (on-line everything and the face of the high street changes), innovation develops new-business-4-old (Amazon) and offerings are remodelled (Tesco-Home-Delivery) and some businesses just wither on the vine. Blockbuster ousted by BlinkBox and Netflix.


The NHS is not exempt from the ineluctable passage of time and Roy's 5 Quarters Rule.


Born out of the pre-1948 chaos of voluntary and charity healthcare the NHS dropped into the infrastructure quarter, new buildings and management structures; pressures of benefits realisation, technical improvements stoked demand and was soon into the fourth quarter of mergers, job losses, regulation and all the rest.


The fifth quarter? Lansley tried fragmentation, technology based solutions exist but there are only a few hardy pioneers and we cling, resolutely, to old business models. The primary, secondary, social and community classics.


It gets worse.  The NHS has to do all the new stuff without, first, getting the old stuff out of the way.  So, new-fangled is piled on old-dud. Everything is run at the same time, change-management is fitted around the day job, like a hobby and everyone wonders why nothing much changes.


The NHS is a compost heap of dead ideas each one of which has gone through its own 5 quarters cycle. Remember Lean, organisations with a memory, Your Voice-Your Say, quality circles, QUIPP, PFI, Connecting for Health, every contact counts, celebrity chefs, efficiency tables, no decision about me without me, Stuart Rose, sustainability, prescribing initiatives, Living Well, health authorities, PCTs, CCGs, enhanced recovery.... that's a few top-of-the-mind bits and pieces. I could fill up the rest of the pages for a week with the dead-bodies of bright ideas.  (There are nearly 100 I can remember, here).


The fifth 1/4r is the last chance saloon. Do or die. To make this quarter work you need dedicated change makers, protected resources and a free hand. 

The 5YFV and Vanguard are born of the 5th quarter in the life cycle of our NHS; we can't have them changing guard and at the same time struggling with the rear-guard and fighting off the old-guard.

What creates lasting change? A revolution, protest, governments? No, history tells us it is people. People, who love change when they feel they are in charge... that happens in the 6th quarter. 


If you haven't had a look at the 

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please do.  Hundreds have searched for ideas and shared their successes.

How about you?

Make a note; be a sharer this week. 


TV doctor and comedian Phil Hammond in conversation with Roy Lilley

59 minutes to save the NHS - can they do it?

 RCN HQ London 1st April - details here.  



  Contact Roy - please use this e-address


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

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Health Chat
An evening with
Dr Phil Hammond
In conversation with
 Roy Lilley
'59 minutes to save the NHS.'
1st April
RCN HQ London
Dr Sarah Wollaston MP
Chair Health Select Committee
In conversation with
Roy Lilley
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