26th August 2015

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Health Chat

29th October King's Fund 5.30pm

Samantha Jones NHSE Director of New Models of Care and Vanguards.

Tickets only a few left here.

We've tried everything else 
News and Comment from Roy Lilley
Are you back from the beach? Maybe, this is the last week before it's back to the grind? Or, like me; waiting 'till the hullabaloo is over and find a quiet place at half the price.
After a week or two in flip-flops don't shoes feel strange?
Back to decisions and choices; the stock in trade of the manager. If I do this, I get that... or maybe not. Evaluate, plan, think through, do, review.
The more I see of how the landscape of healthcare is panning out, the more I come to the conclusion that everything is probably wrong! We're heading for a new era of healthcare; nimble, boundary-less and unstructured. Old solutions won't work, old organisations redundant, old regulation out of step, old approaches to decision making, unwieldy.
Once there was a time when strategy followed structure. Later, in the mid-90's we became braver and structure tried to follow strategy and ever since we have been caught in a maelstrom of service redesign that has taken us in a circle.
CCGs are little more than PCTs in drag. PCTs looked very like District Health Authorities. Local Area Teams are edging ever closer to Strategic Health Authorities, once called Regional Health Authorities.
Trusts look like DGHs and what the difference is, between an FT and a non-FT, is known only to three blokes in the Treasury and a dog. And the dog is not so sure anymore.
As the NHS tries to change it gets pulled by the centrifugal force of the past. We changed the future into something that was familiar and before you know it, it looks like the past. Reorganisation is circular.
Like a giant coral reef; we add bits and imperceptibly it grows until the NHS becomes the managerial equivalent of 1,553 miles of the Great Barrier Reef. Blimey, how did that happen? Answer; three millimetres at a time!
If the NHS is going to change it has to change how it changes.
In the late 1930s Harvard's Roethlisberger and Barnard taught us 'paying attention' can deliver change. In a factory they improved workplace hygiene and turned up the lights. They got an unexpectedly big increase in productivity. They turned the lights back down and productivity stayed the same! It was paying attention to the detail of hygiene that made the difference. It had a personal connection with the workforce.
We've been managing organisations for long enough to know; changing things from the centre means issuing an edict and hoping something good happens. You'll find out, too late, it hasn't. Manipulating rewards, tariffs and incentives creates gaming and loop-hole-jumpers.
Centralisation, decentralisation, matrix... we've tried them all. All except the obvious.  Swap strategy for tactics and techniques and start trusting the people who actually do the job.
Example; setting target times for A&E has created gaming, cheating, observation units, rows, angst, inspection, costs, stress and the totally worthless concept of failure.
If we said to trauma folk; we all agree getting through the system as fast as possible is mostly a good idea, please go and do it... then publish unit times, once a week, do you think they'd be satisfied with 4 hours? No, pride, professionalism, sharing best practice would take over; times and outcomes would improve.
Right now we are stuck with what Herbert Simon (Nobel Laureate 1977) called 'satisficing'... settling for adequate instead of optimal.
Waterman and Peters teach us; effective change is achieved by recognising the relationship between structure and strategy, systems, and style, skills and staff.
In my view, the most important is staff and what I call the five 'secret ingredients'; their ideas, morale, attitude, motivation and behaviour.
To cultivate these five ingredients means managers have a choice. They can have a clear vision of what the organisation is try to achieve meddle, micro manage and step forward to take the blame. Or, they can articulate the vision, inspire with it, socialise the concepts, orchestrate it and step back to take the credit.
This is why the Vanguards are so important. They are a genuine attempt at disruptive, troublemaking, untried, experimental change; I think, based on the five ingredients.
Shall we give them a go? Let's face it, we've tried everything else.
I'll be talking with the Chief Vanguardista, Sam Jones, at the King's Fund, 5.30pm 29th October. Let's see if she 'gets it'.
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Sam Jones
In conversation with
Roy Lilley 
Chief Vanguardista
... and NHSE Director of New Models of Care
What are the new Vanguards all about?  Can they save the NHS?  Come and find out.
King's Fund
29th October.
1st December
King's Fund 5.30pm
Janet Davies
New boss at the RCN
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This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing - the TDA have been coaching Trusts to pass CQC inspections; mock visits and interview panels.  Well. well!
>>  I'm hearing - of a Trust that was inspected in October 2014 and the report published June 2015.  In all seriousness I ask; what is the point?
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