Last weekend's choices; in the teeth of Biblical rain; go to B&Q for 7 cubits of wood, to Pets-R-Us, buy two of everything, head for home and make an Ark. Or, cheer myself up by having a sort through the shares at the Academy of Fabulous NHS Stuff.
There are hundreds of good ideas that are not just concepts; they are examples of good ideas that are up, running and changing things for the better.
Who says innovation is difficult?
Sadly, me...
I have to admit, the NHS, makes it is very difficult. The competition rules, regulation, payment systems, structures... everything you can think of mitigates against the NHS doing good stuff easily and quickly.
That is not to say we shouldn't try. To understand why it is difficult we need Herbert Simon's parable.
There were two watchmakers:
...... Hora and Tempus, who made fine watches. The phones in their workshops rang frequently; new customers were constantly calling. Hora prospered while Tempus became poorer and poorer and went broke. Why?
The watches consisted of about 1000 parts each. The watches that Tempus made were designed such that, when he had to put down a partly assembled watch (...to answer the phone), it fell into pieces and had to be reassembled from the start.
Hora had designed his watches so that he could put together subassemblies of about ten components each. Ten of these subassemblies could be put together to make a larger sub- assembly. Finally, ten of the larger subassemblies constituted the whole watch. Each subassembly could be put down without falling apart.
Conclusions? The ability to develop large complex systems depends on two elements:
First; the environment. How frequently and how seriously does it disrupt the developer?
Second; the ability to develop stable 'sub-solutions' that survive these disruptions.
Translated into NHS it means; constant reorganisation is most likely to defeat innovation. Smaller scale innovation works because it is componentised and is immune from the turbulence around it. Do loadsa smaller things, relevant to the workplace and in aggregate the whole system moves the 'box-of-average-performance' up the graph.
Arthur Koestler, in 'Ghost in the Machine', tells us about the 'holon' and the holarchy, which is both the whole and the part.
In English; we don't need just 'change makers' in the NHS. We need Holarchists; people whose value is their ability, as individuals, their uniqueness and their skill to work with others. Unlike 'hierachists', who are valued for their rank, position, seniority and as changers of big stuff.
Look at it this way; since the late '70's I've seen 12 NHS reorganisations and 4 structural changes. Have any of them improved healthcare? No.
It remains the case; people get sick, go to the GP. If the GP can't fix them, they go to the hospital. If the hospital can't fix them it is called a long-term condition and the practice nurse looks after them.
What's changed? The Structures? No. What's changed is the practice nurse and the emergence of the nurse specialists. She (or he) is now doing what the GP once did. Practices nurses are Holarchists.
What else has changed? Average bed-stays probably halved; emergency responders transformed life chances; centres of excellence (stroke and cardiac units); imaging, diagnostics and check-lists.
Has any of this improved because politicians reorganised District Health Authorities, payment systems, markets, fines and penalties? No, they are hieracrhists. It is the holarchists who have changed things.
Lessons for those seeking innovation:
- Solutions to problems are to be found at the front-line; make a habit of asking; 'What three things could we do to improve things around here?' Make a routine of saying... 'Let's give it a try'.
- Fail tenderly; it is rare everything work first time. If there is a failure forget; 'Whose stupid idea was this!' That stifles new ideas, discourages invention and encourages people to keep their heads below the parapet. Say; 'We gave it a try, what have we got to do to make it work?' Fail fast, fix it fast and learn fast.
- Be nimble; innovation is responsive, reactive, and quick. Don't kill ideas with appraisals, bureaucracy and business plans. If you know your business gut instinct and 'give it a go' is all you need.
Aim for 'distributed creativity'. That's what The Academy is all about. In English 'we share stuff'. Organisations need evangelists, enthusiasts and fans to share ideas, horizontally across the place.
Stop looking for silver bullet innovation. The answer is in silver buckshot.
I'll be at Expo in Manchester on Wednesday chairing a discussion on all this; I hope to see you there. Come and say hello.
