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Health Chat

29th October King's Fund 5.30pm

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

This event sold out the normal venue very quickly so we have got a bigger room and now have 30 extra tickets. Please book this week... here.

Silver buckshot

News and Comment from Roy Lilley

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.

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Academy of Fabulous Stuff;

Have you looked at the fabulous stuff?

New 'shares' every day.

Make a note; be a sharer this week.

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Contact Roy - please use this e-address

roy.lilley@nhsmanagers.net

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

Leaving the NHS, changing jobs - you don't have to say goodbye to us! You can update your Email Address from the link you'll find right at the bottom of the page, and we'll keep mailing.

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Disclaimer

Medicine for Managers

Dr Paul Lambden

1628

It's in the blood...

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Raining? It's pouring good ideas

here!

LATEST SHARES

Moment of brilliance; Diabetes, digital self management.

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News and Stuff

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>> BMI - buried evidence? This is a terrible story. This is today's must read.

>> MPs get VIP treatment - no they don't; scurrilous article choosing to ignore privacy and security implications of having a famous face.

>> Racial bias - can healthcare be cured?

>> E-fag study was funded by industry - Lancet.

>> E-fags - correspondence re-the above.

>> HEE report on paramedics - stating the obvious, really.

>> Nurse numbers - confusion over who stays and who goes.

>> Physician associates - �50k to practice here.

>> Industry call for more make carers - why don't they recruit them, then. What's it got to do with the government?

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Search for good stuff

Here

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HealthChat

Sam Jones

In conversation with

Roy Lilley

Chief Vanguardista

Last few tickets today.

King's Fund

29th October.

Important Notice

To cope with demand we have booked a bigger room and have 30 extra tickets. Please book this week.

Details here.

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PLUS

1st December

King's Fund 5.30pm

Janet Davies

New boss at the RCN

King's Fund 1st December 5.30 pm.

Details here.

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JOBS

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Looking for something different

Have a look here

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Tell us about your jobs or post them for free.

Give it a try.

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Gossip

This is what I'm hearing;

if you know different,

tell me here

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>> I'm hearing - Monitor and the TDA (aka The Crankies) sent out rules on nurse agency spending. The loopholes are so big Euro-Tunnel are thinking of bidding.

>> I'm hearing - NICE are backing off antibiotic prescribing claims. (Here) Wouldn't have happened in Sir Mike Rawlin's day. What is happening to NICE? Bloated, bumbling and out of it.

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Need inspiration, a good idea or solve a problem

Look here.

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Thank You Wall

Our wall of

Fabulous Thank You's cheer yourself up and have a look; post yours and join in!

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>> Tarzan writing in the Sunday Times about healthy towns - may I suggest the press office at NHSE realise not many NHS people are going to stump up the money to get through the Times' paywall. He might do better in the Telegraph? It's a pity; its a good article but we can't publish it because Murdock has more money than us and we don't want to be sued.

>> Healthy culture - I'm not a great believer in changing culture. I would say you can't but you can change the climate. Nevertheless, this King's fund graphic is really worth a look.

>> How the NHS is being dismantled - in 10 easy steps. Really?

>> Paediatric care - gaps.