29th September 2016

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Matthew Syed - author of 'Black Box Thinking'
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In conversation with Roy Lilley
25th October 2016 - King's Fund - tickets here.
In charge
News and Comment from Roy Lilley
Speaking at a recent HSJ event Tarzan said; 'there is no new plan to reform the NHS'.
Reform?  Well, maybe not.  How about amend or rebuild, repair, revise, trim, realign, refocus, balance, buttress, correct? 
What about sort-out?
I don't think you have to be a professor of organisations to know the Lansley reforms were very stupid.  We all knew.  Some of us said so.  Even the Prime Minister, David Cameron, knew they weren't right.  

He brought in Steve Field to conduct a pause and rethink.  Field fumbled his chance and so, thanks largely to him and his, 45 strong gang, we are where we are.
Given a free hand would we continue on with the cacophony of over 200 CCGs?  Would we reinvent them?  I don't think so.
If we could start again, would we try and run the NHS from the middle of the Bermuda Triangle; Waz-Monitor, the Carbuncle and Fawlty Towers at the DH?  No...
You can try and polish it up by calling it a 'distributed leadership model' but we know it's just code for chaos.  It works because the Jim Reaper and Tarzan get on well.  Management-by-personality only works whilst the personalities are in place.
The lack of a strategic hand, to ring-master events, leaves the National out of the health service.  Local and responsive is fine but national and collegiate is important, too.
So, are Tarzan and the Jim Reaper changing the NHS?  Of course.  But, it is not the kind of change we are used to.
Normally, change happens by edict, guidance, ministerial announcements.  Top down, targets bungs and beatings.  What we are seeing now is a new type of change.  A more mature approach.
There is no appetite for a Change the NHS Again Bill and no Parliamentary time.  What is happening is much more subtle.
Management gurus have a phrase for it; Positive Deviance.
We are doing PD.  Big time.
What is it? Try this;
Positive Deviance is; based on the observation that in every community there are certain individuals or groups whose uncommon behaviours and strategies enable them to find better solutions to problems than their peers, while having access to the same resources and facing similar or worse challenges.
The Positive Deviance is; an asset-based, problem-solving, and community-driven approach that enables the community to discover these successful behaviours and strategies and develop a plan of action to promote their adoption by all concerned.
Yup, you might have to read that twice.  My up-sum...
people doing the job know what needs to be done, to do things better... so let them get on with it, do it and make it easy to share the solutions.
The extraordinary success of the Academy of Fabulous Stuff is based on PD.  Three quarters of a million page views, 40 new contributions a week from people doing the job, who have found a better way to do the job and want to share it with other people, doing the same job.  

We have created a community and a social movement.  People share because they can.  No one makes them do it.
Create the space and the place and good people will do the rest.
We are seeing PD in action. 
Bright and brave people know there are too many CCGs, they cost too much and half of them are hopeless.  'Individuals and groups with uncommon behaviours' are just getting on and changing them, merging them, federating their components.
The absence of a strategic overview has inspired an 'asset-based problem-solving approach'.   The speed and spontaneity outstrips anything Fawlty Towers could come up with.
People, have recognised the problems, come together looked around at what assets they have and got busy reshaping them to fit the challenges they are facing; money, demand and consistency of outcome.
Change like this lacks elegance, it's lumpy, clunky and ugly.  It will be messy in the middle.  The STPs, particularly, will be brutal, lack the usual transparency and puzzle the naysayers and objectors with their speed and focus.
The process of change has changed.  Our responses have to catch up.  The 5YFV, the Vanguards... all founded in PD... and only 900 days left to deliver.  
A note of caution?  A scintilla  of doubt?  Well, perhaps a hint of advice, if I may.  Look at the definition of PD again;
'...develop a plan of action to promote their adoption by all concerned...'
That's where the skill comes in.
I would add to the definition; 

'people love change when they feel they are in charge'. 
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Dr Paul Lambden
'...next time you are on a train have a look at the legs...'
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Matthew Syed
Former Commonwealth Table Tennis Champion and author of Black Box Thinking

Half price tickets for IHM members
25th October
King's Fund
This is what I'm hearing;
if you know different,
tell me here
>>  I'm hearing -the junior doctors who lost their High Court battle, sued as Justice for Health Ltd.  Good move.  They will have some money left over.  Does this give them the basis to start a new union?
Dr Rodney Jones 
New Analysis
The Elephant in the Room and rising Emergency Admissions 
Need inspiration, a good idea or solve a problem
Dr Rodney Jones
More excellent analysis
This time the number of critical care beds.
Cuppa-builder's read.
Dr Sir Sam Everington
Barrister, doctor, leader.
In conversation with 
Roy Lilley
He was even a 'rough-sleeper' and charged with making fraudulent job applications to highlight discrimination.  The first medic on the scene after the 7/7 bombings.
This will be a really interesting evening.  Medico-politics, the future of Primary Care.
Tickets for IHM members half price.