2nd November 2016

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Dr Sir Sam Everington
GP extraordinaire!  In conversation with Roy Lilley
9th November 2016 - King's Fund - tickets here. Half price for IHM members.
Their own weather
News and Comment from Roy Lilley
Managing.  To administer is not quite the same.  To execute, maybe?  Direct?  Well, sort of...
I've always said it is the role of the manager to create the time and space for good people to do great things.
That means decluttering the organisation, streamlining it.  Oxygenating it.  Letting some light in.  Demolishing  hierarchies.  Hierarchies; the last hiding place of the scoundrel, the bone idle and the incompetent.
Want to know how good the organisation is?  Look at the organigram.  More than three layers and four tiers and you'll know there is some clearing-out to be done.  More undergrowth than a caber-tosser's armpit.
Organisations that flourish have very flat structures.  They are delayered.  Few, or no middle managers between the staff and the executives.  

The famous Netherland's Buurtzorg home care model; run by a chief executive, a finance director and the rest... nurses working in self-directed teams.  No middle managers.
Management gurus Ghiselli and Johnson tell us:
"... the amount of independence managers in flat organisations possess as a result of the flat organisational structure satisfies many of their needs in terms of autonomy and self-realisation.
The idea behind flat organisations is that well-trained workers will be more productive when they are more directly involved in the decision making process, rather than closely supervised by many layers of management."
You can see the point; greater employee involvement, decisions made by people facing the problems, feed-back and comment faster and in real time.
On the plus side; flat structures are more likely to be fast adopters of innovative solutions.  On the minus; they can be prone to workplace cliques and bullying might go unnoticed but I guess that is true of most workplaces.
Mangers, if they contribute anything, must be to iron out the bumps in the road.  Make it easy for people to do their jobs.  The Lean approach is overcomplicated and far too fussed over.  The essence of Lean is simply to create work flow, making it easier to do the job.
Harmonising effort.  Coordinating effort, coordinating the functions of the organisation to achieve the agreed outcome.  And, that's the big trick; agreeing the outcome.
Patients; speedily into and safely through the system, ready to speak well of their experience 
and their outcome. 
Easier said than done!
Coordinating the work of the organisation, synchronising the effort both internally and externally.
There are five aspects;
  1. Understanding the significance of outcomes through the eyes of the service user.
  2. Keeping the organisation delivering the agreed outcome, focussed on its importance.
  3. Creating the environment where the outcome can be achieved all the time, every time until you want to improve it or change it in some way.
  4. Ensuring the employees are able to deliver the outcome through training and resource.
  5. Celebrating success; each and every one, no matter how small.
Of the five, the last, 'celebrating success' is arguably the most important. 
Celebrating success generates a climate where people want to be part of success, be more successful and take success to a new level. 
Success is hypnotic, intoxicating, addictive and develops an environment where people want to accomplish more, achieve better.  In turn this creates confidence and a climate where people want to know what good looks like, how to do it better and be more open to change and innovation.
And, in turn, it is climate that creates an organisation's culture because culture is a product of an organisation's values and behaviours... its collective beliefs.
You will hear people speak of changing 'NHS culture'.  You can't.  

Culture has a life of its own.  History, employee legacy, communication, language, assumptions, beliefs, customer narrative, values and organisational norms.  Culture is like a coral reef, it gets bigger and more complicated and no one knows how it got there in the first place.
Climate, you can change because good mangers create their own weather.
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Medicine for Managers

Dr Paul Lambden
'...don't be caught off balance....'
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Another storming paper
Role of a day-of-week cycle in blood biochemistry in the weekend mortality effect.

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6th December
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Dr Sir Sam Everington
Barrister, doctor, leader.
In conversation with 
Roy Lilley
King's Fund
9th November 
Tickets for IHM members half price.
New Award

'Are you using health technology that is making a significant difference to your patients?
Nominate it for a Health Tech and You Award!'
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Have a look, nominate someone and make their day!