Model 4: data, information, knowledge, wisdom

The Model from Infovis below shows just what I always struggle in explaining to tohers as to why the results of one project cannot just be pushed onto other, adopting, groups.

The producers, the pilot projects, create the basic data and some information (patterns) about it. The consumers (the adopters) need to retest this in their own environment.  Any pilot project that can be written up in a way that helps the consumer to bridge the gap from information to knowledge will likely be more successful at spread than others. This can include things like: you can adapt this in the following way, we did the following and it didn't work but it may work in xyz circumstances etc.

Model 3: data, information, knowledge, wisdom

One of the QI refrains is "increase the capability and capacity of employees". While this is a great concept, easy to declare and impossible not to support, for me it lacks any concrete applicability. What exactly is meant by this? There is another one of our data-information-knowledge-wisdom models which may help pin down what might be meant. Next time you hear somebody say the capacity/capability thing then whip this model out and ask them to explain their intentions and expectations along the data to wisdom curve.

 The challenge here is to produce learning experiences that enable someone to move up the curve. In my experience, much of healthcare improvement work is focused on developing data based skills - how to measure change. Some people get to the information stage where they learn to look for patterns, say by using SPC charts. Can they port this knowledge to other projects in a predictable way? Can they make intelligent choices? To what extent do the participants on a QI project become "wise"?

The above curve comes from Designing Knowledge Eco-Systems for Communities of Practice.  The web resources are excellent - especially if you are developing CoP's as part of your QI strategy.

Model 2: data, information, knowledge, wisdom

There is an excellent post about wisdom on one of my favourite sites - Big Dog and Little Dog's Performance Juxtaposition (yes, really!).  It's a place I recommend you spend some time checking out.

I like the way this model gets me thinking about how we learn - there are connections here to the Honey & Mumford Learning styles.  The fact that there is a continuum for context is also thought-provoking.  This model has left me wondering whether in many of our quality improvement projects we focus too much on the bottom left hand corner and assume the progression to wisdom will be automatic. What would happen if we thought more and designed more of the journey to wisdom into our improvement interventions (and by extension, into our evaluations of projects)?

Model 1: data, information, knowledge, wisdom

The old adage goes along the lines that knowledge can be defined as knowing a tomato is a fruit, and that wisdom is therefore knowing that you don't add a tomato to a fruit salad...  There are a number of models and frameworks that investigate the data-information-knowledge-wisdom continuum and in the this series of posts I cover a few of these.

For the theorist a good place to start is with an online paper A Primer:, Enterprise Wisdom Management and the Flow of Understanding by ScottCarpenter@CognitiveCybernetics.com

I like the way environment and context have come into play as important factors in understanding that knowledge and wisdom have a contextual perspective.

New Paper: What is the experience of national quality campaigns?

I liked the conclusion in this paper - "..may depend on.." as it summarised my experience of national quality campaigns - the results depend on a multitude of factors - and I would add depends on the perspective/s of the stakeholders involved.

 Health Serv Res. 2010 Dec;45(6 Pt 1):1651-69.

What is the experience of national quality campaigns? Views from the field.

Bradley EH, Nembhard IM, Yuan CT, Stern AF, Curtis JP, Nallamothu BK, Brush JE Jr, Krumholz HM.

OBJECTIVE: To identify key characteristics of a national quality campaign that participants viewed as effective, to understand mechanisms by which the campaign influenced hospital practices, and to elucidate contextual factors that modified the perceived influence of the campaign on hospital improvements.

CONCLUSIONS: The impact of national quality campaigns may depend on both campaign design features and on the internal environment of participating hospitals.

New Paper: Short and long term effects of a QI collaborative on diabetes mgt

I'm always on the look out for evidence of the sustainability of QI projects. A new paper in Implementation Science has some thoughts on this though I am not convinced 1 year classes as "long term".

Implement Sci. 2010 Nov 28;5(1):94. [Epub ahead of print]

Short- and long-term effects of a quality improvement collaborative on diabetes management.

Schouten LM, Hulscher ME, Van Everdingen JJ, Huijsman R, Niessen LW, Grol RP.

ABSTRACT:

INTRODUCTION: This study examined the short- and long-term effects of a quality improvement collaborative on patient outcomes, professional performance, and structural aspects of chronic care management of type 2 diabetes in an integrated care setting.

CONCLUSIONS: At a time of heightened national attention toward diabetes care, our results demonstrate a modest benefit of participation in a multi-institutional quality improvement collaborative focusing on integrated, patient-centered care. The effects persisted for at least 12 months after the intervention was completed. 

New Paper: How to use an article about quality improvement (JAMA Nov 2010)

One of the difficulties in spread and adoption is, on the one hand avoiding the temptation to take the results from one project and then do a back of the envelope calculation and announce if the results were spread then there would be x billion savings etc; and on the other hand, if you're a project lead, how do you read a piece of evidence and work out its relevance for your own work?  There is a new paper out which touches on this subject.

 JAMA. 2010 Nov 24;304(20):2279-87.

How to use an article about quality improvement.

Fan E, Laupacis A, Pronovost PJ, Guyatt GH, Needham DM.

Abstract

Quality improvement (QI) attempts to change clinician behavior and, through those changes, lead to improved patient outcomes. The methodological quality of studies evaluating the effectiveness of QI interventions is frequently low. Clinicians and others evaluating QI studies should be aware of the risk of bias, should consider whether the investigators measured appropriate outcomes, should be concerned if there has been no replication of the findings, and should consider the likelihood of success of the QI intervention in their practice setting and the costs and possibility of unintended effects of its implementation. This article complements and enhances existing Users' Guides that address the effects of interventions--Therapy, Harm, Clinical Decision Support Systems, and Summarizing the Evidence guides--with an emphasis on issues specific to QI studies. Given the potential for widespread implementation of QI interventions, there is a need for robust study methods in QI research.

Testing the transferability of ideas and practises

We are not short of good ideas on how to improve healthcare. Nor are we short of good examples and case studies. What we are short of is evidence that good examples are transferable form one place to another.

I really like the way in which NHS Improvement has reviewed their own work with the aim of testing out how transferability their work is. The organisation works in an unpretentious way, in that their work is organised by healthcare pathways rather than improvement techniques. In their Cancer stream they have reviewed how good examples are transferred from one team or organisation to another and made notes about the issues and difficulties. These reports are easy to read and full of the lessons of the spread and adoption process.

Web 2.0 not role modelled is inauthentic

Anyone or any organisation that flies the flag of change management and improvement always has the difficult task of acting what they say, namely being a role model for what they espouse.  It is difficult to get right all the time and I certainly don't.

One positive example I have experienced is the Institute for Healthcare Improvement who, a while back, took on the challenge of improving their invoicing and payment system on the basis they couldn't teach others to do it unless they (a) were a good role model and (b) learnt from their own experience.

The worst of management consultancy is when concepts and theories from books are copied onto PowerPoint slides and then used to train others. Where the trainers have no experience of the content their audience will soon figure out the dissonance and leave the session - either physically or mentally.

In England we have a rash of NHS Improvement related organisations trying to get onto the social media bandwagon. I am all for it as I believe it is an essential tool for communicating and engaging with others. However, when the organisations involved have no official and monitored Facebook page, do not use blogs (as in few is any of their Executive Teams or Senior Staff use them), have never used a wiki, do not use RSS feeds themselves as part of their own learning, or never used a discussion forum in-house etc - then the exhortations and training comes across as inauthentic.

There are one or two NHS Improvement groups, like NHS Improvement, who are using Web 2.0 techniques to their advantage and I like the way they are starting with themselves and learning how to use them in-house, before going outside.  I am sure they will be excellent role models for the future.

Public Value in the Public Sector: Literature review and toolkit

The University of Birmingham Health Services Management Centre and the NHS Institute have completed some research on public value in the context of public services. The literature review and associated "toolkit" is available on the NHS Institute Website.

Hoorah! It is now recognised that the technical tools of change (like redesign, scenarios etc need to be combined with the more non-technical aspects such as the media, local pressure groups, politics etc.

As always, turning theory into practise is the difficult bit and I look forward to these concepts and new ideas being used.

Influencers: How trends become Contagious

The DigitalBuzz blog is one of my great sources. They found a high video (a film, really) Influencers: How trends become Contagious from R+I Creative that documents the importance of Influencers in setting new trends that move to mainstream. No theory, models or management gobbledegook in it!

Helping leaders understand variation

What does your leader do when you put a control chart or run chart in front of them? There is an excellent paper available from the Institute for Healthcare Improvement on the topic of helping leaders understand variation.

Lloyd R. Helping leaders blink correctly: Split-second decisions have patient safety implications (Part 1). Healthcare Executive. 2010 May/June;25(3):88-91.

This article describes two of four necessary skills health care leaders need to develop in order to "blink" appropriately (i.e., make decisions based on robust analysis and interpretation of data): understanding the messiness of improving health care, and determining why you are measuring.

Download part 1 here

Download part 2 here

eLearning Perspectives: Free eBook

The Masie Center has released a comprehensive ebook with contributions from 40 Global Leaders.  A must read for anyone who is interested in the topic of eLearning.

Download it here

Contents
Part I: New Learning Frameworks

Learning National Park, Needs Rangers! Getting to Know Bob
- Allison Anderson, Intel Corporation...............................................................10
What Problem Are We Really Trying to Solve? - Julie Clow, Google..................15
An Idea Whose Time has Come - Deb Tees, Lockheed Martin .........................21
The Power of Deep Expertise! Developing Expertise in a Corporate Environment
THE POWER OF DEEP EXPERTISE! - Raj Ramachandran, Accenture .................27
LEARNING ORGANIZATIONS: PEOPLE POWER?
- Nigel Paine, The Learning Consortium ..........................................................35

Part II: Under30 Perspectives
Learning: Converting the Crash Dieters to Lifelong Healthy Eaters
- Liz Scott, ZS Associates ...................................................................................39
Inspiration and eLearning - Linda Backo, PPL .................................................40
Access and Opportunities - Ben Betts, HT2 Ltd..................................................41
It’s Curtains for the LMS - Joe Beaudry, Verizon Wireless ..................................43
Engaging Learners Through Gaming - Lacey Grande, Ogilvy & Mather...........45
Learning Together To Change the World - Elizabeth Musar, InsideNGO.........46
Underemployed or Unprepared? - Kaylea Howarth, Alliance Pipeline .............47
Conscious Incompetence - Doug Livas, Moss Adams, LLP ................................49
Exciting the Learner - Aviva Leebow, Pacesetter Steel Service, Inc. ....................51
“Question? Try Twitter!” My Take on Social Networking
- Rachel Donley, BGSU Student ........................................................................53
Learning by Falling - Jen Vetter, TorranceLearning ...........................................55
What Happened to OJT? - Michelle Thompson, Poole and Associates .............56
Get Out of Your Comfort Zone: Developing Training for the Learner
- Emily Fearnside, General Mills .......................................................................57
Just Ask! - Katie Mack, Westinghouse Electric Company ..................................58
Passion for Learning - Sarah Carr, Google.......................................................59
4
Gamifying Learning with Social Gaming Mechanics
- Enzo Silva, Oracle Corporation......................................................................61
Incorporating the Human Touch in Online Education
- Jessica Sanderson, Cleveland Clinic ...............................................................63
The changing expectations of learners and the LMS
- Connor Gormley, FM Global .........................................................................64
Getting Beyond the Formal Classroom - Grant Velie, Farmers Insurance .........65
Establishing a Training Culture – Moving from Data Deluge to Learning
- Jennifer Wright, Alstom Power........................................................................68
“Y” not Mentor? - Danielle Sagstetter, Capella University / PACT .....................70
Common Constraints - Meg Hunter, CFA Institute ............................................72
Students have a say too! - Joshua Smith, Department of Veterans Affairs..........74
Learning That Makes a Difference - Julie Thompson, Xcel Energy .....................75
Part III: Learning in Action
The Impact of Knowledge Management on the Workplace Learning Organization
- Patty Glines & Eric Zenor, CUNA Mutual Group.............................................78
The New Ground Rules: A Collision of Knowledge at the Speed of Light
- Lisa Pedrogo, Turner Broadcasting/CNN BEST University...............................84
The Blended Future of Learning - MaryJo Swenson, Novell...............................92
Learning to Meet the Mission - John Guyant, CIA University ............................ 98
Blending AVON’s 125 year Old “Social Network” into Our Learning Approach
- Stephen Barankewicz, Avon .........................................................................107
Is Learning & Development Being Lost in the Age of Talent Management?
- Sean Dineen, Luxottica.................................................................................111
Part IV: Learning Changes
Combining “Cool” with “Core” in Learning
- Elliott Masie, The Learning Consortium .......................................................117
What Shapes the Future of Learning? The Third Industrial Revolution
- Wayne Hodgins, MASIE Fellow aboard the Learnativity ................................119
Trends in Learning Technology: The View from Late 2010
- Rick Darby, Rollins’ University .......................................................................132
The Times They May be a’Changing: From Sizzle to Fizzle in Learning Technologies
- Larry Israelite, Liberty Mutual Group ............................................................139

Social Marketing Podcasts from the Open University

I had a proud moment when listening to Michaela Firth via iTunes talking about Social Marketing. She is really a leader in this field and I'm glad we've shared coffee and brownies over the last ten years. The Open University has a series of podcasts that I recommend to anyone working in the field of trying to spread behaviourally related  good ideas to a wider audience.

Social marketing - Audio

by The Open University

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To listen to an audio podcast, mouse over the title and click Play. Open iTunes to download and subscribe to iTunes U collections.

Description

Have you ever wondered how marketing techniques have been used to promote positive social change? In a series of lively interviews, Professor Gerard Hastings of the Institute of Social Marketing, faces questions from members of ISM-Open (the Institute of Social Marketing at the Open University Business School) on issues such as the ethics of social marketing, branding and advertising, and the morality of shocking or scaring people into changing their behaviour for the better. This material forms part of the Open University course B324 Marketing and society.

Social marketing	View In iTunes
What is social marketing?	View In iTunes
Critical marketing	View In iTunes
Ethics and advertising	View In iTunes
Evaluating social marketing programmes	View In iTunes
Ethical brands	View In iTunes
Ethics and social marketing	View In iTunes

eLearning 3: 5 Resources for effective online conferences

With the bans of travel and other cost reductions in place, eConferencing is on the up. Unfortunatley, this is iften paralled with a signficiant reduction in value for the participants. eConferencing is more than ticking the box that you've "run an event".

Let's look at what not to do in a video conference:



Other resources

• 19 tips for effective online conferences; from eLearning Technology
• http://onlinelibrary.wiley.com/doi/10.1002/stvr.411/pdf (I liked the lessons learned and tips for the future) PDF
• Guidelines for running online seminars
•  Online conference - a participant's perspective

eLearning 2: 5 Resources for learning about Teaching Online

Teaching online is quite a difference from teaching face-to-face. If done properly it can be an inspiring and motivating process for both teacher and learner. If not, it can be awful, especially for the learner. In my experience there is not much mediocrity - just brilliance or horror.

Try a book or two:

• Collaborating online; learning together in community 
• The ins and outs of online discussion; transitioning from bricks and mortar to online teaching 
• Creating a sense of presence in online teaching; how to be there for distance learners

Check out a video or two:

eLearning 1: 5 Resources for supporting online discussions

Creating and moderating an online discussion group requires more than sending out an email inviting people to join. In some cases it is not the cheap, quick fix you may be after. It's work. Treat it like a project - from strategy, planning, resource allocation through to evaluation.

Here are a few of my favourite resources on the topic:

1. Designing and Managing online discussions from Oxford Brookes University (PDF paper, with references - my favourite)
2. Teaching with online discussion forums - good introduction 
3. Online discussions: Tips for Instructors from the Centre of Teaching Excellence at the University of Waterloo. Web page with bullet hints
4. Using discussion boards to engage students 
5. How to avoid problems with online discussions - student guide. Short web page with more links on it. USeful because it is from the student/user perspective

Productivity 8: Where to find ideas for improving productivity in the NHS

This is the 8th in a series of Productivity notes by Sarah Fraser. So where do we find the "no-brainer" ideas for improving productivity in healthcare.

There is no need to start from scratch if you're looking to improve productivity in your organisation, team, ward or practice.  Many have gone before you and many have spent time writing up their experiences so you can learn from their efforts.

This is where I start looking:

1. NHS Library (or any other academic library). DO some proper searches. I do feel that starting on productivity initiatives without doing a couple of hours research is shortsighted.  Google is not enough..
2. NHS Institute for Innovation and Improvement; for NHS England there is a lot of information available.  Scotland and Wales I know have similar organisations who gather and share productivity and improvement information. The same is true for most countries which have a public sector health system
3. The Institute for Healthcare Improvement has a great deal of case studies and resources freely available

If I find nothing in the above then I will find another topic to work on. There is so much to learn from what others are doing that can make the productivity process easier that it doesn't feel worth being the one person who decides to design a research project instead of getting on with the change process.

If you have any favourite place to look for productivity ideas then please add a comment to this post.

Productivity 7: How replicable is productivity?

This is the seventh in a series of productivity notes by Sarah Fraser.  If one organisation or region is classified as productive, can we make generalised statements that the rest of the organisation or nation can implement the same and be as productive?

A new report by York University is making big claims.

"The NHS could cut expenditure by £3.2billion without reducing the number of patients treated if all parts of the country were as productive as the South West, according to a report published today by the Centre for Health Economics at the University of York."

The report has many maybe's and possibly's as to whether the rest of the NHS could see the same cost savings if they performed like the South West Region.  I have no doubt the SW is producing excellent care. My concern is headlines like this paper produces sets unrealistic expectations on others. The delivery of healthcare is significantly contextual in its nature. Services all over the country reflect the complex make up of the areas they serve. The report summary on their website states:

"South West may also benefit from a more stable workforce, vacancy rates for non-medical staff being well below the national average. Lower productivity in the hospital and community sectors may be because more work is undertaken in primary care."

I believe this is enough uncertainty to warrant being very cautious about ratcheting up national numbers. Additionally, there is significant use of the "average" in this report. I am not convinced that averaging data and using the average as a measure is a good one for healthcare. As I pointed out in my earlier Productivity note, there is a big difference between accuracy and precision; basically, it is possible for there to be little variation across the regions (precision) but they are all delivering the wrong solution (accuracy).

Like all theories, this research is helpful to a degree (mostly in applying judgement) and like all theories, needs to be treated with a pinch of salt. If you are going to quote the headline £32billion on the stage then make sure you've read and understand the limitations of the report.

(To those who read the previous Productivity note about definitions - productivity is defined in this research report as output / input - how much output you get for the inputs...)

Productive 6: Are Patients Productive?

This is the sixth note in the the Productivity series by Sarah Fraser. You can find the earlier notes here.

Mark Russell commented on the first in this series and he got me thinking. Healthcare is different from being a consumer of say a car dealership. We know that. We can learn from techniques used in industry and we can apply them to our services to gain some benefits.  But I wonder whether we are too focused on programs such as Lean, or too focused on seeing the patient as someone with whom we need to engage?

The car dealership or company with be thinking about their customers constantly. It feels to me they spend time in empathy mode, figuring out how to make things easier for the customer. This ease translates into more sales (yes, I know I am reducing an entire academic discipline into two sentences.) They may even run focus groups.

When it comes to patients and productivity I am thinking the relationship is more than one of engagement. As a patient I am not seeking to be engaged with my local healthcare providers. I am expecting the provision to help me be a productive member of society. This means, for example, I don't' want to take an entire day off work so I can have an 8 minute blood test. Equally, I am prepared to to help the providers be productive by being an efficient and responsible patient - but I may need help to do so. If I have a chronic disease, then help me learn how best to manage it so everyone benefits from this productivity.

When the patient's interface with the provider is not productive for either party, then we have work to do.

Productivity 5: What do we mean by "Productive"?

This is the fifth in the Productivity Series by Sarah Fraser. If you want to sign up to receive updates in your email inbox or your Reader (your choice) then go to the Blog and click on the Subscribe button.

So what do we mean when we say we want to be productive or we want our services to be productive? This is something we think we know but until we articulate exactly what we mean, the term is uncertain and ambiguous. What one person understands as productivity may not be the same meaning that another has.

The online dictionary provides a number of definitions and I liked the way it provides similar, related and dissimilar words.

ThesaurusLegend:  Synonyms Related Words Antonyms

Adj.	1.	productive - producing or capable of producing (especially abundantly); "productive farmland"; "his productive years"; "a productive collaboration" creative, originative - having the ability or power to create; "a creative imagination" fertile - capable of reproducing fruitful - productive or conducive to producing in abundance; "be fruitful and multiply" profitable - yielding material gain or profit; "profitable speculation on the stock market" successful - having succeeded or being marked by a favorable outcome; "a successful architect"; "a successful business venture" unproductive - not producing or capable of producing; "elimination of high-cost or unproductive industries"
	2.	productive - having the ability to produce or originate; "generative power"; "generative forces" generative
	3.	productive - yielding positive results successful - having succeeded or being marked by a favorable outcome; "a successful architect"; "a successful business venture"
	4.	productive - marked by great fruitfulness; "fertile farmland"; "a fat land"; "a productive vineyard"; "rich soil" fertile, rich, fat fruitful - productive or conducive to producing in abundance; "be fruitful and multiply"

Based on WordNet 3.0, Farlex clipart collection. © 2003-2008 Princeton University, Farlex Inc.

Using the above I came up with a number of questions to ask myself and others who claim to be working on increasing productivity:

1. If being productive can be defined as the capability to reproduce I wonder what productive spread is? I think it is about how efficiently we adopt and implement best practises, but that may not be the all of it.
2. If being productive is about abundance, how can we shift our mindset to one where we aim to use and create abundance rather than to streamline, cut and destroy services? How much impact can a mindset shift make?
3. If being productive is about yielding positive results, I wonder for whom these results are? How do we manage the differing expectations of different stakeholders?

How do you define "productive"?

Productivity 4: Leaders need to be productive

This is the fourth in the Productivity series by Sarah Fraser. Is is possible to have a productive organisation if the leader is not productive?

This short video by Patrick Collins focuses on how leaders can use the 80:20 rule to ensure they focus on what matters and what provides the value you provide as a leader.



If you think you know the 80:20 rule, then I challenge you to watch this video and test whether you put it into action.

Productivity 3: Productivity is more than a process

This the the third in a series of Productivity notes by Sarah Fraser. Productivity is more than a process.

New and improved policies can impact the design and implementation of efficiencies. For example, new recruitment, pension, appraisal and similar policy changes can impact processes not only in the short term but also long term. I do think that policy improvements are a necessary condition for many other efficiencies to be put into place.

Clinical productivity is often conceived as as "how hard are we sweating out clinical assets". Another way of looking at this is to see clinical productivity as the most up to date and best practice clinical methods being used. For example, continuing to carry our surgical procedures that are no longer proven to be effective is not productive.

Process productivity is the most familiar aspect of efficiency chasing in healthcare. Largely based on the principles of Lean (or reduced and less focused use of Lean) it is helpful but not enough to meet the healthcare challenges for the next 2 - 5 years.

Productivity 2: Reduced variation is not enough

This is the second in a series of productivity notes. Reducing variation is only part of the productivity process.

Reorganising processes so they are precise and prediction is helpful but not enough. In the diagram, the red dots are hitting the target in a predictable way. However, while they may be precise, they are not accurate. The green dots, with less precision, are more accurately placed around the bulls eye.

What I learn from this is the need to

• know the definition and position of the bullseye (what is the purpose of the process being improved)
• measure for accuracy as well as measuring variation
• fix accuracy first, then go for reduced variation

Productivity 1: Operational Efficiencies are not enough

This is a the first in a series of Productivity notes from Sarah Fraser.  Are your productivity projects innovative enough?

Organisations, like the NHS, will need to do more than streamline some processes as part of their cost saving initiatives. Many projects underway are badged as productivity improvement yet mostly they are about basic good management. For example, reducing DNAs (Did Not Attends), improving the Discharge Process, holding less meetings, carrying less stock etc. These are important and help to provide a good base form which to develop more innovative approaches, however, I am concerned few organisations considering gains in productivity through redesign and reconception of processes.

Many managers may feel like they are standing in the equivalent of the Victorian cotton mill with a clipboard in one hand and a stop watch in the other. Yes, it is possible to gain more efficiency from a process. I argue, however, that the leaps in efficiency come from reconceptualising what is being delivered. For example, in many countries for at least a decade, group appointments are available for patients with long term conditions. This is one small example of how rethinking a process can create both an efficiency and an improved patient experience.

Gartner's Hype Cycle is more useful than the Rogers' Diffusion of Innovation Curve

The classic Diffusion of Innovation curve was created by Everett Rogers back in the 60's, before many improvement facilitators were born.The terms, early adopter, majority, laggard etc have survived because they provide an explanation for something that is often difficult to fathom - how different groups of people respond differently to the same innovation. I have written at length (see previous posts and books) about the limitations of this theory and it inability to predict or provide guidance about what to do next.

Gartner introduced a theory in 1995 designed to explain what happens when a product or innovation is hyped, and then goes through various stages to acceptance. I like this theory because it steps away from the position of blaming people for not doing something and focuses more on the intrinsic value of the innovation or product.

Image from Wikipedia: Hype Cycle

The Trigger is the first breakthrough event that starts the interest in the product/innovation. This is followed by the peak of inflated expectations where the optimism for application outweighs the difficulties. The focus is on the possibility of the product/innovation. The trough of disillusionment comes when the failures start stacking up, expectations are not met, or something new comes along and this idea is no longer fashionable.  The slope of enlightenment may turn up years later when the original idea is tweaked and adapted and made more applicable. The plateau of productivity is reached when the product/innovation becomes mainstream due to its stability and usefulness.

Obviously, this curve will have different shapes for different products. Here are a couple of exercises:

1. Take one product/innovation which you believe to be at the Plateau of Productivity, and track back, seeing how the curve shapes with regards time and visibility (visibility = talked about, in the press, on agendas etc)
2. Map your current products, innovations and ideas on the cycle and see what you learn. Are they grouped in one area? What might you need to do to manage the transition to the next phase?

Let me know how you do by filling in the comments section below.

Scheming Virtuously; A Handbook for Public Servants

Nick Charney (Canada) has written a brief e-guide on how to get things done in the Public Sector, perhaps innovatively, whilst keeping our sanity, job and relationships.

Highly commended and you can download Scheming Virtuously; A Handbook for Public Servants as a pdf from the davepress blog (which is worth subscribing to davepress.net).

4 resources why PowerPoint is not a good format for influencing others

PowerPoint has its place. As a method of influence it is limited, however, it has become pervasive in corporate life to the extent it is used beyond its purpose.

1. Life after death by PowerPoint 2010
This video by Comedian Don Mcquillan says it all.


2. Do my slides suck? test
This "Stop your presentation before it kills again" blogpost provides a compelling arguement to ditch your slides, or at least do some self analysis to discover the reason why you are using PowerPoint.

3. 11 ways to images poorly in slides
This blogpost covers 11 ways in how using images in PowerPoint can detract from your message. It is a compelling argument to beware the selftrained designer...

4. Dodging bullets in presentations
An excellent slideset which not only highlights the problems with using bullet points but also shows how to move to something better and more effective

Oh dear, I see I wrote this blog in bullet points. Deary me.

When stories and Powerpoint clash

A mantra I keep hearing is "we need to tell stories to influence change." I agree with this, however, I do have a few provisio's

• if the story has no relevance to your message then why are you telling it?
• if you provide a personal story to illustrate your values then please make sure it connects with the audience at the time (please update and avoid repeating)
• when you use PowerPoint to tell your story there seems to be a dissonance - the method is not matching the intent

As a method of influence, especially for large scale change, stories work well because they contain the emotive meme that a PowerPoint presentation usually lacks.  So let's use stories, but let's use them advisedly and with care.

7 Resources about Social Enterprise

With the decimation of the quangos in the NHS in England there will no doubt be a rush to create a variety of social enterprises to fill the gaps and maintain employment. I have been on a mission to try and understand a bit more about social enterprises and here are a number of links and resources that I found useful.

1. Social Enterprise Coalition (UK) is a good place to start. It is fairly comprehensive and I learnt a lot about what is going on, right now, with regards social enterprise. There is a Health & Social Care forum.
2. If your interest in Social Enterprise is beyond the shores of the UK then Wikipedia has an overview of what it means in different countries.
3. Business Link (UK) has the how to steps if you want to set up a Social Enterprise in the UK
4. Social Enterprise Live is a useful magazine, giving news, resources, blogs and comments on the topic. There is a recent post on how the organisational from will suit the NHS.
5. The Department of Health has a fairly comprehensive guide on social enterprises and health
6. If you are up and running as a Social Enterprise and need support and resources then an excellent place to start is with Social Enterprise Works.
7. The most inspiring, for me, website on Social Enterprise is SE London. Lots of resources, videos and success stories.

Overcoming resistance to change - isn't it obvious

How to overcome resistance to change is one of the most common questions I am asked. The dominant mindset I encounter is that the person who does not want to change (aka doesn't want to do what they are told to do) is resistant and therefore wrong.  There is as many answers to this issue as there are management consultants. An interesting approach is the animated video with a script by Eliyahu Goldratt of "The Goal" fame. Despite the video being largely a promotion for his new book, it does have some useful content and ideas.

Different types of practice; good, best, novel, emergent

The definition of good practice has always been contested and maybe the use of the phrase "spread good practice" is part of the problem as to why adoption of existing practice is so difficult.  The Synefin model provides us with four categories of practice:

1. Best Practice (simple systems where the idea is obvious to all and obvious to adopt)
2. Good Practice (complicated systems where the relationship between cause and effect is less obvious, some investigation is needed and usually adaptation in order to solve the problem
3. Emergent practice (this occurs in complex systems where you only figure out in hindsight how something happened, how the results occurred - and this analysis is not necessarily predictive.
4. Novel Practice from chaordic systems where there is no relationship between cause and effect

If the goal of a large scale program is to spread the use of methods or techniques that deliver improvement then I think it is important to be able to diagnose what type of practice is being touted. Often novel or emergent practices are praised as the solutions to problems, putting the pressure on other individuals, teams and organisations to do something similar - and when they don't they are castigated for not trying.

The devil in the diagnosis of type of practice. Do you have any examples of the different types of practice?

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New Tools Wiki - a stunning set of resources

The newtools workshop wiki is the most amazing set of resources I have come across for months - and those of you who know me well know that I don't use "most amazing" very often. I'm at a loss for words on how to describe it so you need to go and have a look for yourself.

Be prepared to spend some time exploring it...

How to implement 7-30-90 Day projects

“Being busy does not always mean real work. The object of all work is production or accomplishment and to either of these ends there must be forethought, system, planning, intelligence, and honest purpose, as well as perspiration. Seeming to do is not doing. “ - Thomas A. Edison

The purpose of this blog is to set out some ideas on the how of a 90-day improvement project within the context of healthcare. This project process is evolving so please add comments to this post so everyone can learn from your experience.

Principles:

• Having more time doesn’t mean getting more done
• Manage the tasks not the time
• Deliver incremental value
• Deliver results within a defined timeframe
• Honour the concept of organisational learning and continuous improvement
• Discover a rhythm of change and implementation that balances risk with results
• Use these ideas as ingredients and make your own recipe
• Ensure a focused, targeted and committed action process

      “Absorb what is useful, reject what is useless, add what is specifically your own.“ –Bruce Lee

There are a variety of approaches. The choice of your approach will depend on your strategic aim, the timing that best suits you as well as the nature of your improvement process.

STEP 1: Create your format based on your timescale

“Once you have mastered time, you will understand how true it is that most people overestimate what they can accomplish in a year - and underestimate what they can achieve in a decade!” - Tony Robbins

It is possible to deliver changes in 3 days (see Kaizen methods for further information). 

Consider your desired results, the amount of people who need to be involved in the process, the team and organisational culture as well as the nature of the problem to be solved / the solution to be implemented.  With this in mind, look at the options below and see which most closely matches your needs.  Where possible make your task

 smaller and the timing shorter.

All of the timescales contain a basic strategic rhythm of

a) diagnostic steps

b) implementation focus

c) review and next steps

 It is possible to design a 90 project so the phases are sequential, or it can be built up from a series of smaller 30 day cycles.  The choice depends on your strategy for change:

“Hell, there are no rules here - we’re trying to accomplish something.” - Thomas A. Edison

Why 90 days?

• Scope is more complex though is manageable within the timescale
• Sufficient interdependencies that will need to be followed through with conversation and negotiation
• Good if have high energy people working on the project who can also maintain their focus

Why 30 days?

• May be easier to commit to than 90 days or 18 months
• Deal with the now; plans remain relevant
• Long enough to see an improvement (or not, so can then change the strategy)
• Scope is such that one individual or a small team can make the changes with no further resource to committees or individuals for permissions

Why 1 week?

• Good for those who are too time / task pressured to commit to improvement
• Able to test an improvement-through-learning process
• If used as part of a longer project the 1 week cycle can provide a mechanism for involvement (different people different weeks)
• Good for working with those with a low energy

	Diagnostic	Implementation	Review
12 week (90 day)	4 weeks	6 weeks	2 weeks
8 week (60 day)	2 weeks	5 weeks	1 week
4 week (30 day)	1 week	2 weeks	1 week
1 week (5 day)	1 day	3 days	1 day

A diagnostic phase includes, to varying degrees, some of the following (remembering that diagnosis is part of the change process as individuals discuss and assess their own situation):

R  What is the current situation, including baseline measures; this needs to be localised to the context of those making the changes. Process and value mapping, relationship mapping and other techniques are useful here.

R  Creating ideas for change and improvement; being creative rather than just implementing known tasks (otherwise we end up with low energy projects)

R  Understanding any interdependencies and carrying out appropriate negotiation

R  Planning, designing, getting in the resources that may be need (like equipment) etc.

An implementation phase includes, to varying degrees, some of the following

R  Action, with measureable results

R  Learning, from personal and team reviews

“Words may show a man’s wit but actions his meaning.” - Benjamin Franklin

A review phase includes, to varying degrees, some of the following

R  Working out what is going well, and why

R  Figuring our and being honest about the problems, and then working through some ideas to resolve these

R  Capturing personal learning as well as team and organisational learning, specifically noting those things you would like to do / feel more of

A project of any length can be constructed from a weekly pattern of activities.

“If we did all the things we are capable of, we would literally astound ourselves. “ - Thomas A. Edison