Friday, 16 November 2012

Will Improvement be the new Nokia? An open letter to NHS Improvement Leaders

An Open Letter for NHS Improvement Leaders

Look around you - how many people are using a Nokia phone?

My first mobile phone, in the 1990's, was a Nokia. I wish I'd kept it as it sells on eBay now for more than it cost at the time. However, it's now perceived as an art form, not as a workable option for making phone calls.The demands on mobile technology have also moved on - I use my smartphone less for making calls and more for reading email and playing Bejewelled.

What happened is the context changed. The markets developed, the customers upped their expectations. Nokia, very successful in the early days of mobile technology got comfortable with their success. They became blind to the shifts and the need to dump their favourite (and no doubt hotly promoted in-house) technologies.

The basic concepts of mobile technology has not changed much - but the products have changed significantly.

The basic concepts of what we understand as quality improvement have not changed much since the days of Deming - what hasn't developed much are the products to implement change. TQM has been rebadged, with minor modifications into Lean, which has been rebadged, again with minor mods into a variety of corporate improvement programs. And so on.

Now, I'm not suggesting we throw out all the good things we know about improvement (I can't bring myself to call it improvement science" - it isn't a science.)  We can keep the basic concepts. However, I do feel strongly that retaining "legacy products and programs" is lazy. If you feel the need to say "we need to retain what works" then think through how that sounds to NHS staff - and what it reminds you of.*

Every improvement product designed in and for the NHS has been a consequence of the context within which it was designed, then implemented. The NHS is making enormous changes  both structurally, conceptually and clinically.  Retaining "legacies" doesn't feel like support to this new context.

Be brave, NHS Improvers. Match the pace and scale of the changes in the NHS around you. Let go of your outdated models, methods, tools and products, in just the same way as thousands of NHS staff are having to do on a daily basis for the practises they believe are useful and good.. Design for the future.  Practise what you preach and get innovative - from within.  And I mean truly innovative. I don't mean coming up with an edited version an existing product, or a new framework for something. Instead, create the breakthrough applications that not only fit in the current context, but reset the whole discipline of "improvement" in healthcare. The NHS has an enormous amount of improvement experience and brainpower - use this to good effect.

Nokia missed the boat. It's trying to turn around, but playing catch up in a fast developing market is far more difficult than leading the market by designing the market - think Apple.

In April 2013 the NHS boat will sail. New structures will be in place, along with new demands that will change the face of the NHS for both staff and patients.  My hope is for "improvement" to be on the same boat, and not one of the tugs pulling in the opposite direction.

Note: * Improvers often talk about wanting others to adopt new practises and when these people don't want to, they're labelled as "resistant to change". I'm just saying...

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