Hospitals as prisons

To compare a hospital to a prison is challenging. Maj Rom, leader in Sweden for the project to improve the experience of life for the Elderly, used this comparison to wake us up, to make us think, to challenge our perceptions.

I found this a shattering concept, but the more I considered it, the more I realised we can learn from the challenge. Where else, toher than in a hospital and a prison do we:
• Have rules regarding who may enter, who may visit and the times of this visit (and even what they may bring in with them)
• Segregation for those with problems (like infections)
• Rows of beds, organised like cells, with a co-ordinating point for the “guards”
• A hierarchy that determines behaviour and where the inmate/patient is the recipient and often seen as the lowest of the low – to be done to be organised, to have rules explained
I could go on, but you know how the list continues. You may even discover that some of the aspects of prison are better than hospital – privacy, own TV, better food etc.) Try it out at your next meeting.  Or better still, walk around your nearest hospital with the eyes of an alien comparing it with a prison.

The challenge is not to make the comparisons, but to figure but what this means to us.  It’s not about criticising hospitals but it is about engaging with what we have created and finding the strength to change what we don’t like.

Spread and implementation; making practices real

At a recent awayday for a team in Sweden who are working to improve the experience of life for  the elderly, I had the fortune to listen to and work with Bodil Jonsson. I was thinking out loud and expressing my concern that the use of the word “spread” may allow people using it to disengage with the reality of what is involved. There is an ease by which leaders say “spread”, and then disengage themselves from the detail of what it means. So insteadI tend to use “implementation” as this word, to me, has a more active feel, and directs the users to consider what might be involved.

Bodil suggested the Swedish word “forverkliga” (please imagine the two dots on the o). This means to make real”. This was a light bulb moment for me. Think about guidelines; is the issue to spread them, to implement them – or to make them real. I like forverkliga because reality is made in one’s own context, thus enabling adaption, without further explanation And making real is far more than the objective task of copying another’s good idea. Instead it is the process of taking another’s idea and focusing on the added value to, say, the patient; unless something is made real, there is no value.

In my mind’s eye I say websites full of stories and examples, of guidelines and exhortations – and at once, saw useful information, that was of no value unless “made real”.

Forverkliga.

Rain, risk and redesign

It’s come as a shock to me to discover that teenage cousins in California have a “rain schedule” at school. Basically when it rains, children are kept indoors in their classrooms.  If this were the case in England our children would probably never see daylight!  Rain is seen as bad, something to be avoided – wrong even. Apart from my concern that they are disconnected from the realities and needs of life on earth, I was provoked into thinking about risk and perception.

One of the reasons for the corralling indoors is to reduce the risk of colds and flu (though this is a fallacious one), that they don’t have the clothes for wet weather (really?) and they might slip and injure themselves. We have the health and safety elves in England too, so overly risk averse behaviour is one we know well. However, all learning involves some risk.

In healthcare, I wonder what we are perceiving as so risky that we reduce the ability for anyone to learn. Health services are by their nature risky and much of the safety discipline is about reuing that risk. But is there something else we’re doing that we don’t recognise as limiting learning?

The only thing I can think of at the moment is the way we redesign (improve, change) services. The predominance of the Improvement Model and the attending PDSA cycles are a way in which we reduce risk, and I think, may actually reduce learning rather than enhance it.  I’m open to other thoughts and perceptions about this – please leave a comment on this blog if you feel differently.

Social Friction; the essence of innovation

There are as many theories of creativity and innovation as there are consultants – I suspect! Most of these have at their core, the concept of the “spark”, the moment when the new idea pops up.  There are theories as to how this happen. For some people this appears to happen when they are working on their own and get   new insight – for others it is the product of analysis, debate and reflection.

A spark is the product of friction. This friction can be internal or external. Not everyone can abide internal friction; to be able to hold contrasting thoughts at the same time, to read away from one’s own perceived knowledge and to ask oneself the disconfirming question. For many, it is easier to work in a group and encourage the challenges and questions that lead to new knowledge. But the value of this group work is in relation to the group’s ability to handle critical debate and questioning.

What saddens me most is when groups avoid this friction. They end up with interesting new ideas, but the potential of their knowledge and experience coming together to discover breakthrough concepts is diminished. This is a waste of capacity. The long term cost of this lost opportunity is significant.

When you next work in a group whose remit is to develop new ideas or to innovate, then consider how you manage social friction. Does the group seek out the disconfirming questions? Is the “solution” grasped too quickly?  Look around you – is all that experience and knowledge truly being employed in the creation of something that adds value.

Use-worthiness

The pleasure and advantage of working in different cultures, with unfamiliar languages and with bright and thoughtful people, is the discovery of new perceptions.  I was reviewing a systems model developed with Ken Thompson with a team in Sweden. We were considering how to “package” it in a way that made sense to those who might use it.

Bodil Jonsson provided the term “use-worthiness”. No, this isn’t an English term (and I think there isn’t an easy Swedish translation either) but I know exactly what it means. This one term covers the remit of technical usability as well as the value to the user. I like the way it conjures up the notion of return on investment (ROI); that something is worth using.

“Use-worthiness” – what does it mean to you?

How do we tell our Emperors and Empresses that we know they are naked?

Image from: www.emperorerswithoutclothes.com

The fable about the Emperor who had no clothes is well known. He believed he was wearing sumptuous velvet adorned with jewels, but in truth he was naked. His minions played along with him, "dressing" him every day and complimenting him on his attire.  Then one day, someone decided to tell the truth...      

How to diagnose whether you are an emperor or empress

1. Do you have strong beliefs about something?  What people or processes do you have in place to ensure you are not believing your own beliefs? For example, a mentor or critical friend who has the strength to point out when you are dashing about naked.
2. Do you have "minions" around you who are constantly agreeing with you, forwarding your tweets, nodding their heads in meetings and running about in the shadow behind you.  Can you remember the last time someone really disagreed with your point of view? Does it happen often? Do you ever disagree and have a constructive debate with someone?
3. Do you talk about your "clothes", are you constantly changing them, adding jewels etc.  The endless focus on the clothes, and the changing thereof, can make it difficult for "minions" to comment.
4. Do you marginalise the person who disagrees with you. This may happen without any conscious thought. You could be picking up a signal and then ignoring them out of fear they may point out what you already know.

A number of CEO's have mentioned to me that one of their greatest fears on appointment to their role, is that staff no longer tell them the truth about what it happening and instead tell them what they think they want to know. They then set up ways to counter this problem.

If you are an improvement leader in healthcare  do you have a way to check the extent to which your clothes belong to an emperor or empress?