New systems model to simulate spread and adoption of good practice

I've worked with Ken Thompson of Bioteams to develop a systems simulation of the spread and adoption of good practice.  Our aim has been to provide a method for individuals and teams to play about with different strategies and to model the impacts of those strategies. It's not a prediction tool, but rather one which helps you gain an insight into the complexities  It's been important to us to produce a simulation which provides an adoption curve - having an idea of the speed (or not) of spread is crucial to your planning.

The simulation is ready for testing. It's not perfect, and we'd love to demo it and take your feedback on how to make it even better. Feel free to tweet Sarah @sarahfraser or Ken @kenthompson, leave a reply to this blog, or email Sarah, if you'd like to have a go.

A screenshot of the main screen is below. You can choose your strategies and then simulate, quarter by quarter, the rate of adoption. There are other input screens where you can assess your readiness for change and where you can enter details about the strategies you'd like to use.

On being productive

I thought I'd start 2013 reading around the topic of productivity at work.  I was looking for new ideas and testing my own assumptions. After a fair amount of reading, this is where I ended up.




General principles

• Productivity means different things to different people
• Learning styles matter; so there's no point in promoting one method as the best - it needs to fit the style of the person, and their workplace. People who shout about a specific system are those who discovered something so perfect that works for them - this doesn't mean it will work for everyone else
• A home office and freelance lifestyle is not the same as a 9-5 office job

What I do already, that works for me, that I will continue

• When I am with a client I do only that client's business; I stay present (and this means being organised, not doing email etc)
• Don't do work email after 5pm on a Friday and before 7am on a Monday. I've learnt that even if I've been away for a week, I can get through it all in a couple of hours on Monday morning
• Don't accept paid work on a Monday. This means I don't travel on a Sunday (which is important to me). It also means I have Monday to get sorted, do admin, meet my Mum for lunch, go to the Post Office, read a book, research papers etc.
• When I'm in my home office I try to do one task before turning on the computer (filing, reading a paper, tidying up), then one task before opening my email (designing an agenda, writing ppt or paper).
• Use lists. I have a "lab book" which usually has all my lists in it but I have been using the Allen Getitdone app which syncs my lists across PC, iPad, smartphone. I'm not entirely certain I like it but will keep trying it for another 3 months. I do like the way you can send emails to it, then schedule working with them.
• Work with my energy. I'm a morning person. I know I do very little between 11:30 and 2:30 pm so I don't bother any more. I go for a walk or lie on the sofa and read a book.
• I don't try to work while I travel. The results are never good. So I sleep, relax and read. This does mean I need to put preparation time into my diary. I've always felt that preparing while travelling is not giving the work my proper attention.
• Finally, my favourite productivity technique is the Pomodoro method. You work (set timer) for 25 mins, then take a 5 minute break - and repeat. Do one thing in the 25mins (like this blog post). After a few repeats, take a 15 minute break.  I divide my productive time into these 25 minute blocks. And have 3 of them during the day for doign my email.  You can download a Chrome Pomodoro extension to be the timekeeper.

What new ideas I got from my reading

• not so much new as a reminder - exercise is good for me. So I shall put in the diary.
• turn off the Twitter alerts!!

Consistency of leadership matters

No matter what "evidence" you seek, leadership is always in the top ten of factors necessary for change and transformation of systems of care - or any system for that matter. There are books, papers and reviews all trying to qualify the type of leadership that works well.

I've been asking myself whether length of time in a leadership role makes a difference. When I look about me at the organisations who are held up as role models for good organisational processes, good collaborative working and good results - most often the leadership team has been in place for many years. Not just one leader, but at least 2 or 3 of the team.

Perhaps it important just to be there to hold the history and to maintain some form of continuity. Doing this while everything changes around you means the good leaders are naturally those who learn to adapt themselves  and their organisation, to the changing context.  I suspect they don't have great charismatic abilities, not do they espouse clever theories - they just get on with the job - year by year.

I applaud that level of commitment.

What happens when your quality improvement project is too long

Quality improvement projects have traditionally been 18 months long - at least that's my experience in the healthcare in the NHS in England. I expect they are that length of time because it is about the right length of time to second someone into the role of project leader. After 15 years of experience, I believe this is far too long for a QI project.




The problems with 18 month projects

• they take 18 months... 
• over-work the process; carry out redundant tasks to fill the time (every project leader wants to look good)
• too much emphasis on innovation and clever solutions, that are difficult for others to adopt
• difficult to maintain focus over so many months
• many clinical staff are unwilling to commit to the project
• the context changes  reforms, new organisations, new care methods - all come into play during the period of the project

Instead, I advocate the 90 day project. This is enough time for the average team to implement the average type of changes; and average matters. Most teams can imagine 90 days and are more likely to commit to making the effort to improve a targeted area. They will know within 90 days whether their efforts were worth it. 90 day projects need lots of planning by the project leader, though this can be done with minimal intervention with the clinical team, leaving them to spend more time with patients. They are best done with known best practices that are known to work in a similar context.

For more info on 90 day projects from this blog:

1. What are 90 day projects
2. How to implement 90 day projects

Or hang in there for my new book on 90 day projects which will be out in January 2013.

Who does “Improvement”?

When I ask national and regional teams what their purpose is, they usually say something along the lines of “to deliver improvement in our health system”.  I’m not so sure about this. The people who deliver the actual improvement are those who make the changes. What advisors, consultants, internal change groups, OD departments etc. do is to enable and support others making the change. It’s perhaps a rather arrogant stance for those wearing an “improvement” badge to think they are making the improvement.

To be an improvement leader is to sit in the mist of humility, where your personal satisfaction comes from seeing others develop, from watching them stand on the stage and share their experiences, and from knowing that the success of others is sufficient to satisfy one’s own ego.

The improvement leader is a sherpa, whose role it is to support, and when the time comes, to applaud the team’s success, quietly, from the shadows.

A Mandate for NHS Improvers?

The new NHS Mandate sets out the standards the patients and their families should expect. It is both strategic and operational. It’s not perfect but what it does contain is specific and difficult to argue with. Yes, there will always be things it hasn’t covered, but in the end, it’s better to have something than nothing.

What might be a Mandate for people whose task it is to support he implementation of the Mandate, to work with CCGs in making local changes and whose role it is to help individuals and teams create the new NHS.  I’ve drafted a few thoughts on this mandate, please add your comments if you have additional items to add.

The NHS you support should expect interventions that:
1. deliver a good return on investment
2. take the minimum of staff time away from the patient
3. are directly connected to the CCG or provider business
4. are for the user of the intervention
5. focus on the NHS rather than other systems national or internationally
6. practice what they preach (QIPP especially)
7. others?