Organisations as thought leaders; some healthcare examples

Thought leadership is not just about individuals. For many organisations, their mission is to be the thought leader in their sector.  I’ve listed below the healthcare related organisations that I believe to be thought leaders.

·     The Health Foundation  in London practices a pragmatic and sensible thought leadership. They base their knowledge around programs of work, linked the more academic reviews. They share knowledge very well and a great example is their work on Self Managements where all the materials can be accessed, free of charge, including train the trainer packs.  They take on new ideas and put them to work in programs. They are prepared to take risks and their work is subject to evaluation – which is also shared.  They are a charity so have no need to sell – and this shows.

·     The Kings Fund, London,  is a traditional thought leader for healthcare. They’ve moved into blogs and videos, and other social media platforms such as Twitter, Facebook and LinkedIn, as a means to share their news and views – and to help others connect. They are best loved for the discussions they hold. These are tough questions with a wide range of people taking part. They empower thought leadership in others, which is very magnanimous of them.

·     The Nuffield Trust is another UK based organisation which is a thought leader, in a fairly tightly packed thought leadership arena. They are probably best known for their sharp and necessary evaluations and reviews of policies and programs. They are trusted because they are independent and not in anyone’s funding pocket. They do blogs, publications, videos and some excellent charts.

·    The Institute for Healthcare Improvement  in Boston.  This is a well-known organisation for its work in developing strategies for improvement and in bringing together groups of interested people to share. Like any organisation, they have something to sell. However, they are quick to share new ideas in white papers and make many of their materials available to anyone, free of charge. (excepting their conferences which are notoriously expensive).

i    The other articles in this series are:

1. What or who is a thought leader
2. Being a thought leader

How can patients use social media? 7 thought provoking references

There's a buzz at The 24th National Forum run by the Institute for Healthcare Improvement; and it's not just because the weather is warm in Florida and thousands of gallons of coffee is being consumed.  It's taken a while (I did the first social media presentation there about 5 years ago) but social media is hit the top of the agenda.

One of the questions being discussed is how patients and their families are using social media.
I've done a run round the Internet and collated some references to help this discussion. There are some condition specific references, most notably diabetes - however, I'e stuck with the more generic links.

• 4 ways social media can improve your medical practice AMEDNews; useful tips with some examples
• Using Twitter for e-patient communication  A comprehensive PDF guide
•  NHS reaction to online patient feedback is changing Guardian Newspaper article 2011
• Patient satisfaction in the age of social media  Excellent blogpost by MD suggesting some disruption necessary
• Can Twitter be used for doctor-patient communication from same blog as above
• Unleashing the Power of Social Media for Patient Experience  Has some useful links to examples
• How the NHS uses Twitter  Guardian Newspaper 2011 

Self Management Support Tools and Resources

Hoorah! We're finally moving from what often feels the patronising approach of "empowering patients" to finding ways to truly be partners in their care process.  There are multiple projects and programs round the world which demonstrate what can be done.  I've put together a list of resources which you may find useful.

1. My favourite are from The Health Foundation. Their package is comprehensive and includes materials for training staff so is excellent for getting the message out there in a practical way. They've also got resources for improving patient skills.

2. The Institute for Improvement has a short guide which is useful if you want to check what you may need to do to get some benefits.

3. There's an excellent write up about the long term conditions collaborative in Scotland where they identify the top high impact changes you can make.

4. Selfmanagement,.co.uk also has resources and it's one of the few places I've seen where there's information on relevant published literature.  In fact, the more I look at this website, the more I feel it is perhaps the most comprehensive and useful...

Do you have any favourite self management support resource links you'd like to share? Please comment below and I'll add to this blog.

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

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.

Learning networks or social movements? Which is best for large scale change?

I'm not sure there is a specific answer as to whether learning networks or social movements are best for large scale change.  However, my personal preference is for learning networks and these are my reasons:

1. learning networks connect the people who are interested in solving the problem, and they do so in an interactive, participative and empowered way. In comparison social movements have the image of someone wanting to make something happen and in manipulating the joining in process and to an agenda they have set.
2. learning networks are about the exchange of information, discussion and both personal and group learning. Personal behaviour may change as a result of learning about something new from within a peer group. When a group discovers new knowledge and feel the creative process of doing so, they may become quite committed to then implementing changes.
3. learning networks can be direct and specific. They can be topic based or professional grouping based.
4. there is a sense of an output with learning networks. Social movements are useful in that they are purpose driven, however, learning networks to me are more concrete, pragmatic and easier to associate with outcomes and results.
5. we know learning networks work in healthcare while social movement theory is in its infancy. I am a proponent of using the existing knowledge we have to best effect.

This doesn't mean social movements are not useful, rather that I am sceptical about their ability to deliver results, especially when we know learning network can have an impact.

There is an excellent paper on Learning networks for sustainable, large scale change which is worth a read. 

Options for large scale spread; excellent new report by WHO, IHI, Harvard

A new report about large scale change and spread of simple, high impact interventions is available now. And it is a really good summary of methods old and new. I highly recommend it for anyone planning simple large scale spread, especially if you think you know the answers. This report summarises a variety of methods and is very pragmatic in it's use of examples.

The World Health Organization Patient Safety Programme and the Harvard School of Public Health commissioned the United States Agency for International Development’s Health Care Improvement Project (HCI), managed by University Research Co., LLC (URC), to present its understanding of and experience with the effective adoption of simple, high-impact interventions, such as the Surgical Safety Checklist. URC is joined in this effort by the Institute for Healthcare Improvement, which also has decades of experience in this field.

Readers should note this report and advice covers the spread of simple, high impact changes - namely it does not cover complex, system related changes.

The report covers:

III. Spreading Evidence-based Interventions
IV. The Scientific Basis for Spread
A. Framework for Spread
B. Individual Adoption and Behavior Change
C. Positive Deviance
D. Factors that Influence the Rate of Spread
E. Understanding the Social System
F. Integrating Content into Process Design
G. Testing and Implementing Change
H. Executing for System-level Results
V. Approaches for Large-scale Spread
A. Natural Diffusion Approach
B. Executive Mandates
C. Extension Agents Approach
D. Emergency Mobilization Approach
E. Affinity Group Approach
F. Collaborative Approach
G. Virtual Collaborative
H. Wave Sequence Approach
I. Campaign Approach
J. Hybrid Approaches
K. Lessons Learned from Large-scale Spread
VI. Which Approach Should Be Used to Disseminate Checklists?

(And thank you to the authors of the report for referencing my book on how good practice doesn't spread)

Resources to understand tragedy of the commons

At the Institute for Healthcare Improvement's National Forum today, Don Berwick used the example of 2tragedy of the commons" in his Opening Plenary. His pitch was to encourage healthcare leaders to cooperate and work for the wider and more common good and to beware of continuing to work on a self-centred and healthcare industry basis.

For those interested in the concept of "tragedy of the commons" I have put some links in here where you can get more information.

The original article by Garrett Hardin in 1968 which introduced the concept can be found here.

A special issue of Science magazine provides not only all the critical papers you need to read but also links to excellent web resources. You can find this here:

Some games you can play to simulate and understand what is meant by ToC (though anyone trying to get onto the conference wifi will know just what it feels like!). You can access these here:

One of my favourite bloggers covered ToC a while back. You can read his post and associated comments here:

I've been a fan of Systems Thinking for years. There are loads of tools and techniques to understand how ToC occurs and how to work with it. I'm looking forward to healthcare improvers adding systems thinking techniques into the regular and perhaps rather technical improvement techniques. You can learn about ToC using causal loop diagrams here, and discover resources at Pegasuscom.

Any more - please add in the comments below.

Presentations to watch; 2009 Quality & Safety in Healthcare - Berlin

Part of sharing good practice and enabling others is about just that - sharing. I was unable to attend the International Forum on Quality & Safety in Healthcare, run by the IHI and the BMJ, held in Berlin in March 2009. However, I can watch the plenaries and check out the posters. I can also contribute to ongoing discussion. It is really good to see what used to be "closed" and only for those who could afford to attend, is now more available and creative in the ways messages can be sent out and conversations continued.

Plenaries: http://www.axisto.com/webcasting/bmj/berlin-2009/
Plenary 1 — What patient-centered care really means
Plenary 2 — Medical success leads to medical error: how health professionals accept responsibility for safety
Plenary 3 — Transforming whole systems: in search of theory and method

For all poster details and other resources: http://internationalforum.bmj.com/multimedia/multimedia-resources

To discuss the plenaries and posters: http://doc2doc.bmj.com/forums.html?slPage=overview&slGroupKey=f1ee0d38-22c5-450d-9f33-40bf110975f7

Surgical Safety Checklist Sprint 10th March 2009

The IHI www.ihi.org are leading a "sprint" to have every hospital in the USA test the World Health Organization (WHO) Surgical Safety Checklist at least one time with one operating room team. Sprint Day is 10th March 2009. The version in England is more marathon-like with a target set for February 2010 for all hospitals and teams to be using the checklist. So, we have two different approaches to getting this life-saving tool implemented.

If I had to place a bet as to the effectiveness of each strategy I would go for the sprint. Yes, the aim here is only for one team in each hospital to test it out. This strategy is going for coverage by having every hospital participate. The marathon version is going for both coverage as well as completeness - wanting every team to be using it. I expect the Sprint version will migrate into a marathon so completeness is developed in each of the hospitals that tested the checklist.

I'm placing my bet on the Sprint because I would rather the checklist got tested soon. If a team finds it helps and is not too onerous then they'll gossip about it in the surgeon's coffee lounge. To me that is preferable to planning sessions and meetings about how to implement marathon-style. Better to get on and test it.

As a patient, there is no choice - the sooner the better.

The IHI has all the tools you need to get started http://www.ihi.org/IHI/Programs/ImprovementMap/WHOSurgicalSafetyChecklistSprint.htm. So what are you doing? Sprinting, doing a short jog or planning for a marathon?