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.

Book Review: You can't order change: Lessons from Jim McNerney's Turnaround at Boeing - Peter Cohan

I was attracted to this book because the title said what I have always thought yet doesn't seem to be what I get involved with doing! I spend a lot of time on Boeings so I felt I had an interest in knowing what they doing and how they are doing it.

A while back Boeing was in a mess - stockprice was down, staff were complaining, revenue was not as anticipated, key people were leaving, lawsuits abounded and generally everything was on a downward trend.  Enter CEO Jim McNerney who gained a reputation of requiring results to speak for themselves rather than putting himself on a pedestal.

This book takes you through the CEO perspective and actions in turning around a self-destructing monolith. The view I got form the book was the importance of people stuff, relationships and leadership in times of trouble. Sounds obvious but in my experience I see organisations go down the route of more rules, process redesign and the like when the crunch hits.

Cohan interprets McNerney's approach as expressing what is required from leaders in the organisation, working with people so they jointly own these leadership attributes and encouraging communication at all levels. He also got rid of the people who didn't make the grade while investing in those who were growing into leadership roles with the right skills and capabilities. After people, the big message is the importance of the person who manages the finances. Then there is also the piece about customer involvement.

Written in summary here all this looks like the standard stuff of management and leadership texts. However, Cohan does explain all these actions in the context of Boeing. Still - to me, much of the diagnosis ended up a bit samey. Maybe that is more a reflection of my expectations - was I looking for something unique? Maybe the answer to large scale change in large organisations really is simple - the difficulty is in applying the tactics.

Overall - nothing new in here and maybe that is what is new.

Changing Minds by Howard Gardner

A book with the subtitle "The Art and Science of Changing our Own and Other Peoples' Minds" intrigued me. So much of the change process and scaling up better practice across larger systems involves helping others change their minds.  I've made a few notes from the book which I will post here in a series over the coming days.  I recommend you get hold of a copy and have a read for yourself.

Why do we forget good practice?

I spent a lovely English Spring day visiting the Roman Villa of Chedworth. I came away marvelled by the way in which they had underfloor heating and an hygienic toilet system fifteen hundred (and more) years ago. When the Romans left our small island, those who remained ignored / forgot about (not sure which) these and many other useful inventions.  Why did they do this?

And what other well evidenced business related techniques and products have we forgotten about and are ignoring?

Canadian Best Practices Portal - Healthcare

The Public Health Agency of Canada has a very interesting website: Canadian Best Practices Portal.  I think it is an excellent example of helping to spread good practice.

1. It describes interventions (best practices) without overly classifying them. The reader can make their own judgements of value and worth. I also like the way these are summarised as they are written for the reader and not as corporate sales pitches which is a temptation other organisations fall foul of. 
2. The resources have a great at-glance feature which show how they relate to define, search, appraise, synthesise, adapt, implement, evaluate.
3. Their list of systematic review sites is extensive and pitches these best practices as being based on evidence which is both appropriate and welcome for healthcare interventions.

Video: Christakis on Social Networks, Spread

Nicholas Christakis is my hero - his research is moving us on from the staid, static and way out of date work of Rogers (Diffusion of Innovations). I recommend spending 18 minutes to watch the video below if you're part of or planning any large scale change, social movement (not that I believe they can be planned), spread of project results.

The shift to norms being spread and not behaviours is significant. What are you doing in your own project work to build on this?

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?

(If you are reading this in an email or on your smartphone, to get automatic updates on this blog go to http://spreadgoodpractice.blogspot.com/ and click on the Subscribe Button)

Airlines & Healthcare; what can we learn

We consider airlines safe so in healthcare we adopt some (and only some) of the techniques they use to be safe - like checklists used by pilots and engineers. I say @some@ because we often forgot some of the more basic and fundamental safety aspects employed by arilines - the often more complex human resources, financial aspects, organisational learning, training etc.

Putting safety aside I read the report by the USA Bureau of Transportation on the statistics for 2009. In 2009 of the 19 airlines who reported they had an average on-time arrival performance of 79.5%. Hmmm. What I like about this figure is it represents the complexity of different airlines, operating in different ways, to different airports - and all affected in some way by the things out of their control, like the weather. This sounds to me like the healthcare system - in public sector systems anyway. So the airline travel system in 2009 was designed for 1 late arrival in every 5 flights. This makes me feel a lot better about the flow of patients around the National Health Service in England. A way higher percentage experiences experiences on time care. I also feel that the NHS is able to work well in a crisis like bad weather.

Ever lost your baggage? Well in the USA in 2009 3.91 bags were mishandled (isn't that a lovely term!) in every 1000 handled. This was an improvement from the 5.26 in 2008 - well done. As rates go these mishandlings are very few. Of course, if it is your bag lost, then the amount of year on year improvement and the overall rate is of no interest. A failure is a failure. This reminds me of the way most healthcare projects adopt goals that are less than perfect. For instance, 95% of patients to be treated xxx. What this tells me is that the improvement project team and the organisation are opting to design for a certain amount of failure. And I am not sure I am happy with this. Mistakes I can forgive. Designed in failure rate, often large ones, are to me a sign of lack of confidence in the people and processes. And as a patient I am less confident being treated there.

We have a great deal to learn about and adopt from other sectors as part of improving healthcare. What have you adopted from another industry and how has it worked for you?

Keeping track of progress; learning from DHL

It's a long story, but the short version ends with my handbag needing to be sent from Stockholm to Buckinghamshire in England. This experience has left me wondering why it is we find it so difficult to keep track of patients within a hospital, let alone across systems.

From time of pick-up to signature at home I could watch the 24-hour journey unfold (one click on a weblink, no data entry). I could see what action was being taken at each stage. If you're interested you can see the detailed information below (it's not the greenest of journeys...). It took only 2 minutes from the time of signature for the information to appear on the system.

Yes, patients are not parcels. Patient information also requires a certain degree of confidentiality management. However, I wonder what it would be like if within hospitals (let's start somewhere simple) we were able to keep track of the inpatient, figure out in which corridor they are now, how long they have been waiting for their scan, whether they have had their meal etc. This information will provide insight into the systems and the patient's experience. Maybe we could start by monitoring blood samples in this way as they are already bar coded. Maybe we could start with a system to help keep track of patients in the hospital for who speaking is difficult, such as those with dementia, stroke or some other disabling condition.

I wonder what else we can learn from DHL about how to monitor and improve pathways using technology?


585907200 - Detailed Report
Date Time Location Service Area Checkpoint Details
Oktober 18, 2009
11:59

Arlanda - Sweden Försändelse hämtad
Oktober 19, 2009
18:04

Arlanda - Sweden Processed at Arlanda - Sweden
Oktober 19, 2009
18:28

Arlanda - Sweden Skickad från Arlanda - Sweden
Oktober 19, 2009
18:49

Arlanda - Sweden Anlänt till DHL i Arlanda - Sweden
Oktober 19, 2009
19:48

Arlanda - Sweden Lämnat avsändare
Oktober 19, 2009
19:55

Arlanda - Sweden Processed at Arlanda - Sweden
Oktober 19, 2009
22:16

Arlanda - Sweden Skickad från Arlanda - Sweden
Oktober 20, 2009
00:15

Leipzig - Germany Anlänt till DHL i Leipzig - Germany
Oktober 20, 2009
00:46

Leipzig - Germany Processed at Leipzig - Germany
Oktober 20, 2009
03:27

Leipzig - Germany Skickad från Leipzig - Germany
Oktober 20, 2009
05:28

London-Heathrow - UK Skickad via London-Heathrow - UK
Oktober 20, 2009
05:37

London-Heathrow - UK Skickad från London-Heathrow - UK
Oktober 20, 2009
05:51

London-Heathrow - UK Anlänt till DHL i London-Heathrow - UK
Oktober 20, 2009
06:18

London-Heathrow - UK Processed at London-Heathrow - UK
Oktober 20, 2009
06:41

London-Heathrow - UK Skickad från London-Heathrow - UK
Oktober 20, 2009
07:33

Gatwick - UK Anlänt till DHL
Oktober 20, 2009
09:12

Gatwick - UK Ute för leverans med kurir
Oktober 20, 2009
10:39

Gatwick - UK Signatur

Knowledge Management on my iPhone/iTouch

A key aim in healthcare is to reduce variation. One of the methods to do this is to encourage the sharing and adopting of good practices.

• Problem 1: where is the good practice and who is doing what?
• Problem 2: how do I get to hear of good practices?
• Problem 3: how do I share what I am doing?

If data is information and knowledge is information we can use to make decisions, then how can data about good practices be shared.

A free application called "Healthmap: Outbreak near me" for the iPhone/iTouch has got me thinking. You can submit data about any disease and the location. This gets added to their database. You can see on a map any number of different diseases from Swine Flu through to African Horse Sickness. You can search by location, keyword or disease. If you allow it, the system can let you know what diseases are currently prevalent in your current location (using the GPS function).

So my please is for someone to develop the application for say, diabetes or cardiac care. I want to be able to find who (locally is great) is doing well on these healthcare processes and has something to share. Maybe even a version for patients where we can see the currently publicly available healthcare data on a map and in a searchable way. Also, we could add comments about services using the system.

The technology to do all this is here and available. As with so much I encounter in healthcare I suspect it may be another decade before we see something like this used.

Can someone prove me wrong please?

Blogging policies and blogging in healthcare

Over the last few months I have been meeting up with groups and organisations who want to dip their toe into the social media soup yet are concerned they have need a policy and/or are worried about what is /isn't kosher when it comes to blogging and twitter etc. I acknowledge the need to develop some guidelines that both enable the best of blogging yet manage corporate requirements.

This reminds me of the early days of email when some organisations felt email was very risky and clamped down on it with many rules and regulations. As time went on, the wisdom of the crowd took over and a "norm" was established. The book "Groundswell" - see my book review blog for a review if you're interested http://www.mybookblurb.blogspot.com/ - has a page http://blogs.forrester.com/groundswell/2004/11/blogging_policy.html listing Blogger Code of ethics which I like.

There are also some links in there to publically available corporate blogging policies, like Harvard University, Sun Microsystems.

The BBC has a simple page that makes sense to me as being sufficiently practical without being onerous http://www.bbc.co.uk/guidelines/editorialguidelines/advice/personalweb/blogging.shtml

Working in healthcare and think that blogging isn't relevant? Check out 100 Best Health Care Policy blogs and see what is on offer and the potential impact they are having http://www.rncentral.com/nursing-library/careplans/100_best_health_care_policy_blogs

Or if you need a more research based approach then have a look here http://blog.mathemagenic.com/2008/12/15/research-papers-on-business-blogging/

If email is your only means of electronic communication then maybe now is the time to test something new to add to your skill base.

Blogging best practice

Over the last few months I have been meeting up with groups and organisations who want to dip their toe into the social media soup yet are concerned they have need a policy and/or are worried about what is /isn't kosher when it comes to blogging and twitter etc.


I acknowledge the need to develop some guidelines that both enable the best of blogging yet manage corporate requirements. This reminds me of the early days of email when some organisations felt email was very risky and clamped down on it with many rules and regulations. As time went on, the wisdom of the crowd took over and a "norm" was established.

The book "Groundswell" - see my book review blog for a review if you're interested http://www.mybookblurb.blogspot.com/ - has a page http://blogs.forrester.com/groundswell/2004/11/blogging_policy.html listing Blogger Code of ethics which I like. There are also some links in there to publically available corporate blogging policies, like Harvard University, Sun Microsystems.


The BBC has a simple page that makes sense to me as being sufficiently practical without being onerous http://www.bbc.co.uk/guidelines/editorialguidelines/advice/personalweb/blogging.shtml



Working in healthcare and think that blogging isn't relevant? Check out 100 Best Health Care Policy blogs and see what is on offer and the potential impact they are having http://www.rncentral.com/nursing-library/careplans/100_best_health_care_policy_blogs

Or if you need a more research based approach then have a look here http://blog.mathemagenic.com/2008/12/15/research-papers-on-business-blogging/

If email is your only means of electronic communication then maybe now is the time to test something new to add to your skill base.

Blogging best practice policy checklists

Over the last few months I am meeting up with groups and organisations who want to dip their toe into the social media soup yet are concerned they have no policy or ground rules for staff to do this. Why do they want to blog - well, various groups and different answers. However, a continuing theme amongst all of them is in finding a way to reach out to others to share their experiences, news, views and opinions - often about products or services they are working with. They are seeking new ways to enable others to learn about and adopt their prodycts and services.

A good place to start when developing your own strategy is

a) avoid reinventing the wheel

b) use existing checklists and guidleines such as those provided by the blogcouncil http://blogcouncil.org/disclosure/

c) be brave and know the genie is already out of the bottle and know that success is in how much you let go rather than how much you control

Benefits are in the behaviour not the software

For every problem you have there are probably at least three technology solutions out there that can help you. Though is a technology solution always the right answer? Sometimes, yes. However, the first step might be to check out what you're using.

For example, many people I come across at the moment are looking for ways to keep track of their relationships with their customers and clients. So they are tempted to buy in complex customer relationship management (CRM) software. These additonal programs mean they need to record their transactions with each customer. Yet what they may not realise is that for many of them, a solution may already exist that meets their modest needs. If they use Microsoft Outlook then already every email is tracked by contact (check the Activities tab under the contact name) and if you set up your Journal preferences you can do a heap more. If you have the business contact manager add in then this has an almost full relationaship system and it integrates with much of what you use at your desktop - and does so without you doing any additional tasks. Whatever you use, what I have worked out is that if you end up having to do extra tasks, then you are unlikely to use it. So get something that integrates and works in the background. Not may software programs have that sort of ego.

Other software that causing angst is where we want to collaborate. Some use Sharepoint, other Windows Office Live, others Google groups etc. I personally prefer Windows Office Live as it integrates well and is less clunky than other programs. I can save directly from my desktop - no additional steps and it also comes with Shareview where we can share screens, all very quickly if we are on a telephone call and want to share and talk about a document together.

All the software comes with bells and whistles but they are irrelevant if they are not used. Think about your washing machine. How many of the fancy programs do you really use? In our house it is just the two. A quick wash and a regular wash. Heaven knows what all the other options are for.

If we're needing others to adopt the use of some technology as part of our better practice implementation then a good idea is to find ways to integrate it as much as possible into existing systems and to minimise the bells and whistles.

Creative Commons 2008 Sarah Fraser Attribution-Non-Commercial-No Derviative

How do we know that what gets spread is of value?

I thought I was being radical in my last book, "Undressing the elephant; why good practice doesn't spread in healthcare" (2007) www.undressingtheelephant.co.uk when I wrote about the problem of the idea bias. Of course Everett Rogers and others have researched the issue over many years. I tried to be a bit more in your face when I wrote my chapter, challenging how egos, organisational politics and indeed, governmental Politics all let to inappropriate and questoionably poor value practices being implemented.

I'm still worrying.

I came across an organisation where a team leader proudly shared that his teams "best" practice in a safety issue had spread "virally" to all wards round his hospital. So I asked him some questions. I leave you to imagine some of the conversation we had.

How do you know it was "best" practice?
If it was proven as best for you, how did others who adopted it, know it was best for them?
How will they continue to know it is the best practice?
If it is not the best practice for some wards, then what should they be doing?
How can you use the dynamics of how this spread, to spread what you would prefer to have spread?
What really matters - the spread of the practice, or the improvement of results?

We retired for top up of coffee and both agreed that there is something very scary about self-organising systems, though perhaps not quite as scary as when one person tries to impose their value laden idea on a system that opposes it.

(c) 2008, Sarah Fraser