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 Let go of your outdated models, methods, tools and products, in just the same way as thousands of NHS staff are having to do on a daily basis for the practises they believe are useful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...

Test, Learn, Adapt: Developing Public Policy with Randomised Controlled Trials

A good friend, Bill Russell, told me about a paper produced by the UK Cabinet Office calling for Randomised Controlled Trials for Public Policy. I was sceptical. When he told me Ben Goldacre (author of the excellent book, "Bad Science") was involved I was intrigued, and then wondered whether it was a spoof. But it isn't.

Hallelujah!

This paper is required reading. [update: new link] I commend it to you all and especially those I've been trying to convince for years that spreading improvements or innovations can have an ethical bias - how do you know it's a good and effective thing to spread?

And when you've read it - read it again. This has to be the best paper I've read for some years.

(I hope someone has passed it on to the Department of Health and the NHS Commissioning Board.)

Improvement Leaders - role modelling

Improvement leaders know a great deal of theory. One aspect of leading that I am constantly aware of, is the need to role model - practice what you preach. It's no good me pushes for the Lean 5S of a hospital ward if my own office is a complete mess. There's a dissonance here.

I recently attended a workshop at NHS Improvement in the UK. This is a smallish group who are dedicated to working with healthcare professionals to improve care. They are all very practical, work in clinically specific teams, and have good results from their projects. They don't get huge press coverage for their work, largely I think because they are humble - and too busy to do PR and marketing!  I joined the session at dinner and was inspired by the way they were holding a raffle to raise funds for a need close to their own values. Not only did they raise money, but there was a lot of fun in doing it.

I left the session the next day quite inspired - and know they will be inspiring others in their day to day work.

Web 2.0 not role modelled is inauthentic

Anyone or any organisation that flies the flag of change management and improvement always has the difficult task of acting what they say, namely being a role model for what they espouse.  It is difficult to get right all the time and I certainly don't.

One positive example I have experienced is the Institute for Healthcare Improvement who, a while back, took on the challenge of improving their invoicing and payment system on the basis they couldn't teach others to do it unless they (a) were a good role model and (b) learnt from their own experience.

The worst of management consultancy is when concepts and theories from books are copied onto PowerPoint slides and then used to train others. Where the trainers have no experience of the content their audience will soon figure out the dissonance and leave the session - either physically or mentally.

In England we have a rash of NHS Improvement related organisations trying to get onto the social media bandwagon. I am all for it as I believe it is an essential tool for communicating and engaging with others. However, when the organisations involved have no official and monitored Facebook page, do not use blogs (as in few is any of their Executive Teams or Senior Staff use them), have never used a wiki, do not use RSS feeds themselves as part of their own learning, or never used a discussion forum in-house etc - then the exhortations and training comes across as inauthentic.

There are one or two NHS Improvement groups, like NHS Improvement, who are using Web 2.0 techniques to their advantage and I like the way they are starting with themselves and learning how to use them in-house, before going outside.  I am sure they will be excellent role models for the future.