Most popular posts on the Spread Good Practice blog

Here is the list of the most popular posts on this blog for the last 6 months.  If I'd had to guess I'd not have guessed these - nothing like a good bit of measurement to separate fact from opinion!

Model 2: data, information, knowledge, wisdom 22 Dec 2010, 1 comment 640 Pageviews

The quickest way to spread scale up change 21 Jul 2010 484 Pageviews

Model 1: data, information, knowledge, wisdom 20 Dec 2010 339 Pageviews

Using Twitter in the Classroom or Organisation 2 Sep 2010 320 Pageviews

Productivity 1: Operational Efficiencies are not e... 24 Oct 2010, 1 comment 284 Pageviews

Productivity 7: How replicable is productivity?

This is the seventh in a series of productivity notes by Sarah Fraser.  If one organisation or region is classified as productive, can we make generalised statements that the rest of the organisation or nation can implement the same and be as productive?

A new report by York University is making big claims.

"The NHS could cut expenditure by £3.2billion without reducing the number of patients treated if all parts of the country were as productive as the South West, according to a report published today by the Centre for Health Economics at the University of York."

The report has many maybe's and possibly's as to whether the rest of the NHS could see the same cost savings if they performed like the South West Region.  I have no doubt the SW is producing excellent care. My concern is headlines like this paper produces sets unrealistic expectations on others. The delivery of healthcare is significantly contextual in its nature. Services all over the country reflect the complex make up of the areas they serve. The report summary on their website states:

"South West may also benefit from a more stable workforce, vacancy rates for non-medical staff being well below the national average. Lower productivity in the hospital and community sectors may be because more work is undertaken in primary care."

I believe this is enough uncertainty to warrant being very cautious about ratcheting up national numbers. Additionally, there is significant use of the "average" in this report. I am not convinced that averaging data and using the average as a measure is a good one for healthcare. As I pointed out in my earlier Productivity note, there is a big difference between accuracy and precision; basically, it is possible for there to be little variation across the regions (precision) but they are all delivering the wrong solution (accuracy).

Like all theories, this research is helpful to a degree (mostly in applying judgement) and like all theories, needs to be treated with a pinch of salt. If you are going to quote the headline £32billion on the stage then make sure you've read and understand the limitations of the report.

(To those who read the previous Productivity note about definitions - productivity is defined in this research report as output / input - how much output you get for the inputs...)

Productivity 4: Leaders need to be productive

This is the fourth in the Productivity series by Sarah Fraser. Is is possible to have a productive organisation if the leader is not productive?

This short video by Patrick Collins focuses on how leaders can use the 80:20 rule to ensure they focus on what matters and what provides the value you provide as a leader.



If you think you know the 80:20 rule, then I challenge you to watch this video and test whether you put it into action.

Productivity 3: Productivity is more than a process

This the the third in a series of Productivity notes by Sarah Fraser. Productivity is more than a process.

New and improved policies can impact the design and implementation of efficiencies. For example, new recruitment, pension, appraisal and similar policy changes can impact processes not only in the short term but also long term. I do think that policy improvements are a necessary condition for many other efficiencies to be put into place.

Clinical productivity is often conceived as as "how hard are we sweating out clinical assets". Another way of looking at this is to see clinical productivity as the most up to date and best practice clinical methods being used. For example, continuing to carry our surgical procedures that are no longer proven to be effective is not productive.

Process productivity is the most familiar aspect of efficiency chasing in healthcare. Largely based on the principles of Lean (or reduced and less focused use of Lean) it is helpful but not enough to meet the healthcare challenges for the next 2 - 5 years.

Productivity 2: Reduced variation is not enough

This is the second in a series of productivity notes. Reducing variation is only part of the productivity process.

Reorganising processes so they are precise and prediction is helpful but not enough. In the diagram, the red dots are hitting the target in a predictable way. However, while they may be precise, they are not accurate. The green dots, with less precision, are more accurately placed around the bulls eye.

What I learn from this is the need to

• know the definition and position of the bullseye (what is the purpose of the process being improved)
• measure for accuracy as well as measuring variation
• fix accuracy first, then go for reduced variation