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 Let go of your outdated models, methods, tools and products, in just the same way as thousands of NHS staff are having to do on a daily basis for the practises they believe are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

Overcoming resistance to change

Resistance to change is on that "Top Five" list of topcis I get aksed about.

I think the video below is a great answer to the question on how to overcome resistance to change:

Difficult Conversations 4: Fierce Conversations - practical tips

The practical advice in this slideshow is very helpful. I particularly like the "Sixty second" technique for starting off the conversation.

Fierce Conversations

View more presentations from Evan Wood

Difficult Conversations 3: Tips from the psychology viewpoint

There's no one way to approach a difficult conversation. The short slideshow below covers some useful hints and tips - if the psychological viewpoint is interesting and useful to you.

Making Difficult Conversations Less Difficult

View more presentations from John Deely

Difficult Conversations 1: The DED Technique

Dealing with the difficult situation is difficult - usually because emotions are running high and emtoional responses tend to send all good planning straight out the window. One technique I've found useful is simple enough to remember when the flak hits the fan and tends to work well - the DED technique.

D = Describe 

E = Example

D - Discussion

Describe the behaviour you're finding difficult, how it makes you feel and explain the wider impacts of the behaviour. Without any description the other person probably has no idea why you are upset.

Then provide an example of what it is you've just described. Without an example the other person may think you're making it up and may not be able to ground the descriptions in reality.

Discussion - or I prefer the term dialogue as that presumes it is a two-way thing - is the obvious important and final step. If the first D and the E have gone well then the discussion should be fairly straightforward - though posisbly still emotive.

Do you have a favourite technique you'd like to share?

Overcoming resistance to change - isn't it obvious

How to overcome resistance to change is one of the most common questions I am asked. The dominant mindset I encounter is that the person who does not want to change (aka doesn't want to do what they are told to do) is resistant and therefore wrong.  There is as many answers to this issue as there are management consultants. An interesting approach is the animated video with a script by Eliyahu Goldratt of "The Goal" fame. Despite the video being largely a promotion for his new book, it does have some useful content and ideas.