NHS England Lesson 8 – Getting things done – the bias to inertia

A past CEO of the Kings Fund once described the NHS as being dynamically conservative, it shifts its shape to make resistance look like progress.

Lesson 8 – Here are 12 steps to getting something done:

  1. Know the change you want shape, don’t ask a committee to work it out for you

  2. understand the business priorities and frame your change in these terms

  3. get it into the Business Plan

  4. find academic evidence to support the change – harder than you think, but only new ideas have to have evidence, all the old ideas are just taken on trust .. bad luck!

  5. get the backing of a senior clinical leader (your choice here is important)

  6. take your case through the committees personally, don’t rely on the apparatchiks.

  7. find a supplier/delivery partner on “G-Cloud”. I advise against an internal delivery organisation.

  8. make sure you have it complete to stage 1 within 3 months

  9. Set up a cross ALB stakeholder group… otherwise someone else will

  10. Deliver incremental benefits and make sure the benefits deliver the cost savings,

  11. Market the service or change continually, get the nay sayers off your bus

  12. Make sure it remains within the business plan/5 year forward view/whatever the new name will be.. keep up the momentum.

That’s it, eight lessons from 30 months in NHS England, would I do it again, I think I will take the Redgrave oath on that one. So you can now do one of two things; pick apart my lessons, easy to do, I have kept this short, and things are never quite as bad or as good as I have suggested, and tell yourself that all of this is irrelevant, do remember that they are my lessons not yours, or, think deeply about what you are doing and see if we share any common ground. If we do then you know where to find me and perhaps we could add to the “what next” for the NHS in England.

NHS England Lesson 7 – A Marketing free zone.

Marketing is a blind spot and is misunderstood by almost everyone in NHS England. The worst excess of this lack of understanding is the “focus group of one”, the idea in the head of the senior person present becomes the received wisdom of the crowd. NHS England’s failure to engage with the needs of patient groups is the outcome of a complete lack of marketing attention to the public, patients and professionals.

Lesson 7 – make your voice heard, you will have to shout, no one is actively listening. Most likely, you are going to have to use something like 38 Degrees to crowdsource your power. We the public have far more “new power” than the NHS would like us to have. New power operates differently, like a current. It is made by many. It is open, participatory, and peer-driven. It uploads, and it distributes. Like water or electricity, it’s most forceful when it surges. The goal with new power is not to hoard it but to channel it.

NHS England Lesson 6 – A lack of Corporate Memory

Never joke about memory loss, if you have seen it in patients it is far too serious to make fun of. But there is no excuse for the NHS to loose it’s memory, and yet we do. Reinventions are common place, and because there is no Librarian in the cloud to remind us of the lessons learnt we are doomed to repeat the mistakes. You need to look no further than Care.data to know that this is true.

Lesson 6 – make sure you have an access point into the corporate memory and jack in as often as possible. Make it part of every programme and project.

NHS England Lesson 5 – Management Skills and Best Practice….

Somewhere along the way the NHS/DH/Comissioning Board/NHS England missed the 90’s. I am not sure how this happened but all of the management skills and best practices of the last 20 years seem to have passed NHS England and Department of Health by. Peter Druker’s The Age of Discontinuity says it all. I thought his sometimes dystopian view was wrong .. Lesson 5 – I was wrong about Druker, there is a “Sickness in Government”. If you haven’t read his 1998 article you can find it here. The Sickness of Government.
“Bureaucrats keep on doing what their procedures
describe. Their tendency, as is only human, is to identify
what is in the best interest of the agency with what is right, and
what fits administrative convenience with effectiveness. As a result
the Welfare State cannot set priorities. It cannot concentrate its tremendous resources–and therefore does not get anything done”

NHS England Lesson 3 – Parity of decision making.

In health and social care it would seem eminently sensible for everyone to be involved in decision making. Unfortunately, NHS England is essentially a passive aggressive organisation, brilliantly described in the HBR. As a result everyone has to agree to instigate change, as you can imagine this is impossible. In these conditions innovation cannot thrive. Those accountable for outcomes find they are only in the position to be blamed when delivery fails or is inevitably slow. In Gareth Morgans book, Images of Organisations, “the machine metaphor” describes the style of NHS England.

Lesson 3 – make sure your leaders are able to lead and that the organisation understands this. Enable decisions to be taken quickly, decide early and decide often.