- Create a project plan that is all things to all people,
- Sell it on ease of data integration and use.
- Don’t write a service blueprint
- Don’t speak in endless detail to those that will use and benefit from the product
- Fail to limit the scope; the business case forces too many “benefits” at the outset.
- Keep the details hidden as much a possible
- Don’t use GitHub to see if anyone has done this before
- Through 2 or 3 project cycles reduce the scope of the project
- Start to cut code before completing any UI and Service Design testing
- Roll out a beta that fails to meet the reduced scope
- Rewrite the service blueprint to de-scope the work
- Project Board finally pays attention to the detail and realises this is a hopeless case and blames everyone
- Project V2.0 is created from the remains.
- Promoting individual well-being. It’s not good enough to just hand out leaflets, it requires a proper campaign to address the well-being in all demographics. Cherry picking vulnerable and disabled people for example would discriminate against those that are trying to keep themselves fit and well. It’s as important to engage the self funding middle class as pensioners receiving pension credits. And it’s important to see their children as an constituency of interested people.
- Preventing needs for care and support. Prevention has to be done at scale, there is no point in having two people as the single point of contact in a Council. This approach will fail for even the most vulnerable groups. Typically there are 15-20,000 chronically lonely people in a London Borough. To address a problem of this scale, the solution has to the facilitation of self and community help. Councils cannot set themselves up as the one place to go for everything. They need to develop the social capital within their communities to tackle this problem within each Ward. In Ealing the Councils approach touches less then 1,000 of the 17,000 chronically lonely people in the Borough.
- Promoting integration of care and support with health services etc. The NHS cannot have it both ways, complaining about a shortage of funding and failing to engage with the social capital development in their communities. The NHS has over the last few years conducted a scorched earth policy around their services. Placing impossible contract requirements on Social Enterprises, often letting contracts to itself and failing to integrate its care services in a meaningful way with local community organisations. As as a result, there is little innovation in local health and care services.
- Providing information and advice. If you have looked at any council health and care information services, this link is for older people in Ealing, (you can make your own mind up how useful it is), most information is partial, out of date, broadly inaccurate and not designed with the user in mind. Information is not even curated for particular demographic groups. More often than not they are just a list of organisations and locations that mean nothing to local people. Contact number is really answered and access and disability services poorly described. So why do authorities see this as a useful way to spend resources, at best it’s likely to be a box ticking exercise to address the bare minimum of requirements.
- Promoting diversity and quality in the provision of services. The first step here is to allow online feedback on the services, few councils do this, and it’s very hard to understand the quality of a service. In Ealing you can complain but we have no idea what people have been complaining about, no one can judge the quality of the a service. Pretty much all industries have worked out the benefits of listening to their customers.
- Co-operating generally. Looking beyond local services and embracing the people that create and run them is a better way of thinking about how cooperation might work. Most Councils have no idea of who runs such 3rd services and does not provide any support services for them. The relationship is often transactional and based on erratic funding. Most of the effort of these hugely generous people is unacknowledged and certainly never engaged with. More often then not the Council is quick to criticise even the slightest failing in such people, and yet it ignores the rising complaint about its lack of local relevant services, blaming anyone but criticise itself for the issues.
Addresses these issues would not cost a great deal, probably no more than is being spent currently. Sadly not doing it means that peoples self-reliance is under-minded and they struggle to stay away from the local health and care services. We should all demand higher standards of the information provision and local coordination within communities this would go a long way to reducing costs and improving outcomes.
There should be a thought at the heart of every organisation; are we doing good or ill? In Microsoft we worried about a new found monopoly and we engaged with this through responsible leadership. We understood that our role as managers had to change, we had a responsibility to our partners and customers beyond just making money for our shareholders. And over a number of years we became a better group of leaders.
In the NHS I am not sure we have yet to fully understand the constraints and opportunities afforded to us by our health and social care monopoly in England. Monopolies nearly always display a number of traits:
- A lack of transparency
- Poor levels of service.
- No or low consumer power.
- high prices for low quality goods and services.
- out dated goods and services with little or no innovation.
I believe that these ought to be leadership concerns of NHS England.
Despite rises in medical legal costs through greater insurance payouts and premiums, the Francis Report and the Institute of Customer Service Report 2014,that shows lower and lower levels of customer satisfaction within the NHS, the NHS has yet to focus managers in the same way as those of the commercial sector near monopolies.
It may that the NHS has never really developed, in organisational terms, beyond the passive aggressive org that Neilson so graphically describes in his Harvard Business Review article.
It’s time we all demanded more of NHS leadership, the call for privatisation is the wrong way of tackling the issues of lack of competition. NHS Leaders should address the monopoly traits. This could be achieved through greater transparency, and by commissioning services for improvements in public, patient and professional experience.
There is some light at the end of the tunnel, the Kings Fund paper Reforming the NHS… is a very good place to start. But until the traits are on the agenda of every NHS leader we are not going to make progress.
There has been some discussion of leadership in Microsoft lately.
Shackleton or Slim.
Shackleton Leadership… not one I would follow, he was a leader we studied at Sandhurst when we looked at the dark arts of leadership, coercion, peer pressure and religious intolerance.
Undoubtedly once in the boat he did an amazing job of keeping people alive and navigating the small craft across a huge expanse of open water… the key is don’t prepare so badly that you have to get into the boat in the first place.
Our leader of choice was Lord Slim…he had 3 elements to his leadership:
(a) There must be a great and noble object.
(b) Its achievement must be vital.
(c) The method of achievement must be active, aggressive.
(d) The man must feel that what he is and what he does matters directly towards the attainment of the object.
(a) He must be convinced that the object can be attained; that it is not out of reach
(b) He must see, too, that the organization to which he belongs and which is striving to attain the object is an efficient one.
(c) He must have confidence in his leaders and know that whatever dangers and hardships he is called upon to suffer, his life will not be lightly flung away.
(a) The man must feel that he will get a fair deal from his commanders and from the army generally.
(b) He must, as far as humanly possible, be given the best weapons and equipment for his task.
(c) His living and working conditions must be made as good as they can be.
I think there is much we can do with Slim’s simple outline.