Weeknote: 23 to 26 April 2019

View from my hotel room in Leeds

Some different questions than usual this week, because 3 out of 4 days were on the residential for the Bevan Programme. There was loads to take in and many productive conversations with my fellow cohort members, which made it worth the decision to stay in the residential hotel even though it was only a few miles from home. I even got a view over Leeds city centre from my room this time.

What did I learn?

  • The power of where we direct our attention as leaders. People notice what we notice and focus on the things we focus on.
  • The high likelihood of being wrong in a time of rapid change, and how vulnerable that can make a leader feel. When leaders close the door to their teams, it might be this insecurity in action. That’s a shame because it cuts us off from our staff and stakeholders just when we need their wisdom the most.
  • Coordinated care problems – clashing appointments, lost test results and so on – are design problems: 19% of UK adults in a 2016 survey reported that they had experienced a problem with care coordination in the past two years. Coordinated care problems are also an equalities problem: the number rose to 37% among low income adults.
  • When multi-disciplinary teams collaborate on the design of a care pathway, the value is not only in the design, it’s in the conversation and agreement between professions.
  • Experiments with self-organising teams, such as the Buurtzorg model, can seem counter to clinicians’ instincts to govern and drive out “unwarranted variation”.
  • There’s a reason why lean methods borrowed from manufacturing are commonly adopted in secondary care, but less so in primary and community care. In the latter, the potential for variety is infinite, and the environment far less controllable.
  • Many in public service fear working with technology sector suppliers, and rightly so because the sector has so often taken taxpayers for a ride. Often these objections are more practical than ideological. They represent genuine confidence and capability gaps that we need to work on.

What does all this mean for me?

Coming up to my 2-year anniversary working at NHS Digital, the wonderful peer group in my Bevan Programme cohort is helping me to understand that we face many of the same issues at both national and local levels. Some of us are forming and storming new working relationships between the national arms-length bodies, just as, locally, leaders are getting used to collaborating across sustainability and transformation partnerships and integrated care systems.

This week has made me more confident in describing the problems I see nationally, because I’ve heard them all from my peers who run services locally. And I’m clearer on my role in transformation: it’s the NHS I’m here to change, not a single arms-length body.

What will I do differently?

  • Empathise more with my executive directors. I hope this will make me better able to support them when they need it.
  • Reflect the issues of local NHS people and teams back into my national work.
  • Lead more clearly and simply, especially when leading on change.
  • Show what I’m paying attention to (Someone gave me anonymous feedback that I can be “difficult to read.”)
  • Discuss using the OKR format with my profession leadership. I think that could help us be more explicit about our objectives even as our tactics and priorities change.
  • Inquire more into quality improvement practice in the NHS. One of my learning set has offered to help, and I will take her up on this.

What else inspired me this week?

  • The fortnightly NHS.UK show and tell was a good one. Teams covered “find an NHS service”, cookie consent, code club for International Women’s Day, and automated testing.
  • Throughout the week, I recommended that people read and reflect on this blog post, which powerfully brings to life the issues around co-ordinated care, trust in our system, and how we engage patients and families in change. Collectively, we can do this better.
  • I was grinning from ear to ear when I saw Dean’s post on the growing pains of design leadership. We’re so lucky at NHS Digital to have a design leader as focused and thoughtful as Dean.
  • Late in 2017, Pete ran a sketching session in our weekly design huddle to gather ideas for improving patient letters generated by the e-Referrals system. This week, a family member received one of the better letters that resulted from that work. Little changes, national impact :)

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