Weeknotes triple edition: 30 August to 16 September 2022

Carved wooden angel scuplture in a glass and wood framed museum gallery
The wonderful Burrell Collection, Glasgow

I just returned to a half-finished note from the week before the August bank holiday and published that pretty much as I found it, leaving 3 more weeks to catch up on. The main reason for my weeknoting hiatus was that I’ve been busy every weekend – visiting in-laws in London, taking my son back to university in Scotland, and meeting up with family while my brother was visiting from Japan. It’s lovely to see everyone, but also nice to spend a Saturday afternoon sitting on my own sofa.

Quite a lot of things happened between 30 August and 16 September.

Patients in the boardroom

Some of my team and I spent two days together in London with members of our awesome mental health patient and public voice board for digital in urgent and emergency care (UEC). Thanks to both of the 111 providers who presented to the board, and to Jacqui, Marie, Natalie, and Jacqui for making sure our board members were looked after.

I was struck by the way patient representatives can get to the heart of what makes a good 111 call. Of course we must focus on making every triage clinically safe and evidence-informed, but that counts for little if the health advisor or clinician can’t give the caller confidence about what to do next. When appointment booking slots aren’t available, or health records are slow to access, it undermines people’s trust in the whole system, and makes the frontline worker’s job harder.

Back to school

I spent a day and a half at Cranfield School of Management for the first module of the Project Leadership Programme (PLP).

Regular readers of this blog may spot the irony of me doing a project leadership course just when my organisation is moving to a product-led approach more suited to digital services. I hope I’m undertaking the course in a spirit of humility: the project delivery profession has learned a lot about how to get things done in the public sector. As a Senior Responsible Owner I need to understand that stuff, even though projects and programmes will no longer be the dominant paradigm for managing our work.

Aside from the formal learning, the course gave me the chance to meet an inspiring group of civil service delivery leaders. I’m looking forward to learning from them as we go through the programme together.

Digital leadership

From my room on the Cranfield campus, I joined a leadership event for new colleagues from Health Education England, which is merging along with NHS Digital into the new NHS England.

On a panel discussion, we were asked to bust some myths about digital transformation. I’d come prepared to talk about two myths, but the first – that digital is all about the tech – had been roundly dispelled by previous speakers. I focused instead on the myth that digital transformation is an internal task that happens within an organisation under controlled conditions. Digital transformation is a societal change that happens in people’s lives far beyond our direct control. This demands a different way of engaging people as the experts in their own lives, using the skills of humanities and social sciences as much as engineering.

Burning the boats

Not long after I took on digital urgent in emergency care last year, a programme business case was approved to cover our work on the condition that it be updated 12 months later. Despite much work to strengthen the benefits case, and Brin and Marie’s efforts to clarify our work, the approvals process for the update has dragged on to the point where it no longer makes sense to continue. We’ll be seeking a shorter term approval to continue our work instead.

In place of a multi-year programme business case, we’ve agreed for my area to be an early adopter of the new product-led approach to managing delivery teams’ time and taxpayers’ money. This will be based on a more iterative approach using proven product management techniques to prioritise work. There’ll be greater accountability for the difference we’re making for patients and frontline staff in line with the overall UEC strategy – and less upfront guessing about what may or may not happen in the future. It’s the right thing to do, but it does now give us a hard deadline to design and implement the new agile governance in time for the next financial year.

What do I need to take care of?

Planning to create the new NHS England is proceeding at pace, with senior colleagues responding to rapid requests for information and being asked to put forward options. That’s going to continue, and we need to do it justice without distracting people from important delivery work. I’m reassured that there are external advisors involved who have worked on similar large scale changes and know how to avoid organisational self-harm.

One concept from the Cranfield course that I immediately reflected on was the difference between transformational and transactional leadership. I would put my own style in the first camp, as befitting of my current job title: Director of Service Transformation. But I’m also aware that’s not everyone’s preferred style. Some people would prefer for changes to seem less radical, with a bit of give and take. I need to work with those colleagues to create a coherent case for change, otherwise our teams won’t know what to expect.

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