What did I do to avoid disempowering people?
I listened. Specifically, I listened in on a user research session with a woman who recently had a baby (burbling in the background of the Teams call :) One of our teams is looking at improving digital self-referral to maternity services, and the research was to learn about this experience first hand from people who recently used those services. Regular exposure to primary user research should be a must for people at every level in our organisation.
I asked questions. In an intro to an event this week, I referred back to the principles of Asset Based Community Development (ABCD). I asked colleagues to consider a useful set of questions that I learned from social care innovator Mick Ward a few years ago. When thinking about the impact of any intervention, ABCD practitioners ask:
- What will be enhanced?
- What will be restored?
- What will be replaced?
- What might this mutate into?
What collaboration did I see?
It’s complicated.
We’re in a strange place as an organisation (the whole NHS as well as the national centre) where the urgency of cross-team and cross-organisation collaboration has never been stronger, yet the pressures to perform and meet isolated targets set in parallel plans constantly pull natural allies apart.
This was apparent in the planning for the second of a series of in-person collaboration days between digital, operational and policy colleagues in my part of the new NHS England. I pushed quite hard to focus the agenda on the here and now because that’s where collaboration has to start: not debating new priorities but together (“co-“) working (“-labour-ation”) around the common goals we already share. We agreed those goals through our business planning processes in March, now we’re halfway through the financial year. I wanted our team of teams to reflect on how we were doing, and on whether we needed to change tack on anything in order to meet expectations by March 2025.
I was glad we did because it flushed out a couple of shared initiatives where we’re in danger of not delivering what stakeholders are expecting. What was said, and not said, and the body language and reactions of some colleagues in the room when those topics came up, gave me as a leader a clear signal on things that I needed to follow up in the days that followed.
A number of colleagues, including me, have had some tough conversations this week, but that’s our job, and as far as I can see and hear, the honesty is taken constructively in the spirit it’s intended.
On Friday, I hopped straight from one of those hard conversations into a short intro call with a coach I’ll be working with. The coach mentioned Lencioni’s five dysfunctions of a team (absence of trust, fear of conflict, lack of commitment, avoidance of accountability, and inattention to results). I reflected that I had seen some good leadership behaviours which would help to bust through all of those.
Where is innovation happening?
I got out of the building a couple of times to hear from innovators and thought leaders about things that could help us to fix the broken NHS.
In a “Chatham House rule” round table event, a senior NHS England leader heard views on the future of primary care.
And the following day, my colleagues and I saw how artificial intelligence and service model innovation are combining to help get patients to the right care first time in different parts of the world.
Among the reflections at the end of the innovation session was that we have many of the building blocks for these models already deployed at scale in the NHS. But we need to combine them in new ways, designed around the needs of patients, not the silos of our systems. We also affirmed that other health systems face similar challenges – integration with downstream services, and joined-up data about patient journeys and outcomes. Without these, the gains from innovation will remain theoretical.
My go-to definition of innovation, as a socio-technical process, comes from the late Bruno Latour:
…a project is considered innovative if the number of actors is not known from the outset.
And so it was great to see a diverse group of colleagues together in the room looking at opportunities in triage and navigation. We don’t know fully where this work will take us, but we can be certain it will demand collaboration with a wide range of participants:
- patients and the public,
- frontline staff,
- the NHS’s own experts (many of whom were in the room),
- and people who bring us fresh perspectives outside-in.
What are we learning and improving?
I saw an encouraging demonstration of a tool for exploring the data around acceptance of service recommendations from our clinical decision support system and directory of services. One of my team’s shared objectives this year is to increase the proportion of 111 calls where the first recommended service is taken up by the caller. These insights will help the people responsible for operations and commissioning to pinpoint the services most often rejected, and the reasons given for rejection.
What’s lovely about this work is that no senior leader specifically asked for it to be done. Instead, the team were empowered by the first choice acceptance objective to make a tool that others could use. No coincidence that in the merger last year we named this team “Using data to improve”. It’s great to see how they have taken that to heart.
Matt Edgar writes here 