Day 89: User-led Change

I heard from one of our service managers today about service users meeting to discuss complaint themes and present these back to the service.  This is a fantastic innovation with the people we support empowered to identify areas for improvement and to facilitate change.

This approach requires a leap of faith and trust from the service’s management team.  There needs to be a belief that there will be more benefit than cost and service users need support to be effective.

This won’t work everywhere but is a good addition to a toolkit of approaches for improvement and can be replicated.

Day 88: Rock The Boat!

Are you disruptive, do you go against the grain, or question authority?  Organisations need you!  We need people who challenge the established, those who ask “why?”, and who don’t automatically follow.

Innovation and improvement can arise from constructive challenge.  If you have a colleague who is seen as ‘disruptive’; ask yourself if they really are, or are they just not so quick to fall into Group Think?

If you always do what you’ve always done, you’ll always get what you’ve always got (Henry Ford). We need people who think differently so we can change and behave differently to improve outcomes.

Day 68: Pace of Change

How fast you make changes/improvements should be determined by the urgency with which change is needed.  It’s important those directly involved in and affected by change are involved in agreeing the change timetable.

It’s also important any change has the right measures so that it can quickly be determined whether it is working.  If it is not, fail fast and move on to the next thing.  I like the use of a PDSAR cycle for this:

  - Plan,

  - Do,

  - Study,

  - Act,

  - Rest.

 

This last stage is valuable as change fatigue can be debilitating to improvement activities.

Day 59: National No Smoking Day

It’s not easy quitting smoking!  It can take between eight and 30 attempts before the average smoker gives up.  We have a responsibility working in health and social care to take every opportunity to support people who smoke to quit. 

I am the Executive Sponsor of ‘Smokefree at TP’, our internal campaign to help the people we support and those who work for us to lead healthier lives through reducing and/or stopping smoking.  This is a co-ordinated set of actions aimed at providing the tools to our people to help others.

What can you do to help us be Smokefree?

Day 25: Innovation

I had a really good conversation today with Harvey Wade from Innovate21 about improving our organisational capacity, capabilities, and culture around innovation.  There is significantly commonality between the cultures needed to foster innovation and quality improvement.

One of the things that featured in our conversation was the need to look outside your own organisation AND outside your own industry to understand who does change well, who has the right culture, how they got there and what did they learn on the way.  This external benchmarking or ‘appreciative enquiry’ is vital to being able to progress beyond your own internal limits.

Day 24: User Engagement

There has been a huge amount written over the years on Ladder of Engagement, which takes you from sharing information all the way up to genuine co-production.  There is great opportunity now for a shift-change in how we partner with people to develop services that help them to meet their outcomes through excellent experiences.

We must be purposeful in our approach to this, saying, meaning, and resourcing our approaches to co-production with the people who have the greatest knowledge of what excellence looks like and what it means to have bad experience – they are the people who use our services.

Day 62: Chief Nursing Officer Summit - Part 1

Today was the first day of the annual Chief Nursing Office Summit.  It’s invitation-only for all Directors of Nursing from across the NHS in England.  It’s publicly streamed live online to be accessible to a wider audience.  There was also a lively conversation on Twitter through the hashtag: #CNOSummit.

There’s far too much from today to mention in this blog, but I will break my 100 words rule to share an element of the inspirational talk by @ElaineInglesby about how we improve patient safety through culture change.

There’s been much talk previously about how the culture in the NHS needs to change; today Elaine spoke passionately about some of the practical ways we can make this happen.  She shared a leadership example from the USS NIMITZ, an American Navy Aircraft Carrier.  This isn’t the most obvious comparison to draw for the NHS and certainly differs to commonly used examples from the airline industry.

On the NIMITZ they apply simple principles to bring clarity of role and effective leadership.  This ensures the safety of 5,500+ crew and the aircraft that can take off and land at a rate of every 25 seconds.  Read the principles below, as I think they speak for themselves and the NHS can learn from this. You don’t have to look to hard to see our Culture of Compassionate Care #6C here:

“We are NIMITZ professionals and we apply the following principles all the time, in everything we do.

INTEGRITY:  We expect honesty from all our Sailors.  We expect our Sailors to take responsibility for their actions and to never avoid accountability.  We expect our Sailors to take ownership of their tasks, their spaces and their ship.

FORMALITY:  To accomplish the mission, Sailors aboard USS NIMITZ work as a team.  But they also perform their individual tasks in a manner that contributes to team success.  To do that, each Sailor communicates well by giving precise orders, providing verbatim repeat-backs, listening to repeat-backs and adhering to established NIMITZ standards.

PROCEDURAL COMPLIANCE:  This principle takes formality a step further.  Aboard NIMITZ, established procedures have evolved over many years from the lessons learned following mistakes made by others.  We don’t want our Sailors to re-learn old lessons the hard way, so we insist on using the right procedures for each evolution.  We train our Sailors on what the procedures and we also train them to understand the ‘why’s’ behind its use.”

LEVEL OF KNOWLEDGE: We know that a sound level of knowledge leads to intelligent on-the-spot decisions.  We train our Sailors to understand the how and the why of their contributions to the ship’s mission.  We believe that if we’re not learning and teaching more each day about our job and our ship, then we’re not doing our job right.

QUESTIONING ATTITUDE: A questioning attitude is both a critical thinking skill and an exercise in vigilance.  It is a personal trait that it  learned, yet requires practice to remain sharp.  Aboard NIMITZ, each Sailor is encouraged to have a questioning attitude.  Many of the best ideas on how to improve processes and procedures have come from our junior Sailors.  A Sailor with a questioning attitude is learning more about the ‘why’ and that can help improve their level of knowledge.

FORCEFUL BACKUP: NIMITZ Sailors watch each other’s backs to ensure an evolution is being conducted safe and proper.  The ‘forceful’ part of this principle is tied to integrity.  Being ‘forceful’ when backing up shipmates means our Sailors have the courage to point him or her back on the right path if they’ve started to stray from it.

Day 23: “Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen” Winston Churchill

I spent time today thinking about courage (one of the 6 Cs in the NHS’s aim to improve compassionate care).

I had an induction meeting with our local Director of Adult Social Services and reflected afterwards how some of the integration we need to do will take courage

I thought about the courage displayed today by members of my team in dealing with difficult situations and challenging the established way of doing things.

I am also hoping for courage tomorrow from CCG staff when we undertake a listening exercise at our monthly staff meeting aiming to identify barriers to change and how we overcome them.