Friday, 23 January 2009

Delivering Change - where people design it themselves

Hugo presenting a Benefits Dependency Network
Of course the best solution is to have the front-line professionals involved, fully engaged and on the design and implementation team from the start.
But far too often clinicians, team leaders and the front-line support team don't get involved in the idea, the design or the implementation plan.
When they are eventually engaged (such as when they are called upon to implement the change and make it work for service users and patients), quite naturally they don't see why.  Why change the status quo, the intricate pecking order that has taken years to develop; the forms, procedures and rhythms that evolved naturally around the daily obstacles of the workplace (who finds a parking space and gets in early, who late; what report needs completing because management once asked for it and have never said it is no longer needed; which room is available for overflow patients, etc).
At Ltd and through the organisations we associate with, we have accelerated programmes to
  • retrofit clinical engagement ('put right past wrongs')
  • gain real front-line input at the design phase of new initiatives
and a clinical engagement workshop which involves your clinicians telling your managers how they like to be engaged.
Dragon tattoo to sign off
The difference, in delivering change, in aligning initiatives to organisation and health economy strategic goals/ strategic objectives, and in staff morale is tremendous.
Please use the link to Ltd website to find out more and contact us.

Monday, 19 January 2009

Clinical Engagement

Many attempts have been made to engage clinicians and other front-line staff in service improvement in NHS.  Theories about.  But what works in one place seems as though it doesn't work in another.
All too often, a carefully planned engagement strategy finds that the clinical representatives your initiative is talking to don't have the credibility they claim, or groups previously ignored suddenly need to be considered.  I've been brought into many projects to address this, including a running course on developing clinical engagement strategies.  I can assure you - if this is the problem you face you are not alone!
It seems that some people are able to talk the right linguage - or more accurately, laungages; to show the right understanding and empathy; to identify with the issues and make people feel listened to.
Clinical engagement should be a two-way street :- 
  • the initiative can be improved by the advice and wisdom of clinicians who understand the planned service improvement, can understand it in their own context and recognise what will work and what will cause problems, and can manage the risks.
  • For their part, people who feel involved are more likely to champion the change in their environment and if the change is linked to strategic objectives for the organisation, then to ensure these objectives are achieved.
The course in clinical engagement (mentioned above) becaue a workshop hosted by local front-line clinicians, and proved far more effective.
In other cases, even though they were brought in late to an initiative, front-line staff have endorsed the planned change, have not demanded a return to the drawing board, and have ensured successful delivery.
I'd be delighted to structure and facilitate (in conjunction with your front-line staff) engagement sessions around your service improvement initiatives.  Expect faster achievement, more stickability, and more engagement with the organisation's goals.
Of course you, too, must be flexible to the changes your staff suggest

Clarity of Outcome

It always helps to know exactly what the client wants.  But if the client doesn't actually know at the start of the project, then it is helpful to work together to an agreed policy.
On one of my current projects, I'm struggling with mixed messages, which often eventually conclude that the starting point was in fact correct but which involve quite a lot of "urgent" correspondence and discussion to get back to where we started.
This takes time, energy, and emotional energy.  On a fixed price contract, it's the supplier who ends up paying, though a prolongued period of uncertainty can also cause timescales to slip.  As the conclusion is all-too-often the same, it is difficult to get the client to agree to changes to the costs.
The difficulty is that I specialise in new areas of service improvement, where the client often hasn't thought the requirement through.  Many clients are extremely pleased with my work, including one who says "I know I can come to you even though I'm not really sure what I want, because you will help me clarify it and then deliver something wonderful".
I believe that clients need to recognise their own limitations and trust suppliers to be professional.  This means making a clear choice and setting a protocol:
  1. Involve the supplier in exploring the findings and implications, and genuinely working together to find the best solution
  2. accepting the supplier's direction of travel
the third option, deciding a direction or change of scope without discussion with the supplier, is difficult - the supplier is often far closer to he work than you are and there are often implications which aren't immediately apparent.
Trust your supplier, they have as much to lose as you have and may know more about the immediate problem.

Sunday, 18 January 2009


The initiative is already started, the money has been committed, staff are in post, and the PID is already gathering dust on a shelf.
Yet there's still a nagging doubt - exactly why are we doing this?  
The sponsor knew, but their interest is on the next initiative.  the Project Lead knew, but examined in the cold light of reality they aren't so sure anymore.  The aims certainly weren't Specific, measurable, ambitious (and agreed), realistic or timed.  The staff know what they have to do each hour of each day, but now nobody's quite certain how to demonstrate that the project has been a success.
I encounter this situation regularly, and I'm sure you do too.  All too often, the Benefits File for a project was only produced to tick the right box and unlock the funding.  Staff want too make a difference to service users, but nobody really knows "what good looks like".  Remedial action - retrofitting the project into a benefits framework - is needed so everyone (staff, service users, the public, sponsors) can see what's being achieved, and focus their effort on making a bigger difference.
I've covered elsewhere the concept of the Benefits Framework; it isn't new (in case you've forgotten, the Framework will apply to all services in an organisation, or all projects in a major workstream, so they all use one or more of the same benefits measured and defined in the same way).
A good Benefits Framework allows you to aggregate benefits across a number of different projects and across the whole organisation, and demonstrate actual progress towards delivery of the strategic goals; it means staff and the project board can take pride in what they have achieved/ are achieving, in context.
It isn't difficult to retrofit, it just takes a bit of determination. But then, getting people to measure what they do and seek benefits takes a bit of determination too.

Monday, 12 January 2009

Strategic Delivery Frameworks

Playmobil Hospital
Project managers, and their sponsors, may be concerned to ensure that a project delivers on its aims. BUT The aim of one project coudl be in direct conflict with the aims of another.

If the projects are from different directorates (eg in NHS, Practice-Based Commissioning increasing community services whilst Finance and Facilities try to reduce costs and premises) then the conflict may not be identified.

At some point in every strategy, in every organisation, you need to take stock - to appraise not just the new initiatives and projects, but also existing services and the gaps that have opened up because of:

  • demographic change

  • new technologies and/or understanding

  • or simply changing expectations

this applies whether you set strategy for the commissioner, or the provider! It's just as applicable in health, social care, education, justice, or any commercial or charitable organisation with more than one single initiative. Many public sector organisations may have hundreds of distinct services and perhaps 100+ new initiatives at any one time.

I can help you with Benefits Dependency Network (BDN) development workshops for aligning service delivery to strategy, and for empowering staff both to embed strategy and to get engaged with it; and to deliver performance and outcomes aligned to strategy. Uniquely my BDN workshops are designed around whole strategy rather than a single project.

we're all faced with the imperative to do more wih less. Your frontline staff are the only do-ers in your organisation. Creating Strategic Deliver Frameworks WITH frontline staff harnesses their energy to really give your strategy legs (and arms, and hands, and mouths - in fact the limbs and functions it needs to bring it to life).

Monday, 5 January 2009

COPD - commissioning innovation in Easington

Innovation - butterfly leaps from hands.  Image borrowed from nextup
Does Practice-Based Commissioning (PBC, asking the GPs and GP surgeries to decide what their patients need, then providing the funding to pay for it) work?
Many erudite commentators say that GPs aren't getting engaged, aren't bothered to come up with good ideas.  Is this because the GPs have tired of coming forwards with ideas, or because they are too greedy and can't see where to make a profit?
Obviously it is easy to find any number of cases to support each point of view, but (you will have to register for Pulse before they let you view the page) illustrates clearly that GPs do understand their patients and their patient needs, and with no benefit at all to the GP (because Co Durham PCT has phased out the 70% of savings going to the GP surgery) are fully prepared to step in and defend the patient's right to dignity and the best possible life.  In this case, GP practices in Easington, in combination with community staff, PCT and social services, created a simple to follow chart which relieves anxiety during a COPD attack and in many cases means the patients choose not to go to hospital.

I've written about this before.  Without someone prepared to take a gamble we'd never move forwards.  So many management consultants explain how you can shave 5% off here, and 2% off there, always working within the bounds of what is already known, asking each organisation to do the same as the best organisations.  Where's the innovation?  How will we find anything new?  
Patients aren't widgets to be processed as quickly as possible.  If we don't get it right, sickness has a nasty habit of getting worse, finding another way to pop up both in terms of time and use of resources, and in terms of pain and incapacity.  If we do get it right, happy people live active and fulfilling lives.  Innovation is important!