A letter for keeping Jobs

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Let's be realistic: this crunch won't last for ever. And when it ends, consumers will need new products. We're going to need innovation in financial services (after all, we can't reuse the failed products of last year and preceding decades). New delivery services (keeping food miles down, recognising more purchasing on the internet, even home delivery services from a trip down the high street so you can go on spending!). New transportation options (carbon footprint again). New eating and socialising options (when facebook and twitter take their rightful place not as substitutes for an evening out with mates, but as the enabler). New everything.
We could leave it to a few very talented inventors to come up with new ideas - but the things that catch on have a habit of being surprising.
Perhaps we should dedicate the hundreds of thousands of people who are at risk of losing their jobs, dedicate them to creating innovation. The alternative is that society has to pay for them anyway (unemployment, mental health medication, lack of confidence to contribute for decades to come) but gets nothing back. This way (ie with government paying the same amount to their employers, as long as these workers are dedicated to discovering innovation rather than business as usual) gives people their self-esteem and puts Britain in a very very strong position coming out of the recession.

Dr Chandy on You Tube (B12 deficiency/ Cobalamin Deficiency)

At last - found the BBC Inside Out programme from 30 October 2006 on B12 deficiency

When you think you (alone) know

Two heads are better than one, especially when they look at a problem from different perspectives.
The saying goes that if you ask 2 doctors for an opinion, you’ll get 3 different opinions. And probably each will assume that everyone agrees with him/her. This could apply to any professional, and even more so between different professions – picture a question of additional hours: someone with a responsibility for finance argues completely logically for a very different outcome from someone concerned with staff development. They haven’t understood their differences, and none understands why the initiative hasn’t gone ahead exactly the way they assume it should.
This lack of understanding of each other affects many service transformations: nobody is exploring what the blocks to delivery are; clinicians are blaming management as the key block, and of course vica versa
Facilitated sessions have unblocked similar situations in the past. In particular elucidation of what each means by their understanding of the overall goal, where there are similarities and how they can be brokered together has fostered new understandings and a common desire to achieve a common goal (exactly where you thought you’d started).
Think of the time these professionals spend in meetings and not able to make any progress. Think of the frustrations, and the mood that puts people in to obstruct future “management initiatives”, the measurement and monitoring, and service transformation. I’ve facilitated a change in awareness and appreciation of difference that breaks down barriers and aligns people, both with each other and with strategic goals.

Call to Action

Invite facilitated workshops specifically arranged around bringing different professionals together.

Did we really mean that?

Half-way to implementation, we have to look at the unrecognisable mish-mash of a service that’s somehow evolved from the original idea, and seriously consider whether to cut our losses or whether it can be remodelled into something functional.
There’s many a slip ‘twixt the cup and the lip. The right research, analysis and design puts forward the right solution, for example a new care pathway complete with new or adapted services and service delivery. But a service definition can only define so much, and you still need people to align with the reason WHY.

It brings to mind my report on the pilot of Payment by Results. I interviewed medics, nurses, commissioners and managers in the South Yorkshire Laboratory after PbR had been running there for 12 months and was about to be rolled out in the rest of England. I asked them “how do you see this evolving?” (and to stop them committing suicide after I left, I concluded each interview with “what are you personally doing to put things right?”). The overall conclusion was that PbR is simply a system, and its success or failure, its ultimate benefit to the health of the population and best use of resources, depended almost entirely of the will and intent of the people who work within it. It’s possible, nay easy, to game the system. It’s also possible to provide an exemplary service and to receive due reward for quality. I like to think that the current HRG4 with reward for quality was in response to my little report.

So

What are you trying to implement, that you haven’t explained? Worse, what are you trying to implement where you haven’t involved people in designing, ensured everyone agrees the goals and strategic directions, that you haven’t put in place inspiring markers that let people know whether they are making progress (I call them “benefits”)? Social care and health care are staffed by inspired, highly intelligent, highly motivated super people. Without a system to report progress made, to tell each and all of us what progress we are making, many become demotivated. At least if you are following an accepted protocol you can assume that you’re having the effect that usually follows from following this protocol, but when change is asked for, naturally change meets resistance. If people understand the why and the evidence for the change, they are far more likely to engage.

How do you demonstrate improvement?

Do you have a reporting system (especially on service initiatives)? Is it designed to report on things that motivate people, such as proxies for quality outcomes (better health, better quality of life, better results, even better targeting of resources) – or does it just report a table of numbers or activity?

What could you achieve by aligning all of these superpeople (supermen and superwomen)?

Cultural Differences

Where are you today? How much of your environment, the jargon and language you use,
the attitudes, do you take for granted? Do you sometimes find (for example at conferences, or dinner with non-work friends) that you have to explain something you thought ‘everyone knew’?

The biggest barrier is assumption

In professional circles, particularly where the training is lengthy and the regulations and license to practice onerous, one of the biggest barriers to communication is assumption. You hear a word and think you know what is meant – the other sees you nod and carries on, and 10 minutes later you realise just how far apart you really are.
What would it be like to be understood first time around? Not to win every argument, but at least to be heard, permitted to make your point? And what can you learn from your colleagues, if you take the time to recognise that they may be talking a different language (using the same words with different meanings, or different words to talk about the same thing)?
Think what you could accomplish!

Action

Next time you’re talking with people of a different professional background (eg health and care professionals to administrators, health professionals in different environments, the next MDT meeting especially if it includes enforcement staff), listen out. Not just for the words that help you build rapport, the pace and tone of speech and representational systems used, but for the line of reasoning, for the little red flags that suggest you might have missed the point although most of it sounds familiar.
When is the next interdepartmental meeting? What could you achieve by getting this right? What do you need to prepare to achieve this?
A lot of questions, but I’m sure you’ll agree (after the event) that it transforms what used to be frustrating wastes of time into really valuable and productive meetings.
If we’d known the start point, we wouldn’t have ended up here!