Tuesday, 12 May 2009

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.


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)?

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