Tuesday, 21 July 2009

Inspiration and a job well done

Why did you join the caring professions?
Everyone I speak to has a story to tell – a family connection, a loss, a deep desire to help / to heal / to cure. But so often this original spark, this burning desire, lies buried under the petty annoyances and humdrum activities of day to day service.
Doctors and nurses, AHPs and social care workers, managers and support staff talk about the high points in their career in terms of single instances – the child who felt strengthened at their lowest moment, the obscure diagnosis with a straightforward cure. Moments of inspiration that are few and far between. Most days a seemingly endless and uninspiring routine.
As you know, my work is to help people involved in service delivery and service change to remember why they are doing this, to understand what a difference they are making, and if it isn’t good enough, to change their approach THEMSELVES to make it better. I do this through helping people, teams, organisations and whole health economies to define the measures that mean something (reports that people can take home and tell the kids “I made a difference today”). To record things that they put a value on, to analyse and report because THEY WANT TO, and to feel good about the outcomes.
We align the measures for new and existing services to the objectives of the workstream, the organisation, and the health economy. You can see your individual contribution, how you fit in, the difference you are making. You have a place, a significance.
This has an interesting knock-on – public sector objectives move as fast as (or faster than) local demographic change, political whim, and new understandings/ new technologies. Which is pretty fast. When teams set their own measures, they tend to align the measures with strategic objectives meaning that as these change, so the individual team measures change. And as people do what is inspected not what is expected, as we change the measures we record and report, we change what we do. No longer the need to send someone from management in to redesign services and impose the changes on people, because we’re doing it ourselves.
This theme and others on the use of measurement and Benefits Frameworks for performance improvement, alignment to strategic objectives and Recruitment and Retention, are explored further on my web site www.minney.org and blog http://benefits.minney.org. Please call me to talk further

Thursday, 16 July 2009

The case for change - funding innovation in social care

Allan Bowman, Chair of SCIEAllan Bowman of SCIE (Social Care Institute for Excellence) points out that it’s not enough to throw money at the requirements to fund care for older people and those with a disability; we need to consider whether the capacity is there to deliver care at the right quality (reported in Guardian Public magazine [1]).

Of course this doesn’t just apply to social care for these groups – it applies to all public services where the care will be provided by a mixture of public and independent providers (ie pretty much everything).
Care is constantly evolving, getting better (whether this means more tailored to individual need, giving outcomes that meet a higher criterion of health and well being, more effective use of limited resources, or all three). However any change costs money – requires that pioneers develop the new enhanced service. The mantra at the moment is to learn lessons from overseas – but with USA trying to be like UK [2], and many other countries with no real concept of publicly funded health and social care, where will we learn these lessons?
Public sector commissioners used to rely on charities for innovation. But charities are increasingly reliant on an income from the provision of specific services[3] and have less left over for testing out new types of working[4].
There’s a vital need to invest for innovation – the funds have been made available but without the security of a funding stream many organisations are simply unable to commit to building the capacity which will provide services of appropriate quality, and enough workforce to provide the capacity, We found [4] that the expectation is smaller organisations are more agile and likely to innovate, whereas they don’t have the capacity to deliver the volumes local authority requires. An ideal solution would be to contract with a consortium of suppliers required to collaborate, so some can focus on innovation and sharing, whilst others can provide the vital services. But getting innovative organisations to share their intellectual property, and service providers to share their income, is proving tricky.
I’d be delighted to work specifically with the following groups to bring together groups of public service commissioners and existing and innovative providers to build a consensus and prepare for an innovative service:
• Charities which commission personal care and health care services
• Capacity builders and those who fund innovation
• statutory commissioners eg Local Authority, Social Care, NHS


1. Dudman, J., Social care professionals cautious over new funding plans, in Guardian Public. 2009, www.guardianpublic.co.uk: Internet.
2. Porter, M.E. and E.O. Teisberg, Redefining health care : creating value-based competition on results. 2006, Boston, Mass.: Harvard Business School Press. xvii, 506 p.
3. Minney, H. Innovation - Case for Investment in Social Care. Performance Improvement and Outcomes Realisation 2008 [cited 2009 16/07/09]; Skills for Care workshops in North East]. Available from: http://minney.org/?q=benefits_third_sector.
4. Minney, H. Commissioning Innovation. Performance Improvement and Outcomes Realisation 2008 [cited 2009 16/07/09]; Available from: http://minney.org/?q=Commissioning_Innovation.

Tuesday, 7 July 2009

Innovation in the NHS

Innovation, path to the future
How to improve outcomes, how to be more effective?
The Darzi reforms had their first anniversary last week - and they have been very successful over the last year, certainly in terms of brand awareness.
Quality was the theme for the year. It was a good theme - highest quality removes waste which avoids unnecessary costs (more effective), and often quality and effectiveness go hand in hand.
There's only so far you can go with improving quality and improving efficiency. The same pathway but better. 10% cheaper. As the Wanless 2002 report indicated, if we're still doing health care in the same way in 20 years as we are today, every able person will be occupied looking after the less able - we have to change.


Making a real difference comes from being prepared to start again, to go back to the drawing board. All the lessons we learnt about process mapping, about redesign with patients and front-line staff, are all appropriate here: perhaps one of the classic examples is the ECP, giving the first professional contact with the patient, the skills, competencies and authority to change the care, to refer to a more appropriate patient pathway. This makes a real difference - community care instead of hospital care, self management instead of institution.

Permission to fail

But how do you know when it's working? That's when a really strong measurement and reporting regime is needed, tied to meaningful measures designed and implemented by front-line staff, permitting staff to recognise where their own project works and where it needs modification, and the tools to make the changes themselves.


Of course it requires people to talk to each other. In a market place environment, commissioners and providers need to understand the risks and rewards of innovation and work together to achieve the much-needed benefits

All of the above projects were run by Hugo Minney and I'd be delighted to work with you on your project

'Securing our future health: taking a long-term view' April 2002, HM Treasury an independent review by Derek Wanless
Search for: INNOVATION

Monday, 6 July 2009

Quality is the new buzzword

Quality is the new buzzword (HSJ 25 June 2009).
I return to my original thesis, that all care is delivered by people and therefore innovation, and quality, is predicated on the motivation of staff, volunteers and carers.
QualityMark.jpgMeasuring becomes ever more important than ever. "People do what you inspect" is just as relevant to the self (I do what I'm measuring - I take a shower faster if I'm timing myself, I stick to speed limits if I treat that as a priority) and staff that set their own goals and have the tools to understand how they fare compared to the goals they have set are going to achieve more, with more enthusiasm, faster, than a team with an imposed goal, and feedback 6 weeks after each monitoring period.
Give people the tools to make a meaningful difference, and we'll do it!
Hugo can establish - with front-line teams - frameworks for Benefits design, planning, realisation and reporting and help align individual and team goals to the strategic objectives of the organisation or local health (and care) economy)

Sunday, 5 July 2009

Stormy Weather

Today at the supermarket we saw rather a lot of very smart convertible cars. Drop-top jaguars and mercedes, roaring porsche and TVR. I'm sure I read somewhere that there's a recession on. Isn't it interesting how the weather can reflect the times? Or do we just notice it when it does?
The weather's unpredictable. The public appears (at least from the newspapers I read) to be completely split on who is best to run the country - do we go for the party that promises everything to everyone (in the same speech promising to "cut mindless burocracy" and "provide administrative support for frontline staff"; then promising to hold down public sector spend with reductions of 10% a year, but of course the [insert audience here] department will have its budgets maintained), or the party that everyone loves to hate but rather a lot of economists and bankers are saying other countries should immitate?
The health service faces its own dichotomies. There are finite resources. There are new technologies, each more expensive than the last, each marginally better. People are definitely sicker - where did MS, ME, Fibromyalgia, CFS come from? Or did we just not diagnose them before? Why the sudden increase in diagnoses of depression, neuroses, autism? Is it really because we can diagnose them, is it really because we keep people alive who would otherwise have died, are there enough kept alive to account for these large increases?
I wonder how many of these problems come back to simple things. Take the situation in the health service: could it be that something has changed about the food we eat? And could it be that unexplained presences or absences in the food are causing all of these problems?
Makes you wonder if the same is the case for politics . . .

Exciting Writing

THIS PAGE HAS MOVED TO http://minney.org/node/99
‘Writing to inform and persuade’ is the knub of it; but who is to say what is good and what is bad?
Two presenters
I listened to two medical talks a couple of months ago. One followed all the rules: the slides were clear and memorable, forming a continuous story with a start, middle and end. The content was relevant to the audience; the talk ran to time.
The second stood between the delegates and dinner. It consisted of 40 slides for 20 minutes, each one another case study. Many of the slides were scans of handwritten notes and Word documents. With every slide, the presenter paused, looked at the slide, said “oh yes, now this is a very interesting one” and proceeded to spend 5 minutes describing it in detail. At 20 minutes I interrupted and asked the audience if they were prepared to delay dinner to listen to more. They were fascinated at this old man, talking about his life’s work in this rambling way, and many committed to check their own patients for the same symptoms. The younger doctor who gave the first presentation left in disgust.
My lesson
I wonder if we concentrate too much on form over function. PowerPoint slides “should be this”. Rules for doing a good presentation. Dressing for power. I don’t give talks unless I have something to say – content leads, followed closely by enthusiasm (if it doesn’t excite me, why should it excite anyone else?).
It makes me wonder how many times people try to whip up enthusiasm when they are only faking it. How many talks have no real content – they just fill a 20 minute, or 90 minute slot. How many times we say what we don’t mean.
Action steps
If you want people to buy more services from you, what’s the risk in saying so? Be clear: “this is what I’m enthusiastic about, this is the difference it can make to your work, now buy from me”. Audiences are cynical and suspect that’s what you are trying to say anyway, and telling them that they were right is surely one of the most sincere forms of flattery!
If you want to reignite that enthusiasm that people had when they joined, the passion for the work, aligned to your business objectives, that’s my specialist area. Talks, workshops, implementation; make it happen, make your organisation sing again.