People Drive Digital Reflections


networkI have been to NHS EXPO today. As always it was great to meet lots of people I have met and worked with over a number of years; I love seeing them, giving them a hug and re-connecting with them (you all know who you are). It is one of the privileges of my working life that I have met so many fabulous people.

Today was interesting for me as I didn’t go to EXPO in my professional capacity but in a personal one, as someone who has an interest in digital innovation but from the perspective of a citizen and patient and today felt very different – but is it EXPO that has changed or me?

PDDigitalToday I briefly presented with Victoria Betton and Mark Brown the work we have done on People Driven Digital and the PDD Awards (HT to the others too Michael Seres, Kat McComack). I realised that I had changed from a year ago.

I spent many years as a nurse giving patients advice and information. We thought it was the right thing to do and of course it is but it’s also paternalistic, based on the assumption that ‘we’ know and ‘they’ don’t.

Over the last year my experiences of working in collaboration with other people like my fellow collaborators for #PDDigital, and many others in my social network with Diabetes, has made me realise that the system doesn’t know what problems people face as intimately as they do. We can make assumptions, we can guess and in doing so we may well get it wrong; we may hit the target and miss the point. Mark spoke eloquently today (you can read what he said here http://thenewmentalhealth.org/?p=182 and it’s well worth a read) about focussing on trying to find digital solutions to those issues that really matter to people, not necessarily the big things but those that in people’s lives make a real difference. You can see our presentation here

So today, whilst I wandered around EXPO, I reflected on what felt ‘real’ and what maybe mattered the most. There was little evidence of people driving solutions and creating ideas and I realised I had changed. I have come to realise that unless we engage at the start with the citizens, we are unlikely to make the differences we need to make. We might create elaborate solutions but may completely miss the point. We need People Driven Digital Innovation.

pump openerI have an example: I was a grateful receiver of a new insulin pump a few months ago. It has a snazzy screen and some new functionality that means if you are a user of a continuous glucose monitor (I am not funded to be one) then it will switch off the delivery of insulin if your blood glucose goes too low – very clever indeed. But what was it that delighted me when I collected my pump? On my old pump, in order to access the battery to replace it (yes insulin pump are powered by a traditional AA battery!!) I had to carry a 20p coin in my bag. It’s the only reliable way to be able to open the battery space – it’s tricky but fairly crucial to be able to get in! On my new pump there is a removable clip that had a snazzy little device on the end that enables you to open the battery space. A simple remoulding of the clip – inexpensive and functional – I know, I know, so simple – but it was the snazzy solution for the battery opener that delighted me. A small but delightful improvement and now I don’t worry about 20p pieces. Let’s try focussing on the small things that might matter to people.

How do you think we could develop the ideas from #PDDigital? Let us know.

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A messy unpredictable future?


Recently I was lucky to be a member of a leadership Indaba. An Indaba is a South African word often used to describe a gathering or meeting and I was with a diverse group of leaders thinking about the system challenges we see in the health and care system and this blog is my reflections at the end of the Indaba.

anne 1983I started my nurse training on 31st January 1983. As it turns out 1983 was quite an important year for the NHS too. On 6th October of the same year the Griffiths report was published. Funnily enough it was mentioned in our training; I can remember being intrigued as to why a Director from a supermarket called Sainsbury’s should be asked to look into how the NHS was run. We didn’t have a luxurious Sainsbury’s in the North East where I lived so that made it exotic and slightly strange and I confess I might have been more impressed back then if it had been M&S! Little did I know how important that report was going to be for the NHS but also my career.

Sir Roy Griffiths was asked by Margaret Thatcher to look into and give ‘advice on the effective use and management of manpower and related resources in the National Health Service’. As the Griffiths recommendations were implemented it started the evolution of a strong management culture that had by all accounts been lacking before this. Griffiths clearly pointed out that in his opinion there was little difference between NHS management and business management and the NHS went on to be restructured into a management hierarchy not unlike a national ‘for-profit’ business.

So how did that affect me? By the time I qualified in 1986 many of these structures were in place, budgets were devolved to wards and gone had ‘nursing officers’ and we had brand new ‘unit managers’ (who often happened to be a nurse). The first additional serious studying I did was a Certificate in Management, I had already been identified as having potential so this was the first thing that was suggested, and I went on to complete a Diploma in Management. I was ambitious and had a hunger for a healthy career – studying management was the way to go!

I believe that most of the senior managers in the NHS of my generation were brought up this way. Of course we need excellent general management in the NHS, probably more so than ever before, but this type of approach and culture may not be the only thing we need in 2015. Most senior managers are of my generation and if they have a career spanning decades in the NHS they too are likely to have a background context firmly embedded in general management. OrganisationManagers work through cultures of systems and order – give them a messy problem and they will seek to resolve it in a systematic and logical way. They most often seek order and control and although they believe in delegation, power is only given with a good dose of performance management sprinkled, or is it heavily blanketed, over the top. They seek organisational structures with clear and logical relationships, the right ‘span of control’ and formal reporting mechanisms that allow them to feed their external regulators. They seek to be successful at an organisational level as that means survival of their organisation – they are organisationally centric.

I was trained and educated like this but I believe that in 2015 and beyond it will no longer work. Over the last few years I am starting to see that the complex adaptive system that is the health and care system can’t survive if we behave like this and yet I still see these old styles of thinking. We often say the right things but we don’t walk the walk. So what do I mean:

1     Giving things up

In the new world working across communities, which is what we need to do, means giving up power and sometimes resources for the greater good. If we are going to change the way we deliver care it means some organisations will have to change and give up some of their share.  It takes good managers to make this happen but it takes guts to lead it.

I have blogged about this before, and I won’t repeat it here, for me Buurtzorg remains a fantastic example of siting power in organisations back where it matters, in the staff working directly with communities.

2               Dealing with messy people

Change in the way that we need it means messiness. It means small may be beautiful, that solutions delivered in local communities may be messy unpredictable and probably don’t look like to corporate solutions managers know best. It’s taken me a while to get used to this, the idea that each local ecology may be different from its neighbour but that’s how it is – messy and complex – so get used to it!

Salford Dadz for me is a perfect example of how messy can be glorious and beautiful – you can read more about it here. I’m not saying that it’s disorganised or out of control, more that its perhaps unexpected and beautiful for it – an example of asset based community development outside of the corporate systems with a unique system of its own.

3     The role of citizens and the impact of unexpected choices

Systems think they know best for people. I hear people talking this way all the time, assuming that all the expertise is in the ‘system’ and implying that there is none beyond. I do not believe this is true. Citizens, patients if you prefer, or even service users, may also have other ideas about what is the right thing to do and choose differently.

I remember working on a rehabilitation ward a couple of years ago. At the team meeting they were discussing a lady who wanted to go home. She wanted to go home despite the fact she couldn’t get up independently during the night to go to the toilet. She chose to go home and be ‘padded up’ at night, preferring her own bed and a sort of adult nappy rather than being in a care home or institution. It really made me think about the choices I might make. We may have some way to go with personal budgets but I think they could provide a way for people to make different choices. As system leaders we will need to help to make these things a reality even if they mean breaking up what we know and throwing it away and living with unexpected choices.

4     Finding energy where it smoulders

digitalawards VB, RL, AC

Lovely Victoria Betton, wonderful Roy Lilley and me kicking off the #PDDawards15

We need to find the energy where it smoulders, in communities, in people, in hearts and let it burst into flame. As well as the Indaba I have been helping Victoria Betton (@victoriabetton) to deliver the People Driven Digital unAwards – a celebration of people and solutions that come from the ground up. We had the award ceremony on Friday 3rd July (you can see the nominated people here) and its humbling to hear about people finding solution to problems for themselves. Yet we do little in the way of supporting these people, our systems are bureaucratic and laborious, almost impenetrable – we need to take some of this red-tape away to let the smouldering passion burst into glorious flames – this is how we can find new solutions. By the way the solutions came from everywhere, not just ‘patients’ but from staff, students and citizens with a drive and ambition to make things better. It was humbling.

5     Networks

connections 2I think John Kotter is right that in addition to formal systems we need to have in place there is a role for networks that sit alongside. The role of networks is the more creative change work, whilst letting managers get on with making sure the books balance and the operational services remain on track. These networks need to operate beyond the boundaries of organisations and may be populated with unexpected people. These will be the people who want to make a difference, the ones who are smouldering with the passion to do things differently and they will drive the change. Gone are the days when networking was just about careers now it’s about doing real business, making connections that drive and shift the whole system ecology.

So all in all the last year has been great for thinking. The last few years have helped me to perhaps evolve past the manager I was trained as in 1986 and I look forward with to the messy unpredictable future we face.

never stop learning

Guest Blog: Compassion – a MARLARKEY or a CASE FOR CHANGE?


Maxine 2014This is a guest blog from my friend and colleague Maxine Craig who is Head of Organisation Development at South Tees NHS Trust and visiting Professor ( Sunderland University).

Maxine can be found on Twitter on @Maxine_craig and she would welcome conversations about this blog.

Maxine’s blog speaks for itself – so here it is:

This week whilst at a training event in the coffee break a lady approached me and asked me “Was I Maxine Craig who is part of this ‘NHS Compassion Malarkey’? ” – now this has hit a nerve!

Maxine nursing

I have worked in the NHS since I was 17 and this ‘malarkey’ has been my life for 33 years. Ensuring patients get the best we can give and staff are well and healthy is my purpose. It’s no malarkey!

 

This is what a malarkey is:

malarky

I believe there is a compelling case for change in the delivery of care; the latest Panorama programme surely reinforces that? – Yet I sense that a back lash about compassion is building.

For the past year I have been making myself available to help people think about the issues we face, making spaces where people can think more deeply about compassion in our lives. And I am learning that everyone I speak to in the NHS, social care and wider society recognises that something about it needs fixing. Everyone appears to have a perspective on the general lack of compassion in the wider world and that the NHS needs to ‘do’ compassion better.

elderly lady

This is a real puzzle for me. I work in a great organisation and I witness compassion every day, in abundance, and I see situations where compassion in lacking; It’s not as clear cut as the media would have everyone think. I am worried that being compassionate is becoming an industry in our health and social care settings, others also express this view and some are becoming cynical of anything with a compassion label. I would like us to pick out and continue the genuine good work.

In all of my learning I have found that people find talking about compassion rather uncomfortable. Yes, everyone has an opinion, a surface view. Some people have been deeply affected by a positive experience of compassion in their lives and some hurt by a gap in compassion. Everyone who comes to talk about compassion has some interest, and I have noticed that many have some degree of discomfort.

angry womanI think this is because it’s about all of us, not just the bad guys who don’t do it! It has the potential to make us feel guilty, uncomfortable about our personal struggles and challenges.

At a system level the NHS voices that it wishes to improve compassion but it continues to work in a non-compassionate way and I suspect the care sector is the same. This is a paradox. I do not believe this is a ‘problem’ that needs to be solved but see it as more of a societal context, leaving me as an OD practitioner with a complex and sometimes frustrating dynamic to work in. So I am working to explore and practice the ‘HOW’ of increasing compassion in our system – I want to get on and DO something about it not just talk about it!
 

The NHS is deeply evidence based. In some parts this might be more espoused theory than theory in use, but it is an important guiding principle. We also wear the cloak of evidence as a defence. Another important fact is that many professionals and managers (and I include myself in this group), actually were professionally socialised at a point in time when the control of emotions and ‘not getting emotionally involved with the patient’ were prized professional competences. The new world of the psychology of work offers a different view, with burn out, compassion fatigue and emotional labour as key and important phenomenon. It is important we remember the shift which has occurred within one generation. As a result of this shift the current reality of the compassionate intervention is very challenging for some.

the compassionate mindSo I have learned that the very best way into these conversations about compassion and the psychology of work and caring is via the science. The work of Paul Gilbert who established the Compassionate Mind foundation gives us the basis of the neuroscience of emotion (you can read more here) and I have been able to link this to stress in life and wider society.

Tree huggingI have witnessed the relief in people when they come to talk about compassion and are met with the evidence base. It welcomes them in, it is a context they know, it allows them to be open to the practice of compassion. When coming to a talk about compassion people have shared with me that they were worried it would be too soft and fluffy. When I have explored what this means some people say they don’t want ‘new age’ or religious or spiritual. So like all good change agents let’s start where people are at – let’s start with the science!change agent

Compassion is no malarkey; it’s vital and too important to be pushed aside because it makes us uncomfortable.

I am DIGGING IN for the long haul on this one – I want to make sure the NHS and care system is good enough for my dad. Will you join me?

Maxine's Dad