The Magnificent 7

I was sent this by a friend as words he’d seen elsewhere and I thought they might be good to share with you all. I hope you find them of value.

 Remember:

 1.  The importance of your team ‘agreeing’ their behaviours and ways of measurement

 2.  The immense ‘commitment’ you make as their leader to being the best you can be

 3.  The value of regular feedback from the team on their own performance and progress

 4.  To ask people what has gone well today

 5.  The importance of enjoying oneself

 6.  The significant added value of teams setting their own targets and their increased motivation in achieving them once set

 7.  The improved performance levels obtained when people truly believe the potential inside them needs your help, leadership and management.

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“So what can a blog do for me?”

I’m not certain what a blog is. At 500 words it’s too short to be an essay, offering a well reasoned argument, aimed at persuading the reader to adopt a new course or prescription. It’s certainly too short to warrant attention for any serious peer review. Likewise it’s too long to smack you in the face like a twitter or sound bite. So what is its purpose; an advert, a critique, a rant? My observation is it is too often the latter. So how about having a blog that is a compliment instead?

 As we reflect on the success for the country of the recent Olympics, I’d like you first to reflect on another ancient Greek concept we seem to have perfected in the UK better than them, “Governance”. The historical route of ‘governance is indeed Greek, coming from the word used for the “steers man” Kubernan (or gobernante as the Romans translated it and hence governance). To steer, drive and pilot a vessel on the open seas, following a safe course is a great skill and one our top Olympians of today have taught us deserve acclaim, indeed a Gold medal. Awards in this craft have come to Team GB not due to any God given right, but due to the considerable hard work, commitment and capability of those athletes who have managed to get to the top of their competition. My compliments go out them all.

Getting to the top spot however is not always down to these key attributes. Some times, to corrupt Shakespeare, ‘greatness is thrust upon’ some people. This happened in 2002 when the then Health Authorities handed over reign to the new kids on the block, the PCGs. The result was four years of painful learning and the realisation that some of the new governors were not fit for purpose. History often repeats itself and there is considerable concern amongst many that 2002 is about to repeat itself in 2012 with GP Commissioning. In my belief however the NHS is, in good part, a learning organisation. The paradox of the NHS is, despite what many might believe to the contrary, both inside the NHS and out, that in many of its organisations, the NHS is well governed when compared to other similar sized organisations.

 The Francis recommendations are about to teach us important lessons, on safeguarding, patient focus and good governance. We can learn as much however, from catching organisations in the act of doing ‘good’, as we can from catching them doing ‘wrong’. The challenge is, can the NHS evidence where it is well governed and do it quickly enough, spreading this recognition as best practice and ensuring the learning is totally, not partially, deployed. Much evidence suggests the NHS currently takes around 15 years to make best practice, common practice. This clearly isn’t good enough. We need a ‘Gold Medal’ governance Olympian. The NHS Confederation has recently signed up as Founding Patron of a new European wide initiative, EIGA (the European Institute of Governance Awards). Maybe our Olympians are about to emerge.

Getting a lift from the elevator

Over the years I have had the pleasure to go to Chicago USA on several occasions. A great friend of mine and erstwhile business colleague there took me to the ‘Sears Tower’ and told me a story that I assume is true but have no evidence of. As I trust him however I’m going to pass it on to you as I was reminded of the story whilst listening to a very inspirational speaker at a King’s Fund Conference on leadership recently, where I too was asked to speak. The speaker was Maureen Bisognano. She is CEO of Healthcare Improvement based in Boston USA and a very intelligent person I could listen to all day and draw inspiration from.

Two quotes from Maureen:

“The ultimate inspires and accelerates …. Peer review improves!”

“The physical presence of seeing sparks innovation”

The story is about the Sear’s ‘special elevator’, the one that the members of the public never see. Apparently Sear’s Special elevator is a slow elevator and takes quite a time to reach its destination. Why, because on a regular basis Sear’s top executives in the field are called to the building to present them with awards, coveted awards. The crowds of executives arrive in eager anticipation of the day, knowing that the top achievers in a number of different fields are to be honoured, exemplified for their great achievements and used as role models to inspire and accelerate improvement. The elevator plays a significant part in the process. The executives are held so as to ensure they travel up the elevator, deliberately slowed for the day, together as peer groups. On the walls inside the elevator are the league tables. At eye level, those organisations who stand firmly at the foot of the performance ratings. Ascending up the wall are their superior performers, until at the very top, right at the point where the paper reaches the roof, is the performer in 4th place on each table. Places one, two and three are deliberately missing. Of course everyone can work out in the time available who they are, the elevator is going very slowly after all, but no one knows the number one slot, ‘The Top Achiever’, until it is announced to great applause.

The captured executives also have plenty of time to note those at the bottom of the league tables and as you might expect, time to cast a few comments about the lowest performers capability and offer advice on how to improve it. These comments are offered in line with the organisation’s values of course, which are also on the walls of the elevator, just in case.

Once out of the elevator two things happen. Firstly, the poorest performers are never mentioned again. The focus is completely on the top three and especially the top one. What they have done well and why they have achieved success is captured, celebrated and the learning disseminated for others to emulate and improve. The second thing that happens is the poorest performers leave. Armed with the humility of having been in the elevator for a long period of time with their peers reviewing their performance and their renewed connectivity with the best exemplars at the Award event, they leave sparked, motivated, their innovation juices switched on and their energy to make improvement high. The great outcome of this story is, apparently, no Sears organisation has ever appeared at the bottom of a league table for more than one trip up that elevator at a time and Sears continues to be one of the most success retailers in the world.

Chainmail may look ‘integrated’ but it’s still full of holes!

As a Radio 4 listener I often hear the “Thought for the Day” and admire how the presenter manages to get such a strong message out in such a short time. So the above title is my attempt to inspire a fresh thought about something that is being discussed by so many this day, “integration and competition”.

‘Integration’ in an environment of ‘competition’, is not about linking our services together, knitting them into a fabric that envelops our patient in a weighty, complex system that looks defensible to us but is still full of holes. Yet the concept of competition in the health care system is making many key players behave as if this were the solution. One reason for this may be, our lack of trust in the evidence base or our inability to see the evidence base at all, where is it? Another might be our misaligned thinking and behaviour. For example, the vision of our core purpose, to put the care, safety and health of our people first, is being challenged and fogged through political restructuring and the message that we need to achieve greater efficiencies. It is in some areas perceivably being replaced, possibly instinctively, with the drive to ensure the survival of established organisational forms or the power based that is occupied by them.

What ever the reason two fundamental challenges are obvious:

Firstly, if the evidence base isn’t transparent how do we make it so? How do we bring it in to the health care debate so that the energy in the current storm that is going on in the system can become harnessed, and used for constructive not destructive purposes?

Secondly, if irrational behaviour exists, how can we challenge it? How can we show and recognise leadership so that change can occur and genuine improvement in real ‘outcomes’ of value to the people who use and pay for our system can become the norm?

It is after all they who we should be integrating with and they who will be telling us if we’re winning the competition at the end of the day.

Olympus in Focus

With the arrests today in Japan of several people associated with Olympus and the serious alleged governance issues , we’re reminded in the health sector about the value of a set of independent eyes.

In October of last year, the organisation’s British CEO, Michael Woodward was, according to news reports, fired summarily by the Board after he raised concerns about  significant sums of money (reportedly more than a third of the value of the deal) the Board  were paying in advisory fees concerning a recent purchase of a UK company. It would appear from today’s news that these concerns are now shared by the authorities.

Board transparency is clearly being raised as a significant issue in the Olympus situation. As the NHS edges closer to a system where the transparency of its own spending decisions seems to be diminishing we therefore need to head the Olympus story as an early warning signal now and ensure we don’t allow the potential future lack of transparency to become material from the start. It seems clear to me that the Board of Olympus failed to effectively provide “independent” (non executive) oversight on behalf of its shareholders. I’m informed that only three of the 14 directors on the Olympus Board were independent. If there had been a balanced Board, maybe the independent directors would have spotted the issues before Woodford and as such he wouldn’t have needed to call in PWC (Price Waterhouse Coopers), to conduct an independent audit. The question is, will we maintain the required level of independent oversight in the system as the NHS has historically been used to, and has been deemed necessary, under the new commissioning arrangements? I’m not certain.

Where the Olympus issue will finish I cannot predict. What is interesting is that  the results of the Independent review were distributed to the entire Board prior to Woodward leaving the organisation. It was because of the noise, created from the dismissal and not the independent report itself, that the attention of organisations like the U.S. Federal Bureau of Investigation, the U.K.’s Serious Fraud Office, and by authorities in Japan was given to the situation.

NB In December, Olympus announced a $1 billion hole in its balance sheet.

“An old soldier”

It is not often that I see the need to support Roy Lilley’s views but his article “An old soldier” of the 12 December 2011 on ‘public health’ is really an issue we should be picking up as it didn’t go far enough. I bet you never thought you’d ever see the day when that was said!

In the article Roy quotes Charles-Edward Amory Wilson’s definition of Public Health from 1877. It is, he states: “the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private, communities and individuals”.

The fact Roy had to go back to 1877 is telling. As well as all the issues Roy raised there is another big issue: Public Health has to become current. Whilst epidemiology as a science is hard to criticise the output from the process isn’t. Flogging data to Commissioners to help them make their investment decisions that is two years old, no matter how accurate it is, is of less value than providing real-time data if you want to maximise impact on outcomes and change future behaviour. It is nice to have but doesn’t and shouldn’t influence decision-making when more current intelligence is available through integrated health informatics sources.

Last weeks debate on the ‘big data’ sets required by pharmaceutical organisations necessary to maximise the return on their investment decisions isn’t just needed in regards to this industry. The whole system needs to think about how it frees up data from its informatic technologies too in order to commission more intelligently.

In the New Year the Centre for Better Managed Health and Social Care will initiate another seminar debate to pick up on this issue. If you’re interested please join us or send us your thoughts so we can send them on to the Future Forum in a paper we will produce.

Unleashing the Fat Cats

I was approached recently by a “Fat Cat” of industry, you know, one of those people we like to bash because they do nothing for society other that take excessive remunerations and exploit their poor long suffering workers. He asked me if he could get involved with the Centre because of an experience his Chief Executive had had. His Chief Executive had received such bad treatment at the hands of the health system that he had nearly died. His Chief Executive’s post trauma rationalisation was, “if this is how they treat me, an educated, articulate and well informed individual, how is the health system dealing with my less well educated, inarticulate and ill informed employees? I need to do something” and so he mobilised the resource of his senior team and set them a challenge, “sort out our health system”.

The real irony of this conversation isn’t lost on me. The long suffering tax payer, often referred to as being over looked in the debate around the provision of care services is not just you and I, the individual citizen, but those same “Fat Cats” of industry, often criticised, who are not recognised for the significant contribution they pay in the form of tax into the health system. A representative of the tobacco industry at a conference I recently attended claimed that her industry alone paid as much tax as England spends on the NHS each years, but then so they should and more too in my opinion. The point is that industry and commerce pay tax too. Lots of it and lots in the form of National Insurance targetter theoretically solely on funding our health system.

The individual that I referred to earlier is not from an industry that is in any way responsible for causing harm to anyone in society. In fact completely the reverse. The irony I therefore raise is, for all the tax that this, and other ‘fat cat(s)’ pay through their organisation(s), what do these organisations get back from the society they support? Does our health system contribute sufficiently back to them for all the National Insurance alone that they pay? Clearly in the view of the Chief Executive of this specific organisation it doesn’t. His belief is that the care system is confusing and confused, too systematic and yet at the same time too chaotic, theoretically care focussed yet in reality uncaring, commodity and money focussed and yet not innovative in its use of resource and certainly not consumer experience focussed.

There is a considerable debate at the moment about integration, competition, the rights of the patient and many other details of microscopic proportion. As we enter into these debates, please remember why the health care system is here. When I have conversations with people like the “fat cat” discussed at the beginning of this text, I sometimes think we’ve forgotten.

Professor Dean Fathers