John S. Toussaint M.D. Chief Executive ThedaCare Centre for Healthcare Value
The health care industry is one of the least reliable industries in the world.
A recent British Medical Journal paper claimed medical error is now the 3rd leading cause of death in the U.S. and of similar magnitude in most western countries. This creates a burning platform for change. Most of that change is going to come through the leaders of healthcare delivery organisations making that change happen. This is going to require an intense learning process that includes awareness of different ways to solve existing problems and individual coaching to learn new skills.
It also requires association with a group of peers that are trying to make similar changes – the focus for this blog.
Chris McCarthy Executive Director, Innovation Learning Network @McCarthyChris
What would an “innovation learning network” for healthcare look like? Coming off of two successful years of co-launching an internal innovation group at Kaiser Permanente in 2005, it was time to build and connect to a larger community, and it was clear that to be successful, the network had to be different and valuable. The “value” piece emerged quickly in two of the three Innovation Learning Network pillars: 1) Share innovations across systems and 2) Teach innovation and design technique. These were important, valuable and obvious.
And although, the “being different” piece emerged quickly as well, it was intentionally downplayed, almost hidden. And yet it’s why leaders and innovators have come back every six months for over a decade and why the ILN continues to grow at a healthy clip of 10% a year. I used to stumble when talking to new potential members about this third mysterious pillar. It felt weird and uncomfortable discussing its value and importance. But time and success has liberated us to now say:
“...and we are unapologetic that the third pillar is about cultivating friendship and it is the most valuable and important thing we do.”
There is nothing like the word “unapologetic” to quiet down a potential debate.
Ever felt isolated in your job? How about certain that you were reinventing the wheel but no idea what to do differently?
The experience isn’t uncommon, as I found in my previous role leading UCLPartners’ work on patient involvement and experience. I started in that role by meeting with a range of my counterparts who had responsibility for patient experience and involvement within our partner organisations (hospitals, universities, commissioners, voluntary sector and more).
They talked at length about feeling isolated, both in their institutions but also in their local area. While working within similar geographies, many of them were unaware of other peers. They were certain they weren’t the only ones doing what they did, but felt unable to do anything about it, and uncertain that they were making a difference. All felt more could be done to share resources and guidance, pool training and support mechanisms, while increasing networking opportunities.
So, over the course of two years, that’s what we did, building a network which grew to over 150 people and continues to this day. What did we learn along the way?
How do we learn? Two examples spring to mind from my experiences this summer.
The first: my four year old grandson kicking a football in his back garden, being coached by his ever patient Dad to get more power and accuracy so that the ball landed in the back of the net at least some of the time. After an afternoon’s practice, some gentle praise and constructive feedback he was getting it between the posts more often than the England football team; maybe a ray of hope for the 2032 World Cup?
The second: it’s Olympic year and watching titans such as Andy Murray and Jessica Ennis-Hill turning in medal winning performances made me think of their own countless hours of diligent practice.
Practice is critical to learning. Yet it’s not necessarily true that all practice makes perfect. Recent research into the neurophysiology of learning has demonstrated that it requires the right kind of practice to get good at something – whether it’s kicking a ball, an Olympic event or improving healthcare. You need to practice not only frequently but also correctly. You need to practice with lots of supportive feedback so you learn from your mistakes and don’t hard-wire self-defeating habits into your attitudes and behaviours.
Ben Bray Research Director, Sentinel Stroke National Audit Programme
With so much attention focused on money, it might be tempting to conclude that quality improvement is a luxury the NHS cannot afford. The dominant story of the NHS is now - like for much of its 68 year history - firmly one of financial control, cost savings and desperation to balance the books.
There’s a logic which can be followed here. The level of financial strain on the NHS is hard to understate: 85% of NHS acute trusts are in deficit, and even the Department of Health is unable to keep within its budget. Other areas of the public sector (with arguably as big an impact on health outcomes as health services) are even more under the cosh: secondary schools are facing their steepest funding cuts since the 1970s.
So, against this backdrop, surely the priority for resources should be on keeping wards open rather than on in-house improvement teams, learning collaboratives or improvement training for staff? “False economy” doesn’t do justice to the magnitude of error this would be.
Dr Peter Chamberlain GP and Commissioner at South Sefton Clinical Commissioning Group
What do highly performing organisations have in common? From Team Sky to Salford Royal, growing evidence suggests that it’s organisations’ ability to run a slick and effective ‘learning system’, providing the mechanism to sustain continual improvement. As put by Professor Steve Spear of MIT, “today’s leading organisations outrace their competition by outlearning them.”
But before we rush to think that having a super learning system guarantees success, the system itself is only one of three factors needed to maximize improvement. Also needed is the right cultural and infrastructure ingredients, such as compassionate leadership and the integration of clinical work with informatics. Organisations then need to base these essentials on the right principles, most notably in healthcare that their work is firmly person-centred.
How organisations develop across all three areas is what’s fascinated me across my career. It’s what I’ve learnt from my time as a GP and clinical commissioner on Merseyside, as well as my time studying 15 high performing organisations as part of a fellowship at the Institute for Healthcare Improvement in Boston, Massachusetts
Liz Mear, Chief Executive, The Innovation Agency Guy Boersma, MD, Kent Surrey and Sussex AHSN Deborah Evans, MD, West of England AHSN
It’s been three years since the start of the Academic Health Science Networks (AHSNs), and since the three of us took up our posts (leading AHSNs in Kent, Surrey and Sussex; West of England; and the North West Coast respectively). In that time, what impact have AHSNs had, and what have we learnt?
First, a quick recap. The key tasks of AHSNs are to collaborate with partners to adopt and spread proven innovations that improve health; and support citizens to self-manage so they don’t need to use health services. We help economic growth by supporting pharma, med-tech and digital business to bring innovative solutions into the public sector.
We work with NHS organisations, local authorities, universities, third sector partners and industry. We want to prevent illness and harm and our key collaborators in this are the public, service users and patients, who can do so much more to manage their own health conditions, given access to the right tools and information.
To form collaborations and deliver innovation into practice requires deep and meaningful engagement between partners who work in different sectors and very often, have different languages, different cultures and different ways of working.
For Brexit, read the Health and Social Care Act. That changes in governance alone rarely resolves underlying problems is the story of NHS reorganisation over the past 30 years, and may be a lesson shortly to be learnt by the country as a whole too.
That the English NHS is developing a strategy to support ‘leadership development and improvement’ is positive news. It reflects a welcome acknowledgement that making the NHS more adept at change is the result of a million acts of delicate chiselling rather than the thump of a legislative sledgehammer.
But whether the forthcoming strategy succeeds will depend on whether some tricky decisions are dealt with. From my experience of nearly a decade in government, it's standard practice that such decisions may not even be discussed (there’s a reason why fudge is the policymaker's sweet of choice). As such, here's my take on the three topics most important to the strategy's success, and least likely to be being talked about.
Aidan Fowler Director of Quality Improvement and Patient Safety, Public Health Wales
Never start a blog with “when I was young”, but that is what this is all about. Why would an NHS consultant change their ways when they were not trained that way?
There is always a risk that this conversation turns into a version of the Monty Python ‘Four Yorkshiremen’ sketch, where each explains that his upbringing was tougher than the last (“We used to have to get up out of the shoebox at twelve o'clock at night, and lick the road clean with our tongues”).
But there’s a serious point here we don’t talk about nearly enough.
When I was trained (by the end of which, I was a consultant colorectal surgeon), I was taught to be self-sufficient, to expect little help (especially in the night), and as such invented solutions based on some learning. I only worked as part of a team some of the time, worked at the limit of my stress levels most of the time, and resisted some work because there was much too much of it. I was not taught to see change as a good thing, but as something to be kept at arm’s length. Success was holding out, not giving in.
At a guess, over the two and a half days of the NHS Confederation conference, around 200,000 words were spoken on stage. Inevitably, with such quantity of verbiage, some of those words get repeated, and speakers have to go to increasing lengths to make their points stand out. So, as a recap for those who made it to Manchester, and an introduction for those who didn’t, here’s a run-through of the metaphors of the week.
Do: grasp the nettle.
As has been the mantra at such events ever since austerity started to bite, nearly every talk has begun with a quick recap of the challenges facing the NHS – be they financial, quality, or staff morale. As such, there have been frequent exhortations that now is the time to make the changes that might have been put off previously.