For those who have not really been following my journey over the last 18 months, this is a summary recorded by Leeds Teaching Hospitals Trust and shown to an internal conference. Watch and learn!
For those who have not really been following my journey over the last 18 months, this is a summary recorded by Leeds Teaching Hospitals Trust and shown to an internal conference. Watch and learn!
A few days ago I received a text confirming an appointment at the hospital – this was news to me as I had not been advised of the appointment that was now being confirmed. OK, no problem the letter is likely to be in the post. Unfortunately there was no way I would have been able to attend the appointment without MAJOR disruption and rearrangement and as I know there is nothing significant outstanding I opted to text them back (as suggested) to postpone the appointment. Great stuff.
Even greater was someone ringing me later to rearrange the appointment and offering me another only 3 weeks away. Great stuff.
Today I got a letter:
“Due to unforeseen circumstances your appointment has been rescheduled. Please accept our apologies for any inconvenience caused.”
I haven’t yet had a letter about the original appointment and it would be slightly churlish to comment on the rearrangement. So I am going to be slightly churlish. It’s a minor thing, but the wording suggests that the hospital had to reschedule and are apologising for that. No, I rescheduled and I would simply suggest a small tweak (an additional letter) worded appropriately for the situation.
It’s in no way life-threatening but it is yet another, admittedly minor, example of not really being as patient-focussed as is the expectation. To be fair, this little exchange gets 9 out of 10 (which is MUCH more than some earlier exchanges) but the extra point is the one that makes the difference. Good stuff could easily be a bit better.
I have been delighted to spend most of today in the highly pleasurable company of 25 committed people working in the opthalmology team at Leeds Teaching Hospital Trust. We were working on how to improve the patient experience in their department, with me volunteering my time to the process as a patient representative.
I was delighted to be involved, having been fairly vociferous about the weaknesses (whoops, improvement opportunities!) that I came across during my recent journey through their system (not opthalmology though). Not being one to just complain (and I nearly lodged a formal complaint at one time, before realising that complaining would only lead to effort being committed to investigating my complaint rather than actually making improvements), I offered my services as both a patient and someone who claims to know a fair bit about organisational change and process improvements. That offer was taken up and so far I have been filmed telling the story that is contained in previous blogs, I have helped redesign some customer letters. Now the real hard work starts.
LTHT is one of just five trusts in the country chosen to pilot an approach to process improvement imported from Virginia Mason Hospital in Seattle. In turn they have adapted The Toyota Way – a highly structured approach to continuous improvement. LTHT are putting the patient at the forefront of their efforts in the belief that by getting this right, other things (including costs) will fall into place. That they are taking this philosophy to heart was evident by the warmth with which I was received and the attention that was paid to my observations and suggestions. From my perspective, ‘patient first’ is a major shift and challenge in an industry that has traditionally been medic-led and where the stereotype (and all stereotypes are rooted in some reality) is of patients being called for the convenience of the staff not the patient.
A further aspect of the methodology (now branded “The Leeds Way”) is expressed as ‘Inch wide, mile deep’. Rather than looking widely across a process (‘mile wide’), they choose relatively tiny little areas (‘inch wide’) where improvements would have a big effect and study them in huge detail (‘mile deep’). So today we had a look at the core of the outpatients process (in their jargon – Pathway), searching for those few inches that needed deep study. We found them, and what was a delight was to find that the key areas of study related to minimising patient waiting times. The data was compelling – for new patients, they would typically spend around 90 minutes in the department, only 30 of which were actually spent with the specialists they had come to see; so of my 90 minutes in the department I spend a whole hour waiting for something to happen! Definitely room for improvement.
Lots of detailed investigations needed before further review by the team. However, my purpose here is not to delve into the detail of the improvement process so much as to praise the approach. Not only the approach of the improvement team and their methodology but perhaps even more the openness, creativity and enthusiasm of the range of people in the room (ranging from me and a volunteer through to General Managers, Clinical Directors and no less than the Deputy Chief Executive/Chief Nurse). Worthwhile and sustainable improvements tend to be made by those directly involved in the processes and I feel that people left the room enthused, committed and somewhat more empowered than they arrived. Job well done.
Earlier today the (D)Efra Committee published its review of arrangements for flood risk management. I posted my initial response on Facebook and I stand by what I said there – essentially that the call for a new strategic authority and ‘floods czar’ is misguided. This piece explores more of the issues.
There is a real risk that the report is seen as either a knee-jerk response and/or politicking, yet there is some good (if not novel) stuff in there as well as at least one major flaw.
First the good. Well, that is the vast majority of the recommendations. It’s always good to have p(P)olitical backing, but let’s not get the idea that any of these recommendations are novel. Numbers 1-7, which are the obviously ‘operational’ ones are already developing here in Yorkshire and were long before this report was ever thought of.
The idea of a whole-catchment approach mirrors that of the Catchment Based Approach that Defra set up and funded for ‘environmental’ concerns and bringing those two approaches to catchment management closer together is one of my key aims.
Storing water and land management is a no-brainer, although I remain to be convinced that we should compensate farmers (especially) when the flood plain that they own gets flooded. After all every time it floods they get free fertiliser and soil and owning a flood plain surely means that you understand (Or should do) the issues. So many of our flood plains have been commandeered for other uses and I can get quite frustrated when people complain that their local flood plain floods.
Sustainable drainage systems – it’s taken at least 30 years since the water industry started funding research for SUDS to become mainstream. It’s about time that developers were compelled to install best practice SUDS whenever development of any size is undertaken. Every little bit helps. I believe that much greater emphasis now needs to be placed on retro-fitting SUDS. We have millions of hectares of hard standing in our cities and our roads and by adopting the ‘every little bit counts’ philosophy we can slowly but surely make inroads.
Maintenance and dredging – a sensible recommendation but I feel that insufficient emphasis was put on the very limited usefulness of dredging, especially after the then Environment Secretary, Liz Truss, effectively gave farmers and IDBs carte blanche to dredge in her knee-jerk reaction to the 2015 flooding.
Flood warnings and public understanding of risk – Whilst I have put these two recommendations together, the first is primarily technical and the second to do with communications. Nonetheless they are sides of a coin, without the former we cannot effectively deliver the latter. The key issue is one of active engagement at all times. The history of the EA, which I acknowledge is changing albeit very patchily, is one of ‘Decide, Announce, Defend’ and this has left a legacy of mistrust. They have also tended, IMHO, to consult rather than engage and only to do so transactionally and late, rather than recognising that collaboration demands ‘upstream’ (sorry, but I could not resist!) effort to build trust and understanding in order to be able to reap that when needed.
The rest of the recommendations are clearly relevant at a national strategic level and all except the last make absolute sense and should be acted upon as soon as possible. However, I take exception to the suggestion that a new governance model be created.
There are certainly multiple agencies involved in FRCM and whilst these all need to be involved, I fail to see how creating a single national FCRM body helps co-ordinate them. We already have such a body – the Environment Agency – and my personal and local intelligence suggest that they are doing an increasingly good job in trying circumstances (for which read ‘shortage of funds’). I might argue that a desire to address a democratic deficit has led to a proliferation of agencies with responsibilities, to the detriment of strategic planning. Only a cynic (moi?) would suggest that this also pushed spending and spending decisions out of the hand of national agencies and so allowing government to have an arms-length relationship with these strategic challenges.
Finally, separating the ‘environment’ and ‘flooding’ arms of the EA risks fragmentation of addressing ‘watery’ issues. There is already a, fortunately closing, gap between the two arms of the EA and separating the functions can only make it even more difficult to identify and deliver the collaborative multiple benefits that are undoubtedly available when we work together.
A useful document that doesn’t add much in practice!
I was just watching a BBC Breakfast item about Aberfan. Now if that name means nothing to you then you are probably less that 60 years old. For those of us old enough to remember, it was probably one of those iconic moments in your history that you remember more vividly than most. It certainly is for me.
The item was about the 50th anniversary of the disaster which was a catastrophic collapse of a colliery spoil tip in the Welsh village of Aberfan, near Merthyr Tydfil, on 21 October 1966, which killed 116 children and 28 adults. The tip slid down the slope right into an through the primary school and the film footage (very little outside broadcast in those days) showed hopeful but unexpectant men digging and women waiting to hear of the fate of their loved ones. All those mothers waiting outside the school still bring tears to my eyes, as did watching the item and the old footage.
I was intrigued by the unavoidable tears prompted by the memory and in turn the link between emotion and memories. It’s well-known that linking emotion to events helps consolidate them in long-term memory and enable retrieval. (For once, I am going to give a Wikipedia link, because it has an excellent summary of the field). This works in all directions – positive events, traumatic episodes – and one of the ways we work with clients using NLP techniques is to dissociate a traumatic memory from the emotion, thus helping people overcome phobias and to move on from ‘difficult’ situations.
Likewise the idea that it is ‘better’ to give experiences than things, on the basis that a positive experience is more likely to be remembered than some bit of plastic tat that ends up forgotten in the back of the garage.
So how do you create, for yourself or others, events that have some positive emotional content? Fill that memory bank with positives.
Oh what a mistake!
One issue that does need addressing is a low testosterone level and on 22nd August I got a letter offering me an appointment with the endocrinologist to discuss this. Unfortunately I was due to be on holiday on the scheduled date (13th September) and so rang up noting on my copy that I had explained the position and asked for a postponment until after 19th September when I returned from holiday.
Today I rang up noting that I had heard nothing about a rearranged appointment and wondering what was happening. It turns out that my notes said I had cancelled the original appointment and so I was now at the back of the queue. Well, I suppose that saying I can’t attend is technically cancelling, but at the same time explaining why and asking for a rearrangement surely amounts to asking for a postponment? It seems not. The subtle distinction between “I do not want to see the Dr” and “I cannot see the Dr on the date you suggested, please can you arrange me another appointment” appears to be lost on the system at LTHT. Patient-friendly it is not.
Dr Murray’s secretary agreed to look into getting me a new appointment only to find that the first available one is on 3rd January 2017. Really!! So I asked her to have a word with Dr Murray, relating how long I had been in the system, with a view to finding an earlier appointment. I am not hopeful.
Fortunately this is not an urgent issue, and once again the clunkiness of the system is sadly exposed. I’m intrigued to see that one of LTHT’s core values is described thus (my bold):
Well, the first of these is certainly delivered, but they have a long way to go to deliver the second!
When my surgeon’s secretary rang last week to rearrange my surgery, I just about recall her mentioning a possible need for a further scan. Well, with less than 48 hrs to go before going under the knife, I had heard nothing and assumed that he had decided otherwise.
Imagine my surprise to have a call this afternoon from the booking service for Radiology (who do the MRI scans) saying something along the lines of ‘We have just found this request for a scan and would like to book you in”. Temporarily holding back my frustration I offer immediately this afternoon or Thursday (tomorrow) afternoon. No can do – we have no slots this afternoon and we only offer 0900 appointments. Well my restraint was under severe strain by now, so I explained as politely as I could (I do hope it actually WAS polite) that after rearranging my life three times for surgery that has yet to happen I had scheduled one thing in the morning that I really did not want to move and how hacked off I was with the whole process. Well, for once I did not get the ‘computer says no’ treatment. The nice lady (sorry, I did not get your name) asked if she could go away and see what was possible, maybe even arranging it for the morning of my surgery.
A phone call less than 10 minutes later and i was offered an appointment for 1800 today! Who knows what happened behind the scenes but thank you someone for meeting a patient’s needs, albeit 2nd time round.
Amidst all the gloating, rage, disappointment about the referendum result, my great friend James Traeger reminded me, by posting this blog, that I am a change leadership professional. So here is a short piece reflecting on the outcome from that perspective.
There is a view that many of those voting for Brexit were essentially casting a protest vote. Protest at austerity, protest at uncontrolled immigration, protest at who knows what… What they are saying is that they have not been heard. As a good change professional (well, I think so anyway!) I need to recognise and be able to work with the difference between hearing someone and that person being heard; the difference between my ears listening to the words and my heart and brain listening for the meaning. I need to seek out and learn from the naysayers and the resistors, for sooner or later their grievances will surface and get in the way of progress. Listen to them properly, explore with them what lies behind their position, for only then can we start to change their minds.
We are also repeatedly told that effective change relies on a positive vision of the future. It is not enough to say what is wrong, we need some idea of what might constitute right. Yet here we are with a campaign about getting Britain out of the EU. Where is the compelling narrative of the future? Where is the roadmap for change? Where are the guiding coalition, the leaders? And where were the leaders who could understand and articulate the interlinked, systemic, nature of the argument (shame it wasn’t dialogue)?
Effective change leaders acknowledge the past, picking out and retaining the good whilst changing the bad. Not here, the baby risks being thrown out with the bathwater.
Finally, and for me this is almost above all else, effective change leaders are honest and humble. They don’t make promises and then change their minds; they don’t pursue their own agenda at the expense of the greater good; they recognise where things have gone bit dodgy and set about repairing the damage…
Oh, for politicians of any hue who have studied and practised effective change leadership!
Waking up at 0500 my wife whispered in my ear that it looks as if the majority have voted to leave the EU. I can hardly find the words to express the whirl of thoughts and emotions running through my body at a decision that leaves me wondering what our country has come to that we have a majority of voters who believe we can return to greatness by separating ourselves from one of the largest trading and social blocks in the world. I have been disappointed to be on the losing side of general elections, but never as disappointed as this.
The pound is already lower than for 30 years and I hate to think what will happen when the stock exchange opens. The years of instability we now face while trying to disentangle ourselves from the EU and negotiate alternative trade deals around the world. will hardly encourage inward investment (not that the Little Englanders will want that, after all those foreign Johnnies had better get their nose out of our business) and will likely lead to yet more of the bloody awful austerity that was not caused by the EU but by the greedy banking classes. Egocentrism wins.
I am sad that so many people think that closing our borders to people who make a net contribution to the economy is a good thing and just hope that those countries in which so many of our friends and relatives now live are not so small-minded and will allow them to continue living there. Those emigrants relying on incomes based in sterling have just had their incomes cut by 10% overnight, I doubt that they will thank you for that.
Isolationism has never been a good thing.
I’m trying to fight off my anger at this ridiculous decision, not because I am not angry but because it was anger that led to it. Unfortunately that anger got directed at the traditional enemy – ‘the other’ – rather than the real source of it, our own government and banking classes. For the first time in my life I now start to wonder whether there is a way to bypass a democratic decision. Shall we now pull out of TTIP, NATO etc because they cost us money – but recall that the money will not be spent on the NHS or roads it will be spent propping the pound up in order to make trade with our ex-friends affordable to them.
A sad, sad day and one which really makes me wonder about continuing to live in such a self-centred, little-minded country – but of course why would any other Europen country now want me there either?
Unlike,I suspect, many others, I will be voting in the EU referendum. Moreover, I have a predisposition to vote to stay in based as much on my own biases and prejudices as any hard data. Therein lies the biggest challenge that some of us face. I would like to be able to decide on a rational basis, upon indisputable facts about the various issues at play in what could be a defining decision on the future of our nation. But it’s a political arena and it’s hard to know what’s fact and what’s propaganda. It’s increasingly irritating that the debate (I would rather it was dialogue) is revolving around competing fears of what will happen if we stay/leave.
It is, of course, all speculation for nobody can actually know the consequences of the decision – especially when the consequences rest in the hands of politicians and bureaucrats of dozens of other countries around the world, to say nothing of the multinationals and bankers.
Where to go for this elusive ‘objective truth’? Well, accepting that there is no such thing leaves a hole which can only be filled with whatever sources are available. Newspapers? Each has their own agenda. Broadcast media? Some certainly seem to have an agenda, but what about the good old BBC which is required to be balanced? Well balance seems to consist of allowing equal airtime for opposing views and an attempt to provide independent analysis, but to me they are primarily a vehicle for lobbyists to air their views and I’m getting less and less interested in hearing what Dave or Boris want to tell me, especially when the tone of the debate gets more and more aerated.
So perhaps we can turn to that treasure trove of knowledge the internet? Same story here, what is ‘truth’ and what is propaganda? What about friends – either the real ones or those who simply carry that label on Facebook? Well one who meets both of those descriptions, and whose intellect I have long been impressed with, started posting some apparently objective analysis. But how do I decide it is objective? Academic references and seemingly independent research institutions and think-tanks are subsequently picked apart by others. How do I know they are independent? I don’t, they just somehow seem to be unconnected with the usual sources, but I know no more about their funders that the next man.
I guess where I am going is that, apart from the philosophical position, there is no ‘objective truth. All that exists is a series of more or less biased positions and/or data promoted by individuals some of whom clearly have personal agendas.
How then, do I decide which way to vote? Some (Boris’ camp?) seem to believe that we (the country, or perhaps big business) would be better off freed from the strictures of the EU bureaucracy who they suggest inhibit our ability to make our own decisions about how to live or whether it is OK to sell undersized bananas. One might argue (I do) that they believe in the power of free markets. Others (Cameron?) might want out because they recognise the looming United States of Europe and want to continue believing in a Great Britain that died with the Empire a generation ago. It does seem to me that the long-term vision of the founders of the EU was either hidden from the country when we first voted ‘In’ or our politicians missed it at the time.
Where are the ‘big beasts’ speaking on behalf of the concept of a united Europe? One that is not a United States but which shares enough values and beliefs to keep us from attacking each other for another 50 years; one that values solidarity and communality; one that enables free trade across one of the biggest trading blocks in the world; that facilitates free movement of people across borders that are but temporary artefacts created by politicians?
So in the end I guess I will vote based partly on my preference for the latter philosophy and partly on a belief that the uncertainty caused by exit will be more detrimental than the current dysfunction. For the system certainly needs change and maybe a narrow margin of stayers might give Dave et al a renewed mandate for tougher renegotiation of the way the institutions work.