Saturday, July 1, 2017

Insanity ...or not?

What changes the delivery of healthcare? Is it the structures? The breaking of financial silos? Or is it the quality of folks leading the latest organisational body? Healthcare has always fascinated me, nothing more than the approach we have towards success of leaders. To many, success is ethereal but surely legacy at the very least should be the ask post any leaders tenure.

What has always intrigued me has been the approach towards these structures- if you take a step back, the concept of whichever organisational design you look at is based on a simple principle..."working together". Take vanguards, STPs, ACO... you can criticise them, think it's all wrong but strip away the rhetoric , the political table tennis- and in its essence it's supposed to be about all healthcare professionals., organisations working as one big happy family. The problem invariably arises when the money is linked with a decreasing trajectory, not in line with a changing population --and in simple maths term, when that happens, someone has to lose- and folks retreat back into their organisational boundaries.  The thing the NHS does is to move to another structural redesign in the blind hope it will help yet forgetting perhaps simple human factors.

In my experience, for what it's worth, any redesign, model of care etc is worth not even the value of the paper it's printed on if you don't have someone who can deliver it- whether that be by sheer determination, charm, clinical nous or whatever. It hardly matters what system design leaders come up with..if you haven't got your  clinicians convinced, it's dead in the water. Think of a football team..the coach has a vision, wants to force it through, the players don't believe in it....that team invariably falters....simply because you didn't get the players to believe. It's a fundamental principle we seem to ignore time and again in the NHS. To labour the point, let me give you an example of diabetes. 90-95% is delivered by primary care- with GPs being key to process. It doesn't matter a dime if you create a model - however signed up the specialists are- if the core workforce doesn't believe in it. You discuss the model first, get sign up...and the you do it....we, in the NHS, specialise in doing so the other way around. And then we wonder why project X never worked.

This brings me back to the structures. Is there any point in changing structures if you have the same people leading them- just with a different title or lanyard? If they haven't delivered in their previous role and haven't got the workforce to believe in them, how can they deliver in this new role? What has changed? Just the structure....what hasn't changed is the individual, their ability to deliver or not..or indeed their reputation with the wider workforce. So why will anything change? 

Don't get me wrong, this isn't a call to ditch all existing leaders and start afresh but for sure we need to mix it up. I meet bundles of people bustling with idea but not allowed to get into those tiers where they should be. If you want to change the paradigm, you need fresh ideas, energy- that isn't necessarily an age thing, it's just perspective, it's about reputation, it's about legacy..and it's about trying a new approach. 

One of the best cliches ever used is the one about Insanity..as mentioned by that clever fella, Albert....."Insanity: doing the same thing over and over and expecting different results". 
New structures remind me of that...new organisations will falter yet again, if you don't think about who is steering them. Having the same old folks, the old wine in new bottles saga is absolutely fine- as long as they have delivered something, anything and perhaps more importantly holds the respect of the workforce for their track record. 
Without that, we are just doing what Einstein mentioned.

Have a think about it and ask yourself this....if you want to change the status quo, do you think the existing folks can do it? Or could it be you?

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