Tuesday, 29 January 2013
There's no excuse now to write more how to guides (yes, that includes me!0 - let's get using the guidance we have to make a difference.
The report covers:
Scaling up: definition and underlying principles
Why successfully tested innovations?
A guided process from the outset
Who should use this guide?
Content and structure of this guide
2. An applied framework for scaling up
The user organization
The resource team or organization
Strategic choice areas
3. The innovation
Attributes of innovations that enhance the potential for scaling up
How to enhance the attributes of success and the potential for sustainable scaling up
4. The user organization(s)
Attributes of user organization(s) that facilitate successful scaling up
How to enhance the capacity of the user organization(s) to ensure successful scaling up
5. The environment
How to maximize the opportunities for sustainable scaling up inherent in the environment
6. The resource team or organization
Attributes of a successful resource team or organization
How to ensure that the resource team or organization can maximize the potential for sustainable scaling up
7. Strategic choices for scaling up
Type(s) of scaling up
Dissemination and advocacy
Organizing the scaling-up process
Costs of scaling up and resource mobilization
Monitoring and evaluation of scaling up
8. Strategic planning and management of scaling up are a balancing act
How to create and maintain balance in scaling up
- There are 156 templates available from Jaxworks. I've not checked them all. They do have a US bias but that's not an issue. They cover the entire gamut of business planning and management.
- You can find templates for Pages, and Keynote here.
- There are templates in iTunes which cost around £0.69 for a bundle - not a bad price to save time and to cheer up what might be a dull report or presentation.
Monday, 28 January 2013
|image from plexisinstitute.org|
- Wikipedia has a decent overview of what PD is about.
- The PD initiative is a key resource centre which includes an comprehensive set of resources including presentations, videos, books etc. Most importantly is has many case studies of PD in action.
- The 7 characteristics of positive deviants I'm not entirely certain about the who of PD being the same as the what, but nonetheless, there are lessons to be learnt from both aspects.
- Here is a YouTube list of various videos covering different aspects of PD
- The BMJ had a paper on the topic in 2009 - useful for those who need a bit of theory and credibility to back up what may seem a little "woolly"
The one most important fact of a business, for which there are no exceptions, is "Cash is King".
Even if you think your new organisation you're starting up will be subbed by the Department of Health or some other contract - the same statement holds. You can't pay staff, your telephone bill, you rail-fare etc, unless you have cash in the bank.
Cash is not a promise of work - there are plenty of those that don't deliver/
Cash is not an invoice - though if you're desperate, you can ask the bank to give you a loan against it.
Cash is when the money is in the bank account.
Business planning is essential if you're planning to go on your own. You'll find that the plans have more meaning than any plan you've done for an organisation You need an in year plan and at least a 3 - 5 year plan that sets out your strategies and goes down to the level of cash - in the bank.
To help you, I've complied a list of free templates you can use for your business planning processes:
- There are 5 excellent plans, check-lists, budget summaries etc available from Invoiceberry. As with all plans you'll need to edit and customise to make them your own, but the details are covered in these.
- Microsoft Office has a number of templates for download.. They have a SWOT, 5 yr plan, business plan, balanced scorecard and an excellent waterfall forecasting model which analyse profit and loss, and balance statement each month (remember, cash is king).
- Bplans has templates for different types of businesses - in case you are feeling like opening up a restaurant or a bicycle repair shop.
- Teneric has a comprehensive suite of tmeplates, including a free course on how to write a business plan
Friday, 25 January 2013
Paper: Realist randomised controlled trials: A new approach to evaluating complex public health interventions
Realist randomised controlled trials: A new approach to evaluating complex public health interventions.
Bonnel, Fletcher, MOrton, Lorenc, Moore.
At a high level, there is an ethics issue; to whom does the "good" belong? New ideas often stem from crises, and crises are often either sourced from or produced by competition. When one side creates an innovation, the other side loses.
At a more detailed level, what worries me is that by labelling an idea or activity using words that come with the assumption of good, is that we:
- fail to evaluate whether the idea does what it intends (fidelity; more about fidelity here)
- fail to check whether there are unintended consequences in applying it
- fail to understand the drive of the person or organisation behind it
- urge the spread of a "good" practice, without assessing its value
- just accept; and the more we just accept, the more we open the floodgates to ideas and activities which may no longer be what we need
Thursday, 24 January 2013
It's a little like telling someone who is used to living a life where they can buy designer clothes shop for the best cut in steaks and live in the best areas - that they have to buy from Primark and live in a less desirable area. Obviously this is not an ideal situation. But it is one where the person starts to live within their means. Yes, it means life will never be the same, but if the person doesn't make the shift then they may face bankruptcy and lose everything. Surely it's better to take control and create a new life that is sustainable.
The NHS has a lot of fat in it. There is waste, despite the doomsayers who tell of the end of the NHS due to budget cuts (cloth cutting). This fat often isn't obvious (it is hidden deep within the organs of the organisational body, often in small streaks, but there nonetheless. When I can buy a ream of paper cheaper than an NHS organisation - there is waste. When I or a member of my family has difficulty in getting discharged from outpatients - there is waste.
I'm on my personal mission not to become part of the obesity epidemic. I am pleased to have got through a number of (healthcare...) events without resorting to the biscuits and pastries. Maintaining an exercise regime in the snow is difficult - but not impossible I know that buying clothes two sizes smaller will not cure what's lying beneath them. A radical shift in behaviour is required from me. And so for the NHS - a radical shift in how services are designed to meet the future needs of future patients is necessary. While I commiserate with the pain staff in the NHS are going through, I do hold out hope, as a patient, that eventually the cloth cutting will move on from losing staff to rethinking the way care is delivered.
Tuesday, 22 January 2013
Reason 1: The USA outcomes are worse than the UK.
The IOM has released a new report US Health in International Perspective; shorter lives, poorer health. The facts are stark. US citizens die younger than their peer countries, despite paying more. Crucially, the report suggests that 20% of avoidable mortality is due to poor healthcare (rather than system related issues or behavioural choices). Specifically, the US is worse than many countries in infant mortality & low birthrate, injuries and homicides,obesity & diabetes, heart disease, chronic lung disease.
So why are we copying "solutions" from a system which is providing for worse outcomes than ours?
Yes, it can be argued that some care processes have better outcomes, but even then, there are difficulties. For example, it's widely touted that men with prostate cancer live longer than men with similar condition in the UK. If you look into the detail, yes, US men get diagnosed earlier - but they die at a similar average age as men with prostate cancer in the UK; the US men just had longer with the diagnosis, the treatment and the cost. More details on this and similar topics on the Cancer Research Science Update Blog.
Reason 2: US model is based on cash for activity
The incentive for the majority of healthcare services is to provide more activity as a means of generating more income. This leads to overtreatment. Sharron Browlee's book "Overtreated; why too much medicine is making us sicker and poorer" is an excellent expose on this topic.
I had a debate with a US improvement consultant yesterday about why the NHS may not be rushing to implement rapid response systems in hospitals. We have a different value system, we have a different set of economics, and a different culture about death and dying. Solutions that work in US hospitals may not be the best ones for our NHS. Yes, we still need to resolve some of the underlying issues - but I hope we can do so in a way that fits our own culture, social and economic constraints.
Reason 3: The opportunity for delivering change & improvement in publically (and part-private..) funded health system far outweighs the private led US model.
Even though the NHS is under pressure to privatise part of the healthcare services, the fact that we do have a publicly driven system, connected to social care as well - means we have an incredible opportunity to devise solutions to problems that are truly radical. While we fuss about the speed at which patients are supposed to get electronic access to their records, and how to link them with hospitals - at least we have electronic records. We have register of people with conditions, and many good primary care organisations use these to do their best for the health of their local population.
I sometimes feel that whilst we are in the embrace of US-led improvement and change methodologies we are not devising ones that will make the most of our specific context. A good start is the NHS Change Model, which is sufficiently bland yet comprehensive, to provide useful and reasonable guidance for change. It's not earth shatteringly clever - but it is one for the NHS, by the NHS, and I believe will be helpful for the NHS.
Sunday, 20 January 2013
The briefings can be managers with their teams, or groups of managers - I like the idea of the Executive team holding an end-of-day briefing session.There are both advantages and disadvantages to holding one, though the only disadvantages I can see are ones about timing.
- Reflection on the day's operational activities
- Reflection on personal contribution to the day's operational activities
- Highlight priority issues
- Ensure priority issues don't fall between the management gaps
- Improved communication skills
- Improved meeting skills
- when is the end of the day for managers (though a briefing can be held at 4:45 for 15 mins)
- perception that the briefing gets in the way of other meetings
- poor briefing skills means it turns into a long meeting
Tuesday, 15 January 2013
To celebrate, here is a poem that for me fits also in the innovation and improvement workplace. Poetry is about disconnecting the brain and triggering feelings. Does the poem below mean anything to you? What can we learn from it about how it feels to be an innovator?
Friday, 11 January 2013
My January 2013 Thought Leader of the Month is Paul Levy.
There are five articles in my thought leadership series:
- What or who is a thought leader
- Being a thought leader
- Organisations as thought leaders; some healthcare examples
- Medical Thought Leadership
- Thought Leadership 2.0
Tuesday, 8 January 2013
|Graphic from Indiangroup.com|
I've been saying for some years that the Roger's Diffusion of Innovations version of an opinion leader is well out of date (the book was first published in 1984). Many peer reviewed papers continue to reference this outmoded version of opinion leadership, without considering how social media and other technology based platforms has changed the opinion and thought leadership landscape.
- Active on Twitter; engage in conversation, retweet others (without making them your own), share useful information and links
- Participate in LinkedIn groups; specifically those groups within your thought leadership domain
- Host a Facebook Page, or two
- Maintain a personal blog and update it on a regular basis
- Guest blog for other influential sites / people / organisations
- Host your own podcast / video series
- Guest on others’ podcasts or video
- Use other social media sites such as Foursquare, Google+ etc
- What or who is a thought leader
- Being a thought leader
- Organisations as thought leaders; some healthcare examples
- Medical Thought Leadership
Sunday, 6 January 2013
Previous articles in this series include:
Friday, 4 January 2013
Thursday, 3 January 2013
Book Review: Rippling; how social entrepreneurs spread innovation throughout the world. Beverley Schwartz 2012
This book is about large scale change and transformation. It's neither an academic review nor a pop-science polemic. Instead it covers the stories of real social entrepreneurs as they create and implement systems changing innovations.
The book provides a number of case studies and draws out some guiding principles and lessons.
Advice on being a social entrepreneur includes:
- "Take responsibility for your life"; this is about getting out there and up there with what you believe in. It's about taking your ideas and working full out to find sponsorship and to convince others. It's not about "selling" a corporate idea within the corporation, although the way social entrepreneurs influence provides useful lessons.
- "Remain objective". This sounds really odd but the essence is to avoid falling on love with your idea so much taht you're unable to see it's faults and end up defending it when others try to improve it. It is about focusing on the benefits to others - note: to others, not to yourself or your organisation.
- "Do something"; social entrepreneurs are not thought leaders or academics. They are people who get things done and they do this by marshalling their own resources (internal and external) and expending personal energy on keeping the action going. They are in for the long term and demonstrate remarkable consistency of purpose. They are 'doe-ers'.
- "Solution"; They are entirely solution focused. They constantly work to find a solutions to keep their work moving forward. They tend not to use the language of "problems" or consider problems as barriers - instead they are the opportunities to improve and speed up implementation. Sounds a bit obvious and trite - but the case studies in this book demonstrate this.
Wednesday, 2 January 2013
- What is my POV and why have I chosen to read this?
- Who funded the work and how might this present itself in any bias?
- What has been left out of the paper (by methodology)?
- What terms are important in this paper and do they fit with my definitions?
- What can I learn from this paper; how does it confirm my views or bring me new ideas?
- What similar papers are available that I’d like to follow up?
- How credible is the author/s? What might be their biases? Does this matter to me?
Gandi had a saying that you need to "Be the change you want to be". So if you want to be a thought leader, you need to be one. Obvious, yes? No, it isn't. I know some people who call themselves a fisherman but fish only once a decade, or they say they are a writer of novels, but they've yet to do more than the first chapter. To be a thought leader takes effort and invest in being one.
Tuesday, 1 January 2013
- anyone who chooses to influence on a specific topic
- who doesn't have the responsibility to implement the ideas
- who is recognised by others as having influence on a specific topic
- who has something to gain from hereir influence