My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Lunchtime talk to management staff at University College Hospital London (UCLH)

Filed Under (Culture of the NHS, Reform of the NHS) by Paul on 12-05-2009

Once every couple of months the management staff of UCLH ask an external speaker to talk and lead a discussion. In April I gave a presentation on the lessons that Darwin can provide to the management of large institutions at times such as now, when the environment turns a bit difficult.

Darwin’s lesson to all species is that however big you are, the environment could change so rapidly that unless you are very adaptable to big or little change in it, you might find yourself extinct. The fittest, who survive in Darwin’s terms, are those that learn to act upon those changes the quickest- those that become the most adaptable to environmental change.

The problem for some large organisms (organisations) is that they can think that they are bigger than the environment. In terms, they ‘make the weather’. Its quite likely that Wall Street banks felt that up until the summer of 2008. They created the economic climate and were ‘in charge’ of the world economy.

Since that didn’t work for something the size of the US economy, it won’t work for the NHS.

Health systems even ones the size of the NHS, need to understand and adapt to their environment.

Once you come to the important realisation that your are smaller than the environment around you, the first thing you need to do is find out about the changes that are taking place in your environment.

Given the size of the staff in most NHS organisations, they are plugged into much of that the environment and have the opportunity to learn about all the changes that are going on in the world. Crucially the wise organisations seek to learn from this and celebrate the difficult messages that can be brought in.

Second the centre of the organisation (the brain of the organism) need to constantly try and understand what is happening from all of these different inputs. Is this a big thing or a little change? Will the big change whither and die or will the littlie change become an historical trend? Thinking about all that data is vital. Reinterpreting it in the light of all the new data must happen all the time.

Third the organism (organisation) needs to act on the thoughts that come from the data. It is this that many organisations (organisms) fatally leave out. This environmental data is more than interesting; it needs some activity and change in the way in which the organisation is interacting with the environment.

Fourthly it needs to evaluate what the action is achieving. Did that work? Was it the right thing to do? Should we do more of it or less?

The discussion at UCLH for middle and senior managers was lively as they understood the importance of keeping much closer touch with the speed of change that was taking place. They recognised that it was important even for a hospital that was as large and successful as UCLH, to change and develop in relationship to that environment.

Given the change in the average length of stay in hospitals what will be the core business of a major hospital in 10 years time? How much that is actually carried out as outpatients today, will actually take place in hospital in 10 years time?  What proportion of GDP will be spent on health by that time? And what proportion of health spend will be spent in hospital?

Institutions that are ahead of these changes will thrive. They need all their staff to be empowered to bring messages about change into their hospital to learn about what is happening.

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