How Do You Solve A Problem Like The NHS?


There comes a point when numbers get so big as to become near incomprehensible.

Almost five million people are waiting for health treatment in England alone. Almost 1.2m of them have been waiting at least six months for ‘vital appointments’. Some within the NHS say that in reality that number is far, far greater – perhaps no one even knowing the true number.

I’m currently in recovery following an operation that (hopefully) finishes off my extended exposure to the NHS last year. I’ve been in the fairly unusual position of being an in-patient both at the very height of the pandemic in April 2020, and its low point a year and a half later. By no way am I an expert on the NHS but I would say I’ve now built up a degree of patient user experience that I didn’t have two years ago.

So – as a kind of innovation challenge: where would you start with tackling the NHS problem?

First of all – what actually IS the problem? My experience has been uniformly excellent, only ever let down by a creaking admin that admittedly became much improved through technology during the pandemic. However it seems to be true that once you’re ‘in the system’ the system largely works for you. However gaining access to that system , especially if you’re not an emergency, is a hopelessly disjointed experience. And many of the people working within it are simply exhausted – even before the pandemic NHS workers were taking an average of 14 days off sick every year, compared to 4 for the average UK worker.

Perhaps the biggest problem for the NHS is that you can’t have a sensible conversation about it. If you criticise it in any way the assumption is that you want to privatise it.

League tables have been used to support arguments that the UK health service is one of the best in the world – and also that it is a failing system. For most actual users it is neither of these things, so the obsession with deifying the NHS and its employees is actually unhelpful for everyone. The truth is that the NHS is sometimes great, often not so great and sometimes just plain bad— and it’s nowhere near close to the best healthcare system in the world.

Perhaps because we are dealing with multiple problems we need a multiplicity of solutions. In short though, problem solving should be a priority for the NHS – rather than disruptive innovation. As Greg Satell writes in a different context, we have the power to shape our path by making better choices. A good first step would be to finally abandon the cult of disruption that’s served us so poorly and begin to once again invest in stability and resilience, by creating better, safer technology, more competitive and stable markets and a happier, more productive workforce.

The most famous quote (wrongly) attributed to Henry Ford is “If I had asked people what they wanted, they would have said faster horses.” We don’t need faster horses is the cry of would be innovators everywhere. But in the NHS, faster horses are perhaps exactly what we need right now.

The NHS is observably an environment where efficiencies desperately need to be gained – and on tight budgets a lot of that will have to be through marginal gains and frugal person centred improvement – a sort of healthcare jugaad. Jugaad is a Hindi word that roughly means ‘solution born from cleverness.’ It’s usually applied to a low cost fix or work-around. In a culture where people often have to make do with what they have it’s an improvised or makeshift solution using scarce resources.

I’m not saying that we should rule out innovation altogether and only focus on the basics; but a greater emphasis needs to be placed on harnessing and developing ideas and spreading them across the system. NHS employees will tell you of something working on some wards that have been shut down because it doesn’t fit in with the overall ‘plan’. In any complex system there is often a drive to scaling up which destroys some local innovation. ‘Small, localised and spreadable’ is often more sustainable.

It’s also clear when talking to staff that many are victim to the very large number of administrators in the NHS and the urge to keep changing things. Many talk of process changes ‘all the time’ – something that has , necessarily, accelerated during Covid. The effects of this constant change trickle right through the system: employees wake up wanting to do something good and then find there are new regulations and new rules that act as a barrier.

Of course there is a whole other set of problems outside the immediate control of the NHS.

If the primary problem is demand, then that needs to be tackled. We’re living longer, getting fatter and people now have more chronic and complicated diseases. The Office for National Statistics attributes just 5% of total UK Government healthcare expenditure to ‘preventive healthcare’. We need to remove the politics from healthcare and have a sensible conversation about how much of GDP we are going to commit to not just treating problems, but preventing them in the first place.

The NHS has myriad innovation programmes, challenges and accelerators. It’s not for me to judge any of these. However it’s clear that right now there’s a capacity issue meaning the people, services and systems who would stand to benefit most from innovation end up missing out.

So perhaps it’s time for the NHS to focus employees on becoming better localised problem solvers who can work on existing real-world issues that staff and patients face every day.

Revolutionising the NHS is less likely to come from some grand plan and more likely to result from local trojan mice changing small things in big ways, attacking new problems, and spreading new ways of working. Not winning wars but infiltrating new territory.

All of that requires a less abrasive form of politics, a more forgiving internal culture, and a little less hero worship. Not easy to achieve, but absolutely worth fighting for.


Photo by Andy Holmes on Unsplash

Nine Ways To Unlock Creativity In Your Organisation

Inside Housing Deck

Some organisations are obsessive about finding the silver bullet—the one-shot wonder that solves everything. In an effort to strengthen performance, we’ll often make disproportionate investments in a single initiative to invoke change.

Others are fixed on generating ideas – jumping towards uncontrolled creativity as the solution.

However most of our organisations don’t suffer from a lack of ideas, they suffer from a lack of process that identifies the ideas worth having. 

As David Burkus has said – it’s not an idea problem; it’s a recognition problem. And it’s not always about creativity either.

Creativity is not innovation. Creativity is a prerequisite for sure. Innovation, however, is the practical application of creativity.

Perversely, the answer to unlocking creativity isn’t to go looking for ideas – but to go looking for really good problems.

Many of our organisations have a bias towards getting quick answers. We favour execution rather than contemplation. Great performance at work is usually defined as creating and implementing solutions rather than finding the best problems to tackle.

When you’ve nailed the right problems – that’s the time to go looking for ideas.

This on its own though – isn’t enough.

Many of our organisations , without realising it, act as inhibitors of innovation.

Rules and protocols are put in place — often for very good reasons — that preserve the status quo. Over time, organisations develop a set of social norms — ‘the way we do things around here’ designed to protect the business from failure.

The discipline of innovation, and it is a discipline, takes commitment, resources, and the right skills set to challenge these norms.

Inside Housing Deck (1)

Your innovation approach won’t last long unless senior leadership has a deep investment in it. Innovation dies from the top.

At Bromford we’ve tried to focus on problems — those incomprehensibly complex and messy issues that need to be understood and defined before they can be incorporated into organisational strategy.

Once we’ve done that we involve colleagues formed from a horizontal slice of people from around the business – and grouped around non-siloed themesThey are a way of seeding innovation throughout the organisation and beginning a wider cultural transformation.

We also link up with our Data and Insight colleagues to make sure every concept is supported by sound evidence. One of the big challenges of fostering an evidence-based culture is that it requires a shift in thinking. It’s not easy for people who are used to making instinctive gut decisions to transition to a world in which the smart decisions are data-driven.

How do you unlock creativity?

  1. You find space – mentally and physically to translate thinking into practical applications – and to ensure that any ideas that are pursued connect with the organisations overall strategy
  2. You bring people together to conceive, champion, and carefully develop new approaches that have not been tried before
  3. You nurture bright ideas and protect them from the established practices (and the people) they threaten
  4. You open up internal and external channels and become a conduit with organisations, individuals, and ideas outside
  5. You act as a pressure chamber that allows these external influences into your organisation in a safe and controlled way
  6. You use a mix of methodologies including design thinking and prototyping to help visualise solutions
  7. You don’t talk yourselves out of change where it appears too difficult or complex
  8. You build a culture around evidence and inquiry
  9. You constantly strive to ask better questions

Do that and you’ll always get better answers


This is an extract from a talk I’m doing on 29th October on Unlocking Creativity

Photos from Pexels by Jonas Svidras  David McEachan 

The Problem With Finding Answers

Don’t Look for a Great Idea. Look for a Good Problem – Greg Satell

Yesterday I spent five and half hours in a room with my colleagues Carole and Simon trying to get to the root of a problem.

Three colleagues – over 16 hours of valuable time, just thinking.

It was worth every minute. We’d missed at least two crucial questions in our service design and were perilously close to jumping straight to answers.

If you jump straight to answers two things happen:

  • You spend too little time on idea generation, experimenting, and thinking.
  • You can miss the root cause entirely and embark on silver bullet solutions to the wrong problem.

Many of our organisations have a bias towards getting quick answers. We favour execution rather than contemplation. Great performance at work is usually defined as creating and implementing solutions rather than finding the best problems to tackle.

16 hours of thinking time – with no measurable outcome – is likely to be questioned as an indulgence.

At the same time many of us will spend a lot of this week in meetings, most of which will be about creating activity rather than deliberation.

John Wade is surely on to something when he talks about a different kind of meeting where people rarely speak…and if they do they never try to assert their ideas or opinions over others. Maybe we just need more listening?

More Agile, More Problems

One of the issues I have with agile working (which never feels very agile funnily enough) is the presumption that teams using agile methods get things done faster. And fast is always good.

Fetishising speed results in just hurrying up. And once going fast is on the table, things quickly start falling off.

In the social sector addressing wicked problems is never going to be fast. It’s not just about a launching a new app, or customer ‘portal’ (cough).

We need to question some fundamental assumptions about how our businesses interact with citizens. And that may require unearthing some entirely new problems.

Screen Shot 2017-10-25 at 07.53.38

The Problem with Solutions

If we don’t nail the problem, and fully explore idea generation, we put all our efforts into actions.

This looks good in a project plan because it appears to reduce uncertainty.

Right now people are getting a little nervy as Insight and Innovation at Bromford are expanding the range of options to consider. Our list of questions, our multiple lines of enquiry – grow daily.

But if, as Tim Kastelle says, you’re disciplined enough to be able to live with that ambiguity for a while, you usually end up with a better answer to your problem.

Show Me The Data!

Here’s the thing: most of what we know is bullshit.

We presume that the way our organisations’ operate is because of some profound truth or deeply understood purpose – when often we have just built upon past behaviours and (sometimes false) assumptions.

Amazon talk of a truth-seeking culture. Of a belief that there’s an answer to every question and the job is to get the best answer possible. No PowerPoint is allowed at meetings. Six page word documents are read in silence at the start and never distributed in advance. This is to encourage focus, attention and establishing the facts.

In our session yesterday we stopped many times and asked:

  • Is that really true?
  • Do we honestly know that?
  • Where’s the evidence on that?

Building a culture around evidence and enquiry might not sound as sexy as innovation and ideation – but in truth they go hand in hand.

Ask a better question, get a better answer.

Why Collaboration Does Not Equal Innovation

untitled-5-001
Photo credit: Jonatan Pie

Transformation can’t happen without discovery and discovery can’t happen without experimentation.

It’s a new year and at Bromford we are planning a reboot of our approach to innovation (actually we are planning a reboot of everything).

My emerging thoughts are we need less talk of accelerated fast fail innovation and more a systemic and systematic approach to experiments.

Why?

Because innovation is almost never a single event.

As Greg Satell has written it can take decades for new solutions to be adopted widely. People cling to old models out of habit and convenience. Systemwide change doesn’t come easy.

The idea of putting a few people together in a room and expecting them to have some eureka moment about complex problems is , at best, naive.

Corporate away days, brainstorming, hackathons, conferences, unconferences,  all promote the myth that bringing a few random people together solves problems.

It’s good to talk for sure – but let’s stop conflating collaboration with innovation.

Most hacks and conferences do not solve problems – and certainly not big problems. Problems are there for a reason. People are working to solve these problems constantly, spending much more energy and resources than a single group of people ever can.

As part of the programme I’m working on at the moment potential solutions often only emerge weeks, or even months, after the initial creative session.

The reality is that innovation is an ongoing process. A process that requires problem definition, research, creativity and testing. Lots and lots of testing.

Currently only a small proportion of organisations in the social sector incorporate this process alongside the introduction of a wide range of new knowledge, new process and new technology.

Organisations are jumping to the latter. However technology cannot magically mend broken systems or solve intractable problems.

The real opportunity in 2017 is combining experiments with larger scale transformation.

I’m no longer interested in the cheerleading of innovation and transformation as an end in itself. My interest lies in the practical examples of learning and exploration that organisations are able to evidence.

Smart organisations will:

  • Build a portfolio of many different types of experiments from new customer offerings to new business models.
  • View small experiments as a natural constraint to bloated and expensive ‘projects’.
  • Conduct multiple experiments at the same time and be able to evidence their impact and share the learning.
  • Use the governance, scale and resources of transformation programmes to ensure the adoption of proven experiments.

Our job is to set the stage and create the right environment for those experiments.

We need a safe space for exploration. We need permission to cross organisational silos and assemble diverse co-creators. We need to move out of our ivory towers and shift innovation as close as we can to the colleagues and customers who know the jobs that need doing.

Organisational change doesn’t come easily.

A joined-up process of collaboration, research, experimentation and transformation would certainly make it a lot faster.

%d bloggers like this: