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There’s something we need to discuss.
There is a word. To be honest, it’s a word I’ve never liked but I didn’t realise it produces so much angst.
[The word has arisen out of my skirmish with Whipps Cross, who have charmingly invited me to visit them, which I will do, next month and I'll tell you how I get on.]
It’s a word that has the same effect as scraping finger nails down a chalk-board.
It's a word capable of producing its own misophonia? The word is...
Transformation.
'Transformation' has become detached from its meaning.
If you transform a caterpillar, you get a butterfly.
If you transform a landline telephone system you get aggro wth yer kids and social media.
If you transform the NHS, what exactly does it become?
A different NHS? What’s that? An insurance system? A technology company? A public health agency?
Nobody ever says because no one really knows. Not even the people wearing the badges.
The word is used as if it means improvement. It doesn't. It means 'fundamental change of form', not necessarily for the better.
Most NHS organisations don't need a new form. They just need to work properly, on time, safely, reliably.
Patients are not asking for transformation. They are asking…
- answer the phone,
- see me on time,
- diagnose me quickly,
- treat me safely,
- discharge me properly,
- talk with me.
Staff are not asking for transformation. They are asking for…
- enough colleagues,
- working equipment,
- functioning IT,
- decent leadership,
- sensible priorities.
None of that is transformation. It's competence, and that’s probably the uncomfortable truth.
For over 30 years we've dressed up improvement in ever more elaborate language.
We exhausted the lexicon...
...modernisation, reform, transformation, integration, reconfiguration, system working… place-based care and now neighbourhood care.
None of it has or will, make a blind bit of difference.
What matters remains stubbornly simple.
Can the organisation do today's work well?
Can it learn from yesterday's mistakes?
Can it do tomorrow's work a little better than today, and…
… that's why ‘transformation’ and all the other management mumbo jumbo words are distractions.
Improvement means doing the same things better. Safer, faster, simpler. More reliably. Most healthcare falls into this category.
Transformation means doing fundamentally different things in fundamentally different ways.
The arrival of antibiotics was transformational. The arrival of MRI scanning was transformational. Electronic banking transformed banking.
Genuine step-changes. Yes… but, replacing one management structure with another, creating a new board, merging departments, changing reporting lines or rebadging services is just, reorganisation.
The NHS has so often confused reorganisation with transformation and every hour spent discussing transformation is an hour not spent fixing something.
The irony is that genuinely transformational technologies such as AI are now emerging just as the NHS is talking about transformation programmes taking us back thirty years.
AI could be transformative... when it takes over but... we don’t a have the money, the systems, the governance, or the headroom, to get near it.
Until then, we just need to get better at what we already do.
The NHS doesn't need transforming nearly as much as it needs running properly.
It’s not as glamorous as 'transforming'.
Running places well is the opposite, it is unglamorous, it is a grind, it is mind numbingly repetitive.
We don’t need flashes of brilliance… we need flashes of the blindingly obvious.
We need to obsess over the quality of the front-line experience… for the people doing the job and for the people we do the job for.
The only 'strategy' should be execution… figuring out;
- what we want to do,
- putting things in place to get it,
- first time,
- all the time,
- every time,
- until we don’t want it anymore....
...that’s not transformation, it’s consistency, which is the secret to quality.
It’s the power of acknowledgement; saying thank you, listening.
It’s the ‘soft stuff’, which is the hardest to do but it drives improvement, productivity, and enthusiasm in a way that ‘transformation’ never will
We don’t need a revolution, we need five simple things…
- Face reality.
- Get close to the work.
- Fix the small things.
- Look after the people.
- Be relentless.
This is the hard, unglamorous work of getting serious about getting better.
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