Article: The Quest for Excellence – Healthcare

In my last blog I highlighted that by tweaking our way systematically and methodically out of a crisis we can collectively reach greater efficiency and major overhauls. Health and social care is no exception to this principle but when they reach a point of crisis there is undoubtedly extra pressure to do it quicker as lives are at risk.

Historically the NHS and current benefits (formerly National Assistance) came about to alleviate suffering from illness for every man, woman and child here in the UK.  A noble and bold move. Many causes of serious illnesses were identified as having simple solutions by way of basic housing, dental care and the introduction of free milk and meals for children at school. The funding for which was available because our nation was not as sophisticated in its needs and following two world wars were of a mindset to help each other out. Whereas in the 20^th century people were grateful for any help at all they received, at the beginning of this century people seem to be more inclined to criticise what it hasn’t the capacity to deliver... yet.

I sometimes think we have become like a truculent child never satisfied with what we have got and unaware of how much it helps to keep us safe and healthy.

It would appear that no one in government or in the NHS or Social Services predicted the effect of a massive growth in population or the rate of technological and medical advances. The result now seems to be that both have a demand from patients that far exceeds the supply of staff or facilities to cope with it at the rate that we, the public demand that it should. There are log jams everywhere for while there are many aids to the disabled and chronic conditions it is very much a lottery as to who will have access to them. In some cases it is down to your postcode, in others it is simply down to a lack of investment to roll it out at all which is incredibly frustrating for the medical science that works so tirelessly to find such solutions. It is also frustrating for doctors who are duty bound to constantly keep up to date with what might be possible but most of all frustrating for sufferers themselves desperate for that solution that has been reported in the media. It can be like placing a meal in front of a starving man but banning them from eating. We are all part of the problem and the solution at the same time.

We, the public, have become very adept at making ourselves unwell and disfigured. Professional dancers and sports people in their quest for excellence actually deform their bodies, people cripple their feet by constantly wearing high heels (occasional use doesn’t have this effect), thrill seekers and speeding drivers often end up in serious accidents as do those who would rather ignore or forget safety measures in the workplace to do things their way. We damage our livers with alcohol, our lungs with smoking, our brains with drugs, we eat too much or too little, do too much or too little exercise and most significantly of all make ourselves anxious and irritable about everything. Some even knock out their immune systems by striving to eradicate all germs which help develop them. Hermetically sealed homes are hardly likely to be a solution.

More people than ever attempt to self diagnose without any training by latching onto one or two symptoms and looking it up only to assume they have something terminal. Most commonly we panic that a simple symptom is an early sign of cancer. Early intervention is vital and yes you should talk to a doctor if you are concerned but the reality is that one incident of constipation is not likely to indicate a serious condition of any kind. Many such symptoms could just as easily indicate something very easy to remedy by tweaking your diet or exercise levels and by not leaping to the worst case scenario in the first place.

Quite a few serious conditions arise from anxiety and worry including heart conditions and mental health problems. In short we can help ourselves by not assuming the worst as an immediate response to one or two isolated symptoms. We can instead talk to a local chemist or phone NHS Direct – it can save many an unnecessary sleepless night.

Your GP is an Operations Manager for your well being

When you consider how many disabilities, ailments, accidents and illnesses the human body could suffer from, aren’t you rather grateful that your GP takes several years to train to learn about as many of them as they can? When you consider how many treatments there now are, aren’t you grateful that it you have a GP has the knowledge to alleviate so many by themselves AND direct you to specialists when required for further tests and treatment? Aren’t you glad that we have consultants that specialise in every area of medicine to get you well?

Your GP is responsible for the whole of your health both mental and physical so when they refer you to someone else, I recommend you go unless you want to get worse instead of better. Given how complex the human body is it is perhaps not surprising that in some cases it can and does take weeks and months to track down the root cause of illness, and likewise to get the treatment right. The important point to remember is that they try their best - if they didn’t there are safeguards in place for them to get suspended or sacked. When a GP does not refer you to specialists they do not so out of malice but most commonly because you do not need it, yet I have come across some who will not accept that. A large percentage of the time the GP is right but of course there are exceptions.

Sadly there are instances of malpractice, of abuse and of misdiagnoses but they are exceptions and what I fear is happening is that overall there is a mindset that takes these examples as being the norm when they are not. Statistics back this up. In all cases it is better to not cross bridges until you come to them. Better to find someone you feel you trust for your health care than to trust no one at all. The majority of health care professionals are safe and trustworthy. They entered the profession precisely because they want to help alleviate and cure suffering.

The reality is that not everything is curable, but where there is no cure the medical profession as a whole work to help manage symptoms and help us to adjust to that reality. The truth is there can never be a cure for everything as we inadvertently create new conditions and nature itself comes up with new things too. However, when we consider what astounding things are possible today compared to 100 years ago, I think we’re keeping pace rather well.

The Government’s part

Successive UK governments, just like the medical profession mean well but over the decades government invention often has had a detrimental effect. Just at that critical point when a patient is about to make significant progress a local facility gets closed, or there is less funding for tests as the priority from government is to deal with the increased instances of a different disease which is deemed to be more life threatening or on the increase.

It is an extremely difficult equation to get right as without early intervention people’s health conditions tend to have a habit of deteriorating. Economy drives in the form of services which are cut depletes morale in health care professionals which in turn can lead to increased stress which can lead to an increase in mistakes. Even managers get confused by edicts from government;  access for funding for one area of medicine gets switched back and forth all the time in reaction to demand. Procedures get changed, priorities get changed particularly when it comes to administration necessary for record keeping. The effect is that staff often have to adapt instantaneously to radical changes in both finding information and recording it. This leads to delays and further confusion and sometimes missed elements vital for diagnosis and treatment. In effect the changes insisted upon by government can and have added to stress levels, confusion and errors in my opinion. This is not unique to this parliament/government. This is a recurring pattern no matter which party is in office.

I believe this to be avoidable by the simple expedient of analysing what works first and why in as much detail as we do when there is a fault. In my opinion the best place to start to look for trends in ailments is from those who have the greatest level of objectivity in the medical profession, i.e. those who co-ordinate access to all treatments – our GPs. I can think of no other position in the health profession that is more aware of the most common ailments, and of what is likely to become more common either. If we want to stop being reactive and start being proactive to anticipate future demands it’s best to get the most relevant information we can as a starting point isn’t it?

Change is necessary

With increased awareness of illness come increased demands upon health care. With the mandate to prevent illness demand increases as it does with an increase in population; all come with added need for funding, more administration, more staff and higher levels of training requirements. Most of all it results in a greater need for more facilities – not less.

Like the government the NHS is responsible for just under 60 million people’s health in the UK regardless of those who can afford private health care, because it will mostly likely be an NHS A&E department you will be taken to first in an emergency and most commonly in an NHS ambulance. Even if you have private health care the standard of excellence in some areas of the NHS is such that it is their professionals that you will get referred to for treatment in their facilities. I think it only right that it is the NHS itself that dictates to government what its priorities are, but it can only stand a chance of properly assessing that if it has a chance gain the head space to enter into that process of diagnosing its shortages itself first.

In my opinion it desperately needs to stabilise what is already working first for the sake of its hard working staff and their health, but more crucially for the sake of the health of its patients. No private health care provider in the UK has the remit of looking after the health of 60 million people other than the NHS. Therefore no private health care provider could possibly have experience on how to do it. That is not to say there are not brilliant ideas to learn from private health care though. 

It is nothing short of a miracle that the NHS has and continues to cover so much. It puts me in mind of scientists trying to work out why a bee can fly as for years they were baffled by it. Bees seemed to defy all known laws of aerodynamics and yet they flew. So perhaps it is to science and mathematics that we should turn to find out how the NHS manages as if we understood that it would help to build upon its already marvellous achievements.

Do not stop seeking help when ill from the NHS, but do try to be (pardon the pun) patient. When any of us are ill it is often the hardest thing to do, but hard never means impossible. I’ve never worked for the NHS, but I doubt I would be alive today without it. When seriously ill, I have made matters worse sometimes, been demanding, angry and frustrated. It is very much the nature of us all to do so when we are at our most vulnerable, but by working with my medical team instead of against them my health improved. We can always help each other to improve everything we value and nothing on this Earth is as valuable as our own health. Cherish it, and above all take good care of it. 

"Keep calm and carry on caring!"

Operations File: The Art of Tweaking - 10 Steps to Efficient Working

There is no question in my mind that the smaller an organisation the easier it is to review, assess and analyse faults and identify inefficiencies. The fewer parts there are in any machine or system the fewer points of failure it can have or develop. It becomes a relatively quick process to fix a problem, to reorganise a system, to develop it or add and expand it.

Faults, spanners in the works, inefficiencies can only be in a limited number of places in the smaller enterprise operating in isolation. For larger concerns (including government departments and banks) such challenges become ever more complicated to nail down to just one cause as several factors are always in play at any one point. Put simply, problems multiple proportionately according to complexity of the systems devised. This situation is exacerbated when prior expansion plans were not thought through or could not predict excessive demand and no contingency plan was considered.

Leaving aside health and social care (the subject for a future blog) this blog outlines the basic principles for any other organisation. The reason to separate health and social care is because the effect of changes are far more complex as real lives are at stake and the entire history of such services has to be taken into account. It merits a more detailed understanding.

Signs of overload

Hands up all those who have encountered difficulty getting through to the right person in the right department to resolve a problem; from supplies of raw materials to contractors and delays in applications for funding, loans, getting repairs done and all manner of bureaucratic tick boxes to wade through – all hold us up in our endeavours. This is nothing new, the only thing that has changed is our lack of patience. I am no exception to this at all though I do try to be.

With increased demand comes a higher risk of inefficiency, mistakes and delays exponentially speaking. With increased inefficiency comes an increase in frustrations, complaints and overloading systems and ultimately... collapse. The solution is to calm down. The expedient to deploy is forward planning.

However when a crisis occurs forward planning is not the priority and if no contingency plan has been anticipated for any particular situation it can result in a recipe for disaster. The only way to cure inefficiency is to work methodically through all the following steps.

10 Steps to Cure Inefficiency

Step 1: Identify areas of high risk of overload – they are your priority.

Step 2: Identify specific labour intensive, time consuming tasks – they are areas that need attention.

Step 3: Look at the whole system to see if some faults are occurring everywhere – if so do they have the same root cause?

Step 4: Identify where and how duplicated effort occurs and why – opportunities to simplify should start to become self evident.

Step 5: Identify what still works efficiently and why – you’re going to need to protect it to continue to work.

Step 6: Research ways in which to simplify tasks and reduce duplicated effort that will suit your workforce and its way of working – there’s no point trying to get staff to work in a way that causes stress or worse, disinterest – and discuss options with all staff.

Step 7: Propose a 3 phase plan of action to the workforce and amend according to priority of need for each and every department.

Step 8: Finalise plan of action and set target dates for each phase.

Step 9: Monitor, review and adapt each phase as it is being implemented.

Step 10: Start planning how the new system can be modified and developed for expansion and don’t forget to design a contingency plan to prevent panic should it need to downsize – it substantially reduces risks of stress which enables people to adjust more easily.

All this sounds simple but in practice it requires the full co-operation of everyone, patience and commitment. Just a surgeon wishes to avoid snagging a lung when operating on a heart, success depends largely on NOT disturbing what works as little as possible. The key steps I find that commonly get glossed over or totally ignored are Step 5 – identify what does work and why, and Step 6 – research and discuss with staff. You can delegate or take the first 5 steps in any order it you like, but ensure you do them all thoroughly. 

In one overhaul of systems the instruction came to me to “change everything!” This came from staff and managers alike. What followed was the eradication of duplicated tasks by different departments, increased access of information that anyone needed to do their work. This didn’t mean all information was made available, merely that which was relevant to each department with the addition of overviews from other departments.

During the transitional period staff found that they had to relinquish some responsibilities and take up new ones, but by asking staff beforehand this was achieved amicably so that it all worked out rather well. It did so because things were not such much overhauled as methodically, systematically tweaked into working at every stage of the process across the whole operation at the same time. The result was an overhaul. Everyone was behind it because they totally understood both the risks and the benefits throughout the process.

The practicalities of tweaking is more of a specialism of the staff than managers in practice but only when managers are on top of the whole picture so that they can highlight pitfalls to avoid and reinforce the long-term objectives. They co-ordinate the whole, but it’s the staff that make it happen. Regular updates are vital during any transitional period so that no one department races ahead before others are ready to. If one department is lagging behind to achieve its targets, the others who are waiting for them should help by teaming up with them which increases unity in any workforce.

Efficiency to me automatically means less stress in the workplace and always entails empowering all parties to utilise their skills to their full potential. Collectively we can and do devise solutions that benefit all. In isolation we can only devise systems that will suit a few.

Hard work need never be devoid of fun so enjoy the Art of Tweaking your way to a less stressful and more successful stress free future!

Founders Thoughts: Where are we heading and why?

The primary reason I am passionate about the arts is that they are the safest of all havens for all our thoughts, feelings and opinions. It is there and nowhere else that we have an absolute freedom to express ourselves regardless of the judgement, prejudice and criticism of others. Whether we share such personal expressions is entirely in our own hands, but I would argue in many ways we are foolish not to because it is the safe outlet for our fears, doubts, outrages, anger and deep concerns. It is also though, the home of our laughter, our joys and most of all our dreams of a Utopian world.

If we take a look at how science fiction has become science fact at an alarming rate this becomes more obvious, yet it is just one example of how the arts can help us. (Stick with me and I'll explain how and why I believe it can help even in business terms). From science facts come new initiatives to help with solving health care, new inventions for manufacturing and every kind of product which in turn inspire the arts to generate a whole new batch of dreams.

Any word in the English language ending in 'ology' is a science (a study of), so the relatively new kids on the block of sociology and psychology also are beginning to play a huge part in influencing where we are heading and why but, their influence is not powerful enough yet to help us to avoid the pitfalls that we as a species keep repeating because we are fallible. All of us are fallible, without any exception.

Sadly the truth is, we will never become less prone to cock-ups unless and until we learn to be honest about our own faults, face the hard lessons that they teach head on to overcome them before we can ever hope to avoid the repeated mistakes of mankind since we learnt to think. 

That in essence is the nub of all our problems in my opinion. No, I am not the Messiah or Einstein but frankly for the mess we've collectively made of things, if I were God I would be throwing rocks at the planet by now too simply out of frustration for not learning from our mistakes.

What I feel needs to happen is for us all to stop, pause and reflect and use our capacity to be logical and ethical to collectively work things out through negotiation and yes, through tough decisions and measures to stand a chance of cracking this eternal knot of boom and bust, rich and poor, famine and feast etc etc. On our side we have information, but what use is it if we are only going to waste it by continually deploying it as a weapon instead of using it as an asset that can help.

Information is power

Scary to think how much information every government has on it's people. In safe hands it should never be a problem, but sadly we can not ever guarantee we have safe hands as power has this nasty habit of corrupting and confusing even the best of us. Perhaps though if the world leaders were to agree to use personal information to help identify people at risk or those likely to commit crimes we might start to get somewhere rather nice. Interesting fact: 75% of criminals are illiterate! Er... hel-lo! So what does that tell us then? It tells us that to reduce crime all we have to do is find other ways to teach people to read, write and count. Viola! One problem could be solved as easily as that.

A question of money

Here we go... This is the most problematic issue of all to agree to get right to be fair to all. As I've stated many times before I have no problem with people earning huge salaries so long as they pay their taxes and sadly some of the worst offenders of all are big businesses including many multi-nationals. This I hope explains why I am so passionate about social enterprises as that model, in it's myriad of forms, I believe is the way forward because... at it's core it means that we can only ALL benefit, simply by giving back to the communities which precisely are what the foundation stones that supports everything we do and supply everything we need to be able to function. It really is (or could be) that simple.

Finally, and this is something I have learnt from psychology, we all have the capacity to imagine ourselves to be as wise as Solomon or as villainous as Hitler. Which do you and your loved ones wish to be? It comes down to a matter of choice and in that choice we can all do a bit to help each other just from our own doorstep, be it at work, in the community or at home with our personal relationships. There really never need be a situation whereby a few are responsible for so much if we all help. It is perhaps the most sad indictment of all that we have awards for what we consider to be remarkable people for their dedication to caring for others. Surely we all should share in such accolades for do we not all have that capacity?

"Never in the field of human conflict does so
much depend upon so few to rectify so much." 

Mel Dixon 2013

Are we a team or not? Do we want to be? More pointedly, do we need to be?