Category Archives: Empowerment

Getting better all the time

I have been delighted to spend most of today in the highly pleasurable company of 25 committed people working in the opthalmology team at Leeds Teaching Hospital Trust. We were working on how to improve the patient experience in their department, with me volunteering my time to the process as a patient representative.

I was delighted to be involved, having been fairly vociferous about the weaknesses (whoops, improvement opportunities!) that I came across during my recent journey through their system (not opthalmology though). Not being one to just complain (and I nearly lodged a formal complaint at one time, before realising that complaining would only lead to effort being committed to investigating my complaint rather than actually making improvements), I offered my services as both a patient and someone who claims to know a fair bit about organisational change and process improvements. That offer was taken up and so far I have been filmed telling the story that is contained in previous blogs, I have helped redesign some customer letters. Now the real hard work starts.

LTHT is one of just five trusts in the country chosen to pilot an approach to process improvement imported from Virginia Mason Hospital in Seattle. In turn they have adapted The Toyota Way – a highly structured approach to continuous improvement. LTHT are putting the patient at the forefront of their efforts in the belief that by getting this right, other things (including costs) will fall into place. That they are taking this philosophy to heart was evident by the warmth with which I was received and the attention that was paid to my observations and suggestions.  From my perspective, ‘patient first’ is a major shift and challenge in an industry that has traditionally been medic-led and where the stereotype (and all stereotypes are rooted in some reality) is of patients being called for the convenience of the staff not the patient.

A further aspect of the methodology (now branded “The Leeds Way”) is expressed as ‘Inch wide, mile deep’. Rather than looking widely across a process (‘mile wide’), they choose relatively tiny little areas (‘inch wide’) where improvements would have a big effect and study them in huge detail (‘mile deep’). So today we had a look at the core of the outpatients process (in their jargon – Pathway), searching for those few inches that needed deep study. We found them, and what was a delight was to find that the key areas of study related to minimising patient waiting times. The data was compelling – for new patients, they would typically spend around 90 minutes in the department, only 30 of which were actually spent with the specialists they had come to see; so of my 90 minutes in the department I spend a whole hour waiting for something to happen! Definitely room for improvement.

Lots of detailed investigations needed before further review by the team. However, my purpose here is not to delve into the detail of the improvement process so much as to praise the approach. Not only the approach of the improvement team and their methodology but perhaps even more the openness, creativity and enthusiasm of the range of people in the room (ranging from me and a volunteer through to General Managers, Clinical Directors and no less than the Deputy Chief Executive/Chief Nurse). Worthwhile and sustainable  improvements tend to be made by those directly involved in the processes and I feel that people left the room enthused, committed and somewhat more empowered than they arrived. Job well done.

A rocky road to success…

MRI ScannerWhen my surgeon’s secretary rang last week to rearrange my surgery, I just about recall her mentioning a possible need for a further scan. Well, with less than 48 hrs to go before going under the knife, I had heard nothing and assumed that he had decided otherwise.

Imagine my surprise to have a call this afternoon from the booking service for Radiology (who do the MRI scans) saying something along the lines of ‘We have just found this request for a scan and would like to book you in”. Temporarily holding back my frustration I offer immediately this afternoon or Thursday (tomorrow) afternoon. No can do – we have no slots this afternoon and we only offer 0900 appointments. Well my restraint was under severe strain by now, so I explained as politely as I could (I do hope it actually WAS polite) that after rearranging my life three times for surgery that has yet to happen I had scheduled one thing in the morning that I really did not want to move and how hacked off I was with the whole process. Well, for once I did not get the ‘computer says no’ treatment. The nice lady (sorry, I did not get your name) asked if she could go away and see what was possible, maybe even arranging it for the morning of my surgery.

A phone call less than 10 minutes later and i was offered an appointment for 1800 today! Who knows what happened behind the scenes but thank you someone for meeting a patient’s needs, albeit 2nd time round.

Migrants, refugees, hordes, people…

Refugees

Refugees

This is a thinkpiece, and perhaps inevitably something of an opinion piece as well, about the current challenges faced by people fleeing for whatever reason from the Middle East.

These people, for whatever other label we choose to apply to them they are all people – mothers, fathers, sons, daughters, neighbours, friends – have all chosen to travel thousands of miles, often in appalling circumstances and at risk to both lives and future financial capacity, to escape a regime that dehumanises them in so many ways. Ethnic cleansing, oppression of women, forced combat status, simply being in the wrong place when an oppressive (and yes I reaise that is MY values surfacing) regime decides to start shelling or gassing or raping and pillaging or abducting women/children/men – add your own reasons for wanting to escape ISIS/ISIL/DAISH. As an aside, why do so many politicians insist on using a label – DAISH or DA’ESH – that is known to be offensive? It would certainly piss me off if every time someone referred to me I was called “tosspot” and I would not be likely to engage with them on neutral terms – here is one explanation from The Deconstructed Globe:

In all of the Arabic countries, ISIS is referred to as DAISH, which is short for ‘Dawlat al-Islamiyah f’al-Iraq wa al-Sham’, Arabic for the Islamic State of Iraq and al Sham (Syria).  What makes the Arabic acronym interesting is that the Arabic word  ‘دعس‘ , or daish, which means to ‘tread under foot‘ or ‘crush‘.   I’ve been meaning to look this up for a while, and I’m glad I finally did.  The Arabic acronym is pejorative and clearly hostile, unlike the English word Isis, which is the name of a powerful Egyptian goddess.

But back to the people massing on the shores of Europe. One might argue how great it is that we have created a culture/economy that is so successful and, by and large, accommodating that people want to live here. Does it have to be a culture/economy that is restricted to those of us living here now? Let’s be honest, much of Europe’s success has been built on the Imperial past of the UK, France, Germany, Austria. An Imperial past that, to be very polite, ‘drew on’ the resources to be found in those far-flung lands where we managed to impose our will. We cannot deny our implicit connection to the oilfields of the Middle East, any more than we can dismiss our earlier pillaging of India, Western Africa, the Caribbean etc.

It was us that drew the lines on a map delineating most of the Middle East. Lines that crossed traditional tribal or other groupings, just as the lines dividing India from Pakistan led to discontent that remains today.

It was us that armed and supported regimes that turned tyrannical and now we find ourselves on the horns of a dilemma about how to support whom in the mess that we helped create.

It is us who, if we believe the conflicts to be religious in catalysis, refuse to remember the death and destruction wielded in the name of Christianity. Crikey, if we think the Sunni/Shia division is baffling then how do we account for the Cathars driven to extinction by ethnic cleansing by a Pope who did not like their particular form of Catholicism.

But back to today’s people and ‘our’ response to the reality that so many hundreds of thousands see themselves living a better life in Europe. Can you imagine yourself so dissatisfied with what is happening where you live that you set off to walk thousands of miles across countries you have never visited, across desert with little water or food, carrying your life possessions on your back with your wife, children, mother, grandmother in your company. The when you get somewhere near your destination – Europe – you find it necessary to pay mmore than your life savings to an unscrupulous human trafficker who packs you so tight in an unseaworthy vessel that your mother slips overboard never to be seen again, your child dies of the crush in a locked below-decks compartment and your wife is raped in front of your eyes by those traffickers who you so hoped would lead you to a better life? Go on, imagine it. I have tears in my eyes as I just write these sentences. These people are HUMANS like you or I, with desires and dreams like you or I, but without the ability to make them happen.

You finally make it to your destination, only to find that instead of the dream you are living in the open air or under a plastic sheet with thousands of others who made it. You are treated as criminals by regimes who you believed were more compassionate than the one you escape. You are held in detention centres while some bureaucrat driven by Political will, decides whether HE thinks it was worth all your sacrifice to get here.

We were happy to accept, even encourage the inhabitants of many of our former colonies to come to our textile factories, our buses, our shipyards, our hospitals. We were even magnificent, albeit probably not magnificent enough, in helping thousands escape the Nazis. Yet here we are making it difficult, and more difficult by the day, for those who look up to us, who value our freedoms to share in them. How selfish. How uncaring that we pay for fences and razor wire to stop a few thousand desperate migrants/refugees/whatever coming over from France. How petty-minded that when Germany has accepted over 800,000 such people we are resisting a few tens of thousands. How ridiculous that we spend millions on arming and training and even bombing one or other regime in the Middle East while we refuse to help those fleeing from the carnage.

Let’s find a way out of this situation that treats these poor people as human beings, that shares our wealth with them (maybe the oil companies could ‘repatriate’ some of the profits they make out of ‘their’ oil to the people in such dire straits) and that positions us as a beacon of human responses to human challenges. We need to address both the cause and the effect, we focus on the effect because it is here in our backyard whereas the cause is thousands of miles away in foreign lands so many of us do not understand.

Refugees welcome in german footballWhat a delight to see German football fans with signs saying “Refugees welcome here”. What a delight to hear of Icelandic families offering their homes to refugees.

And what a shame on us that 67% of the population think that sending the Army to France to restore order is an answer!

And one final question. How much is it costing us to resist the few thousand in Calais, compared to how much it would cost to treat them as deserving humans and find room for them in our so-called compassionate society?

A Manifesto of Possibilities – Set your people free

For some time now I have talked to myself about writing a manifesto for the work I do. This morning’s prompt was “What do I really want or need to write about?” Perhaps the manifesto is forming already.

Empowerment A Manifesto of Possibilities – Set your people free

The answers are out there, the people need to be free. One would think that organisations are there solely for the benefit of some ethereal entity ‘the company’, but the company is there for the benefit of its many stakeholders and without the engagement of those stakeholders it can and will only survive in the short-term.

Mindless, thinking-less, managers believe that if they only set SMART stretch targets that all will be well, without really understanding the individual motivations of the people who work for them but should be working with them. Yes, money does matter in a way, but only in the societal ecosystem we have allowed to be created for ourselves; how much more inspiring is the possibility of an autonomous response to great leadership challenge. “Set your people free” applies not only in its original context but also to those within organisations. Allow them to master their science, there art, their whatever… and in the process they will develop beautiful systems capable of spectacular outputs. We only need management, especially old-style Plan/Organise/Control management, when we feel the need to control other people. Well, I ask, do you Mr Manager want to be controlled or would you rather develop your practice in pursuit of some greater good? Inspired by Bill Clinton “It’s the people stupid, not the stupid people”.

So set your people free – ask a good question, and answer is out there somewhere, let us go and find it. The search is not aided by plans and timescales but by the passionate search of somebody doing what they can, where they can, when they.