Care by Design understands the fundamentals of organisational development, service management and leadership for the 21st century public sector organisation and communities.

All Change for the new NHS

I feel like saying – ‘oh no; here we go again! Rearranging the deck chairs’. What is it that Petronius famously said? “We trained hard, but it seemed that every time we were beginning to form up into teams, we would be reorganised. I was to learn later in life that we tend to meet any new situation by reorganising; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency, and demoralisation.

On the positive side of things I liked David Nicholson’s letter to the NHS even if it was a little long (15 pages). I liked his commitment to seeing the NHS as a system and not as an organisation; his commitment to managing the transition this time as well. We forget that

humans + change = transition. 

Poor transition management in the past has meant that despite numerous reorganisations the behaviours have remained the same and little has really changed for the better.

This time the reorganisation MUST lead to major system improvements. Commissioning consortia however they shape up must understand the interdependencies in the system and manage these interdependencies possibly with a supply chain approach. They must understand what adds value to the process of care from a patient perspective and remove non value adding steps. They must help the patient be the source of control in their care and wellbeing and an equal partner in managing the care processes.

Leaders must be recognised at every level of the system. Front line staff need to work together as leaders of improvement of services with a customer experience and assuring value for money focus. Executive leaders need to facilitate this front line leadership and act as ‘servant leaders’ asking ‘how can I help you to remove the barriers to delivering excellent; safe; value for money services’. Leadership that coordinates and cultivates the appropriate behaviours to make the system work as a system whether at the micro level (GP practice; ward etc) or macro level NHS; Social Care; Housing etc.

We really need to understand the new rules and supply chain for 21st Century Healthcare – see details on the Better Care page. Also see information on the work of Dr Gordon Caldwell, Consultant Physician at Worthing Hospital. Gordon is doing fabulous work to develop improved quality and safety of care in hospital through the use of system design to assure quality and safety supported by checklists and LEAN processes. We need to support more clinicians like Gordon in this approach.

The checklist approach is akin to that used by airline pilots – thank God for the people who survived the Hudson River crash that Cpt Sullenburger was passionate about checklists and could pull to hand in seconds the procedure for landing on water! something he and his team rehearsed regularly. 

There may be some resistance to checklists and this may be because of a misperception around ‘professional autonomy’. Professional autonomy drives variability and the potential for human error. Checklists help ensure safety is a system property and therefore designed to take account of the human factor in that ‘to err is human’.


Published 1st November 2018