We try to manage complex problems as if they are simple (top down targets & outcomes)
🌟We need approaches that enable our systems to actually produce results🌟
A 🧵of the solutions in this SUPERB talk @tobyjlowe ⬇️ 1/11
We are complex
Our problems are complex
The organisations impacting on our problems are complex
🌟PRETENDING it's simple so it feels easier to manage DOESN'T work🌟
Outcomes are a result of MANY factors. So if we commission/strategise to produce outcomes, we achieve gaming 2/11
Instead of purchasing services that produce outcomes, we must nurture the systems from which outcomes emerge.
'Outcomes are not delivered by organisations.
Outcomes are emergent properties of complex systems.'
Scrap process specs, output & outcome targets. And do what? ⬇️
3/11
1) We can't predict the impact of our long term strategies/ actions within complex systems.
Therefore we need to:
Act & observe the effect
Rapid feedback loops
Be open to failure as a positive aspect of learning.
4/11
2) We need to allow our colleagues on the front line to have the trust to make decisions about HOW need is met. 5/11
3) Because outcomes are produced by systems, we need to nurture the health of our systems:
Build relationships & connections between partners
Enable leadership at all levels
Have shared goals & purpose to rally around (data used to observe reality, not targets to manipulate) 6/11
How would we expect to happen in a system that serves people with complex needs well?
What does a healthy system look like? 7/11⬇️
Findings from 'Whole new world' report
How do we commission/ plan in light of complexity?
We need to think differently about 3 things. 1) Motivation is intrinsic (people want to make a difference) not extrinsic (someone else's targets demotivates) philanthropy-impact.org/expert-opinion…
8/11
2) Great outcomes happen when colleagues are enabled to improve their work through learning.
Positive error culture
Peer based reflection
Measurement (to LEARN & IMPROVE not accountability) 9/11
Instead of purchasing services that produce outcomes
We nurture the systems from which good outcomes emerge
-Invest in networks, enabling collaboration
-Nurturing the trust that enables people to be honest about what is really happening 10/11
For NHS management give up the (illusion of) control, we need to fund organisations that we trust (or be one that can be trusted!) to do the right thing.
⬇️ 11/11
How can we improve patient involvement In Primary Care?
Blur the boundaries?
Have them/ you involved in the life and decisions?
Here are 11 of my thoughts. Please add your own.
1/12
1) Practices to set up Facebook groups. Won't reach all, but is the most widely used social media, esp for 50+
I've written extensively on this already
2) Having a regular face2face connections with patients who want to support/ improve/ be a critical friend.
This makes the patient experience more REAL.
It can be hard to take criticism when you're on your knees. But the feedback is key to finding your way back on to your feet.
Despite the #gpcrisis we've gone from: Struggling with unmanageable 'demand', exhaustion & low morale.
⬇️
A thriving & hopeful team with excellent patient feedback.
How? Dozens of factors.
This thread describes 1 subtle essential ingredient #TeamGP
1 link.medium.com/JpbZd1BQHnb
Primary care is over worked and overwhelmed. The GP crisis is exasperating for staff and patients. GP numbers continue to tumble. Part of the solution is before our very eyes: the receptionist. But perhaps not as we know them.
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How much of a GPs frantic day is spent solving problems that could have been better solved by someone else? Either by a GP who knows them better, another service or an additional PCN role? GPs also waste time untangling messy tasks like old referrals, prescriptions/ sick notes
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