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Improving the NHS – the role of social media

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Nearly everyone I speak too recently has a horror story to share about their experiences with the NHS.  And nearly everyone has a fairy tale to tell as well.

For several decades now I have been contracted by various parts of the NHS at different times to provide management development and leadership training, to run assessment and development centres, to develop standards for the board of NHS trusts, to turn HR teams into organisational development teams and so on.  And for just about all of that time the training has been done against a permanent backdrop of policy and structural changes that makes real learning almost impossible.

So it was with some interest that I read about some work that the National Health Service Social Media Group had been doing to explore the potential of social media to transform healthcare. Recently this group have been talking about how the use of video cameras by patients could provide feedback to drive service development.

I love the idea of social media being used to report on both the good practice and the bad.  To shine a spotlight on all that we love and hate about how healthcare is delivered.

But, until we we build a culture where such data can be collected, analysed, reviewed and acted upon by experienced clinicians and managers with the time and resources to provide excellent management and leadership we run the risk of finding ourselves with ever more tearful and frustrated health professionals.

And I suspect that it would be the failures and lapses that would get the attention and the resources.  A culture of name and shame is unlikely to work in the long run.  And what would it do to the relationship between patient and staff?  Do we really want patients to be policing their own healthcare experience?  They can recognise and film obvious lapses of protocol and procedures, but the more subtle stuff?  And, do we really want service providers to change what they do just because someone is pointing a camera at them?

At its best great healthcare is delivered as a partnership between clinicians and patients.  I find it hard to see how this partnership can really thrive when when one party is busy filming the other.

It may have a role in driving out bad practice – but I am not convinced that it can ever drive excellence.

As Deming has shown us the road to excellence is reached by driving out fear, not by increasing it.

Danone Think Tankery

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Last week saw a trip down to London to join a dialogue with

  • Myriam Cohen-Welgryn, Danone Vice-President Nature,
  • Laura Palmeiro, Vice-President Nature Finance,
  • Bernard Giraud, Vice-President Sustainability and Shared Value Creation and
  • Laurence Foucher Danone New Media Manager.

The Danone team were joined by

There was no clearly mapped out process or agenda relying instead on getting some interested people into a convivial setting and seeing where the conversation went.  In both cases I suspect that some real learning accrued on both sides.

Once again Danone showed an incredible openness in sharing with us some of their projects and challenges relating to food security, poverty alleviation, health and sustainability and showed how several projects had moved on from our last round of discussions with them.  Highlights for me included investments from their 100m Euro ‘Nature Fund’ to support the development of Cooperatives of  Ukrainian Farmers to supply the high quality milk required to keep the Danone Production lines in full swing.  Danone invested in milking equipment to be shared by small farmers through the cooperative structure and animal welfare standards and husbandry.  These investments were made with no requirement to tie framers into contracts with Danone.  Also Danone say that paying these farmers cooperatives a fair price for milk ensures the long term stability of supply which is more important to them than any short term profits that might be gained through price squeezing.

I was also intrigued by  their research into the fatty acid content of milk and how this can be correlated with the production of methane allowing accurate offsetting of methane production based on the actual methane production of each herd.  Now I am not an expert on off-setting and have a lay persons suspicion of how much can be achieved through this methodology.  Can we possibly plant enough mangrove, mangoes and other carbon fixing crops to ever truly offset production?  The whole conversation about carbon trading was one that left me a little cold.  I am far from convinced that putting a price on carbon is really the way forward.  Especially now that it can be speculated upon.  I am of the school that thinks the next great bubble to burst will be the carbon market….I hope I am wrong and am certainly no expert in this field.

But perhaps most impressive part of the conversation for me was around needing to re-connect consumers to the production process, the reality of farming and food production.  A simple realisation that for Danone, and the rest of us, ‘Nature IS our business’ and simple tools for ensuring that this realisation is that the heart of innovation in the company.  So for example they are using a wonderfully simple compass to provide a test for new developments:

N = Nature – will the development respect nature?

S = Social – will the development lead to improvements in society?  Fair wages, good governance etc

E= Economic – will the project work economically? (I was impressed by Danone’s willingness to flex their normal investment rules to allow projects that would only work with a more generous interpretation of ‘payback periods’)

W= wellbeing or health – the Danone mission is to improve health for the greatest number of people through food.  If the project does not fit the mission then it will not move forward.

My guess is that this compass will be well understood throughout the business and used to assess new business developments and ensure that balances and tensions are effectively managed.

It is a strange phenomena for me to rub against a corporate whom I like, respect and trust.  Generally I am always lifting up the carpets looking for where the dirt has been hidden.  And still questions remain for me at least about the bottling and distribution of mineral water in rich countries (Danone are behind both Evian and Volvic I believe).  But whenever I meet Danoners – be they ‘top brass’ or ‘frontline’ I am always impressed by their passion, openness (‘we have many challenges and we don’t have the answers but we will experiment…’) and commitment to co-invention of ideas and thinking through conversation.

I am already looking forward to the next conversation…when we hope to get some more skeptics involved

 

 



What Now Leeds…for the economy?


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The draft Vision for Leeds is nothing if not ambitious when it comes considering the city’s economy:




By 2030, Leeds’ economy will be prosperous and sustainable. We will create a prosperous and sustainable economy, using our resources effectively. Leeds will be successful and well-connected offering a good standard of living.


Leeds will be a city that has:






    

  • a strong local economy driving sustainable economic growth;
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  • a skilled workforce to meet the needs of the local economy;
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  • a world-class cultural offer;
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  • built on its strengths in financial and business services, and manufacturing, and continued to grow its strong retail, leisure and tourism sectors;
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  • world-class, cultural, digital and creative industries;
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  • developed new opportunities for green manufacturing and for growing other new industries;
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  • improved levels of enterprise through creativity and innovation;
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  • work for everyone with secure, flexible employment and good wages;
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  • high-quality, accessible, affordable and reliable public transport;
    • 



Who are the ‘we’ who will create a prosperous and sustainable economy?  And, what breakthroughs might allow this utopian economy to be achieved by 2030 but that has prevented us achieving it to date?  Or perhaps this is one of those ‘shoot for the stars’ to give yourself a chance to hit a nearby moon type plans?


But, the question of who are the ‘we’ is, I think, an important one.  Is it various collections of the anointed and the appointed, gathered at city and city region level (while the RDA might be going we retain a ‘Leeds city region‘ and have a new Local Enterprise Partnership that covers the whole city region.  The city region representing 11 local authorities across North, South and West Yorkshire, claims to represent the ‘real economy’) to plan economic development?


Or is this a challenge that demands a wider response?


That must engage a much wider group of those with a stake in the future of our economy?


This matters because, depending on the answer, we can either leave the ‘Vision for Leeds’ as little more than a document that steers the work of a small number of civil servants, politicians and strategists or use it as a vehicle for much broader engagement.  Is the vision really for all of us? Or is it just a piece of the political furniture?


The problems of definition seems to me to be immense.  What do we mean by a ‘sustainable economy’? Has this been thought through or is it just another example of what was memorably referred to at a recent Leeds Salon as ‘environmental Tourette’s’.


Perhaps it is OK for us all to have our own working definition of sustainable?  I know from personal experience that for many entrepreneurs ‘sustainable’ means ‘financially viable’, with no environmental implication whatsoever.


What does ‘prosperous’ mean in practice?  Is it OK just for the economy to create more cash, or is there something about how the prosperity is shared that should also matter to us?  Are we sure that ‘prosperity’ should still be the goal of our economy, or should we be considering other metrics such as well-being or happiness?  If part of what matters in our economy is health, then would we really use public funds to subsidise the expansion of the sugar industry?


If a vision is to work in mobilising action, then these issues of definition and meaning, and a robust social process for their negotiation is critical to creating alignments and the possibility of progress.


But let’s set the challenge of definition and meaning to one side.  Let’s look at just some aspects of content.


One of the first things that disappoints me is the way that ‘people and skills’ are once again put to serve the needs of the economy.  Why not try to develop an economy that actually honours and reflects the skills and passions of the people?  Develop an economy that serves people rather than people that serve the economy?  We spend fortunes trying to bend the labour and skills market (people) to meet the unpredictable needs of the economy, perhaps we could instead help people to develop their own economic engine built on the foundation of their passions and skills?  Of course if we have a Strategy Board and a Local Enterprise Partnership dominated by large employers such a shift in thinking towards a DIY/craft/artisan/enterprise based economy is unlikely to get serious consideration.


What does it mean to ‘improve levels of enterprise’.  Is this a euphemism for increasing the start-up rate?  Or is there something more subtle here that might allow us to encourage fewer but better equipped start-ups?  The phrase is dripping with ambiguity….


I love the idea of work for everyone.  Secure, but flexible employment with good wages.  What a difficult challenge. But what a great prize.


And as for ‘high-quality, accessible, affordable and reliable public transport’ bring it on I say!


Who shall lead us to this land of milk and honey?




‘Is a dream a lie if it don’t come true? Or is it something worse?’  – B. Springsteen.




So shoot for the stars and hit a nearby moon?


Unlikely.


Once again if we trace the current route from the high level statements of vision through to the 4 Year Priorities and then on to ‘Headline Indicators’ there seems to be whole lot of dilution going on.


Take for example the challenge of work.  Remember the ‘flexible, well paid and secure work for all’ of the vision?  Well, in the 4 Year Priority this has become ‘More jobs are created’ and the Headline Indicator ‘xx jobs are created’.  We go from a Vision of great ambition to a headline indicator that will allow partners to carry on, pretty much as usual pretending that they create jobs in a modern economy.


And ‘high-quality, accessible, affordable and reliable public transport’.  Well as a 4 Year Priority that becomes ‘Improved journey times and reliability of public transport’, and the Headline Indicator at the moment is ‘Reduced Bus journey time variability on the core network’.


Is there a pattern emerging here?


High falutin’ rhetoric for what will be achieved by 2030, undermined by 4 year priorities and headline indicators that appear to be almost devoid of ambition?


The ‘people of Leeds’ may have spoken when it comes to the Vision for 2030.


I wonder what they would have to say about these draft City Priority Plans?


If they were asked….