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Leader: NHS innovations

9 February 2016

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Chair of The Commissioning Review outlines why being innovative is important in the NHS, but emphasises that it should be the frontline workers that enable change

Chair of The Commissioning Review outlines why being innovative is important in the NHS, but emphasises that it should be the frontline workers that enable change

Will secretary of state for health, Jeremy Hunt’s legacy for the NHS be the same as former Conservative leader and Prime Minister, Margaret Thatcher’s was for the miners?
In this edition we will be hearing from the vanguard sites about how they are changing and improving care for their populations. The issue however is translating and transporting the learning to other areas without the pump priming money that accompanies every new initiative in the NHS.
As a parent I am always amazed by children’s ability to just have a go at something because they are unaware of the consequences. They are not frightened of being wrong and so try out new ideas. If we are not prepared to be wrong, we will never come up with anything original. The NHS has a culture or fear that stigmatises making mistakes, so much so that it paralyses innovation. It suffers from functional fixedness, which is a cognitive bias that limits a person to use tools only for the purpose they were intended. It is defined as the mental block that prevents someone from using their tools in a different way to solve a problem. The NHS is such a complex conglomeration of competing organisations there is no ideal business model available to allow the system to work seamlessly. Every decision can have far reaching consequences because of the interdependencies that exist. Unfortunately the organic nature of the development of the system means that to bring order back there will inevitably be casualties that were unforeseen.
Recent evidence shows that patient satisfaction with their general practice is linked to the level of funding the practice receives. The higher the funding the more satisfied patients are with their care. Funding is a major issue but I would argue it is not what drives people who work in the NHS.
There is a significant mismatch between what the science says and what the business does when it comes to the incentives that motivate staff. We continue to use the carrot on the end of a stick approach as extrinsic incentives, reward and punishment. It has been proven that method doesn’t work. There is a misconception that higher rewards leads to better performance – the opposite is true.
Economists in the US and from London School of Economics (LSE) say that financial incentives have a negative impact on overall performance.
Dr B. Irlenbush from the LSE said that there is such a mismatch between what science knows and what business does. Organisations make decisions on outdated and unexamined assumptions based more on folklore than fact. They then do more of the wrong things and make the same mistakes. Trying sweeter carrots or sharper sticks just does not work. What needs to happen is a seismic shift in the functional fixedness of the NHS to allow change.
Maintaining the status quo is not an option if quality is to be affordable, and the sustainability of the NHS remains a reality.
Successful companies such as Google use three simple words to get the best out of their workforce.
1 Autonomy: Workers are allowed to determine how they work best without top down direction. They know their jobs and can be trusted to deliver.
2 Mastery: By becoming the best at their job their performance improves so they can work independently.
3 Purpose: Workers need to have the drive to do the things that matter. Rediscover what gets them up in the morning to do the job and not what keeps them awake at night.
By getting the issue of money off the table and allowing self-direction organisations thrive.
Valuing people for their purpose and recognising their worth and their drivers are paramount to success. Wikipedia is a classic example of success where money is not the driver. Microsoft developed an encyclopaedia at great cost which no-one uses, yet Wikipedia grew from the desire to do the thing that matters.
With the technological revolution and explosion of health apps and devices for self-monitoring the health service model must adapt and change to one of prevention and proactive care than the current reactive problem solving.
I started with a question about Hunt and his NHS legacy. I believe the NHS will only survive if we can discard the outdated thinking that controls the decision-making and allow the people who do the jobs, to discover their autonomy mastery and purpose.

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