I have the great privilege of working with multiple healthcare providers across different sectors in different parts of the globe – one thing is common to all; great people rock up every day to do difficult work in often challenging circumstances.
The stakes are high in health aren’t they? It’s people’s wellbeing, if not their lives we are trading in, and with this is mind the quest for continuous improvement in the service we offer and the way we offer it is reasonable. What is not always reasonable is the way we go about improvement and change. It is not reasonable to keep expecting the same people to do more and more, while under more scrutiny and with no more resource. All that this does is turns great people into, at best, tired people and, at worst, stressed out burnout people.
I believe continuous improvement is desirable and doable, if – and it’s a big if – we are prepared to take a different approach. Healthcare is, in the end, about patients, about delivering a good and effective care that enables patients to have the best life possible. The things that make a difference to patients are often the small human touches, the feeling like they matter in a big faceless system, the feeling they are safe and someone is watching out for them. This is not dissimilar to why people in healthcare come to work.
Throughout my career I have been lucky enough to witness ordinary people making extraordinary differences to patients over and over. Sometimes this gets recognised and sometimes it does not. I’m not for a second against standards and targets in healthcare – in fact I think they are essential. They define what good looks like. I am, however, completely opposed to the gaming, lip service and manipulation that goes on around such measures, as well as the pressure staff at all organisational levels feel as they get torn between what they might see as best care and the demands of the target. This does not create change for the benefit of patients, this creates knee jerk reactions and at best sticking plaster change.
So how do we fix it? I think first we have to understand how we as humans tick, how our brain’s work. We don’t make decisions, or create change, even have conversations with people based on logic, rational thought and evidence base – much as we might like to think we do! We make decisions based on our emotions, drawn from beliefs, experiences and expectations. These of course are context driven, where we find ourselves, whether we feel safe, how much authority we believe we have, how much trouble we might get into, balanced with how much the issue in question matters to us.
Armed with this, it is not difficult to see why top down, often target based change initiatives don’t always thrive, and why our health care staff often feel pressured and undervalued. It also shows us that if change needs to be made, ownership of the reasons and outcomes of change are key to its success. I’m constantly wowed by the great ideas people have, even in the most challenged of health organisations – I’m also equally as disappointed by how little of a voice they often feel they have.
Even the best can still improve, make the improvement conversation positive, values driven and based on the emotional drivers that actually matter to your team. Listen and come up with solutions together. Then create a road map for change that has the following four attributes:
- It is easy to follow – it is easy to implement in their day job
- It is attractive – they buy into the outcome and it delivers some benefit for them, whether directly or indirectly
- It is social – there is some element of competition, gaming or social currency attached ( this might even be social media)
- It is timely – there is a need for the change now and an opportunity to make a difference now
(based on Behavioural Insights Team 2010)
#EndPJparalysis is a good example of this. There were plenty of ideas and resources available to make implementation easy, the concept was value led and attractive to people, it was social, the campaign ran on twitter and in a closed facebook group enabling people to share their successes and challenges, and it was timely – there were a specific 70 days for the challenge. The momentum is maintained through ongoing local activity, measuring of successes and a 3 day global online summit 10th-12thJuly.
Going back to how humans tick: belonging, security, autonomy (within boundaries), and significance are among the things considered important to how we engage. A few small changes in how we talk to each other and how we value each other’s contributions at work could make a big impact on how and whether change happens. People engage and contribute when something matters to them. So have conversations about value, about impact, about doing the right thing, not about waiting times, lists and failures.
If we can start to address these in the workplace we can rapidly make it safer for people to speak up, to make change in their area and genuinely contribute to continuous improvement in healthcare. Then we are part of the solution and not the problem.