Why I would swap 'transformation' for an ice axe, crampons and climbing rope any time

Transformation is one of those words that is beginning to mean less the more it is used. Increasingly desperate and/or strident calls to ‘transform’ services are shorthand for ‘we are in a fix, have failed to redesign services so far but that is not going to stop us using the word as it makes us sound as though we are on the case’. Watch how everybody nods and agrees when you use the ‘T’ word. So comforting, so aspirational, so ambitious.

Lets just think about it for a moment. Glaciers transformed our landscapes, the Reformation transformed culture and art, the Industrial Revolution transformed economies, air travel transformed the tourist business. None of those was a ‘Great Leap Forward’ – a single bound into a new state freed from the shackles of the old. What they were was relentless evolution, a myriad of steps and changes all heading roughly in the same direction. Multitudes of experiments, successes, failures connected and shared. In some cases that evolution was more rapid than in others – in a connected world with competitive economic and political pressures you would expect more rapid evolution, but still comprised of a series of uneven steps. Another characteristic was that there was no central guiding mind or master plan for any of these transformations. The change was the sum of the efforts of the many, not the few, although a few might initially have influenced the path.

There are quicker transformations, the instantaneous sorts are earthquakes, volcanoes and other major natural disasters. These are the ones where the collateral damage is significant and painful.

So when our leaders call for transformation what mental model is in their minds and what comes to our minds? Our mental model will determine how we respond. Cataclysmic change or rapid evolution?

The illusion of transformation can be achieved by reorganisation but rarely does this impinge successfully on the fundamentals of the service. The alternative is to shout more loudly – transformation by diktat and the stick disguised as a carrot. That rarely goes anywhere constructively except to resistance, riots, a lamp-post and a handy noose.

 The reality is that what really needs transforming is the way we think about change and how it is best achieved, how we can accelerate the evolution of the service – transforming spread and adoption, transforming engagement, transforming mobilisation, transforming how we equip and support staff and clients/users/patients to increase the rhythm of change, to create relentless and rapid evolution.

The challenge facing public services and the NHS in particular, in a feeble economic environment and with the relentless increase in demand from an ageing population with increasing prevalence of multiple morbidities, is ‘epochal’. Most NHS organisations have made the ‘easy’ savings – although many have failed to make these savings fully recurrent so are pushing a growing bow wave in front of them. Now they need to get to grips with the challenge of radical redesign – the change equivalent of climbing Mount Everest in the early days of mountaineering.

Those organisations that succeed will have understood what transformation really means, have understood this for a long while and done something about it. Staff at all levels will have the tools, leadership, support, permissions and space to undertake the ‘climb’ and will probably have already have done a lot of the smaller but challenging peaks. But from my experience these are in a minority. The majority are facing a stiffer challenge and ill-equipped to tackle it without the ‘collateral damage’.

Climbing Mount Everest for the first time was not a ‘transformation’, it was a culmination of many years of trying, failing, dying. The transformation was new techniques, training, advances in equipment and knowledge about how the human body and mind responds in extreme environments.

Just how well equipped our are staff to achieve the ‘transformation’ we exhort them to achieve? Or are we really asking them to climb Everest in trainers and a t-shirt? How many bodies are we going to leave on the slopes before we learn?

(This is a revised version of a blog originally posted in December 2013)

Keeping it AGILE - the core principles

The core principles

Here are what I think are the other core principles of AGILE as it relates to service improvement or redesign. I will be covering each of these in more detail in subsequent posts. If you think there are others then let me know..

• AGILE is as much about a state of mind as a set of techniques and tools - you are acquiring new habits and letting go of old habits
• The beating heart of AGILE - the 30 day test cycle and why it is so hard.
• Failure is expected - Failing Forward is the default mode.
• Understanding why…? Are we all on the same page - but not necessary to be on same line.
• The power and simplicity of the story card…avoiding ‘painting by numbers'.
• Keep it visual…why you need a very big wall!
• The discipline of the SCRUM - sessions that maintain momentum.
• Knowing how we are doing - so how do we know if it works?
• We are all in it together - keeping it connected in a complex world.

Beware of AGILE

Like many methodologies that start from a simple premise AGILE has succumbed over time to an accretion of additional methodologies, tools and constraints. It has also been subject to some misinterpretation. My recommendation is to keep it as simple as possible. The introduction of AGILE is your first AGILE project.

All too risky - capture and constrain

Often traditional project and programme management cultures have sought to capture and constrain AGILE to make it fit within their own mental models or through the fear of failure that is an inherent and essential part of the technique or simply because of a perceived loss of control. 

Making a meal of it

There are a lot of people out there who have made AGILE their business. They have developed flavours of AGILE and surrounded it with branded documentation, pamphlets and generally sclerotic baggage that fills shelves and is handed out at expensive workshops and training courses. In most cases these are people and organisations that are still culturally in the old modes of hierarchical project and programme management. They have seen the possibilities of AGILE but have difficulty letting go of the old certainties and comfort blankets. Overcomplicating AGILE means they do not truly 'get'AGILE'.

You are AGILE if I give you an iPad and remove your desk

AGILE/Agile is as much a state of mind as a technique. Closing offices and making staff work from home, their car or a hot desk is not AGILE or indeed agile without fundamentally redesigning the way staff operate in the new environment. Too often what organisations mean by agility is that you have to move fast and have sharp elbows to get one of the few hot-desks. Or consigning staff to work from their kitchen table whilst competing with a 4 year old making fairy cakes and the teenager revising for GCSEs. 

An Agile Manifesto for the NHS - what's not to like?

About 14 years ago a group of software developers got together at a ski resort in the US to find an alternative to the top-down, over-bureaucratic and over-documented approaches to software development that were a feature of programming at the time. Many of them were already 'insurgents' experimenting with new development techniques that were better suited to the rapidly changing technology landscape. 

Out of this came a bigger, international, gathering of like-minded individuals and the development of the Agile Manifesto.

This was the beginning of a movement that in time has seen the development of methodologies that have transformed the time it takes to get software from concept to delivery and that have transformed the pace at which software is updated and released. 

I have been working in quieter moments to begin to translate those original Agile concepts and methodologies to the world of service improvement within the NHS. Over the next few weeks I will begin to share what I have learnt and hopefully engage a wider community in developing and testing the approach.

So here is the original Agile Manifesto and my translation into Healthcare Service Improvement - you will note that not much has needed to change. What's not to like?

Bringing it to life..

I have been having fun. We are allowed to do so you know. In this case I had put together a PowerPoint presentation which I was using as a catalyst for a discussion with clients and colleagues about the mindsets we bring to change. I was thinking of recording it with a voiceover and posting it on here. 

But I began to wonder if there were other ways of doing it that could be more engaging than a slide show - and I do not have much patience for writing formal scripted voice-overs.

I have always though the

RSA Animate

series was fun and engaging but also thought it was out of my league. But then I found

Sparkol Videoscribe

 which was very much in my league. It is a simple tool for creating whiteboard animations and with some excellent video tutorials I was almost there.

To get the most out of Videoscribe (or indeed most animation tools) your drawings need to be in what is called SVG (Scalable Vector Graphics) format. Videoscribe makes an attempt to import other formats in SVG but it can be variable. So this is where I turned to a market place I had been wanting to try for a while. 

Fiverr

 is where you can turn to find people worldwide offering services (or 'Gigs' in Fiverr speak) for $5 multiples. From Graphics and Design to Programming to Voice-Overs you can find pretty much any form of on-line support. So I found a team in the Philippines who would take my PowerPoint images and turn them into SVG line art for $5 a throw.

And the result - well take a look for yourself. Feedback welcome.