10 years an NHS change agent: Learning #3 – urgency and pace

Ian Railton

Ian Railton

Ian Railton is leaving the NHS after 10 years as a change agent. In his eight-part blog series, Ian gives an overview of his key learning during this time. This installment focuses on purpose and the importance of ‘urgency and pace’.

At 8pm on Sunday night, after a week of half term excitement, my daughter announced that she had homework to do for the next day; an essay on the Cold War. My son, now seeing an opportunity to minimise focus on his own tardiness, chose this moment to proclaim that the following morning’s cookery class required him to supply a mango, a tin of coconut milk and short crust pastry. I really do not understand why this keeps happening, it makes no sense to me. Indeed I was lecturing the kids on that very point when my mother unhelpfully said, “You were just the same, last minute, doing your homework on the school bus”. Thanks mother!

I don’t work or live like that now, there is nothing ‘last minute’ about me. I am not quite sure when that changed, but it certainly became more of an obsession after I joined the NHS. I had just been congratulated for managing to bring people together for a meeting in only 5 weeks. I took my manager to one side and explained that whilst I was so embarrassed that it had taken that long, there really was no need for such a sarcastic comment to be made in public. It took a few days for me to be convinced that there was no sarcasm, that 5 weeks was seemingly some sort of record and that the standard was 6-8.

The standard. The performance target. The thing on which I will ultimately be measured. The more I looked at the numbers, the more arbitrary they appeared. Why is the standard 7 days when the work required to undertake the task can be done in 34 minutes? Why does this task have to be done by next Monday when to do that would require a team of 73.2 people working 12 hours a day – we only have 4 staff!

You know, I think someone might just be making it up – setting targets and deadlines without actually understanding the work involved, the skills and resources necessary, those that are available and from this, the time it should take to do it. But this way of working seems to be everywhere, it’s endemic. It’s the way it’s always been done around here.

It’s going to have to stop.

Proclaiming the NHS needs to transform by 2020 or face a huge funding gap should create a tremendous sense of urgency, but I am not so sure it does. Perhaps instead it creates a view that 2020 is quite far away, something we’ll get around to later, when we have a bit more time…. besides we have these really pressing operational issues and we’re missing that 7 day target on the 34 minute task.

I think there is probably only one way of creating urgency and pace, although John Kotter has written a whole book about it so it’s clearly not as simple as I would have you believe. My straightforward solution is to act with urgency and pace.

You know, if someone says ‘can you do this for me, I need it by next Friday’ say ‘I’ll do it now and have it ready in an hour’. If enough people made a concerted effort to do work as it came in then slowly but surely the whole system would shift forward. Waiting times for staff and patients would plummet, and quality and flow would surge. No extra work would have to be done to make this happen, indeed it would require less work as we reduce the bureaucracy of managing waits, queues and changes.

The earlier the better is typically true of health, it’s also true of the way we should work.

Can we do it? YES
When will we do it? NOW

Next time: Leading and leadership

Related posts:

10 years an NHS change agent: what I have learned
10 years an NHS change agent: Learning #1 – Success is possible
10 years an NHS change agent: Learning #2 – Purpose and the importance of why?

Subscribe to NHS Improving Quality’s blog to get the remaining posts in Ian’s series direct to your inbox. You can also connect to Ian on LinkedIn or on Twitter @verandernltd.

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