Openly Cross-Examining Jozefa Fawcett
31-Dec-99
Typical training programmes run by Jozefa:
- Cross functional team working in health and social care
- Uni-professional strategic planning and team development
- Knowledge and Skills Auditing and Knowledge Development Planning
Knowledge Management Swap Shop courtesy of KnowledgeWorx Ltd http://www.kworx.net
Performance management and personal development awareness- Aligning KM principles with cultural change initiatives
For ARK group conferences, forthcoming event on 'Managing Knowledge for Health & Social Care', London, England on 26th - 28th April 2004, see http://www.ark-group.com
To hear what Józefa has to say about Learning and Knowledge Development during 2004, check out: 'ECLO 11th International Conference - Leadership in Learning', Dublin, Ireland on 24th & 25th May 2004 http://www.eclo.org
Health Care is a, if not the most, vital sector for everyone. So its our privilege to offer you the opportunity to question Jozefa on her opening presentation attached as well as some of her favourite references which will be featured here in a growing catalogue
Reference 1: http://www.bprpct.nhs.uk/Pursing%20Perfection%20Feedback.pdf
Extract:
The East Lancs Pursuing Perfection Programme recently organised a workshop designed to enhance service improvement capabilities amongst the health & social
care leadership.
Much feedback was captured on the day and is documented in this briefing paper
along with a summary response from the executive teams of the organisations
involved.
The table below summarises the written and verbal feedback from the delegates
on the day. The issues fell into four broad categories identified as:
1. The need to overcome a fear of risk
- Managers fear of losing control
Fear of castigation &/or litigation
Absence of permission to make changes
Lack of support for good ideas that we are sure will work but managers are too scared to try out
2. The need to improve communication (in a number of different facets)
- Constraints with information technology systems
- Lack of a clear strategy being communicated to frontline staff
- Inability to see the links between vision and modernization projects
- No system for passing on our ‘vision’ and the changes we are making, to new staff (especially junior doctors) - who change every year and want to reinvent the wheel
Communication at ward level is good but how do we ensure the hierarchy are getting the messages- No system in place to get a consistent and reliable contribution from
patients/service users - Lack of meaningful communication/networking between primary/secondary/social care providers
3. The need to change culture and behaviours
- patient centered culture/need to look at the person not the ‘patient’
- Entrenchment in today
- Staff mindset difficult to change
- Consultants must work with & listen to others
- Fragmented top level leadership
No integration between social care and health care- Individual vested interests/perverse incentives to keep the status quo
- Lack of willingness to work across whole patient pathway
- Too much hierarchy and bureaucracy/internal politics
4. The need to create capacity for change
- High vacancy rate places stress on the workforce
- No time allocated/available to devote to modernisation
- More time for key people to concentrate on sustainability as well as new
developments - Modernisation work is always done as an ‘add on’ to existing work
- Need time and energy to see change ideas through
- Need to improve recruitment and retention
- Inadequate resources to provide a true 24/7 health service – need continuity of services over weekends, bank holidays and nights
Details
Attachments: 1
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Knowledge Managent - a Tool for National Health Service Leadership by Jozefa Fawcett, Business Manager, IHM London Region12-Feb-04
- Author:
- Chris Macrae
- Publisher:
- KnowledgeBoard
- Date:
- 31-Dec-99
- Categories:
- Knowledge Angels
- Sections:
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COWM part 1
Jo, our Community Of Wrong Measurementwas wondering if you have read this book.
Its enough to make me want never to go near the NHS again, and as for politicains they would appear to have more to answer for than they ever have time to know. I cannot understand in the age of the internet why people should take on more than they know instead of opening up care of knowledge to all who volunteer to do so transparently. I particularly cannot understand this in a country like the UK blessed with the world's largest public broadcaster. I wonder why we at B-Legacy & WorldHealth are being over-optimistic in seeing red in this next sentence. If we cannot link up the power of broadcasting to the power of the net to the most vital study connecting 6 billion beings, then we need a regime chnage both in our media and our parliaments.
Book Description
The subject is the misleading numbers that rain down upon us from Government, the Civil Service, the Press, advertisers, academics, special interest groups and a host of others that seek to influence us. The treatment is set at a level that should be understandable by intelligent lay reader and, where occasional statistical or mathematical illustrations are needed, these are worked out from first principles. The style is discursive and irreverent, deliberately avoiding the approach of the academic treatise.
The many examples are largely taken from the popular media. The introduction sets the background and motivation for the book, starting from a brief history of measurement and describing the political and social conditions that give rise to the current situation. The second chapter covers the range of causes of wrong numbers, how they are produced and by whom.
Chapter 4 is a discussion of the phenomenon of scares in the media, how and why they arise and who are the big players in their generation. The account is illustrated with, among others, examples from the environment, the diet industry, Frankenstein foods, electro-magnetic fields, disease and, of course, global warming. The subsequent short chapter gives examples of deliberate deception and fraud, cases being taken from the media and the author's own experience.
Chapter 6 describes the unfortunate state of much of modern science and how the scientific method and the peer review system are abused.
Chapter 8 deals with two topics that are the richest source of false propaganda, namely alcohol and tobacco. In particular, the EPA meta-study on Environmental Tobacco Smoke is analysed and shown to be one of the most egregious examples in the annals of junk science.
Opening Call - Future of National Health Care Systems
Opening Call
I would like to invite the first people who care passionately enough to contribute an hour of mails over an elapsed time of eg a month to play this game
We'll pool experiences to communally map relationships –starting with locating the accident blackspots of the system where disconnections are most likely to fester.
Since the British NHS is the one I know , forgive me for giving some examples on its relationship contexts first.
Hierarchy’s Blackspot – what is the greatest missing link in the NHS about hierarchy? From my experience, it flows both ways. The people at the top and indeed the middle managers break relationships when they fail to stop slapping down. This is the phenomenon when its always the people at the bottom who get the worst of all the emotional flows whenever a team is working under stress. There is also another double top mistake. This is letting the government impose Herculean Micro Management – measuring 100 goals that make good election slogans but that are systemically incompatible with OKM of NHS. Links to this include a BBC Reith lecture on Trust where the term HMM was coined ; the story of the one NHS trust where the CEO of the trust dared to let her people choose what they most want to be measured by and got the local press covering the story until the national government gave up micromeasures (but only in her area!); parallels with other micro-management and regulated disasters which include Britain’s trains
An example of the disconnect of wrong hierarchy from the bottom up is the classic shot the messenger disease. It needs huge courage at the bottom to report something that looks like an error.
Individual Blackspots. Does the NHS have any ways of encouraging joy of accomplishment? The best measure on this I know of is what % of an individual’s time is spent experiencing something that compounds their specific skills? Across all employees in the NHS we could take observation samples and the number would probably come out at 1%. The good news there is think what could happen if you changed the NHS’s number on that to 2%. So the game’s 10 players can discuss that possibility
VALUE - We could also discuss whether in the NHS people join this career for other reasons than money. If they do, are these other reasons measured with as much attention as money. If these measures are not attended to, it is clear that we have a system designed to bust the NHS of all the people values that originally made it the vocational career of choice, and deep community service.
I imagine that even with one hour of playing this game, we could jointly issue a white paper with a few systemic ideas on how to do the OKM of the NHS in a way that compounds better consequences than as is (or as you were).
Chris Macrae, wcbn007@easynet.co.uk
final call and opening call (next post)
Last Call
The last 24 hours of questioning Jozefa Fawcett, about OKM Operational Knowledge Management and also the specific cases of health care and Britain's National Health Service are happening now at www.kwork.org. Incidentally the last 2 weeks has seen over 50 postings , which rather puts this space to shame.
connect kboard and kwork.org and human KM in vital industries
Jofefa is currently the host of 2 weeks of conversations around her favourite themes http://www.kwork.org/Stars/Fawcett/fawcett.html#Learn
A huge opportunity to cross-fertilise any wisdom KB has in hman KM areas
so anyhow here's my take on how Britain's NHS is being decimated and so far KM feels powerless to intervene; (would be interested to know if KM has ever intervened in an industry that is destroying its human relationships- indeed would ghappily blog such cases far and near if you wish to beam us up).
Chris Macrae
Blog for Open Standards of Intangibles Valuation
Productivity in the NHS goes down and down. This is because measurement is only systemised from the top-down (government, local governors, chief executive). It separates hundreds of conflicting performance goals without a relationship system mapping how to connect them over time. But most of all it separates individuals’ trusts from teamwork, even though the service patients receive depends wholly on teamwork. The NHS system would be completely bust if every employee was only a money chaser rather than believing in vocational spirit and sharing action learning through personal networks. Yet numbers inherited from financial accounting of the least human kind (ie assuming people are just costs never to be audited as a training investment in communal wisdom and confident action) RULE and spreadsheet all over the system thereby eroding relationships, vocational belief and team spirit every quarter more numbers spin down from above. Unless a second audit promoting the sustainable trusts and emotional currencies of teamwork is introduced the NHS context will continue to be decimated of goodwill of every stakeholder. The maths to resolve this situation is open sourced , eg at ANTIDOTE. This crisis was described as one of
relevant member project at SOL
more at http://www.solonline.org/static/research/Memprojs.html
This looks like a good approach for those pasionate about health care systems
Transformational Leadership - Gene Beyt
A proposed prerequisite to organizational transformation towards a learning community is leadership based on a cognitive and systems approach. This model requires a personal transformation of the leader and the integration of the leader’s understandings of the followers within the framework of the learning disciplines. Domain specific knowledge and a servant approach may play an important facilitating role in the leader’s understandings. Learning cycles are achieved through iteration of this cognitive approach through a network of leaders. The purpose of this project is to test and refine these ideas in applied settings, increase understanding of the critical success factors, and identify leverage points in the transfer of leadership knowledge between organizational scientists and practitioners.
Gene Beyt, MD, MS
Department of Health Systems Management , Tulane University
New Orleans, Louisiana,
forwarding in case sector interest match
Seth Kahan writes to CoP community
I am writing case studies for Johns Hopkins Bloomberg Center for Communications Program to use in their leadership program for leaders of the developing world. I am specifically writing about health projects where KM plays an important role. I would be happy to use a project that highlights the use of CoPs.
I am looking for candidates for the case studies. The studies will be brief (2 pages), very high level, highlighting the use of knowledge management and its contribution to the project. The purpose is to provide stimulating insights to students of the JHUCCP leadership training program (leaders of NGOs, ministry members, & change agents), helping them to understand the contribution of km and develop their own km efforts. The studies will be in the public domain and can be shared by the project managers or used by their organization to document the work and the effective use of km.
I have already contacted Bruno at the World Bank and the listserv KM4Dev. They have been very helpful, steering me toward Geoff Parcell's recent work (with UNAIDS and UNITAR) as well as several possible projects in the Bank. I am attempting to make contact with Geoff, following up on WB projects and looking for other projects I might write about. I would appreciate any ideas & contacts you can send to me. Please contact me directly at Seth@SethKahan.com
in appreciation,
Seth
SETH KAHAN
Organizational Community Specialist
Conference Speaker & Executive Strategy Consultant
Subscribe to my newsletter at http://www.SethKahan.com
good site cops & healthcare from canada
a canadian healthcare site with good readings on CoPs http://www.healthorgchange.com/community_internet.htm
particular practical paper by Allee
http://www.odnetwork.org/odponline/vol32n4/knowledgenets.html
is world health day connecting any of KB's members?
Seemed like World Health Day was a good time to ask for any healthcare practitioer wishlists for the next year etc?
Anyone in this community doing anything related to world health day etc?
from april's worldbank newsletter:
2. Mobilizing health care for the poor –
Development Gateway special feature
----------------------------------------------------------------
To coincide with World Health Day on April 7, Development Gateway has launched a cross-topic special feature on “Global
Health: The Challenge of Mobilizing Health Care Resources for the Poor". See: http://www.developmentgateway.org/node/130685/special/global-health/.
INTERESTING LEADS CHRIS
Hi Chris,
Sorry not been back before, head down and busy just at present..
I have heard of NHS 24 but had little to do with their progress so far.
When I get the chance I will read your link, from the sound of it there are very useful lessons
By the way, thank you so much for our roundtable the other day, good to see you again and to discuss so many complimentary ideas...haven't forgotton the 50 year old model will post it here so others can see it too
Types of conversations in hospitals
Has anyone heard of the conversational typology work of Winograd (and Flores). They evolve an action-language perspective which I imagine is a useful twin to action-learning views.
http://hci.stanford.edu/~winograd/papers/language-action.html
This paper makes a particularly interesting introduction as in section 5 it applies it conversational typologies to hospitals
extracts
Conversations for action
In the hospital, there are many different conversations for action, with a variety of visible forms. Some are highly routinized, such as the primary CfA dealing with the administration of medications. Requests are made by doctors (either as standing cures or on the patient-carried paper scraps), to the treating nurse. Report of completion is represented on the curve sheet, and the declaration of completion is implicit in the doctors review of the records on his or her next visit. As a precondition for satisfying these requests, the nurse must receive the medicine, and there are CfAs (with the pharmacy) to get the medications, using prescription forms to make requests. In general, conditions of satisfaction are determined in a rigid way by the codes and blanks, perhaps with extra notations in natural language. Acceptance of an offer or request is assumed whenever it is not explicitly rejected. Completion is reported on a standard form, which, like all of the other forms, is associated with standards for interpretation, which are learned as part of the relevant professional training. In addition to these routinized CfAs there are unscheduled verbal conversations. For example, a request may be made by a doctor to a nurse at the bedside, with immediate explicit accept, decline, or counter-offer. Completion may be reported later via a note in the patients chart.In a hospital, completion of conversations can be a life-or-death matter. There is a highly regularized structure of checks and crosschecks to ensure it...
Conversations for possibilities
Much of what appears to be useless copying or verification of redundant information on the hospital ward is really a routine way of generating conversations for possibilities. For example, in the review of medications (see Appendix):Only a minor part of the 30 minutes was used for updating and comparing. The rest of the time was spent on small conversations, initiated by findings in the information they were handling. Some examples of what the nurses did: Reporting to each other about the patients state and activities; deciding what were facts when inconsistencies were found; deciding changes in some medicines after small negotiations; reminding the treating nurse of a test that had been forgotten; investigating why a medicine was not delivered from the chemists; finding out why a patient had to take a specific test.
OD interdependency map
Jozefa: Thanks for the great conversational insights today
Love the sound of that 50 year old framework that mapped the interdependencies of Organisational Development - look forward to references to it
have you come across NHS24?
Jozefa
have you come across NHS 24
This is a speaker extract from Europe's major HR conference connecting Human Capital and Balanced Scorecard in Amsterdam later this month http://www.bsceventportfolio.com/download/pdf/DG159.pdf
14.20 Human Capital measurement and strategy; Linking
performance measures directly to organisational
improvement
Measurement motivates. Lorna Skirving will describe how
NHS 24 is delivering on a new mission and strategy to bring
healthcare directly to the patient through aligning the
performance measurement system to the strategy. The nurses
involved at the call centres use this performance measurement
to understand how they are directly contributing to the
organisation’s mission. Ms Skirving will present a
demonstration of how this motivates the staff to have a
significant strategic impact.
Lorna Skirving
Performance Manager
NHS 24
Personal note as a mathematician I strongly defer from the Balanced Scorecard measurement approach but we start with an agreement on the magnitude of the gap between startegy and implemenation. These stats being in the brochure link
Most organisations do not have adequate processes to manage strategy
and prove the value of the HR function. Consider the following:
95% of a typical workforce does not understand their
organisation’s strategy
90%of organisations fail to execute their strategies
successfully
86%of executive teams spend less than one hour per month
discussing strategy
case for discussion?
I was wondering if you might like to comment on some of the implications of this bookmark. Examples:
appears to be a deep contextual challenge to trust, one of the hottest topics in conversations at Kboard
involves a very senior person claiming that the whole way measurement is systemised in the NHS is dehumanising the service as well as making it uneconomic
is an example of an outstanding good that BBC has done in raising this however much it causes displeasure with politicians and other class powers
seems to introduce a discussion of the knowledge system tensions between :
-pure hierarchy
-teamwork and CoP
-individual lifelong learning
-networking learning across different regional NHS trusts
http://www.bbc.co.uk/radio4/reith2002/lecture3_text.shtml
I think it has to fantasise much less about Herculean micro-management
by means of performance indicators
1. Is Trust Failing?
Like many of you here at Addenbrooke's hospital in Cambridge this evening I live and work among professionals and public servants. And those whom I know seek to serve the public conscientiously: and mostly to pretty good effect. Addenbrooke's is an outstanding hospital; the University of Cambridge and many surrounding research institutions do distinguished work; Cambridgeshire schools, social services and police have good reputations. Yet during the last fifteen years we have all found our reputations and performance doubted, as have millions of other public sector workers and professionals. We increasingly hear that we are no longer trusted.
welcome Jozefa
Its good to have you answering for one of the greatest human contexts any of us can ever know about - our health and how to organise it with as many social multipliers for thoise who make it a vocation as possible (wherever health is only business , what happens next is a socety of have and have nots because helaths starts getting too expensive for everyone to have fair shares)
You've told me in conversations that you advocate practising KISS -Keep It Simple Stupid. I would like to suggest we catalogue some of the simplest methods used to develop KM cultures and communities. Could we maybe make a l,ist of 5 methods to start and then start trying to benchmark where in the UK NHS or indeed where worldwide they have been used. I'll nominate one method: Open Space both because its the simplesy hi-trust method I have had the joy to experience and I know of various health contexts where it is causing extraodinary human results. I am getting a journalist to write up the best one in the Uk we can find, and will post it up once he's written it.
Chris Macrae, Value CALLS
YOUR HR AND OD PROFESSIONALS HOLD THE KEY!
After some 14 years of working in the National Health Service in the UK and actively promoting my version of KM for at least 8 of these, it frustrates me that many of the so-called KM initiatives that I have seen over the last few years - or have been referred to - have been nothing more than complicated IM improvements in processes and systems to connect staff to centrally held information libraries. In itself this is vital if we are to deliver on the NHS modernisation agenda and national targets, however I have found little evidence that the design and implementation of these systems has ever been developed with the 'people management' professionals who work with the individuals who are to use these new systems.
Are we missing a trick here?
After all, how on earth does an organisation achieve any sort of cultural and/or behavioural change in the way it wishes its staff to communicate without using its own expertise as part of the solution?
In my presentation (attached) the work of Carole Nicoladies is cited http://www.progressiveleadership.com She highlights coaching and mentoring as one of the key ways to help develop the so-called 'soft skills' needed to underpin KM initiatives. Without this background work (which by the way many HR and OD/Training teams are qualified to undertake) managers and leaders can misunderstand the benefits afforded by KM and in some extreme cases sabotage fruitful cross-boundary discussions that might challenge (their) current practice and decision making processes.
I would be interested in some examples where this humanistic '3rd generation KM' approach, or as some are calling it, h-side (human-side) or (inter)personal KM (IPKM) has contributed to a wider organisational change agenda and the way results are being measured by the organisation.
Community of Wrong Measurement Part 2
Chapter 9 discusses the interaction of measurement with the law. The following three chapters are concerned with the consequences of the flood of information and the fad for tabulation that is so characteristic of the present scene. Chapter 10 deals directly with the abuse of computers and the numbers they generate, including modelling, packages and spreadsheets. Chapter 11 is based on the modern insistence of measuring the unmeasurable and gives examples in such areas as education and medicine. A prominent current phenomenon is the prevalence of league tables, and the chapter examines the determination of modern politicians to measure and tabulate everything, whether it is meaningful to do so or not. This is elaborated in a wider discussion of the political implications in chapter 12. Chapter 13 returns to the question of risk as it is presented to and perceived by the individual.
Chapter 15 is a reprise of what has gone before, bringing out some of the salient points and dominant influences. Certain recurrent themes are evident. One is the political dislocation that occurred in the early eighties, which is remarkably matched by the account of James Le Fanu in an important recent book. The most prominent agency in the world for the generation and maintenance of wrong numbers has been the Environmental Protection Agency, so the nature of its contribution is reviewed. Other major influences such as The Harvard School Public Health and Vice President Al Gore are also discussed. The fifteen chapters are largely arranged in a logical progression from the origins of the wrong numbers to their social and political consequences.