The Doctor Can See You Now

0:03

Hello, I’m James. Hi, I’m Jimmy and welcome to A Job Done Well, the podcast that helps you improve your performance enjoyment at work.

James: 0:15

Good afternoon, how are you doing?

Jimmy: 0:16

I’m doing well. How are you?

James: 0:17

I’m fabulous, thank you very much. What are we going to talk about today?

Jimmy (2): 0:21

Today we’ve got the follow up episode last week. We talked about the Lord Darzi’s report into the performance of the NHS. We talked about some of the issues and how we thought they were very common in many, many organisations that we’ve worked in. Today, we’re going to talk about what would we do about some of those issues.

James: 0:41

is this the episode that we’re going to forward on to the, Secretary of State for Health and, um, try and get a job?

Jimmy (2): 0:46

Wes Streeting, no, we will not be passing this on to, to Wes, uh, but what we will be doing is sharing some ideas that perhaps could help, improve performance.

James: 0:58

Things we’ve seen elsewhere.

Jimmy (2): 0:59

Yeah, exactly.

James: 1:00

So what have you been up to this week?

Jimmy (2): 1:02

so this week, I have been doing something to help my brain.

James: 1:06

Oh, is that right? That’s quite a big job. It

Jimmy (2): 1:09

took me a while to find it, but I did a masterclass on this. So masterclass for those you don’t know is a subscription service. You can sign up to that. You have eminent professors and famous

James: 1:22

people. So it’s only a masterclass’cause you paid a lot of money for

Jimmy (2): 1:24

a lot of money to get a masterclass or the one I did was on neurological development.

James: 1:30

All right. So

Jimmy (2): 1:31

it was talking about how you keep your brain working well into

James: 1:36

the later years

Jimmy (2): 1:37

twilight years.

James: 1:39

Yeah.

Jimmy (2): 1:39

Anyhow, what he was saying is try stuff that is new, try stuff that challenges you, try stuff that challenges you in different ways. So one of the suggestions that I’m trying out this week is I dusted off a Lego set that I

James: 1:54

Lego set? A few years ago. So

Jimmy (2): 1:56

I’m like, how do I get my brain working better? I regressed to childhood and I’ll start doing Lego. So I am doing a Lego of the Tower of London

James: 2:05

for you. Well, I’ve also been doing stuff that will make sure that I progress well into my latter years.

Jimmy (2): 2:11

Yeah, what’s that?

James: 2:12

I’ve been cleaning out the gutters for Mrs. Lawther. Well, life is just too short to not do as you told, but that was a thrilling autumn little job, I can tell you. So, we talked about the NHS and then we said we would talk about a number of things that we would, um, we would do.

Jimmy (2): 2:29

doing across position. So let’s just recap. So if you’d listened to last week’s episode, great. If you didn’t, we were talking about Lord Darci’s report, which was commissioned by the government to look at the performance and state of the, of the NHS, so that they can put together their 10 year plan to improve the current NHS. situation. And we thought that when you read through the issues, they were very familiar issues that we’ve experienced many times in our

James: 2:58

nothing new at all.

Jimmy (2): 2:59

at all. So today we are going to talk about If you’re facing those issues, what are some of the things that we would recommend you consider doing.

James: 3:08

Alright. So where would you start then?

Jimmy (2): 3:11

So I would start, at the top, with purpose. And we discussed the

James: 3:17

fact that

Jimmy (2): 3:20

no, but we talked last week about the fact that whilst we’d all agree that the NHS is to do something, something to do with health But it wasn’t clearly articulated everywhere so that everyone could understand. in general, organizations that create that clear and compelling purpose that really drives all of their people and actions and decision making. That’s where I’d start is just really being clear on that and sharing it and making sure that everything is aligned about

James: 3:54

Right. And I know this sounds really nebulous, but. If you don’t know what you’re trying to do, you don’t stand a hope in hell of doing it. That will be my first point. But there are examples of organizations that do this beautifully. I mean, Google wants to organize the world’s information. Amazon wants to be the world’s most customer centric organization. So these companies that are really successful do this.

Jimmy (2): 4:17

this. And what they do really well is not only are they clear on what it is, so that it trips off the tongue for all their staff and their customers, but they drive every action and the way of thinking and the decision making around that purpose.

James: 4:32

Purpose. Yeah. And my, one of my favorite examples of this, was the, I think it was the rowing eight Sydney two thousands. Yeah. And there’s a guy called Ben Hunt Davis who was in that rowing eight and he wrote a book called, will it made the boat go faster? But that was their real thing. They always used to say, will it make the boat go faster?

Jimmy (2): 4:53

And they used to drive all of their decision making and all of their focus and all of their activities on that question. A examples that really brought it to life for me is they skipped the, um, the opening ceremony for the Olympics. So a great honor to walk around and represent your country at the opening ceremony. They didn’t go because they asked themselves how would attending the Opening ceremony, staying up late, how would that help the boat go faster? And they concluded,

James: 5:23

probably wouldn’t.

Jimmy (2): 5:24

So they didn’t go. They watched it on TV instead.

James: 5:27

But, they won a gold medal. So, there’s an example. So, number one, purpose. Right, now, when you’ve understood purpose, what’s the next thing you’d go looking at?

Jimmy (2): 5:37

the next thing is to really think about the system in its entirety. We touched on the fact that the NHS appears to work in a complex series of silos and there are lots of knock on impacts from one silo to another. thinking about the whole system end to end, how everything works together, how the everything from technology, the processes, the policies, the way you’re managing people, everything. Does that help deliver that on that purpose?

James: 6:14

nearly every organisation I’ve ever worked for, they work functionally or by silo and so they optimise the functions, they don’t optimise the system. So really it is, look at the system, think about what you can do with your interdependencies to improve the way the system is working.

Jimmy (2): 6:30

And once you’ve got that, one of the things that is clear is in the NHS, they are probably in a situation of overwhelmed with opportunities to improve. So how do you figure out what the best opportunities to improve are? And I guess what we’ve talked about, if you go back and listen to series one, episode four. Yeah. You will hear our views around, finding improvement opportunities. And basically, we say that you look holistically at these. You ask your customers and understand your customer needs. You look at your data and analyze what your data is

James: 7:07

figure out what the best opportunities

Jimmy (2): 7:08

You talk to your employees. The people doing the work will know what gets in the way of delivering the purpose. And go and see that work.

James: 7:17

Yeah, and yeah, go and see. But of course, this really ties back to the past two things about understanding your purpose. So you are looking for opportunities to improve against that purpose. But it also ties back to the thing about the system, because you’re looking to ways to opportunities to improve the system, not just your wee bit of

Jimmy (2): 7:35

Exactly, James. And that’s why if you haven’t defined your purpose, and you’re not thinking about the system, when you start looking at what you improve, you could be going after all sorts of stuff. If you’ve figured out those two things and you go and do it the way that we’ve said, you’ll find out the best opportunities for improve. But you also need to hold your solutions and hypothesis lightly. What you often see is senior people in organizations form a view. They know what’s right. They know what the answer is, and they look at the opportunities to improve to just back up their views. That never works because you know, rarely in an organization does the exec team know best. You know, eight brains against 10, 000. Where are you going to place your bets? So be open and hold your hypothesis lightly.

James: 8:27

And then, you know, at the risk of piling on with the, truisms, walk in somebody else’s shoes. Go and, you know, understand what it’s like to be a porter, understand what it’s like to be a doctor, understand what it’s like to be a nurse. And if you do all of those things, and you can’t find any opportunities to improve, then you probably ought to find a new job.

Jimmy (2): 8:44

What do you look at next, James?

James: 8:46

Well, the next one is, uh, It’s one of the most common things, but probably one of the most unpalatable. So they have got, at the moment, the mother of all backlogs.

Jimmy (2): 8:55

Didn’t you say it was something like 8 million surgeries and

James: 8:58

or something, yeah. It’s just horrific, right? the problem when you have a backlog, and common to all organizations, is that backlog breeds work. Worked for two organizations, had slightly different terms for it. One, they talk about a callback spiral. So people couldn’t answer the phone, so they called back, and they called back, and the volume should just go through the roof.

Jimmy (2): 9:17

yeah.

James: 9:17

the other organization I worked for, it was a bit more macho, they used to call it turbo.

Jimmy (2): 9:22

sounds more

James: 9:22

Yeah, but it was exactly the same problem, But of course this is happening. If you’ve got people who are sick, and you’re not treating them, they are going to get sicker.

Jimmy (2): 9:31

And this happens, the dynamics of a backlog happen whether you’re dealing with patients, dealing with claims, dealing with applications. It doesn’t matter what the work looks like. And as you say, it breeds work, but also it’s incredibly hard working in an organization that’s holding a backlog because it overshadows everything that you’re doing. So a few basic rules that we find work really well with dealing with backlogs. The first one is don’t let it occur in the first place. So, you know, because they do grow exponentially when they get a life of their own. So jump on it quick. Admittedly, in this situation,

James: 10:11

bit late.

Jimmy (2): 10:11

the, uh, the, the, the horse has definitely bolted and gone to the next county. So what you need to do is create a fire break.

James: 10:20

So what do you mean by that?

Jimmy (2): 10:21

So you need to stop the backlog being able to grow and spread, to start to break the back of it. I mean, you know that they have fire breaks back in the, uh, the day of the fire

James: 10:32

fire.

Jimmy (2): 10:33

They do it in the US in wildfires. How do you create that break to stop this out of control thing? And actually what you have to do is you have to start to think about doing some unpalatable actions.

James: 10:45

Well, absolutely unpalatable. So in the way that they flattened a house in the fire of London, yeah, it was unpalatable, but it was the way to stop things. Stop the fire

Jimmy (2): 10:53

spreading. Well, the way of doing it with a backlog is you have to do some stuff. Maybe you pay overtime, you pay more overtime, you change the, you bring in different resource, change the conditions for paying that resource. You use assumptions. I mean, a good example of one that we, um, did is looking at claims. Well, we found that a cost of setting a claim was 500 pounds. So when we’re facing extreme conditions, any claim regardless of its validity, under 500 pound got

James: 11:25

Right, because it was going to cost you that much

Jimmy (2): 11:27

Now, these aren’t things that you would necessarily want to do in business as usual situations, but in extreme situations, know what those things are ahead of time, think about it ahead of time. And then when you get the backlog, this is how you deal with it.

James: 11:43

And I don’t know what those things are for the NHS. maybe it’s buying capacity in the, private sector. Maybe it’s using pharmacies. Yeah,

Jimmy (2): 11:53

and it might be. Yeah, and that’s a good example. It might well be. I mean, we used pharmacies in COVID for vaccinations, but I wouldn’t necessarily buy in capacity from the private sector. Take it. And it’s that sort of thing where you just have to go to the extreme to solve the problem. The third thing is mitigate the work coming in. So this is in the NHS terms, how do you get into prevention and you can’t wait until the backlog has gone to zero to start getting into that. So how do you look at preventing some of the health issues? How do you look at dealing with the incoming claims, the incoming work, whatever it is, to try and mitigate that. So the backlog stops growing.

James: 12:37

it really is a question of thinking of all the things you could do, writing them down, and stacking them from least unpalatable to most unpalatable, and just working your way up the

Jimmy (2): 12:48

list. Along with impact. Absolutely. What would you do next then?

James: 12:52

Well the next one is a bit more esoteric, and actually in fairness to the government they are talking about doing this, but it really is about taking a long term view. most things that are worth doing take a period of time to do. And yeah, you’ve seen this, you know, people trying to hit their sales numbers and they’ve got three weeks to go. They’ll do all sorts of ridiculous things, which, actually mess things up rather than fix them. So if you really want to improve your system, it’s about standing back and taking the long term view and thinking, well, what are the bets that we need to be placing now to, to make sure that it’s working in the future.

Jimmy: 13:27

Yeah, don’t just be dictated to by the political cycle, the monthly target, the annual budget cycle. They’re all the things that drive you, but they’re unlikely to drive you to come up with the best. Absolutely.

James (2): 13:43

absolutely.

Jimmy: 13:43

So

James: 13:44

that I think is the next thing. And in fairness, and we’re looking at it, but how do you stand back and take a long term perspective of what you’re

Jimmy: 13:50

But even, I agree James, but even in their situation, they’re saying it takes 10 years, but they’ve got to show progress in the first

James: 13:58

Well, yeah.

Jimmy: 13:59

they will have to prioritise some stuff to give them some wins that allow them to tell the story, allow them to get the full 10 years to do the

James: 14:07

that, and a linked thing to that then is the whole thing about being able to stand back and, reduce some of the political points scoring, so that you can actually say, this is what we’re doing and it is going to take time.

Jimmy: 14:18

take time. Well, your great example of this uh, is Amazon.

James: 14:22

Oh yeah, I’m the Amazon fanboy. Not sure that’s strictly true, but Jeff Bezos goes on record and he’ll say, we like to take the, um, the seven year view on things. And I think, yeah, all right. But the point he makes, which I think is really interesting. He says most companies at the extreme, they’ll look at things for three years. If it doesn’t be a maximum, but if you didn’t pay back in three years, they’re not doing it. But Bezos’s point is, well that actually gives me years four, five, six, and seven. There are a whole host of games and projects and Lord knows what else I can do, moves I can make, which no other company will even look at because they’re not prepared to take the longer term perspective.

Jimmy: 14:57

In fairness, you can have that view when you’re the richest

James: 14:59

Well, that is quite true, yeah. Musk the richest man in the world? Oh, there you,

Jimmy: 15:06

Jeff versus Elon.

James: 15:09

if ever the Yeah. Alright, so there you go. Long-term view. What next? Then

15:15

The show you’re listening to right now. Brings you insights to help you improve performance and enjoyment of work. It takes a long time to produce, but we think it’s well worth it. It’s all in the name of helping you get your job done well. All we ask in return is that you share the link to the show with someone that you think would benefit from it. And if you haven’t already, click on follow the show wherever you’re listening to this podcast right now. Anyway, let’s get back to the show.

Jimmy (3): 15:47

So next you’ve got to be open to learning. one of the things that came out of the review was that in places the NHS is performing well. There are plenty of examples of exemplary performance. So you’ve got to look for and learn from the

James (2): 16:07

Right, that’s really interesting because quite often, and we’ve seen this time and time again, but the solution is in the room. Yeah. Yeah, so understanding what the performance is like, being honest about it, understanding where it’s good and then going and learning from the people who are doing a good job and copying what they are doing and applying that to your own situation. It’s really powerful stuff. Yeah.

Jimmy (3): 16:29

And it depends on how you define the room, doesn’t it? Is the room your team, your organisation, your part of the world, your industry? The answer will be out there. You’ve just got to really Do two things. One, be curious and two, avoid the wasn’t invented here

James (2): 16:48

Yeah, I mean, I’ve seen that. It’s as mundane as call handling in a call centre. But when you stand back and look, some of the agents are really, really good at it, and they, answer customers queries and kill them stone dead, whereas other ones just bounce calls left, right and center. So even though it’s more scale like that, just looking at the variation and understanding who’s good and what I can learn from me. Really powerful

Jimmy (3): 17:08

that example, I remember you looking at the variation in performance in a particular team and got outstanding results by doing exactly that. Picking the best and learning for the best. Let everyone get that learning and that becomes the best way of doing

James (2): 17:25

Yeah, but it is, the key word there is learning. It’s not about centring your target in the same way, you’re as good as they are. The other thing actually is it’s not just about, what’s happening internally. If you really want to be good, go and look at what’s going on outside. So, there you are, an interesting one. We can argue the political rights and wrongs of it, but a fabulous bit of capacity management in the UK court system recently, where they prosecuted loads and loads of people over the riots

Jimmy (3): 17:52

Oh yeah, yeah. But

James (2): 17:53

but you think, right, so you’ve got to switch on judges, you’ve got to switch on jurors, you need court capacity. Yeah, I mean, yeah, it shows what can, which comes back to our backlog management point, right, but it shows what can be done if you’re prepared to go for

Jimmy (3): 18:07

it. you don’t want courts working 24 7 all the time, but in extreme circumstances they absolutely stepped on that backlog straight away and stopped it from growing.

James (2): 18:17

from growing. So, one of the things that struck me out of

Jimmy (3): 18:23

One of the things that struck me from the Darzi report was the view that they had, didn’t value and hadn’t invested in leadership and management. And I guess that’s two parts to it. One is they have a central leadership function that oversees the NHS. That sounded like it was like 19, 000 people. in leadership and oversight roles. And then there’s the local leadership where often the best technical expert, the best clinicians are getting promoted to leading departments, leading hospitals, et cetera. But they haven’t, they don’t value that skill and they don’t invest in the development. So I’d make sure that you really valued leadership and management as a skill. If you want to know more about our views on that, Series 2, Episode 1. But value it as a skill and develop it in people. It’s a good thing. You can learn it. It’s not necessarily something you’re born with

James (2): 19:25

Yeah, but to bang on and hit your point again, it’s not about being a good medic. because these things we’re talking about, these problems exist everywhere. So it’s really about understanding how your organization is working and being able to manage it. the other thing, just as a quick aside, I read an article, interesting article about Google, and they were quite interested in finding out who their best managers were. And they did a survey, and they came back with a whole, host of things, you know, nine points, which make a good manager. But what was really interesting was of course to find out. They had to ask their staff. So, you know, if you really want to understand who your good managers and your good leaders are, go and ask your

Jimmy (3): 19:59

Back to the improvement

James (2): 20:00

Yeah, absolutely.

Jimmy (3): 20:02

Your best technical expert isn’t necessarily your best leader. So how do you make sure that you’re not just promoting on the basis of technical knowledge, and if you are, make sure that you give people the right leadership skills.

James (2): 20:15

to understand. Yeah, totally agree. Um, next one. Well, and this one is a bit old hat. Some people roll their eyes to the back of their head when they hear it. But for me, a lot of it’s just about performance disciplines and consistent ways of working.

Jimmy (3): 20:30

Yeah, and we’ve seen this in so many organizations. It’s just the basics. Have you got, if you’ve got your purpose clear, how are you measuring that purpose? Do you have those measures on performance boards around your organization in your teams? Do your teams do huddles on a regular basis? Do you have the right review and oversight of performance? These are just basic. Performance practices that are not always, consistently done and used through organisations.

James (2): 20:58

have no doubt that the people are saying, it won’t work here. Well, it works other places, what’s so special about you?

Jimmy (3): 21:05

and we’ve seen it work in everything from frontline contact center teams, fraud teams, technical teams, data teams, exec

James (2): 21:13

industrial workshops,

Jimmy (3): 21:15

big organizations, HR, it

James (2): 21:20

works. but of course it only works if you’re clear about your purpose because if you’ve got something dodgy that you’re going after it will just reinforce those bad habits. Okay, getting towards the end of our list now then, what’s

Jimmy (3): 21:33

Well, culture, and there were lots of in Darzi reports about this, but it wasn’t clear how the culture of the NHS really supported the delivery of the overall purpose. it is important to be clear on what sort of culture will deliver your purpose, and How is it now, and therefore what needs to change? And don’t shy away from the reality of today. Not what would you like it to be today, what is it actually today?

James (2): 22:03

Yeah, and you hear all sorts of horror stories about people covering things up. So what does a good culture look like? Well, a good culture is one where you’re constantly improving, sharing information, and striving to deliver against your

Jimmy (3): 22:17

And working together as one team to deliver that purpose

James (2): 22:20

Then that leads me to the final one, which I think is the overall, problem in all organizations. and it’s just about education. there is a, there is a company called Vanguard Consulting, who people may or may not have heard about. And they’ve got a very simple model, but it’s quite powerful. They talk about thinking, system, and performance. Now, as we talk about performance, you know how it breaks your backlog. And then we’ve talked about, well, that’s actually driven by the system. How are you managing your systems? Yeah, but actually the system is driven by the thinking of the people who design the systems. So if you really want to improve the performance of your organization, you need to change the thinking of the senior people in that organization.

Jimmy (3): 23:00

I think you’re right, James, the, but there is a link, you know, and Lord Darzi does talk about the fact that the outcomes that the NHS are getting are exactly what the system is designed to deliver and exactly the inverse of what the strategy they should have.

James (2): 23:18

So

Jimmy (3): 23:20

over the couple of episodes, we started off by looking at the NHS as an interesting case study. but it’s problems are far from unique. And in fact, when you break down what Lord Darzi says, a lot of it we have seen in every organisation we’ve worked in.

James (2): 23:39

Yep, same repeating pattern. So

Jimmy (3): 23:41

So funny enough. A lot of the solutions, are also universal. if you’re interested, go, go and read the report, Whilst it’s an interesting case study in the NHS touches all our lives. I think it’s important for understand for us to understand the challenges it’s also really useful to learn from the good and bad that happens elsewhere

James (2): 24:02

Yeah. the one thing for me, the most important thing, it’s about thinking and learning. So go and understand what’s going on, try new stuff, see what works.

Jimmy (3): 24:11

Because, if you do what you’ve always done, you’ll get what you’ve always

James (2): 24:15

Yeah, absolutely.

Jimmy (3): 24:16

Hopefully, you’ve all found this episode useful, both in terms of understanding how the same problems happen in organizations, but also some of the solutions that we would put out there. If you want to talk more about it, so Wes, if you’re listening, give us a shout. Thanks, everyone.

James (2): 24:34

Speak to you next week. Cheers now.