Getting rid of the mess

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The impact of the Francis inquiry in health care in the UK continues to reverberate. We like the very practical things (speak – act – lead) that individual doctors are being encouraged to do by a bunch of their peers.

And in a recent blog we posed the question of what can be done– and offered a teaser of an example to learn from…

We think the improvements that have led to a reduced nuisance of dog fouling is due to a number of ‘nudges’ that make it easy for people to do the right thing, every time.

Looked at through one of our favourite frameworks – SPP– there are a number of things that have helped sustain progress in cleaner streets and parks over the last few decades:

There was change in three dimensions:

1) STRUCTURE change – by laws to regulate some action, set a path and direction – with prosecution of (human) offenders

2) PROCESS change – town planners listened to local people and put in dog poop bins and systems to empty them+++

3) BEHAVIOURAL pressure for personal responsibly – from other dog walkers to do something pretty unpleasant with a plastic bag (even when no one is watching)

So, how does this help in thinking about getting rid of the mess in health care? For example, on improving compassion in health care, I think there are things to do at all three levels:

a) STRUCTURE: Promoting leaders for their values (plus thorough regulation of professions too)

b) PROCESS: Investing in the capacity for bottom up staff and patient led improvements – leaders listening and helping

c) PATTERN: Building a cultural campaign amongst staff for calling unproductive behaviour by peers on the wards, etc. This is something that is pretty hard for many to do – and not for just when others are watching. But it is essential to get beyond the sort of verbal ‘window dressing’ (“we are here for the patients”) that can happen in ‘noble purpose organisations’.

I walked over a verge in the dark the other night and realised I no longer worry about what I might stand in like I did when a lad delivering papers during early winter evenings. It reminded me again of this inspiration for health service improvement post Francis. An example based on 3 levels of ‘nudging’ – structure, process and pattern of behaviour. A model on what has helped eradicate dogs mess on the streets.

(btw, I think the process improvements of the bereavement system (with the one stop shop approach to cancelling passports, driving licences, etc) is another example of a study of success change/improvement with the SPP framework in mind: new integrated IT system, more time for registrars and a willingness of staff from hospitals to town hall to help make it work for relatives….but maybe that is another blog…)

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