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Building blocks of change

This blog is part of a series of reflections by the Re-imagining Healthcare SIG. Here Matthew Bell summarises the building blocks for change he thinks is needed at organisations move to dynamic and collective structures of control, authority and assurance.

This will repeat what many other blogs talk about, but there are a few key areas I would like to highlight as being important to moving to a better working culture. That is, one that values everyone’s input and views and so is able to make better, safer decisions with more accurate information held by authority close to the information.

  • Feedback – at the centre of this change is a discovery of relationships that are able to manage the flow of information necessary to deliver the value and purpose of the work. This requires everyone to be able to give and receive feedback and to use that to learn and development. I saw this across the work, the value achieved with good feedback vs the pain and upset caused when people kept information to themselves.
  • Data – still on the subject of high quality information, if feedback is one important source, so is organisational data including finances. Being able to test assumptions against something measurable, produces insight and understanding. I saw this when looking at how workload was distributed, the good data available helped raise questions about what was happening. The data in itself doesn’t have to absolutely accurate, but just good enough and accepted as good enough to be able to generate some questions that lead to further insight into what is happening.
  • Exposure to the environment – again, still on the topic of information, I found that the reality of the environment was something incredibly important to be very clear about. To do this you need to have an organisation that is constantly sensing and then adapting to the environment. Without this data being shared this cannot happen.
  • Improvement methodologies – this is a skills need. Having people able to understand improvement methodologies whether this is lean, agile, PDSA cycles or design techniques is really helpful to be able to have a built in sense of how to respond to issues that occur. The discipline of know what the problem is/outcome that is desired and the logical steps that might be tested to get there is something that can help gain traction on a test of change.
  • Decision making processes – by just describing the current methods of decision making makes this area of the work that is so often taken for granted and invisible, more visible and therefore easier to change.
  • Clear accountability/responsibility – this was extremely strong at Shared Lives SW. Almost everyone knew their role and function and was vital to operation.

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