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  • Kim Croasdale joined the group Sustainable Healthcare 2 months, 2 weeks ago

    • Dear Kim,

      Welcome to the group! It’s really good to see you here. We’re currently growing the group and starting work on some initiatives to ignite more collaborations, so it’s a great time to join.

      What thoughts have you had about what you’d like to gain from being part of the group?

      All good wishes,


      • Hi Olivia,

        Thanks for the welcome!

        I work in the NHS Sustainable Development Unit, managing our approach to operationalising activity across the system in partnership with regions and grass-roots networks. At the moment we’re putting together our interim plan to get the NHS to net zero before 2050. I’m working on a few of the workstreams, including working with regions, mobilising the workforce and models of care. It might be helpful to kick off with a few questions that I’d love to gather people’s thoughts on:

        What do people think of when they hear the term “model of care”? We’re trying to define what it means and collect examples of best sustainable practice.

        How can we demonstrate the carbon and health impacts of some of the stuff that we inherently know is good, like planting trees, preventing illness and reducing demand in the system? We’re being pushed for numbers, which are sometimes tough to evidence.

        How can we help to make sustainable healthcare a part of the new, post-covid “normal”? What are the things that will truly enable change?

        Some big questions…!

      • A Model of Care and its associated processes, incorporating a Process Management System, could work wonders for establishing more sustainable healthcare. A greater understanding of what everyone does at work rather than measuring outputs will facilitate improvement and sustainability. Unfortunately this approach is not given a lot of consideration.

    • Dear Kim,

      Welcome to the group! It’s good to see you here. You’ve joined at an excellent time as we’re just about to launch some opportunities to ignite more collaboration. Do feel free to post to let us know what you’re hoping to get out of the group.

      All good wishes,


    • ‘Model of care’ makes me think of care pathways, management level – important! And it would also incorporate individual interactions and approaches, and ideally would extend to community connections + promoting sustainable healthcare – patient autonomy, green prescribing, etc….?

      • Thanks Sarah, this aligns quite nicely with our thoughts so that’s helpful! We’re thinking it means different things at different levels of the system – at a strategic level, it’s about the strategy/policy framework that dictates how care is delivered. In patient interactions, it is literally the choice of care delivered to the patient. So really it encompasses everything – which makes it a very exciting place to be hopefully! Does that all sound sensible to you?

    • @thomasjohnrose @kimc
      Your comment, Thomas, about using Process Management Systems to promote sustainable healthcare was interesting. Could you say a bit more about this and perhaps give an example?

      I’m also interested to hear how you evaluate the process, rather than looking at outcomes.

      • Olivia,
        All work activities undertaken by the employees or systems of an organization are part of one process or another. Typically employees in an organization are part of one or more work groups. Each workgroup may, for example, be responsible for say 20 key processes. Each process, typically, should be designed to have a maximum of say 8 steps. These steps are the work activities referred to above. This gives a total of 20×8=160 work activities. That is a lot. These activities are the bread and butter of the organization and it is important that they are understood and managed.
        Processes will always have inputs and outputs which can be measured. The acceptable standard for inputs and outputs can be specified and monitored. How the inputs are transformed into outputs can also be specified and compliance can be monitored. Both the standard for the process output and the procedures followed to transform the inputs into outputs can be continually improved and, for example, new technologies can be readily incorporated into both.
        In lots of organizations work activities have evolved over time with little or no real design activity having been undertaken and employees ‘learn on the job’ and the statement ‘this is the way we have always done it’ is commonplace. The result is that everyone does the same thing differently and there is no Process Management. This work culture results in too large a variation in output and much opportunity for process error.
        Key influencers in process design are/should be the organization’s values, mission statement, policy and regulation.
        In order to manage processes they must first be defined and documented. Often organizations are unable to even list their key processes never mind define, document and manage them. This is not true, by any means, of many organizations in the UK. Importantly, although the final design must be approved, the process should be designed by the people doing the work. Initially this is usually a case of documenting the current process and attempting to get some agreement on how work activities are undertaken.
        The steps in getting from the current situation to having an effective and efficient Process Management System are not too difficult if approached logically. The first step is to list your key processes.
        Once a key process has been documented, often using a process mapping technique, it is a relatively simple process to assess the documented process for sustainability.
        My particular expertise are in my ability to identify, define and document processes. I have also developed a technique, called ‘The Busyfish Approach’, to simplify the defining and documenting of processes, using knowledge from within the organization, and to make the documentation readily accessible by all employees all undertaken ‘on line’. This will extend the process knowledge within the organization and enable employees to see the final outputs of their individual work activities. Olivia this fits in with your ‘thinking space’ idea and can guide content for activities like Adaptive Space and Communities of Practice.
        Typical processes for a small organization would be, for example, marketing, product/service development, sales, customer feedback, process management, purchasing, etc. I like to split processes into two groups, Product/Service realization processes and Business processes. These equate roughly into income generation and overhead processes.
        Clearly I have only been able to provide a very basic outline of Process Management here. If you are interested in Process Management I’d be happy to help out; via Hexitime maybe.
        In response to your last point, process design can be evaluated using the usual evaluation techniques. In regard to monitoring and managing the process there is a highly developed methodology in use throughout the UK but not in healthcare. I can provide details of this methodology but a prerequisite for its application is documented processes.
        Sorry about being a bit wordy – I think it must be due to being locked down!

      • Thank you, Thomas @thomasjohnrose.

        I agree that process maps are a key tool in designing sustainable healthcare; one needs to know where one is before redesign can start…and, as you say, many people are not clear on the process, especially beyond their individual role or their team’s roles. Process maps can help open up people’s view to consider the context in which they operate.

        Tight standard operating procedures are more common in some healthcare settings than others. I have worked in clinical trials where processes were clearly defined. This certainly had strengths in helping us to meet tight deadlines and standardising processes. It did have downsides too though; it led to staff having tunnel vision for the targets and deadlines and failing to attend to the broader needs of patients, which was a failing when we were dealing with patients nearing the end of life who had psychological, spiritual, social needs as well as physical needs that were not an adverse drug event! One could argue that an SOP should be devised for these too?! I do wonder how flexibility of thinking and responsiveness is maintained in a tightly process-driven environment?

      • Olivia, Flexibility of thinking and responsiveness of all employees (and all other stakeholders) is absolutely essential for the design and maintenance of a good Process Management System. I certainly would not be happy with a tightly process-driven environment. It is a fact though that certain processes, particularly those with a high patient safety element, do need to be more tightly managed.
        Targets and deadlines should not part of a Process Management System. The elimination of error, Continuous Improvement (CI) are the key objectives.
        I would be happy to continue this conversation with you or with any interested party.

      • Thank you, Thomas @thomasjohnrose, for your helpful and full reply!

      • Last but not least – Please have a look at ‘National patient safety syllabus 1.0 Training for all NHS staff’, published January 2020. This document describes what UK business calls a Process Management System.