The greatest danger in times of turbulence is not the turbulence – it is to act with yesterday’s logic - Peter Drucker

The TurningTides Blog

Ideas and inspiration from Turning Tides

Deepening Perspectives on Change: Five Questions

Number 5

 What are the five questions you ask yourself as you embark on a major change for service improvement? This was the question that RCN Scotland asked me to address when they invited me to take part in the 'Expert Express' session at their 'Activists Conference' last week. It was a great question!

The thing I value most about being asked to speak at such events is that to articulate my view, I have to think deeply about subjects I deal with every day. This preparation and subsequent reflection on the audience response enables me to deepen my learning even further and, importantly, to stay fresh in my thinking. Here are my five questions and why I think they’re important.

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Alternative Advent in 24 Words


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An alternative advent - 24 words for 24 days!  That was the challenge set by one of my writing buddies. Back in October I posted a blog about my creative writing for business experience with Dark Angels. I loved it and wanted to keep on cultivating my ' true voice' in a writing context. I particularly wanted to bring more of a human touch to the written word. So when Pip Trentham set the challenge I was up for it. 

Writing Short

Writing a little advent message in 24 words certainly challenged my ability to 'write short'. However, given that we live in a world of truncated electronic communications, it turned out to be a discipline well worth developing. I'm not saying we have to get our message across in 24 words all the time, but sometimes we do have to get to the point quickly or risk losing our audience.

Going for Stretch

There were no other rules as such; just write 24 words each day and share it with the others from the course. Ah, now that's where the other challenge came in.  I don't know about you fellow bloggers but it takes a bit of time to get used to exposing your inner wordage online. The words never seem quite good enough.  

My writing course buddies were all pretty accomplished writers already. In fact most of them were writers in their day jobs so I knew I was in for a 'stretch situation' when I signed up for the course. But why undertake a course if it isn't going to stretch you? That's my philosophy anyway. So, of the 24 word challenge, well lets just say that, like the lion from the Wizard of Oz, I found my courage and the s-t-r-e-t-c-h I was looking for!

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A Steady Hand on Quality

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Managing quality in healthcare seems like a rather sedate affair in the academic literature, but in my experience it's more like trying to control a herd of wild horses! Sounds a bit dramatic I know, but this is how I see it when I reflect back on my service management days. My observations suggest quality management is as unpredictable today. Probably more so.

The wild horses I'm referring to are the Six Dimensions of Quality - timely, safety, person centred, efficiency, effectiveness and equity - a framework widely used in the NHS. While the Six Dimensions framework has its origins in the USA health sector, the versatility of the framework makes it applicable to most service sectors. Personally I find the framework a useful way of making sense of quality, particularly in situations of high complexity.

In Scotland the Scottish Government sets the strategic direction for improving quality in the NHS. A few years ago the spotlight was on improving waiting times for treatment in cancer services and for surgical operations such as in hip and knee replacements (the timely and equity dimensions). Things improved and waiting times became shorter. The focus then moved to ensuring services were safe, effective, efficient and person centred.  

I can understand why different dimensions are selected for closer attention at a strategic level. This prioritisation allows additional resources to be targeted at areas identified as needing improvement. However the closer you get to the people you serve, the more unpredictable the management of quality becomes. Rather than being selective, there's a need to keep a watchful eye all six dimensions simultaneously. 

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