Workforce Design and Culture Development

Keywords:

NHS faces its biggest challenge since the funding increases seemed like water to a parched flower - funding will cease to grow in 2011. Workforce is the area of biggest spend[1], so reviewing this using
workforce design techniques, and consulting with the staff to bring around culture development, are vital to achieve change in this area
But the 2002 Derek Wanless report (Securing our future health: taking a long-term view) already told us that if we carry on doing health the same way as we do it today, every able person in the country will be occupied looking after the less able - we have to change!
So how do you design a workforce fit for purpose?
And more importantly, how do you deliver such a workforce?
Firstly, understand that there are many ways to achieve the same end. A few very skilled, very highly paid people can provide a very fast service and deliver excellent outcomes: a larger number of less skilled, less highly paid people can spend longer with each patient and deliver equally good outcomes[2] - the choice really seems to depend on your starting point

young skilled and well-qualified staff anxious for more responsibility, or
the senior staff about to retire

Of course you need to match the workforce to the need in terms of activity and competency, and I've looked at this in different ways - see Resource & workforce planning for an overview, and more specifically Economic and workforce modelling in urgent & emergency, and workforce reprofiling in acute & mental health as well as the introduction of ECPs to the first contact team. There are more examples on the pages listed below:
And what about changing the culture?
So many culture change programmes attempt to align culture to the Chief Executive's view of what the culture should be. It's like getting a marketing company in to write you a vision and mission statement - it sounds great but nobody buys it.
We engage with all the staff, in a four stage approach:

understand the current culture(s), how they vary by top/ middle/ bottom[3], where the gaps and glass ceilings occur, reporting back not just to the board and project team but to the whole staff
helping front-line and support staff understand what is expected of the organisation, in clinical outcome and quality terms, volumes of activity, economically, politically, and the constraints. Help everyone to feel they belong (see one example, where feedback included "now I remember why I joined the NHS")
gaining consensus on where the organisation would like to be, culturally, and the activities each individual and team need to do to make this happen
monitoring: setting the performance measures (yes, for cultural development!) and showing a reporting mechanism and reporting which gives everyone feedback - each can see the difference their activity makes both to cultural development and the performance of the organisation in each of the areas it needs to perform

This can be very scary for an unconfident or over-controlling executive board. Are you willing?
 
Footnotes

NHS employed workforce represents around 70% of costs, but 15% goes on independent contractors (GPs, Dentists, Pharmacists, etc) who presumably have a similar proportion of staffing costs. This suggests workforce (NHS and independent) represents closer to 80% of the total NHS budget
A study on ward staffing and healthy outcomes for patients at Sheffield Teaching Hospital concluded that you could achieve the best outcomes for patients through a variety of different staffing models; meanwhile lowest wage bill was usually not cost-effective on a per-patient basis because of increases in complications, extended stays and readmissions.
Top - often bullish about a wonderful future and keeping on coming up with new ideas. May have forgotten that there's a service to deliver 24*365 in addition to any new ideas. Middle - fearing another new idea from the exec team. Bottom - getting on with the day to day mundanities and resenting any attempts to change their work

Further Reading
There are thousands of books on culture change, many assuming that you can apply the same change processes to public service organisations, and NHS in particular, as you would in the commercial world.
I've identified just three below which I think are the most pertinent, and that don't make these sweeping generalisations

 
As for workforce design, there's surprisingly little of use: I compiled a list of workforce design tools which is due to appear on the Skills for Health New Ways of Working workforce tools site.

Economic & workforce modelling: Resource and economic analysis of urgent and emergency care in London

As part of the wider project examining options for redesign of emergency and unscheduled care for NHS across London, I prepared the detailed modelling (workforce, financial, business change).

This involved tackling the requirements from both ends and using two tools for triangulation:
how many people are coming forwards with what requirements, and what care pathways would it be possible to use
based on the current numbers of staff of each type and their competencies, how much would each pathway get used and what implications does that have for transition and for costs
and tools:
MS Excel for dynamic steady state modelling year by year, forecasting activity, pathway use, requirements for staff and resource use, staff training required, staff in training
cross-referenced with Care Pathway Simulator (CPS) workflow modelling based on patients entering the system at random in line with the current peaks, troughs and cycles of patients through the 24 hr, week and seasons; confirming for different staff and competence mixes that the results would agree with those predicted by MS Excel models
The results of this study represented a blueprint for real change, and although only the conclusions formed part of Prof Darzi's review of Urgent and Emergency Care in London (part of "Reform for London"), individual organisations have based their training and planning on the detail

BOOK: Employees First, Customers Second by Vineet Nayar

I first bought the book in hardback - then found I was enjoying it so much I went and bought the Kindle edition too!  It's a fascinating case study with much wider application.

The key to the whole book is to identify where value is created in your organisation.  Do you do it, in your office, thinking great "strategic" thoughts, or is the strategy more of a foundation on which value can be built?

Nayar identifies the part of HIS organisation that creates value - the people who work for the customers.

With the right support, Nayar believes, these people can create much more value for customers, which means the customers will create the business success that the organisation wants.

This book is more than the exposition of a theory.

Nayar became CEO of a $700million turnover 30,000 staff professional services company in 2005, and he describes the journey he and the company traveled, from a company that was being left behind by its peers, to a multi-billion turnover (Turnover for the most recent 3 months was $1billion) 80,000 staff company with 21% growth year on year.

This brave CEO rethinks the very basis of 19 and 20C business management.

He explains that in a knowledge economy, knowledge is power, so each level of management jealously guards his or her knowledge because it appears to be the sole reason they hold that management position. Then he asks the question "What if you share your information with the front-line staff, the people who create value? What if the whole company, all of the support functions, the office of the chief executive, are dedicated to supporting the front line to produce the highest quality, best, and most effective experience for your customers? What if you (as Chief Executive) refuse to pretend that you have all the answers, and instead insist that people come up with the solutions themselves?".  He reasons that 80,000 heads are better than one. They know the customers better, they know the technology better, they know their own passions better. The proof of the pudding is in the eating, and Nayar has transformed HCL Technologies. The numbers speak for themselves (4X increase in turnover and 2.6X increase in employees in 5 years is impressive in anyone's organisation, even more so in the crises of the last few years). But the reputation that HCL Technologies holds has also transformed, both as an employer and as a supplier.

This is a book everyone should read. It's relevant to industry, to commerce, to public sector, to charities and voluntary sector. Even if you don't do everything that Nayar suggests, you'll pick up plenty of ideas to focus on value creation.

The Responsibility Deal and the Fukushima nuclear power plant

Fukushima power plant explodesThe Responsibility Deal is about our responsibility to each other and society. It is a shame that such a noble sentiment has been hijacked to describe an attempted deal between the manufacturers and promoters of alcoholic drinks (who want consumers to drink as much as possible) and health promotion groups (who want consumers to drink a great deal less), and it is no surprise that the talks broke down given their limited remit.

Where does the Fukushima nuclear power plant come into this?

Well that is the true responsibility deal. The whole area has been devastated, people are missing, and most people are being kept outside an exclusion zone. Yet a brave crew has stayed inside the nuclear power plant to try to keep it safe. They probably want to find out what's happened to their families. They probably are the same shift that was working on the day of the tsunami, who are still working round the clock without relief. The situation they now face is outside the plans laid down so they have to be creative. But they stay there.

That's real courage. That's real responsibility to society.

I'm not in anything like such a difficult situation. I can go home at night and check my family are safe, I can eat and sleep and I'm not in fear of my life.

So what do I contribute to the Big Society of UK?

I, we, commit to our work which is aligning the priorities and objectives of individual organisations to the needs of society and the people as a whole.

We commit to doing our work well, helping organisations and individuals to influence the direction that Big Society takes by showing what they have achieved and how this makes a difference.

We commit to demonstrating, using the Social Return on Investment (SROI) framework and appropriate reporting, that people and organisations are worth the investment that society makes in them (or alternatively, that they need to change), and to making a difference. It might not be in fear of our lives, but it is still a commitment and a responsibility.

National Insurance - A Tax on Jobs?

HMRC taxation systemsAt last there is clear blue water between the UK political parties in the run up to the General Election - over taxation.
And the parties are acting true to traditional form - Labour wants to raise taxes, and Conservatives want to lower them.
But the picture isn't quite so straightforward.  The Tax selected, National Insurance, is actually a tax on the poor, taxing those on low and middle income at a higher rate than those on high income.
National Insurance is a sort-of 'hidden' tax.  It doesn't appear on any headline rate, so successive governments, in my memory beginning with Margaret Thatcher (Conservative) but probably since a long time before, have kept income tax low whilst taking the money out of yours and my pay packets through National Insurance.  It has now reached a phenomenal 23.8% (higher than the average tax rate which is made up of 20%, 40% and 50% tax rates with a tax-free allowance for the lowest paid).  The trick is, that over half of NI is paid directly by the employer to the treasury and doesn't appear on my pay slip, so although it is part of my cost of employment, I don't see enough to get upset.  I do see the 11% I pay, just not the 12.8% my employer pays.
Labour plans to raise National Insurance still further, though I'm not clear whether this is by 2% overall (1% on Employers and 1% on Employees) or only 1%. Either way, it is enormous.  But it is much worse than this - National Insurance represents a tax on the poor because above a certain income (£844/week ~ £42,000/year) the employee rate goes down to 1%.  This means that the total tax take from payroll (ie Income tax, National Insurance by employee, National Insurance by Employer) is:

Earnings/year
% Income Tax
% NI
Total Tax
Earnings in Euro
Earnings in USD

 £             4,696.00
0%
0%
0%
€ 5,307.12
$7,147.62

 £          12,000.00
9%
13%
23%
€ 13,561.64
$18,264.78

 £          18,000.00
13%
17%
30%
€ 20,342.45
$27,397.18

 £          24,500.00
15%
19%
33%
€ 27,688.34
$37,290.60

 £          50,000.00
22%
20%
43%
€ 56,506.82
$76,103.27

 £          75,000.00
28%
18%
46%
€ 84,760.22
$114,154.90

 £        120,000.00
34%
16%
50%
€ 135,616.36
$182,647.85

 £        200,000.00
39%
15%
54%
€ 226,027.27
$304,413.08 

 
National Insurance actually starts to go DOWN as a % of the total after £50,000 earnings per year, and total taxation hardly rises as a % above this level.

Can we have a little more honesty from politicians please?

Initiating joint working - cross sector forum

With New Ways of Working I initiated a core planning group to identify cross-sector issues (health, social services, childrens incorporating commissioners and providers from public, independent and voluntary sector) and share knowledge.
We all know that decisions on the funding and types of care in one sector often impact on others; staff and users want seamless care delivery, and of course transferability of skills and qualifications.
The core planning group (Champions of the Future Workforce) meets in parallel with regional joint planning groups and is made up of representatives from each.
What does it achieve?
An excellent example of sharing knowledge comes from East of England. EoE already has very successful links between the workforce planners for Social Care and those for Health, particularly important as so many of the staff move between sectors regularly. The representative was able to share the "how" and others can apply this back in their own regions.
AIMS of the national planning group are to:
share learning and understanding of what works so that each region can "stand on the shoulders of giants" and together we can deliver more success and more benefits

Jobs on the Line

Letter in Health Service Journal - 17 Sept 2009
medium_HSJ2009-09-17_letter.jpg"if we're still delivering healthcare the way we do today, by 2022 every able person in the country will be occupied looking after the less able - we have to change" summarised Derek Wanless's Securing our Future Health in 2002. But demand for healthcare will grow, and care means people.
So how do you get more for less (news, page 4, 3 September)?
Getting people involved in the business goes a long way.
Engage people setting the aims, the strategy and in making decisions. A lo of things don't need doing, but nobody knows which things until they ask why, and the answer has to come from people who understand both the business and the doing.
So fiddle about with nurseries and staff car parks at your peril - you'll save a few pounds but at what cost? To make a real difference we need to put our own job titles on the line and ask our staff for help.
Dr Hugo Minney, managing director, Minney.org

From the Bottom Up - Employees leading change

Employee EngagementThe relationship between employer and employee is at its most strained at the moment, as people try to carve out security for themselves and companies consider who they cannot afford to keep on payroll.

And yet, this is also a time when many organisations need engagement from their staff. It is unlikely that the CEO has all the answers to deal with this challenge, but very likely that the front-line staff have - answers to cost reduction, to improving customer satisfaction, innovations which customers are asking for. Why would they share those ideas freely? Do they even know they have these answers?

 

Getting staff commitment - why do you want to do that?

At its simplest, people cost money. They cost money to recruit, to retain, and they cost money when they don’t have enough work to do so they are marking time, eg between those bursts of activity that come around regularly.

But people also deliver. In public services such as health, all care is given by people. Yes sure there are medicines and technologies that help, but someone greets the patient and either inspires or depresses them, which makes all the difference to patient experience and their chances of recovery. People deliver change and innovation, without which companies get left behind in this competitive environment - they make things happen, they even achieve the impossible sometimes. Self-motivated, committed staff make all the difference.

There are degrees of engagement.

At the basic level, staff can be sufficiently “engaged” to do what they are paid to do. To turn up at 9, not let too many things get neglected, and not go home too early. I’m sure we can all think of colleagues or former colleagues who didn’t even manage this.

What about getting people so inspired that they contribute more? This isn’t a new idea - Konosuke Matsushita (founder of the Panasonic company) designed his company around autonomy and the contribution it could make, and was rewarded with employees bringing their commitment to excellence and to innovation.

Semco in Brazil (see book review of Ricardo Semler's book Maverick) demonstrated the same thing in 1980s - the young chief executive knew that he didn’t have all of the answers, and readily turned decision-making and even decisions over the salaries of the executives, over to the staff. They voted for competitive salaries for their managers, as long as the managers were effective. This was no beauty parade - everyone voted not just those reporting directly to the manager.

Perhaps the greatest success has been achieved by Vineet Nayar at HCLT (HCL Technologies).

Nayar joined HCLT as CEO in 2005 when the $700million technology company was clearly falling behind its competitors. He embarked on a process, to understand what was wrong by asking employees and customers, and to find out how to solve it, similarly by asking. Nayar didn’t work with the customer every day - how could he, as one individual amongst (then) 30,000, make a difference?

His employees delivered innovation, quality, customer satisfaction and delight, repeat business, new customers. The company continues to grow with over 80,000 employees and Quarterly revenue > $1billion.

 

What do people want in return?

 

Most people want to do a good job. They want to feel they have made a contribution. Of course there are people who have lost their inspiration, but these people have typically had it taken out of them in the workplace.

A comment at one of my workshops which has stuck in my mind was from a senior NHS nurse. She started with “now I remember why I joined the NHS”.

Nurses are committed to their caring vocation. Many are suspicious of attempts to measure their work, to count their patient. It wastes time on paperwork that should be spent with patients, and it gives “managers” permission to take the humanity out of care.

But she continued: “for the last 15 years, I’ve been turning up at 8am, seeing a bunch of sick people, and going home at 4pm. I knew the clinical job so I didn’t really need to think about it. But with the measurements and reporting that you’ve introduced, I can tell my grandchildren ‘I did a good job this week’ ”. Before, they resisted any attempts at change as “know-nothing management trying to save money”. Now, they examine their changing environment and make the changes necessary to be at their most effective as a team delivering health.

The Social Return Company (TSRC)

Our mission in life is to inspire people to enjoy and to be enthusiastic about the work they do.

We do this by using the tools of benefits management - measuring and reporting to show what is effective and what isn’t, so people at the front line can make the right decisions about how to be most effective in their day to day work. It’s just as applicable in industry and manufacturing, just as applicable in professional services, as it is in healthcare.

You can see case studies all over this web site. We can help to engage employees and other stakeholders with Social Audits, evaluation and reporting of Corporate Responsibility (Corporate Social Responsibility or CSR) and Triple Bottom Line design, measurement and reporting, and we can direct focus onto your direct commercial success or revenue building/ cost cutting/ value add (Intellectual Property pipeline).

What advantages does TSRC offer?

TSRC is an independent consultancy. We can engage with your employees and other stakeholders as an outsider, to understand their concerns and complaints, and we can engage with your senior management to understand the value of using the talents and contributions on your doorstep.

We will use Benefits management techniques such as Benefits Map and Results Chain to link everything you do to your strategic objectives, especially highlighting what makes a positive contribution. We then help you to design common-sense and inspiring measures and measurement, and a reporting process that keeps everyone’s focus. People will measure if they want to know what the measurements show (ie if they care - which they do when the measures mean something to them).

We will help you to engage with your talent, and help you to design recognition and reward programmes that really work. It’s worth adding at this point that “more money” rarely delivers the desired result - it changes the culture from “we want to make a difference together” to one of “I’ll do just enough to get my bonus and everyone else can whistle”.

Competence vs Competency

What is the difference between Competence, and Competency?

mice watching humans in maze

The idea of 'competencies' vs 'competences' took hold in 1980s (Management Today Apr 2010 p69): a core COMPETENCY is a particular attribute required by someone's job, such as IT skills, industry know-how, or customer service (the output)

whereas a COMPETENCE (defined by Chartered Institute of Personnel Development) is the minimum standard demonstrated by performance outputs, rather than individual traits.

HR departments measure both, in particular to determine how well an individual meets the requirements of their job (how far the competences go towards fulfilling the competencies), and of course identifying candidates for promotion.  Perhaps the easiest way to look at it is a Competency is what is required for the job, and a competence is what you have.

The problem is that such paper competence offers little insurance against real-world incompetence.  All of us probably know someone who performs well on paper, shines at interview, yet appears hopelessly incompetent in the real world.  Sir Alan Sugar hit the nail on the head when he described one of the front runners as "will do extremely well in a corporate environment and rise through the ranks, but i want people who can create a profit"

 

Promoted to the level of their incompetence! How common is this? Actually, it's quite a natural process. Someone who has been competent in a role often finds themselves promoted. There will come a point, unless they are conscious, continuous learners, where they will end up in a role for which they aren't competent, and labour laws and the way management work mean that once promoted someone can't be demoted again.

Perhaps the answer is to promote anyone and everyone "for a trial period" (of say, 12 months) and then re-appraise.  But this needs to apply at all levels even executive board level and Chief Executive, and it needs to be an accepted part of the culture and enshrined in labour law before we can do it.

 

What do you think?

Project management: New Ways of Working National Governance Group

This group has representatives from SHAs and national agencies and is set up to identify the issues relating to the introduction of new, enhanced and extended roles in healthcare and in particular those issues which need national support. Within this role I prepared the Baseline Report (below) and begun work developing the communications strategy ,which includes designing a web site to share information, interviewing potential users about their needs and preferred mode of communication, and reviewing the styles of similar web sites.

Baseline Report on New Ways of Working, Warehouse of Roles and Transferable roles

Before planning new projects, the National Governance Group needed to know what was currently happening. Reconfiguration in NHS meant that a lot of corporate memory had moved on or left, but I managed to identify 700+ projects and interview 41 stakeholders to identify both the current state of New Ways of Working and the support which would offer most value.
The baseline report and its conclusions were accepted and the examples, new and existing roles and workforce innovation tools are now being collated for sharing.

SfH "Baseline Report for the National Governance Group for New Ways of Working" - (Sep 2007)

Skills for Health's New Ways of Working governance group commissioned this report and the enclosed appendices to understand what service improvement is going on at the moment (2007).
The Baseline Report concludes that whilst a lot is still going on (we estimate around 3000 service improvements involving new, modified or enhanced roles) coordination and mutual support has tailed off rapidly since the conclusion of the NHS Modernisation Agency. (PDF 770k)

Tools and Resources presents around 150 resources available on disparate other web sites which will help you to plan, and deliver, your new role. This was due to be turned into a tools web site but it hasn't happened yet (PDF 916k)

Evaluation of Existing Evaluations of NWW reports that sadly far too many projects have been started, and even carried out, with no lessons learnt from previous projects. The result is an enormous amount of energy and resources wasted in re-learning lessons. Conclusions of the evaluation of projects include comments like "ensure high-level sponsors support your project" and "measure a baseline before you start" which could have been concluded by reading any business transformation book since about 1906 (the year, not the time). It emphasises the urgent need to produce tools and guides that are accessible and readable. (PDF 770k)

Research: Staffing from overseas – feasibility for a commercial provider

Just before joining NHS in 2004, my last project was to examine the options for an international staffing agency already successful in other service industries eg hotels, oil rigs, etc; whether this provider should begin to provide staff for healthcare in UK (they already have recruitment offices in Pakistan, Philippines, China etc, all countries listed as legitimate recruitment sources).
This work covered the likely needs of NHS and independent healthcare provision in UK in terms of patient need, care pathways and potential changes to care pathways, the competencies to fulfil these including by volume, and current levels of staff and staff in training to learn these competencies. In addition to the desk analysis, I conducted a number of interviews, which were very revealing!
My report predicted that numbers of newly trained practitioners (especially of generic staff eg Junior doctors, Nurses) would increase over the following two years due to the substantial increase in training places for both doctors and nurses. This happened: through 2005 and early 2006 England complained of lack of staff and lack of service and continued to try to recruit from overseas. Then in mid 2006 the situation changed dramatically - nurses couldn't get jobs, and doctors complained that there were no places. Court cases raged as UK and European graduates demanded priority over candidates from India and other overseas locations. Our investment in additional student places had paid off, but for some reason NHS's workforce planning machine hadn't factored it in.
My report allowed the company to focus on more sustainably profitable economic sectors, where investment in this market would have brought them at most 12 months' of returns.

Resource and Workforce Planning

When making a change in a system as complex as UK health service (whether a single department, or a whole region), getting the resources right both in terms of investment and in workforce can be quite a challenge. Moreover there can be more than one solution, for example more lower cost staff or fewer higher-cost.

Tools and Techniques
Computer simulation is one whole set of tools we use to understand the sensitivities and the potential impact on patient experience, whole system and other parts of the patient pathway and health and care economy, and the needs for new build, recruitment, education and so on.
Examples of tools used include:
MS Excel dynamic simulation models as used for Economic and Workforce modelling
MS Excel staff profile patterns as used for acute and mental health staffing
process flow and activity flow using Care Pathway Simulator (CPS) and Simul8
But there are many others.
Workforce Planning is all too often considered a simple matter of allocating people into deck chairs. I use the metaphor advisedly - an organisation that takes this limited view will sink as surely as the Titanic did.
Workforce planning is more akin to designing the workforce you really need. It needs to take into account the main outcomes for NHS,
quality outcomes for patients in clinical and health terms
patient experience (especially important under Payment by Results, where patients may choose to go somewhere else; but important anyway as attitude can often determine recovery rate)
effective use of resources - more noticeable now that we know resources won't go on increasing as fast
impact on staff. Without staff there is no health service
Therefore we also facilitate design, planning, implementation and reporting workshops to engage with the staff and design from the bottom up, helping the staff themselves to understand the constraints and targets and to take ownership.
With NHS staff around 1 million in England, a further 1 million engaged in delivering social care and probably 2.5million carers, workforce design and workforce planning are ever more important. With healthcare costs climbing above 8% of GDP, and forecasts of an ever more demanding population, we have to change the way we do things.
The Past
With NHS Modernisation Agency's Changing Workforce Programme (CWP) I assisted with implementing many of the practitioners who would improve patient care. My role was to help teams set outcomes, align their design accordingly, and monitor and report along the way. For some it was a great motivator; the others didn't deliver anything.
With Skills for Health I compiled compendia of New Ways of Working (NWW) projects and workforce planning tools, and these can be obtained from this web page. A few have been incorporated into the NWW web site
The Future
Much needs to be done.
The recent McKinsey report suggests cuts of 10% of staffing; but it needn't be you, and it needn't be your organisation.
We'll help you engage teams and staff to make the necessary changes to be the exception, the one that survives.

Keywords:

Capacity Planning

More women cubiclesAt Ask! restaurant in Durham, where we went on Saturday night with friends, the toilets are more discreet than most.
There are individual cubicles: perfect for  capacity planning. This means that, if you think that women will require more cubicles than men, you can allocate more cubicles to women. And they have done exactly this, four allocated women versus two allocated to men.Available as a podcast
The reason Why?
There may be lots of reasons why they've decided to provide individual cubicles instead of restrooms; studying toilets is not my favourite activity. But it reminded me how important it is to match your resources (your capacity) to meet your demand.
Too much capacity for the actual demand: the service costs too much, and resources are diverted from some other vital service. If you are a commercial entity, your profitability will suffer. If you are a service for public good, you find yourself unable to provide some other service needed by the community.
Too little capacity: queues develop. Again, if you are commercial, you may lose customers; if you're a service for public good, you may be fined or severely criticised.
A dark art
But capacity planning is something of a dark art. In just about every situation I have worked for public good, the numbers have been relatively small; numbers on the list for surgery (12 lists but effectively 12 queues because it’s difficult to transfer patients between lists on the day); numbers of calls coming in somewhere between 1 and 30 of 45 per hour (reform of urgent care services in London) for example; 2.5 full-time equivalent GPs in the GP practice;.
It only takes one member of staff either way
Getting the planning wrong by one member of staff either way can have a dramatic impact on effectiveness. I've used a Poisson binomial distribution which dramatically demonstrates the benefits of scale; I've used Excel spreadsheets, and I've used the care planning system (CPS) designed by Simon Dodd. When the numbers from different systems converge, you probably have the right answer.
The Commissioner Provider split.
For providers, the benefits are obvious: the surplus of income earners costs allows investment in new ways of doing things, and better service in other areas.
But why is this relevant to the commissioner? We've noticed over the last few years the provider hospitals have an uncanny ability to work round demand management; wherever the commission has put their focus, activity booms in another place. It isn't clear why this is happening, but with payments to acute trusts rising faster than the increase in income to commissioners, and commissioners' income coming to a standstill, it matters! It's the same in social care; the providers have a lot more independence, a lot more autonomy, but the tensions to match supply to demand may be even more acute; and the commissioner can often help.
Second-guessing your provider, and understanding how they work, is important. And now, with the new contracts being written (2010/11 templates now available from the DH website) is the time to look more closely.
It's the right time to take action
We all recognise that resources are limited. We do the best we can with what we have. I believe I can help with the scientific approach, based on my experience in all of these areas. Please feel free to contact me.
 

Capacity Planning - Flexibility

What of those toilet cubicles which allow for both sexes - they have a little notice on the outside saying "either"?
They represent a different point of view.  If (to take a healthcare example) your staff are trained to do more than one thing, for example to perform both joint surgery and chest surgery, then you can keep them busy all the time regardless of the mix of cases coming to them.  The same could apply to someone with skills in both health and social care - instead of two people coming to the house (the personal assistant to get the person up and washed, the nurse to check blood pressure and administer medication) only one comes with skills to do both.
Does this make sense? It sounds ideal!
Not always.  There are two reasons why not.

many skills need constant refresh.  In order to be an exemplary surgeon in one particular speciality, you need to practice regularly.  If you have too many different things that you are able to do, then you may not practice enough in any one of them.  For example, nurses trained in treatment of adults have a hard time re-training to become children's nurses, simple because when there's an emergency the rule-of-thumb doses they first learnt and remember first are the doses for adults.
people with multiple skills are often/ always more expensive to train and command higher pay

Multi-use toilet cubicles are great where a restaurant only has room for two or three toilets.  Each cubicle takes up more space as it has to contain its own wash basin, brick walls, etc.  But where numbers are limited then flexibility is important.
Emergency Care Practitioners (ECPs) are more expensive than paramedics because they are more flexible.  In their case, the choice is between two ambulancepeople with a full 1.5ton ambulance and one ECP in a car.  Again, with small numbers (1 or two attending the patient), the ECP is cost-effective.
An A&E department has many more staff and many more patients.  There may be a case for a multi-disciplinary team, ie where individual staff are specialists in specific skills rather than generalists, and patients need to be referred to the most appropriate individual.
Workforce design is an art form.  That is, a specialist skill that relies on more than academic study, that relies on a deep understanding; a willingness to look at alternatives and quantify them and pick the best and second best (3 Ps and 2 Ws - Predicted, Possible, Preferred, Wildcard negative, Wildcard Positive); but principally that relies on experience and knowledge.

Personal productivity vs. Group collaboration

Keywords:

Collaboration - you know what it is but it is hard to manageIn a previous blog, I looked at some of the tools available for group collaboration, using the Internet. We concluded that for a team of admin staff in a GP surgery, Producteev.com was the best tool. It is simple to use, colourful, and much better for assigning tasks than using Outlook. But it has some severe limitations.

I'm a freelance consultant, when I'm not at the GP surgery. For my purposes, I need something with more structure than Producteev.com. Yes, I also want to be able to share my work. I want to be able to set up small collaboration groups with all sorts of different people:

  • to set up a collaboration with Skills for People, because I'm writing an SROI audit and I need to have input at various points,
  • a collaboration group with the GP surgery for couple of things that remain mainly my work, but which involve them.
  • some activities with my brother in London involve sharing not just documents, but also tasks and deadlines.

I also needed much more structure; milestones, for example, and projects with a defined beginning, middle, and end. And don't forget, this is just for me – this doesn't even take into account what a small or large team spread across the world would require.

Producteev.com is just a task list, and you usually don't see anything shared with you unless it is directly assigned to you. This has advantages for workflow, because it keeps your task list empty. But it has disadvantages, because someone working on a number of different projects, like me, has to look in different places (the different workspaces) in order to find all of the tasks that are urgent today. There's also a cost of having more than one collaboration with – I have to pay a subscription for each separate group. With the subscription running at $20 per month, this could work out expensive.

Google apps – more opportunity

Oh the joys of getting sidetracked by following a bit of research! What I'd overlooked in my previous articles was that Google, and Google apps, are just made for collaboration. Many of the apps available within Google (written, managed, and sold by many different companies) are collaboration apps, and many of them have a free version which is quite sufficient for my testing purposes. Running a search for “project management” brings up a whole range of integrated products, and running a search for “collaboration” brings up many of the same ones.

The last piece of research taught me something very valuable: narrow your range of options down as fast as you can, so that you can put a reasonable in-depth study on to the final few options.

Google apps offers an excellent way to narrow down the selection. You can sort by "highest-rated" (the ones that people using them have awarded the most stars to), and you can sort by "most popular" (the ones most often downloaded). Obviously, plenty of people have done this before me, because most of the "most popular" are also the "highest-rated"! A good start!

Producteev was in there. So were a lot of other products, which are examined in some depth. The one that caught my fancy is called "manymoon.com".

I installed it, and invited some people from the GP surgery to join one of my collaboration groups. They ignored the invitations, because they came from somewhere with a silly name – why do people give such silly names to products? I invited people at Skills for People, and my brother, to join other collaboration groups, and they joined. I now use it for my collaboration groups, and my tasks, and the surgery has decided not to pursue Producteev.com beyond the 30 day trial period, so I'm going to switch them over to Manymoon.

So what does it do different/better?ManyMoon.com - project management and collaboration at its best

Manymoon is designed to put the collaborative working. It is also designed to multiple projects. This means that I can have independent collaboration groups on each project, instead of on each workspace (as in Producteev.com). This is great, because the collaboration group can see all the documents associated with the project (held in Google docs), the milestones, their own tasks and everyone’s tasks.  They can see what’s going on, and see what part they play (I find this vital to getting people motivated). They can add to, edit, and complete different tasks – whereas in Producteev.com, only the creator of the task and the person to whom it was assigned could make any changes (this means that if one of the staff went off sick, we could find their tasks but we couldn't update them until that person had returned).

Another very important difference is that documents attached to a task in Manymoon.com are actually only linked back to the original document in Google docs. This means we have one master copy in Google docs, attached to any number of different tasks. This is potentially a dealbreaker against Producteev. If you attach an actual copy of the document to a task, there is a real danger that you end up with lots of copies of the same document, each with different edits made, and people can't understand why the changes they made aren't reflected in the final document.

Will it work in the GP surgery?

Manymoon will be a real challenge. The interface is a typical project management interface, with lots of extra information besides a simple list of tasks, such as links to show you the projects/ milestones/ documents/ project members etc. This is bound to confuse people.

We keep all our documents on our S:\drive. Nothing that would have tasks associated with it would have any confidential content, so they could be hosted on Google Docs, but we would then have to make a special effort to move many of the key documents to Google Docs, and remember that the master copy was on Google Docs, not on the S:\drive.

What's my conclusion?

Manymoon.com fulfils a purpose for me, So much so, that I have bought the premium subscription, which gives me a few extra features that I will find useful, and a whole lot of extra features that a tiny business like mine won’t use for at least a few months. What I do get is a bullet-proof environment which does exactly what I need for my day-to-day work, in planning projects and executing them, and in collaborating with different groups of people to deliver work for them, and with associates. Whether I can convert the Luddites in the GP surgery is another matter.

How to make a busy team more productive

Productivity - how can we improve it?

Aim - to improve productivity through better collaboration

Primary health care, and in particular GP surgeries, are in the middle of some of the most dramatic changes in 60 years. We're faced with uncertainty, with falling incomes and rising demand, and we've made a commitment to make sure that we provide the best healthcare to the patients of our surgery. We have to innovate, we have to deliver new services, but we have to keep the basic service is going.

I’m looking for a tool which enables a team that is already working flat out to capture and deliver innovation.

 

Context – GP surgery 22 staff

One day per week I work in a busy, but completely average sized, GP surgery.  My role is to find ways to deliver the care that the local population needs – whether this is care closer to home (we don’t have a local hospital – everyone has to travel and so do their friends and well-wishers), better care (new pathways from new understanding) or prevention.  The NHS initiative for all of this is QIPP – Quality, Innovation, Productivity and Prevention (no this isn’t some sort of joke/quip – it really is QIPP).

In my one day per week, I run the audits to check how things are going, and the reports to make sure we get paid on what we do (without income we can’t pay the staff for the hours they do on services.  It’s a sad fact of life that GP surgeries are independent businesses and nobody bails them out if they spend too much).  I need information to compile these audits and reports, and I need information to redesign services or create new ones (such as numbers of patients affected, amount we spend on sending patients into hospital to determine whether we can invest in a new diagnosis machine, etc).  I need to get staff together to discuss the best way to approach a problem, and they are just too busy and practical to take time out to meet up and discuss something that is only an idea. 

Requirements – improve productivity through collaboration

At the moment we have ideas, but they often don't get done:

  • One of the partners asks for a whole lot of things, then forgets he’s asked and the following week asks similar but not the same questions
  • I ask for reports and analyses
  • All of these requests going missing, and nobody follows up
  • Tasks don’t get done – the person asked to do them has forgotten (even if they are on email, they get buried).  Alternately, they have so many requests they decide to ignore all of them
  • Duplication – someone else gets asked to do a similar task, and doesn’t know it has already been done or has already been asked for
  • Working together to make things betterWe’ve created a mini-industry (no pun intended) of extra work trying to manage tasks: each team leader uses a different system to remember what tasks they requested or have been asked for
    • memory
    • paper lists
    • Excel

Decision to go to the web

I thought there must be a better way.

The king of Getting Things Done is David Allen (author of the book by the same name, known affectionately as GTD).  His method is based on keeping a single comprehensive task list, so it is out of your head and you can get on with the job in hand.  The examples given are usually trivial, but it can be made to work in a shared environment. 

Project Management is an alternative approach; with defined objectives, defined milestones and the tasks to achieve those milestones.

We need a hybrid – GTD is about day-to-day tasks, but we also need a sense of purpose to create innovation.

I plugged these two concepts into Google and went looking for my solution on the Web.  I also want a solution which is web-based because that means we don’t have to set it up or maintain it, and we don’t break the rules on our outsourced IT support.

Choices:

A search for Getting Things Done reveals a number of web-based shared task lists which claim to comply.  I investigated the following:

ActiveCollab; GetItDoneapp; GoalsOnTrack; Gyronix Result Manager for MindManager; Jello-dashboard.net; Nozbe; Producteev; Propel’r; Remember the Milk; TaskAnyone; TaskMerlin; Taskmind Web; Toodledo; Vitalist; Voo2do;

A similar search for Project Management revealed these as the main contenders:

Basecamp; Nirvana; Zoho Projects;

The next thing to do was make sense of these results:

(Comparing the options)

(Conclusions)

Make a busy team more productive (2)

Collaboration is everythingOn the previous page I outlined the problem that I was facing: improving productivity and innovating with an already busy team.

 

I went through each of these tools are at their ability to fulfil our requirements – how expensive are they,what technologies they use and support (do they support smart phones for example), and what features they have. I didn't know exactly what I was looking for the start, so I found I had to go through the list twice, and try out a couple, to work out what would work best.

Scoring system:

Of course we couldn't try out every single product.

first pass through identified a number of results from the Google search which didn't really exist. They automatically scored zero. I also excluded all products that were really only designed for one person rather than a team – after all, the point was to improve collaboration.

 

Single user

No product available

Still in Beta

0

Not strong on collaboration

1-3

Good product for our purposes, if pricey

4

Selected best products to research in depth

5

in the above scoring table, you will see that some scored for, and some scored five. There are a lot of excellent products out there, but some of them come at a price. What do you get this price? Ease of use, ease of setup, extra features that we can't find a use for, and the ability to scale for staff of thousands (which we don't have).

The products.

I sorted these products in order of their attractiveness to us (score, as in table above). One of each type (task manager following GTD methodology, and project management) scores five i.e. we look at it in more detail.

 

Product

Price

Where does it run?

Access in other ways

Notes

Collaborate score

Producteev

$20/month (unlimited users)= $220/yr (£170)

Web

iPhone & Android

Task lists with tags which approximates to projects.  Tendency to become cluttered as every assigned task becomes a separate task and tasks out in the future are also visible

5

Zoho Projects

$99/yr (unlimited users – other options including time tracking and billing also available)

Web

Use a simplified Mobile web interface

Zoho is a powerful suite and Projects is good at getting things done, by highlighting what is dependent on what and keeping status reports.  Doesn’t include tags and context, and may be project centric

5

ActiveCollab

$249 to buy, $99/year after purchase (£150 + £60/yr)

Local server (we’d have to set it up)

We’d have to set this up – not sure

Considered one of the best solutions for collaborative working, but requires technical knowledge to set it up

4

Basecamp

$49/month (unlimited users but only 35 projects) = $600/yr

Web

Various tools, extremely widely supported

Very project centric.  Not easy to tell if it is easy to run multiple projects at once, ie to give a list of to-dos across all projects.  It looks as though we need to work the Basecamp way for best results

4

GetItDoneapp

$39/yr/person; for 20 people $780 = £500

Web

iPhone, Android; Can also collaborate through email

Hides tasks which are not due

4

Nozbe

20 users = €49.95/mo ie €600 (£550) per year

Web

iPhone, Android, paper

Seems to be second best known after Producteev (though that may just depend on the review articles I read).  Very good user interface

5

Gyronix Result Manager for MindManager

$285 per person

Desktop

No

Works with MindManager, which in turn works with Project Management software and allows collaboration

3

Taskmind Web

€12/user/month.  For 20 users = €2,880 (approx. £2500)

Web

Also desktop (Adobe AIR) and iPhone

Projects appear to be an afterthought, and tags are personal.  The web page makes interesting reading though

3

TaskAnyone

$49.90/mo (Checklist+TaskAnyone combo), for 20 users that’s approx. $12,000/ £7,500

Web

Don’t know

Web site not explicit, though collaboration on projects looks like an afterthought

2

Toodledo

Free, more features with Pro $14.95/user/yr (20 users $300 =£200)

Web

Paper (special printed lists), iPhone, Android

Use Folders (like projects), subtasks (hidden within a task to save “busyness” – pro account only), tags, contexts.  Not quite as robust collaboration tools as others

2

Vitalist

$49/yr, for 20 users $1000 £750

Web

iPHone, Smartphone

The standard for GTD, but not strong on collaboration

2

TaskMerlin

$99/yr, id $2000/ £1500

Runs on server

Don’t know

Focussed on capturing tasks.  Not strong on collaboration

1

Voo2do

Free

Web

 

Collaboration features aren’t particularly well developed

1

GoalsOnTrack

single person setting goals. $5/mo

web

Haven’t investigated

Thought to be very good for life goals – includes Vision Boards etc

0

Jello-dashboard.net

Free – Outlook add-in

Works with Outlook

Desktop

Applies GTD principles to Outlook

0

Nirvana

Still in beta

Web

Web interface for smartphone

Still in beta

0

Propel’r

Not available yet

Web

Promises smartphone access

Too many promises, not enough product

0

Remember the Milk

Single person lists – usually free

Web

Smartphone access for Pro account $25

Best known task list product, though it isn’t clear how the collaboration works and it isn’t really designed around a project interface – we need projects

0

So what does this tell you?

  1. there's a lot of choice out there, and choosing the right product for you is fairly subjective
  2. some sites have a really good web pages and marketing, but when you start looking into detail (about an hour later) you find that they have show-stopper limitations
  3. there's a vast gulf between doing "projects" and doing day-to-day business. Nobody seems to address this gulf, and yet I bet that many teams and many businesses work exactly the same way that we do – trying to innovate and create new services whilst also keeping the existing services going.

The best Web based tools for productivity and innovation (3)

Producteev.comHelping busy teams to be both more productive, and more innovative will require collaboration, which means we need to know where discussions happening, and how to access the results. We need to focus, so that what is important gets done, and what is not important is identified and ignored.

I outlined the problem, and then I compared the various solutions we found.

Zoho projects (Xmas logo)We identified two front-runners for our purposes – Producteev.com which is an easy-to-use delegated task list, and Zoho Projects, a low-cost Web based project management tool, and part of a major suite of business productivity tools.

How do they work in practice?

Producteev.com is extremely easy to set up. You just type in a series of tasks, and assign labels which, in GTD fashion, allocate the tasks into the equivalent of small projects. Anybody using the system can see all the tasks, and in particular the ones assigned for them to take action on (of course it is possible to restrict which tasks people can see, if that is necessary), but its key advantage is that the tasks allocated to a person are listed in date and priority order so that the most important things get done first.

Even with a very long list of tasks (i.e., so they are out of your head) it's very easy to see what needs doing and get it done. This is proved to be a massive productivity boost – Joseph and I can discuss our priorities and check the duplicate requests before assigning tasks to staff, and we can attach notes and files for clarity. When staff have a moment, whether I'm in the building or not, they can add their comments; and comments are all kept in one place (attached to the task) in case anyone needs to backtrack.

When we need input from each professional group within the GP practice, we can assign a series of tasks, and quickly see who has responded and who hasn't; no more wading through e-mails; no more asking each other whether someone responded to the wrong person. It is cut out nearly all the wait, especially since Joseph and I are hardly ever in the same building at the same time.

Producteev.com has a free account allowing two users, which means we can try it out between us without making a commitment.

Zoho Projects

Zoho Projects has a free account allowing only one project, but Unlimited users, which is also fine for working out if the software will do what we need.

Since most of our work is the day-to-day running of the practice, it was quite difficult to get Zoho projects set up.  We created a series of milestones – things that have to be completed by a certain date. Within each milestone, we created task lists: buckets with the name to hold all of the tasks created. Then within a task list, we could start creating the individual tasks and allocating them to people. This means that before you can start creating tasks (probably the first thing on your mind), you need to work out what you are trying to do (and perhaps this is a good thing!).

The video is included because you need it to understand the concept.

Zoho is extremely structured, almost to the point of irritation.

Fit for Purpose

Producteev.com isn't much good at deadlines.

You can assign a date for completion of an individual task, and that affects its position on the list. But it is difficult to tie a group of tasks together (other than with the tag) or put them in context.  Also, it doesn't implement full GTD methodology – it doesn't have a "context" tag which would allow me for example to see  "I've got an hour of uninterrupted time – what is the best use of that time?".  If I have uninterrupted time, I'd like to fill this hour with things that need concentration, rather than urgent phone calls which I can do from anywhere, even in the car.  

Of course both of these (overall aims, and working in an environment other than the office) are less relevant to the admin staff who want to know what we want, clearly and precisely, so that they can just do it and hand it back.  Producteev.com is great because it's very easy to use, very easy to start using, and very visual. And there's an iPhone app (for Joseph), and an android app (for me).

Zoho projects takes up a lot of screen space to say the same thing.

It shows all the tasks assigned to a person sorted by their task list rather than by their priority or date of completion. This means you can quickly have two or three screens of tasks, and not be sure where to start without looking through all of them.

On the other hand, all documents and discussions are attached to a deadline, which makes it much easier to keep track of a lot of different tasks going on and to see all of the tasks in context – this means that everybody can come back with better ways of ultimately achieving what we want, because they can see where we're going.

It's not quite as pretty as the more expensive web Project Management product basecamp, but it has some extra features, such as dependency between tasks (this is not well implemented – there's no visual representation).

Which did we choose?

Ease-of-use won out in the end.

Project management, done by Zoho projects has some really big advantages for a small business, or medium-sized team, like us. But asking the staff to get to grips with the project management concepts, when most of their work is simply answering the phone and booking appointments, didn't make sense.

Task management, and maintaining discussion areas and document repositories has worked out better for them and us. Productivity improvement still have to be estimated.

Perhaps we'll have another go next year.

Multiple Intelligences and Team Working (teamwork)

Intelligence - in there somewhere?I've never seen any direct link between IQ and riches, and I'm sure we can all name people who dropped out of school and still made it in business (Sir Alan Sugar? Richard Branson?) 

But there is a view about intelligence, which seems to correlate with worldly success. Charles Gardner proposed Multiple Intelligences in 1983, originally seven, and variously eight or nine at present.

INTELLIGENCE

 

What it means

Logistical-mathematical

these two are typically the ones measured by the traditional "IQ" test

engineers (but see spatial intelligence below), mathematicians, anybody who deals in numbers or follows processes. Many people use this intelligence to work according to a protocol, for instance in a factory or call centre.

Linguistic

Able to communicate in words, especially in your own language. This could almost be seen as a "basic" skill or intelligence

Spatial

aware of the relationship between things, and patterns. People strong in this intelligence might find themselves successful as an architect, or use their skills for spotting patterns (criminal detective, quality inspector). A great many people with professional qualifications have this intelligence to gain their professional qualification

Musical

doesn't just apply to singing or playing a musical instrument, also applies to having a clear understanding, or sense of rhythm. Singers, actors, people who speak many languages, journalists (because language rhythm and tonality makes writing pleasant to read, or unpleasant).  Authors like JK Rowling

Bodily-kinaesthetic

a keen sense of movement, and the ability to train one's responses so they are like reflexes. Sports people like David Beckham will certainly be strong in this intelligence

Interpersonal

sensitivity to others moods and feelings and motivations. Ability to work as part of a group, to lead. Some have suggested that these people are extrovert, but although some extroverts are sensitive and empathic, other extroverts are just loud.  People with this intelligence to a high degree find that they are best rewarded as salespeople, politicians, Presidents of USA, etc.  Note the banking bosses may be able to do maths, but only the people people get to be boss

Intrapersonal

Able to understand and control your own moods and emotions.  The supreme example of this is the Dalai Lama, and if there is one characteristic of these people it would be happiness.  On the scale of income or wealth, they have everything they want, ever.

(Daniel Goldman’s descriptions of Emotional Intelligence and Social Intelligence approach a totally different issue.  Note that there is no direct evidence to support Multiple Intelligences, but educationalists have found it extremely practical. Gardner has come up with another couple of intelligences since this list of seven: naturalistic, and existential. They aren't relevant to this discussion and most people ignore these other two).

You have all of them, developed to different amounts (except savants on the autistic spectrum, who may exhibit one intelligence to an exceptional level at the expense of the others). But you will tend to gain the rewards of your most rewarding intelligence – if you are brilliant at music and also at people, your most rewarding intelligence is your interpersonal one, so you may have music as a hobby but will tend to spend most of your time doing people stuff.

What is the point of this discussion?

Teamwork - we all bring different skills  These "intelligences" (or abilities or traits, to quote Gardner's critics) can be trained. As you can see from the salaries benefits, it is worth improving (in a rounded way).

Perhaps most importantly, you can get a team that has all of the intelligences by bringing together different people to bring different skills and intelligences to the team – if you know what to look for.

People tend to gather "people like themselves" around them, which means you usually end up with a team with only one skill. You want a rounded out team, so that it can see all sides of the problem and deliver the best solution.  For example a GP surgery needs People People (the doctors, nurses and Receptionists) to face the local population, but it also needs people who are good with numbers to make sure the finances work and staff get paid on time, and it needs managers to plan ahead.  You often find that the GP Partners have quite high IntraPersonal intelligence, they are at peace with themselves and this peace permeates the whole GP practice making it a nice place to work.  If you don’t have this, there’s often high staff turnover and unhappy patients.

Action

Before you rush off and work out everyone’s Multiple Intelligences, think for a bit.  What are you trying to achieve, and what do you need to do in order to achieve this?  It may be worth calling in a consultant from Minney.org to help you through this process.

Sky Care - the channel for the caring professions. Subscription really cheap

Teamwork

Dear your Murdochship

We are delighted with the enormous success of sky sports, the vast amounts of money that flows into Premier League football, and the resultant stratospheric salaries that footballers are able to earn.

We're wondering if you can apply your magic to other areas of public interest – nay public fascination! Just as there are very few talented footballers, there are very few talented social workers. Of course the reasons for this are different – nobody particularly wants to work in a job where you are overworked, underpaid, the but of hate, and subject to a criminal prosecution because you somehow didn't find 200 hours plus in a single week to follow up every case in your case load.

A Footballer’s preparation, and a Social Worker’s preparation have a lot in common.

The mind of a championBoth spent most of the week in training, for 90 min with the ball/with the client (in social work's case, the training consists of endless meetings, Case reviews, and so on). Only the very best make it – those who are strongest in mind, who can combine compassion with an ability to prioritise, the most disciplined. Both take on superhuman workloads, and triumph.

Why do they command such different salaries?

It is said that the reward you get is a simple product of the amount of benefit you deliver per person, multiplied by the number of people you affect. A Premier league footballer delivers a tiny amount of benefit per person – £9.99 worth, for a pay-per-view game. But they deliver it for millions of individuals. A social worker changes the lives of their client, and often their family as well. This may be worth tens of thousands of pounds, but it only impacts on 10 or 20 people in a year. With the Murdoch magic, this could all change.  I’m thinking:

  • academies, to bring hopeful superstars into the profession
  • Star coaches, managing teams that work together seamlessly
  • celebrations at every goal, and encouragement from the cheering crowd when the going gets tough
  • salaries that reflect the status, and the difference they make to so many people

we can but dream?

So what would it take?

Celebrating graduation

We already have a channel for Parliament, a blatant offer to the people who make the decision on whether a broadcasting licence is given, which appeals to their self-interest. We've had popular programs about the emergency services – ER, Jimmy’s, Police Camera Action, something about the fire brigade (you'll have to forgive me I don’t watch much TV). Soaps are filled with stories about dysfunctional families, and dysfunctional relationships. It's obviously a popular subject.

Perhaps if everybody wrote to you for BSkyB, asking why they can't run a program about the excitement of social work, they might even consider it. The knock-on effect of millions being poured into football has been very positive (for the footballers). Perhaps having pouring millions into social work would have a similar effect?

Multiple Intelligences and "Learning Disability"

Alternately Abled - JugglingWhat is Learning Disabled, and should you take any notice?

People with a Learning Disability are people who don’t handle numbers well, if at all (for example, they may panic and guess when asked to add simple numbers together), and don’t remember facts like history and geography; both skills so important for getting on at school.  Some have real challenges communicating.

Some children get ‘certificated’, which means the school gets extra money to provide support – usually a teaching assistant to work with the child one-to-one.  But it means the child is labeled for life with a ”learning disability” so some parents won’t accept a certification.  As adults (and many Adults with Learning Disabilities have lost their skills as a result of an accident), they get support to budget and live their lives.

This costs the on Social Care budget.  Very few adults with Learning Disability (about 1 in 12) find work, and nearly all of those that do, find part-time work which doesn’t make any difference to their benefits payments.  On top of this, they often need a support worker, again paid for out of the public purse, to help them budget, set goals and development plans, and so on (on top of benefits, anywhere from £2,000 to £20,000 per year, rising dramatically during times when a person is behaving erratically for example if they can’t get themselves heard by conventional means, and go for challenging behaviour).

What use are they?

Of course I’m being deliberately provocative.  There was a time when political correctness said we should call people with disabilities “alternately abled”, and I have to say that the adults with learning disabilities that I am working with are much better at getting on with people, empathising, understanding how they feel, supporting, and so on, than I am.  And I’m not too bad at it.

What I have noticed, is that most people have had a life time of being told they are stupid, being punished, maybe just being the butt of any anger or just plain cruelty from the people around them.  So they’re quiet and lack self-confidence, and take a while to trust people.  But with confidence, the few I’ve had much to do with turn out to be incredible – charismatic, caring, supportive, everything you could want in a friend.

I’m not making a case for having someone as a friend.

Minney.org and now the Social Return Company are dedicated to looking for the value in things, understanding if the amount we pay for things is repaid by what we get back.  I’m running a Social Return on Investment audit (SROI) on a Learning Disabilities charity, so I’m looking into it in some detail.  And I’ve been very surprised at what I find.

It looks as though we’ve divided our society into groups.  Adults with Learning Disabilities aren’t going to get qualifications within the education and employment system as it stands, and this often means they don’t get jobs, simply because a qualification is the minimum requirement.

But very few jobs actually require you to deal with numbers.  Most of the important jobs are about dealing with people, and most of the important functions in society are about dealing with people.  Sure there are things that require numbers, and that’s why I get paid to do them, but mostly it is about inspiring people when they are up, supporting people when they are down, and coordinating people when they are getting on with life.  And I meet people with no, or far fewer qualifications than me who can do these things far better.

For example, Bill Clinton was President of the USA.  Only two emails were ever sent from his email address – the first from the technician setting it up, and the second almost certainly by his Admin Assistant to check it worked.  Working with computers wasn’t important to the President of the USA (and the Administration might actually work better if it focussed more on people and less on computing).  Was Bill Clinton an adult with a Learning Disability?  We’ll never apply the standard test of IQ because his parents were rich.  Does it matter?  No, Bill Clinton did some pretty good things.

Albert Einstein - Genius at Mathematics and Physics

What am I getting at?  What’s the point of this argument?

Under the Blair years, the UK has become  fragmented; every problem is up to somebody ELSE to solve, and the state is expected to put everything right.  The heart has gone out of society, and it needs something to glue it back together.

I’m just wondering if that has something to do with our focus on education ability (getting everyone a degree).

Daniel Goleman talks about Emotional Intelligence or EQ.  That has similarities to my previous post, “Multiple Intelligences and Team Working”, to the top intelligences of Interpersonal and Intrapersonal intelligences.  I think Gardner’s definition of INTERPERSONAL INTELLIGENCE is of more use than EQ because it is more specific, and I’d like to propose that some adults labelled with a “disability” are infact “alternately abled”, much more able interpersonally and not perhaps so able at the easiest to measure intelligences which show up as IQ (mathematical-logistic and linguistic).

The key thing is, society would collapse – IS COLLAPSING – because society has turned these alternately able people out into the cold.  And we need to put this right.

What’s it worth?

An initial SROI Ratio (the amount of benefit you get back for the amount of money that goes in) on the charity I’m auditing suggests a ratio between 6 and 14 – for every £1 invested, society gains benefits; the stakeholders I asked told me about real financial values which added up to on average around £10 per £1 invested (between £6 and £14 for every £1 invested).  These stakeholders also named a whole lot of benefits that we couldn’t work out a value for, so don’t think I’ve gone around putting silly financial values on everything.

I wish my work was worth more than 10 times what people pay me for it (actually, in some cases, I do know that it is – more on that later).

 

 

 

 

 

 

"The Efficiency Map" - Department of Health May 2005

Department of Health produced a poster designed to show all of the ways of making efficiencies in line with the Gershon reviews.
It never really took off, but none-the-less I contributed the workforce aspects from Changing Workforce Programme

Training and Conferences: School Health Workforce

School Health - a vital topic. But how do you justify spend on school nurses, when their impact won't be felt for years? NHS Employers' Large Scale Workforce Change group commissioned me to train sites in development of an evaluation and benefits realisation methodology, and then to use it . .

We ran a series of conferences bringing the 19 pilot site teams together, and I coached teams between times. Each had decided what new project they wanted to run, often without much research, and had received their funding.
We pulled together stakeholders from NHS, local authority, education, the public, and examined the needs in more detail. We compared the needs to the current staffing, provision and resources, and performed a Gap Analysis. We looked at the resources given by NHS Employers, and in most cases the stakeholders were able to make executive decisions to invest more, now that they knew where the money was going, what the targets were, and what those targets meant in terms of return on investment.
The teams then planned the milestones and the way they'd monitor achievement of those milestones. Suddenly, there was real enthusiasm - this wasn't just another boost of central funding that got lost in the NHS organisation's accounts, the project team themselves had set targets and had them endorsed by the stakeholders and programme board.
With milestones, reporting and monitoring, and team commitment, things moved apace and many very successful changes were delivered.

Workforce Reprofiling in Acute and Mental Health Environments

Workforce is probably the single biggest expenditure of any healthcare organisation, and especially so in NHS (after all, all care is delivered by humans - it works better that way).
Because of this, when efficiencies need to be made, workforce expenditure comes under the spotlight.
Techniques such as Lean, and programmes such as NHS Institute's Productive Series look at ways to shave pennies off each activity. But what about activities that aren't actually necessary, but that organisations hold on to because the individuals fear for their continued employment?
We already know that under Payment by Results, a secondary provider (hospital) can increase their income by increasing their throughput (eg improving quality to the point where length of stay is reduced, which frees up beds, which allows more people to come in for operations). But is this value for money? Does the extra income generated cover the additional cost of driving up quality?
Research
We looked at this with the boards and front-line (clinical and support) staff of an acute teaching hospital, and a care trust. We generated profiles of the staffing currently in place, and the staffing models that the staff themselves thought would deliver best care. We examined cost per unit of activity and quality outcomes, and compared this with the avowed aims of the Trust.
Most importantly, we compared the profiles for similar departments and functions, which generated passionate discussion and soul-searching.
Delivery
The staff themselves agreed potential new staffing profiles, taking into account resources (cash) available and the tariff under payment by results.
Managers, workforce planners and clinicians used the profiles generated to plan and implement projects to deliver the changes and realise the benefits.
Conclusions
In a busy and turbulent world, it's almost impossible for the Directors to mandate every change and every conclusion, and it leads to resentment and de-motivation. The above process engages people, helps them to feel part of the organisation in which they work, to see the bigger picture, to work for the greater good. That's when quality improves at the same time as unit costs reducing.

Career Framework - Assessment of Role against the Competencies

The SfH Career Framework team are building a database of roles and people so that staff and potential recruits can understand
what their local role or title is equivalent to
what they need to do in order to progress to the next career level
what career paths others have followed
what the opportunities are with their skill set
and so that organisations and workforce planners can
understand the different local titles used and how they relate to competence, experience and autonomy
have access to a range of standard job descriptions and person specifications, to greatly simplify recruitment and appraisal
and developing and planning teams to deliver care
In order to achieve this efficiently, the team developed standardised questions that would allow a role to be assigned to a Career Framework level in each of 8 dimensions of the role.
I developed a tool to capture this information and combine it into a database, which allowed rapid capture of over 400 roles so that the Career Framework level, competencies and Job Descriptions could be compared across professional groups and points of commonality and difference recorded.
I reported on the success of this development and on the results, which make interesting reading

Pathology Profiling Project - best staff for the role

The differences between practice for the same task performed in different hospital trusts is striking. Healthcare scientists decided to examine this issue in more detail, and my part was to use competences to determine what were the minimum competences required to perform a particular step on a science pathway (in this case, Pathology Laboratories), the minimum level of scientist with these competences, and compare this with actual staff performing the task in different Trusts.
The results are fascinating: staff profiles vary between core hours and extended hours in those Trusts which run extended hours labs, and between teaching, large and community hospitals providing lab services (big, medium and small labs).
In some cases a significantly better qualified and experienced person performs a task than the minimum needed; in most cases this is justified because the experienced person is required for some stages and using another person would duplicate headcount, or because a senior person is needed during extended hours; in a few pathways there may be opportunities to make significant cost savings through more appropriate team profiling.
The full report (in which my contribution plays a small part) can be downloaded from the Skills for Health web site, on page http://www.skillsforhealth.org.uk/page/career-frameworks/pathology-profiling-project

Secure your confidential information

US Army PFC Bradley ManningWouldn't it be nice to do what the US Government does, and condemn someone to death because they do something you don't like (New Charges Filed Against WikiLeaks Suspect)

However, US Government and the military are the laughing stock of any thinking person - how was this information leaked in the first place?  Thinking people are concerned that nobody is being hauled over the coals for the security policy (or lack of it) in the first place, nor for making sure that US government information is even moderately secure.

Everything is Top Secret

At the root of it, this is the problem.

Private First Class Manning was authorised (as an intelligence officer) to see Top Secret information.  Not restricted to just Iraq.  Not restricted to just military.  Just Top Secret.  And since just about everything the government does is classified as Top Secret (so the voters can't find out about it), that means that the sheer volume of "stuff" classified as Top Secret makes it very difficult to keep tabs and impose any sort of order.

But nothing is protected

What's your IT policy?  Do you have protection in place, so your company secrets can't be copied off onto a flash drive or CD?  Do you have your confidential documents as web pages, so they can't be downloaded en masse, but only read one at a time?

US Government doesn't.  Bradley managed to bulk copy 250,000 documents (you don't do that, one document at a time!) onto a CD-ROM and nobody knew he'd done it without going back to the logs.  He was then able to mail the CD to Wikileaks with no restriction.

So what has this to do with me?

You and I can't (usually) jail someone or condemn them to death for leaking confidential information.

When you pull together, we can move mountainsBut we can get everyone committed to each other, a bit like Edward III did when he created the "Modern Round Table" at the end of the 11th Century.  We can get people to understand the consequences, not to themselves (Private Manning probably knew the risk he was running) but (far more important to most people) the impact to friends and colleagues of their actions.  If you don't share the organisation's ideals, can you adopt them?  And if not, can you be detected? 

Actually, we may look back on this incident and thank Private Manning for sparking off the demands for democracy across the whole Arab world - but that's another story.

It takes Benefits Management

When we all pull together, we can move mountains.

People might not share the ideals when they join a company, and selection processes that put this as top priority may end up recruiting only the talentless.  But they can commit to the ideals as they settle in to the organisation, provided you know what you are doing and make an effort to help them.  That's what Benefits Management is really about.

Benefits Management isn't just about new projects and initiatives.  It's about aligning people, inspiring people to want to achieve the same outcomes, getting people to work together.

It applies just as much to your security policy, your remuneration and reward policy, to your expenses policy, to your recruitment and reward scheme as it does to the new projects and initiatives.

Don't leave it to chance and to the heavy (and expensive) hand of the law.  Take the opportunity and talk to us about how you can use Benefits Management to transform your organisation, from petty office politics and people running in different directions, to an inspired team of people proud to work for the organisation and proud to support the customer base.

Why front line professionals get suspicious of benefits workshops (engagement and benefits)

I went to a benefits workshop on implementing a new IT service within a big organisation. We looked at the features of the solution offered, and were asked to identify benefits for each stakeholder. Over 4 hours we brainstormed, and focussed, and documented, and planned how to measure.
Then it struck me – this is all the wrong way around! Granted, I usually examine benefits in front-line (health and care) environments not in back office functions, but many of the enablers are back office.
Nobody at the event asked “didn’t we already know why we wanted this, before we designed it?”. Instead of starting with the need and creating the solution to solve it, we appear to take the solution as the fixed item and look for ways to justify it after the event. If we knew why it was wanted, the benefits design, planning, management and realisation would be simple: does it do what we want it to do?
Lightbulb moment
[BENEFITS PROFILE]
So start with the need. What is the problem that needs solving (insufficient resources to meet demand, waiting lists too long, costs too high, demand for different services, administration ineffective, people’s safety privacy and respect threatened)? What is the whole of the solution that IT is only a part? What about the IT solution proposed (or mandated) actually solves the original problem, in conjunction with other (workforce, service transformation, facilities change) components?
Build a benefits profile around this. IT solutions can’t deliver benefits in isolation, and nor can most of the other components of the solution. The solution is in response to a need, so the benefit is resolving the need. Monitor progress towards resolving the need, and you have your benefits realisation. Measure something specific to the IT project, and you run the risk of becoming divorced from the whole solution and benefits not realised.

Take Your Child's Teacher to Work Day

Jack Matthews has a beard now(also known as Bring your child's teacher to work day)

I've just spent two days at the New Types of Worker conference in Glasgow "Excellent Out Of Adversity". The keynote speakers were excellent – in fact everyone was excellent!

The Health and Care Sector Skills Councils had invited the head of one of the other sector skills councils: Jack Matthews of the Improve Food & Drink Skills Council. Not only was he very passionate, not only was he very funny, but he made a lot of very important points, entirely relevant to the enormous combined workforce in health and social care (over 2 million).

Children working in a canning factory - Picture HistoryJack shared with us that the Food & Drink industry has an image problem. Schoolchildren just don't want to come and work in the sector, they don't want to "work in a canning factory". Gone are the days when young adults would look starry eyed towards careers in Nestlé, Mars, Kellogg's; the Food & Drink sector is seen in a very different light at the moment.

That’s funny – another keynote speaker pointed out that schoolchildren didn't want to work in social care – it was no longer seen as a profession providing the care of people who desperately needed it, now the job was seen as emptying bedpans.  Same job (if anything, even more professional, and certainly better paid relative to other work), but the perceptions have changed.

What can we do?

How satisfied are you?I suppose the starting point is to work out where these low perceptions come from. Unfortunately, the finger of blame seems to point towards schools and school teachers(!) Children and young adults are brought up with the idea that many of these jobs are somehow less than they appeared to previous generations. Dads and Mums still work in their careers proudly, and many sectors remain so specialised that the children's parents will stay in one sector for life. But schools that used to churn out eager members of society ready to be molded to one or other industrial or commercial sector, now turn out adolescents who want a big salary for only doing the interesting bits, and prepared to stay at home rather than take on a job with unfulfilling parts. Whatever is going on, it needs to be put right.

Bring your child to work Day

At one time, companies wanted to give children an early taste of what their industry consisted of, and invited them in to see what was going on. It gave a parent the chance to introduce their children to the reality of the day-to-day work so vital for Britain's success. Perhaps because the "job for life" doesn't exist any more, this has become less common. And with parents working longer and longer hours and spending less and less time with children at those formative times when they think about study options and future careers, teachers become the main arbiters of children's attitudes.  The teaching environment is very different (children tend to need controlling – employees tend to need empowering, and so on) and the sad reality is that schools and universities fail to turn out people suitable for commerce, for industry, and for public sector and third sector jobs (as predicted by Lyotard 1984). So perhaps we now need teachers with experience of the attitudes, of the pride, and of the hurly-burly and ups and downs of the kinds of jobs that their pupils will find usually themselves in.

How many companies are ready to invite teachers at local schools into the organisation for a week or a month, to shape these attitudes? How many proud parents, instead of taking their child to work, would take their child's teacher to work? Is this the answer, or am I unnecessarily maligning teachers and schools?

Stereotypes and the workplace – the importance of consistency

Stereotypes - men and womenSuccess in business, and outside the workplace, frequently depends on the nature of the relationship. And the nature of that relationship is entirely within the control of – YOU.

 

Cialdini describes six weapons of influence, of which three relate directly to the relationship between people:

  • (2) commitment and consistency
  • (4) liking
  • (5) authority, typically also expressed as competence [1]

these are important to your success: nobody can do it on their own, we succeed when we can persuade/encourage others to join with us, whether through leadership, coercion, or some other form of persuasion. We "infect" others with our enthusiasm, to work together as a team, else we become part of someone else's plan. If you tend to work on your own, or with an organisation from your last autonomous, then they are just as important to help you get your point of view across, to negotiate well, to win the argument. Unless you are entirely self-sufficient, and on an island [2]then you will always affect or be affected by the people around you.

 

So why even discuss this?

The key to consistency (one of the three weapons of influence which relates to the relationship between people) is in being pretty well. Extraordinary leaders have made some of their success on being unpredictable, but let's be frank, it doesn't work for the ordinary person in the street. Being consistent, being predictable, fitting the mould – this is what makes people comfortable with you, this not only makes you trustworthy, but it can also help people to like you (other key weapon).

Consistency, fitting the stereotype, will raise people's perception of your competence, and often your authority.>

The difficulty is that in a wonderful egalitarian society, we have different stereotypes of men and women.

 

Stereotypes: men and women.

Men are expected to be:

  • In authority, driving, strong, team players, logical in their thinking and speech, directing

Women:

  • supportive, defending of their team, caring, nurturing, passionate

woe betide the person who crosses the gender divide.

[2]then you will always affect or be affected by the people around you.

Of course the same applies between the races, between ages, between people of different sexual orientation (if this is even within the workplace), and it is a challenge – it's difficult to have true equality, when people have preconceived ideas of what they expect, and punish those that do not comply with the proper stereotype. Alysia Morga picks up on this in her blog "Why Women Should Flirt at Work"[3]

 

 

REFERENCES

[1]  Robert B Cialdini – "influence: the psychology of persuasion", Collins Business Essentials 2007 pp320, ISBN 978-0-06-124189-5]

[2]   John Donne “For Whom the bell tolls”

[3]  Alicia Morga - "Why Women Should Flirt at Work"    

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