Community Health Innovators

Transforming health through frontline innovators

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Sensing and intuition – The Thing versus the Green Lantern

In my last blog on preferences I focussed on the difference between introversion and extraversion usingBatman and Ironman as my two examples.

In this blog I am discussing how you take information in and whether you are a big picture person or a detail person. I will be using The Thing and Green Lantern as my examples today.

Someone with a preference for Sensing (S) is practical, down to earth and very much grounded in the here and now. They like detail and tell it how it is focussing on facts and on what works now. If you ask this person to describe a Pine Tree they will say something like it is a Pine Tree.

Someone with a preference for Intuition (N) looks at possibilities and patterns, they focus on how to make things different and are very much into brainstorming and taking on new facts and learning. If you ask this person to describe the Pine Tree they may say something like it is a beautiful clear green which reminds me of the scene in Crouching Tiger Hidden Dragon where the two characters fight in the trees.

So onto our superheroes to throw some more light on these characteristics.

When Ben Grimm  (The Thing) is about to get married he leaves his wife at the altar because he realises that marrying a superhero is dangerous. He does not imagine possible alternatives but accepts the fact and acts on them even leaving his wife to be at the altar. He considers Reed Richards  superpowers as fitting because he is naturally tall and therefore can stretch his body, what you see is what you get in his eyes in terms of super powers. When he gets his powers he does not change his personality at all.

The Thing is a sensory being and his senses can withstand greater levels of stimulation than ordinary people except for his sense of touch. In the Civil War Ben has decided that civilians should not be harmed and even leaves the country for a while but on his return is oblivious to the war whilst he makes it his job to protect civilians. He has made a decision and he sticks to it after seeing the result of war on civilians so he has information in front of him, has processed it and taken a decision based on exactly what he witnessed.

On the other hand Green Lantern is a corp and a galactic police force, the responsibilities of the Green Lantern can be passed on to different people. Yet each retains the power ring which generates a variety of effects with the greater the users willpower the greater the effectiveness of the ring. Everything is about the imagination of the user and the rings give the bearers telepathy as an added bonus. The wearers of the ring have to use their imagination to consider possibilities and to communicate these to the ring. In the modern era Guardians of the Universe who are not part of the corp but run it can create duplicate rings giving each member of the corp different powers depending on their imagination.

Green Lantern has an oath which has given rise to a particularly funny Muppet trailer based on the oath, it is that kind of imaginative leap which a person with a preference for Intuition would enjoy.

In brightest day, in darkest nightNo evil shall escape my sight.Let those who laugh at my lack of heightBeware my banjo…Green Froggy’s light! 

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Blocks, barriers and doorstops! Innovation in the NHS

If anyone needs a reason to innovate in the NHS, then they need look no further than the Francis Report into the deaths at Mid Staffordshire. This was published this February and painted a picture of a health service under pressure, constrained by money and targets and managed by people out of touch with the frontline. In the advent of one of the largest healthcare scandals in recent memory, there is a real focus on both improving the standards of care and about driving clinical innovation.

The culture change Francis asked for in order to make sure that patients never went through this again, was enabling fresh ideas from the ground up to be actually put into practice.

So what stops this from happening?

Nurse First recently surveyed NHS clinicians find out what were the major barriers stopping local innovation. We also wanted to know what had worked in order to help others create sustainable local innovation. We were really surprised that the top answer was not money in either case.

The most important factors that helped create clinical innovation (in order) were:
• The attitude of senior and middle managers in their organisation
• Being given skills and knowledge around in innovation
• Being given protected time for innovation
• Being given access to senior managers in their organisation

Access to start up funding was mentioned but was not even in the top 5 factors that actually helped people create innovation.

We were surprised by these findings as we had expected to find money the main issue. Yet in reality it may be liberating because anyone really wanting to create an innovative and safe organisation in the NHS doesn’t have to worry about money first and foremost but should focus on changing the attitudes of management and giving staff the skills and knowledge to put their ideas into practice. If an organisation wants to create more clinical innovation, the answers are less about finance and more about attitude and access of its management team, combined with skills, knowledge and time to encourage innovation.

The issue of getting access to senior managers was a theme that emerged elsewhere in the study. Our survey found that 38% of clinicians found it difficult or impossible to meet their own Chief Executive and some people may find this surprising. One of the things we ask participants on our innovation programme to do is get a meeting with their Chief Executive. This turns out to be a very interesting indicator of the culture within healthcare organisations. In some cases we have seen staff being threatened with disciplinary action simply for trying to contact and meet their own Chief Executive. In these cases Chief Executives were often completely unaware of the gatekeepers in their own organisations who prevent them from talking to frontline staff.

We know that we cannot keep delivering healthcare in the way we have been doing it for decades, pouring more and more money into hospitals and ignoring the demographic time bombs around diabetes, heart disease and dementia. We also know that innovation in healthcare is much more likely to come from the clinical staff who provide care and the management challenge going forward is how to help these innovative ideas flourish and help make them sustainable and scale quickly across the whole NHS.

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Batman and Iron Man – introverts and extraverts

There are some common misconceptions about introversion and extraversion. An introvert is not someone who is shy or never puts themselves forward, nor is an extravert the person who dances on the tables or is always the centre of the stage.  Whilst we all have a preference for one or the other it does not mean we never visit the other but that doing the other thing can make us feel drained.

An introvert is a reflector, someone who thinks and reflects before speaking. Their internal world is important and they are likely to have a few deep friendships rather than many. They are people who draw energy from being time spent on their own and enjoy quiet and reflective space. Introverts often have a few hobbies which they do in quite some depth.

An extravert is a doer, someone who just does it and speaks first then thinks afterwards. They often put their foot in their mouths because things just seem to take no time at all getting from a thought to a spoken word. They are likely to have many friends and hobbies and enjoy being with other people. An extravert draws their energy from interaction and action and like parties and group processes.

So in terms of a superhero or two where do they sit in the scale of things?

Batman is my choice for an introvert particularly in the graphic novels as there are countless pages where he plans and thinks before acting.

Iron Man is my choice for an extravert because he is called talking man by The Hulk at one point in the Avengers stories.

Batman – an introvert

No one who considers Batman can fail to understand that the forces which shape him are internal ones. He internalises his issues such as the death of his parents and is seen to dwell upon them. They are the core of his being and shape his activity. He has a secret identity which he guards fiercely. He has no superpowers  but uses his intellect and detective skills to solve crimes and punish villains. His wealth enables him to use technology and science to create his alter ego and his martial arts skills engender fear in his enemies. He is out for revenge on criminals but is tempering revenge with justice.

Outwardly Bruce Wayne is seen as a superficial playboy but it is his internal alter ego which gives him away. Batman is broody, reflective and considered. Bruce creates a facade to protect his identity as Batman and even drinks in public although his drink is really ginger beer in order to promote his Bruce Wayne persona and fool Gotham. He is a master of disguise and can hide his feelings and abilities in order to gather information.

Most telling is Batman’s ability to create real confusion in those who write about him or try and pin him down. People who look into his sexuality or his psyche get into a muddle because as a character Batman/Bruce Wayne has depth and it is this which clearly indicates he is an introvert. Everything about him is not known he has secrets and protects them with the ability to keep things internal.

Iron Man – an extravert

Throughout most of his story Iron Man is a member of the team the Avengers. He likes to work with others.  Stark is an adventurer, a ladies man and wealthy, he is an inventor and a weapons manufacturer. Whilst at first he keeps his identity as Iron Man a secret it does get out and is a known fact. Iron Man and Stark go through several periods where they are poor and where Stark gives up Iron Man due to alcohol usage. He is not as internally focussed as Batman and does not guard his secrets in the same way. His internal pain is shown in detail in his private life and his personal trials it is not hidden. Stark is constantly seen in the graphic novels through the eyes of the public and his relationships with both them and other superheroes. In the Avengers he is known for constant talking and saying whatever pops into his head. Like Batman Stark is the master of invention but is also a qualified physicist, mathematician and chemist and an entrepreneur who keeps coming back. He even wipes out his brain and then installs back ups of his memories. He likes to speak in public and interacts with government and publicity as both Stark and Iron Man. Unlike Batman his internal battles are fought in public.

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Thinking and feeling :Jean Grey and Superman

Once we have taken in information about the world we have to process it and for this we look at the two ways of processing information or making decisions, thinking and feeling. As in all other parts of the MBTI this doesn’t really mean what it says, because you think doesn’t mean you cant feel and vice versa. It has also always been clear to me that despite the differences in the two dichotomies often they both come to the same conclusion. It is the route they take to get there that is different.

A person with a preference for thinking is logical and likes to consider the logical outcomes of their decisions. They look at things objectively and think about the pros and cons of decisions, evaluating and analysing in order to problem solve and come to the best solution. They like to find a way of applying a standard or principle to work out applications for anything similar which may crop up. They are fair and want everyone to be treated equally and they are often objective and reasonable.

A person with a preference for feeling considers what is important to them when they make decisions and to those who are involved in the solution. They like to throw themselves mentally into an issue in order to identify with the people involved and make decisions based on their values and beliefs. They look for things to praise in others and often work on gut feelings and instinct. They treat everyone as an individual which may not mean they treat everyone equally. Whilst many find them kind and the sort of person who likes harmony cross their values system or beliefs and they are often ruthless in response.

So how do our superheroes match up to these types?

Jean Gray is both caring and nurturing and objective. She has the power of telekinesis so she can move objects with her minds and has a suppressed form of telepathy. She is one of the most important members of the X-men team and also one of their biggest enemies. As the dark phoenix her immense mental powers mean that she eventually commits suicide to save the universe. In this she is applying a principle that she is fair and objective and will put others before herself.  This absolves her of the crimes she commits as well so in essence she is willing to pay the price for her crimes. When she returns to life (as all superheroes seem to do when they are killed off) she finds her husband has re married and uses objective reasoning to tell him to go back to his wife and child. Jean’s relationship with Cyclops is reasonable and she only marries him when the time is right she does not give into her feelings she is rational and able to be logical about what is best for her team.

Her powers of telekinesis mean she can grasp and manipulate hundreds of objects at once in mid-air in complex patterns. She can rearrange matter and manipulate timelines. As a telepath she can read, influence and control other minds. She can take the life force from one form and give it to another this sets her apart from most people with a preference for feeling because they would find such actions incredibly difficult logically putting one life form over another.

This brings us to Superman a hero with feeling. Central to Superman’s decisions is his love of people which mean that he sometimes will not be able to differentiate between what is good for one person or good for all. One of his most important traits is that he honours moral codes and the social mores of humanity. He often tackles people who break these codes because they have broken the code, he has a strong sense of justice and righteousness. He marries his love interest Lois and has been known to put her before other concerns. Lois is so upset by this that she leaves him at one point. He often chooses to protect the little people rather than address universal problems and this causes others to get irritated with him. Batman tells him off because he identifies too much with humanity and doesn’t use his superpowers to lead.

Even Superman’s alter ego Clark Kent is known for his ability to care for others and to interact on a human level with people from his high school to the world of work. He keeps in touch and has feelings for his adoptive parents, his school mates and best friends and the photographer and editor of the daily planet.

His planet of origin still exerts an influence over him which he cannot overcome either for good or bad and his links to his home are always with him. Ultimately superman’s popularity lies in his ability to empathise with the little people rather than taking on universal causes.

Reproduced from the original 

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There is an I in team! The Borg is not the best model.




I was watching a film and someone spoke the immortal phrase “there is no I in team”. Obviously there is no I when the word is spelt out but is there any room for an I in a team? I found myself wondering and as I listened to more and more people spout this phrase, considered the ramifications of having no I but only a Borg like whole.


So if a team operated with no individuals but a collective voice what would be the upshot? Are there times when a team needs individuals? I guess these are my two main questions.


In Star Trek (Next Generation and Voyager) the Borg are a race of robotic assimilated cyber organisms that enforce assimilation into the team of Borgs or the collective as they are known. They are drones and are one of the greatest threats to civilisation because there is no arguing with them as they drive forward in their pursuit of perfection into an emotionless, unified and mechanical workforce which is controlled by technology. Even their homes are cubes, there are no curves or innovations in their space craft.


Drones do exist who resist the collective and survive assimilation. Seven of Nine when removed from the collective is frightened and furious. She wants to be part of the whole and misses the certainty and voice of the collective team. Eventually she comes to recognise her more human side and her unique qualities but at first she is scared and angry.


Interestingly the Borg never run anywhere so most species can outrun them; they are slow and ploddy and can only think in certain ways. There is no room for individuality and definitely no I.  Being part of the collective means that they can use group consciousness to adapt and defend themselves and the mental energy of the whole can be used to heal.


It is an interesting idea that a team with no individuals will eventually become a collective all operating and proceeding with one aim, one vision and one mission. I worry that in some organisations that is exactly what managers wish to achieve. Yet is that what is necessary in healthcare and how will the millennial generation embrace this idea?


In a team with individuals who all think differently, having different ideas, challenging each other and creating space for diverse concepts and ideologies there is much more chance for something novel and innovative to happen. Of course there is also more chance for discord and lack of harmony.


Creating teams which are high performing, self motivated and self governed means allowing individuality to flourish within them. Collaboration is still essential for a high performing team where the views and needs of individuals are considered and each person is allowed the space to grow and develop. This can, in turn mean that the team is flexible and agile thinking able to create new opportunities for the organisation. In a start up this is an essential team attribute.


Allowing teams to function as a self-directed unit and manage their own decisions and performance enables individuals to act in the same adult way that they do in their lives outside work. It also means that work can be directed towards a whole process rather than simply reducing things to the smallest steps. A team which is a collection of interdependent and supportive individuals will see things differently and there is also less scope for error. It means that decisions are taken closer to the patient by the people who know what is going on.


De Bonos thinking hats are of considerable value in any team, the ability to look at things from different view points and consider all angles. In a team with no I this wouldn’t happen and there would be no dissenting voice to protect everyone from mistakes or make them refine ideas in order to improve them.


The journey from a Borg mentality to one of genuine diversity and individuality in teams is sometimes an onerous one. It can sound simple but is far more difficult in practice. Teams should not only work together but learn together and be supported in putting that learning to good use. They also need to learn how to hold each other to account and understand each others jobs and roles as well as being adept at setting goals.


Of course everyone needs a common view of what the aims and objectives are for a company and a shared desire for success in any enterprise but personally I would rather work with a collection of individuals than drones.

First published on


Why the reintroduction of the Named Nurse could be a terrible idea

Bradford22 lo resAnother week and another initiative comes from the Secretary of State for Health. Recently Mr Hunt is launching the idea of a “named nurse” for every patient which is obviously a radically new solution that has never been tried before …. Unless you count that time in the 1990s when it was last tried. For those readers who perhaps weren’t in nursing in the 1990s, this was the “named nurse” initiative which was closely linked with the development of “primary nursing”. The problem wasn’t so much the idea itself which was mainly about giving the patient, their family and friends, etc a single named individual to approach about issues with care. The problem (as it often is) was wrapped up in the devil of the implementation. Without redesigning the staff rotas, what inevitably happened was that the “named nurse” could end up being someone the patient had never seen and was never on duty between the patient’s admission and discharge. In some places, the ward sister or charge nurse was allocated as the “named nurse” for every patient in an area which made the whole exercise pointless.

As with many issues, the key is to understand what the real problem is that the solution is trying to address. Many of the advocates of the approach use the justification of accountability, arguing that it is important that the patient knows who is accountable for their care. Unfortunately this is a very simplistic understanding of how accountability operates and wrongly assumes that there can be a single accountable individual who “the buck stops with”.

Every nurse is personally and professionally accountable for the care that they deliver. The nurse’s manager is also accountable for the care that is delivered, as is their manager, the Director of Nursing, the Chief Executive, the Chair of the Board and a myriad of commissioners, regulators and inspectors. All of them are accountable for the care that is delivered and they discharge this through varying schemes of delegation and monitoring. So there are a whole number of people who are accountable for the care that is derived and not a single individual. There is certainly no single place along this chain of accountability where “the Buck” stops and goes no further. Chief Executives are paid a huge amount of money to ensure that quality care is delivered across their organisation every day and they cannot duck this by pointing at less senior nurses deep in the grains atonal hierarchy.

The concept of responsibility is probably more helpful. The essence of responsibility is the ability to respond, in other words, the capacity and the capability to address problems and issues that arise. What I believe patients, family members, carers, etc mainly want is to know who to go to to find out key information about the care being deliver and who to go to to sort out problems or issues. For a single named individual to be able to be responsible, they have to have the authority to sort out problems and issues. There is no point going to this person with a complaint about cleanliness, food standards, the organisation of care, etc unless this person has the ability to do something about it.

If an organisation creates a culture where nurses are able to control the environment of care and organises staff rotas so that there is continuity between nurses and specific patients, then there will genuinely be “responsible nurses”. In this type of environment, then letting patients know who their “responsible nurse” is could be really valuable. Adding it as a form of window dressing applied uniformly across the NHS without fundamentally addressing these issues will just lead to an irritating time-wasting fiasco. Exactly as happened the last time this was introduced.

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Why do we keep giving the same people jobs?

This week the news was full of the CQC debacle concerning an ex Chief Executive of the CQC Cynthia Bower. 

According to the BBC  documents seen by the BBC show that officers in Cumbria asked to speak to Cynthia Bower and two other named officials at England’s health watchdog.

Police were investigating the death of baby Joshua Titcombe at the hospital.

But the CQC told police Ms Bower and a second official had no day-to-day involvement in the case.

This week an independent report into the CQC’s handling of events at the local health trust in Morecambe Bay was highly critical of the watchdog, listing a series of failures and “missed opportunities”.

The report also found evidence of an alleged cover-up, in which Ms Bower was said to be present at a meeting where an instruction was given to delete an internal review critical of the CQC.

Cynthia Bower was forced to resign from the CQC after the Winterbourne View scandal 

So we now know that she was involved in at least one cover up. Strangely she also appears to be the person in charge  of NHS West Midlands which included responsibility for Stafford Hospital. She has said of that that the situation at Stafford wasn’t on my radar. 

It begs the question how often people are recycled in the NHS and it’s surrounding organisations and how long this can be kept going? 

If the NHS is really going to change dont we need change at the top as well? Is it right that the same people get the top jobs and make the same mistakes and that some of these lead to deaths? 

There are some really good people in the NHS and some really bad and we need better mechanisms for weeding out the bad and promoting the good. 

What do you think? 


Are managers wrong?

“Managers in the NHS appear to be pre-occupied with ‘excellence awards’, innovation and leadership, but appear to have lost sight of the big picture of the real distress shown by some working at the coal face in the NHS.”

Shibley of the Socialist Health Association

This quotation got me thinking and I am not sure I agree. I think Shibley  is talking about senior managers and only some not all.

It seems to me that middle managers sandwiched in between the frontline clinical staff and those at the top of organisations are in an invidious position where they often know what is right and how they should support clinical staff but are employed by more senior people who are giving them a different message altogether.

The people who are often pushing the message about leadership and innovation are also those furthest away from the frontline and of course that can make a perfectly reasonable message look unreasonable and out of touch.

There is real distress at the “coal face” but that is more often than not a lack of resources and staffing and the constant state of flux which the political landscape seems to bring to the NHS.

Of course distress is often passed on from top to bottom just like other messages such as finance before all else and we are under pressure. If the person at the top is fearful that he or she might get a call from the Department telling them to come to a meeting at which “coffee will not be served” and cannot be innovative because they are given mixed messages from policy to politicians it is not surprising that this fear is passed through the service.

What we have found through Nurse First is that there is a real desire to innovate, change practice and save money amongst clinical staff in the community but that often managers get in the way. The pressure of change, time and lack of resources makes for a mind set which cannot see a way out and believes in a scarcity rather than abundance mentality.

We need to listen to the voices below us whoever those people are and value the opinions of those who actually do the job and that includes listening to all care staff irrespective of qualification.

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Business Thinking

I have started and run four businesses now and one of things I often come across in healthcare is the phrase, “We need to be more business-like.” This seems to be a catch-all for managers who want staff and teams to operate on a more formal footing and often to think finance before anything else. But is that how a business really thinks?

Some of the most successful businesses in the world are based not on making a profit but on doing something different, usually with passion; translating a hobby into something which will make enough money to keep doing the hobby. Rather than working for someone else on a project which does not satisfy mind, body and soul, a great business idea means working on something where you are in control and can affect change.

Innovation and change are key to a great business and finance is useful only in keeping the project afloat in the first instance.

I am a business mentor for start ups and growing businesses and in my experience, if the premise for the business is solely profit, then 9 times out of 10 it does not succeed. The driving force in starting a business must be, “I could do this better, quicker, more efficiently, with a greater focus on customers, or differently.” “I could make a shed load of money” is usually secondary and often unimaginable for the first three years or so.

Having a great idea and translating it into a business means incredibly hard work, waking up at three in the morning wondering how you are going to pay the rent or the mortgage and unrelenting focus. Success is rare and failure is frequent but the drive to persevere and make it work is all consuming.

There are many stories out there of people who have been successful, and for most the path to success included failure and hardship. Success in business is rarely instant or overnight; patience, resilience and perseverance are needed.

Success often means doing things you really hate like bookkeeping, sales, form-filling or, for some, talking to a room full of strangers who are not in the mood to invest in your wonderful idea. Running a business is stressful and I have seen people have all sorts of stress related illness including depression, skin problems and asthma as a result of starting on the path to independence.

If managers really want staff to have a business focus, they need to relinquish control and allow people to rekindle their passion, stop talking about work/life balance, stop focussing on finance, and free staff up to innovate and change practice.

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Start from the point of view of your patient

Someone posted a slideshare presentation on a facebook page the other day with the wonderful title, “what would Steve do?” (Steve being Steve Jobs).

It made me think about focus. When we are trying to make a change or innovate perhaps the best question is not “what do we want to do?”, but rather “what does our customer/client/patient want?”

When setting out to change things, do we really put ourselves in the shoes of those who will be affected by the change? Doing so makes a huge difference.

If you are selling a project or an idea to a commissioner, it’s far better to start with a phrase like, “patients want good signage that helps them find their way round our health centre” than “I have invented a large font signage system which I want to implement”.

Usually a story also helps.

I used to work for a charity for the deaf and blind and the changes they had made to their offices were all in order to make access better for their clients, so better signage for the deaf and voice controls for the blind. They talked to me about the way people enter a building, something I had not really considered before.  For a deaf person an intercom system on entry is unbelievably frustrating, whilst for a blind person a lot of glass is dangerous.

Perhaps as a result of learning this, I wanted to implement a better system in my healthcare building that would make more sense to people using it who are elderly and may have visual and hearing challenges. Starting from their perspective and what will help them will make far more sense to the people who have to pay for a new system. Collecting information on how many people get lost, how many end up tired and frustrated even before they have seen their healthcare practitioner may also help make my case.

Telling a story of Allan who is 81 and deaf and cannot hear when his name is called and gets increasingly upset and anxious waiting to be called to see the doctor makes far more sense than walking into a meeting with commissioners or managers and saying we need an electronic screen in the surgery.

If you have a great idea which will change services and make a difference, try to consider it from the point of view of your patient or consider the challenges facing commissioners and managers before you make a pitch for funds. Thinking something is a great idea, when it comes from a provider’s standpoint and involves an injection of cash is not the same as a great idea which is backed by patients and comes from their views of services and answers a problem which commissioners face.