Community Health Innovators

Transforming health through frontline innovators

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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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What difference could YOU make in healthcare?

Innovation in healthcare can seem really tough right now with all the ‘negativity soup’ we are swimming around in. So what type of projects are being considered and being moved forward?

  1. A project to improve the nutrition in the elderly in care homes, using ‘real foods’ instead of sip feeds…saving money, using local sources of food and creating a ‘real food’ culture ( this Nurse First project already has funding and is underway)
  2. Avoiding hospital admissions in respiratory care – again saving money but also improving the lives of the patients by treating them at home
  3. Reducing the stigma in children’s mental health – thus making sure the people who need care and treatment receive great care when they need it
  4. Preventing falls in the elderly – a huge cost to the NHS in orthopaedic surgery and long-term care
  5. Working with individuals with learning difficulties improving their sexual health, support, reducing social isolation, and improving the quality of life – with special clinics, a ‘befriending bus’ and more
  6. Creating nurse-led phone or skype follow-up for patients – reducing costs for the service and the patients – why do we have so many clinics?
  7. Creating an online system in sexual health so people can access their results much quicker, as well as getting advice, a forum and online access to healthcare professionals
  8. Reducing STI’s in young people with a ‘pub quiz’ style game to engage them and entertain them at the same time as teaching
  9. Creating videos instead of worksheets for teaching speech and language therapy to kids
  10. Working with young people in the criminal justice system who have learning difficulties

How can you implement new ideas?

What ideas do YOU have for changing the service you provide?

Can you fund any of these projects?

Join our programmes for training, input, support, ideas and more?


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Finding success in failure

Everybody recognizes that failure plays an important role in innovation but there is a lack of structured advice about how to encourage and use failure in a practical way. Below are some thoughts about how failure can be used in a practical way:1) Remove the stigma from the word “failure” Failure has a lot of negative connotations.  Many people are uncomfortable using the word. In a recent interview, I asked applicants “what was your greatest failure?” and many replied that they did not like the word and did not associate anything they did with failure.
If I had asked “when have you ever tried anything new?”, none of them would reply “I have never tried anything new in my life”. And yet this is precisely what they are saying by saying they never failed. Nothing is ever achieved successfully on its first attempt, so any attempt to try or learn anything new will involve some failure. We need to reclaim the word and recognize its importance as a developmental step.2) Share failure stories and lessons learned By encouraging people to to share their stories of failure, the group or organization as a whole can learn much faster. If mistakes are being repeated in isolation, the learning process is much more difficult and slow. Sharing failure needs to be seen as an important contribution to the success of the group and the success of the organisation.3) Fail often and fail small Very large failures can result in the destruction of an organization (e.g. Barings Bank, NHS University, etc). Even when the organisation survives, a catastrophic failure can seriously damage an organization’s reputation (e.g. BP, Nasa, etc). By encouraging experimentation and innovation at a small scale, any failures happen quickly and at a small level so lessons can be learned before significant resources are invested.

4) Make failure survivable for the person and the organisation Linked to the previous point, the board and management team of an organisation need to make sure that failures do not destroy the organization and so this needs to be managed in a way that encourages failure but at a small enough scale so that learning can happen. Equally individuals who fail must be protected and possibly praised for their innovation. If a culture emerges that failure is met with punishment, then people will quickly learn to avoid doing anything new or innovative and this can be far more damaging to the organization as a whole.

If we can learn to reduce the stigma around failure, openly share our failure stories and learn how to fail fast and often, then we will be well on the road to creating truly innovative organizations and teams.


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Transformation is not the same as saving money.

From a box in a garage to an icon of design, Steve Jobs transformed Apple, the internet has transformed life and social media is transforming relationships and marketing. JK Rowling transformed her life by writing Harry Potter, Spielberg told a story in scouts using his fathers movie camera and won a prize at 13 with a film called Escape to Nowhere, Shackleton transformed an epic failure into a heroic tale of daring and bravery and Florence Nightingale transformed nursing from a drunken haphazard job into a profession.

All of these people have a story and each of them share something unique, a passion for what they did. None of it was easy. Mostly they asked themselves whether they were doing the right thing frequently, they all had failures, they all suffered. I suspect that none of them are or were easy to live with. Not a single one of them transformed anything with the idea of saving money.

Yet I am still hearing the words transformation of services linked to cost cutting measures and redundancies in organisations.

Transforming services is not the same as saving money, it can mean being more efficient but again that is not the same as having a monetary target and working towards it.

So what is transformation?

I quite like the definition for business found on wikipedia but to be honest I think it a little flat.

  • changing appearance – by improving services to customers
  • changing shape – by review and reappraisal of what a business should do, by working with partners and by making better use of all types of resources
  • changing form – by improving the way the business works, and embracing new organisational structures, skills, processes and technology
I really  like some of the mathematical definitions, which are particularly apt considering that it is not about money; a process by which one figure, expression, or function is converted into another one of similar value.
In scientific terms, transformation is almost always accompanied by either a catalyst or a process. Most importantly it is a change which is remarkable not one which is more or less of the same.
The term has been banded around in business for some time and  this has often led to the idea that it is fairly common. External and internal consultants tend to use it when they want to sell an idea to a board or for that matter the frontline.
Actually affecting a remarkable change is neither easy nor quick as can be seen in the fortunes of companies such as Marks and Spencer. The changes which have taken place have not seemed to make much of a dent in the image of a company that was once great and is now a little tired.
Tinkering around the edges, using a new font on the Board papers are not transformation, whatever the new logo says. To transform requires new thinking, the capacity to change and ultimately loss.
– Ali (reproduced from

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The importance of people who don’t think like you do

“I don’t think like other people do,” Roy Lilley told us when he came to visit Nurse First’s current cohort last week. He attributed some of his difference to not having a degree. After asking the Nurse Firsters to raise their hands if they had a degree, or a professional qualification, he declared himself to be the only person in the room who had neither…but I don’t, either. Maybe that’s why I smiled.

Or maybe it’s because I know that “I don’t think like you do” is one of the benefits that diversity brings.

Diversity isn’t just a box to tick, something nice to tack on if you can manage it but the first thing to go if you can’t. Diversity is important to effective, successful healthcare.  Because healthcare has to be for everybody, and the service benefits when it better reflects the world around it.

Needs and experiences differ, not just from one individual to another but between groups too. Patterns can be found in how (to name a few) women, people of colour, disabled people and people in gender and sexual minorities require and experience healthcare.

Of course most people have empathy and anyone can have awareness training — those things are essential — but there’s nothing quite like working with people who “don’t think like you do”, and feeling able to speak up when you don’t think like other people do!

Diversity’s not just good for people, it’s good for the organisations we work for. According to evidence cited in a recent paper from the Department for Business, Innovation and Skills, “increased diversity can lead to a better understanding of local markets and customers, increased ability to attract and retain the best people, greater creativity, better problem solving and greater flexibility for organisations.”

Yet the things that make us diverse are also the things that bring prejudice and discrimination down upon us.  And this is why we need to be diligent in fighting racism, sexism, homophobia, biphobia, transphobia, ableism, and all the other oppression and injustice that people have to deal with just to get through the day, adding an extra burden to the pressures of work and life.

Acquiring and maintaining a diverse workforce isn’t just a hoop to jump through; it’s vital to making sure we benefit from the huge variety of wisdom, skills, knowledge and perspective that people’s life experiences have given them. The government report also notes several times that diversity breeds innovation.  Because everybody can say “I don’t think like other people do” in some way.

What makes your thinking different from other people’s? How can it help your work?


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Rules, rules, rules.

Talking to colleagues in nurse education about the little things that make a difference was very interesting. We thought up many changes that could be made, costing little or nothing to implement, that would improve the experience of being a patient or relative.

One of these was something which has been implemented in a hospital near Manchester where patients are given a ball to hold which vibrates when they are needed. This means that they don’t have to worry about missing things they can’t hear or see. Outlining this innovation to a nurse who worked in outpatients, the first thing she said was, “Oh that couldn’t work because of infection control.

Just as business uses “health and safety” as an excuse for avoiding change and keeping things the same old way, healthcare is now using “infection control.”

Of course patient safety is the most important thing to get right, and of course no one wants to break rules and regulations if doing so risks patient safety. But that is not the same as using infection control as an excuse for not putting things right.

As a manager, I was often told to wash my hands when going into clinical areas, even when I did nothing more than go to an office and talk to a nurse. I asked why I had to wash my hands if I did not go near a patient and was going to an office to talk to someone. No one ever gave me a satisfactory answer. Infection Control rules was one answer and the other was that if I didn’t use the hand wash on the wall others would copy me.

When a consultant told Nick Clegg and David Cameron off a few years ago for not being bare below the elbows and for not following infection control practice on the ward, I understood. They were going and talking to patients. Whilst he was a little rude and shouted at them, it was a reasonable request. Their status and the TV crew present were irrelevant.

Sometimes blanket rules are unnecessary. They prevent staff from doing something sensible or from ensuring patients are comfortable and cared for.

This was brought home to me when a nurse refused to allow a very tall man to have the long bed on admission from the admission unit because the rule was that it was their bed and had to go back downstairs. Unfortunately, this meant that for three hours until another bed was found this man had to have his feet held by his son to stop them from dangling over the edge of the bed. The man was terminally ill and frankly it was an awful and uncomfortable thing to happen.

Many times it is common sense to break a rul, but we should make sure we know why we are doing it and ensure that it benefits patient care.

Are there any rules you think should be broken? Do rules and regulations help or hinder you in your role as a healthcare professional?

– Ali


Why people still believe in the myth of “No Money”

money1One of the most enduring myths in the NHS and the wider public sector is that there is “no money”. This is a refrain I often hear from clinical staff and managers in the NHS: I have heard it every month for the 275 months that I have been working inside and around the NHS.

At face value, this statement is clearly absurd. The NHS spent around £96 billion last year and has spent around £1.4 trillion since I joined the NHS. This would buy every nurse in the UK 20 Rolls Royces each or 3 flats in Chelsea. The NHS spends a colossal amount of money every year.

So why do people still believe that there is no money?

The answer is largely cultural. Ever since the NHS was founded in 1948, it has struggled to deal with demand and to contain costs. There has always been huge pressure to manage the demand — for hospital beds, pay rises for its staff, drugs, advances in technology –within the available funding.

This has meant that generation after generation of NHS managers has spent large amounts of their time turning down requests for increased spending. If clinical staff believe that there is money, they will approach those who they believe have it and ask for it. If the staff believe there is no money, many will not even bother asking managers about it.  Doing so would be seen as a waste of time. So if this belief in “no funding” can be embedded in clinical staff, the managers will get far fewer requests for it.

So where is the money?

We first need to understand the difference between recurrent and non-recurrent funding. Recurrent funding is the funding that most budgets are made of: the money that will be spent regularly every year and usually renewed the following year. Non-recurrent funding is “one off” money that is sometimes available and when it is spent, it is gone.

Non-recurrent money is usually created when there is a delay in recruiting staff to posts but can also be created when reserves are dipped into or when there is a national or local problem that needs addressing or a scandal in the media. When this money is made available it has to spent on very short notice and so the existence of this money is only usually known to extremely senior managers (typically Board-level directors).

Why the money is usually hidden

Non-recurrent money is often made available at the end of the financial year.  February and March are very good times to look for non-recurrent funding.  It is important to understand that this money is often hidden and there are usually only a few senior people in the organisation who know that this “one-off” money is available. If money is suddenly announced, it will damage the credibility of the managers or commissioners who have spent years building up the expectation that there is no money.  This would set them right back to dealing with more requests for funding than are able to be met.

Genuine “invest to save” is always attractive

The sort of schemes that are most likely to be funded from non-recurrent funding are “invest to save” models, where some non-recurrent money spent now will save large amounts of recurrent money in the future. It is the equivalent of spending some money now on insulating your house to save money on all your future heating bills. These are always extremely attractive because the savings usually massively outweigh the initial costs and these are almost always funded provided that:

a)    the person genuinely believes that the savings will be made (and there is some good evidence that this will happen) and

b)    the organisation that is providing the initial funding will receive the savings

The second point is really important: there is no point (for example) asking a community organisation to provide funding which will save costs spent in a hospital or asking a health commissioner to provide funding which will save the local authority money.

If your scheme will genuinely save your organisation (or the commissioner) funding then it is usually only turned down because they simply don’t believe that your project will works and that it will save money. This is why pilots are so attractive as they provide concrete evidence that your idea works and that it saves money.

Do you have any great ideas to improve your patients lives and save the organisation money?