Community Health Innovators

Transforming health through frontline innovators


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.

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I saw a goat.

This is a guest post from Stuart Hayward was on the first cohort of Nurse First.

The other day, driving to work, there were two sets of roadworks which to a cynical mind would have appeared to have been contrived to inflict maximum mayhem and misery. One set was on a main hub into Bristol, the other was at a mini-roundabout serving commuters seeking to avoid the first set. The lack of alternative routes lead to my being stuck in traffic for an hour on a leg of my journey that can take only six minutes.

I sat there letting Radio 4 ramble in one ear and out the other, watching the growing frustration in those around me. Cars were being slewed around in aggressive three-point turns, arms were being thrown up in frustration and bonnets were dipping violently as drivers braked sharply at the last second, after having crawled forward another twenty feet.

Two things then happened to me.

Firstly, I thought to myself ‘I have a glove box full of CDs I either haven’t listed to at all recently, or are my wife’s choice.’ The one I grabbed was Adele. It was something new, out of the ordinary (for me) and took me one step away from the scene around me and the pressures of the world being described on the radio.

Secondly, as I stop-started along a bridge across the motorway I saw the allotments to my left. I often notice the allotments, holding one myself. What was different on this occasion, however, was the paddock between the allotments and the motorway.

‘Ponies!’ I thought to myself.

I then saw a solitary goat. I don’t know what type/breed/make/model or whatever, I’ve never been a goat aficionado. It had big curly horns and was white-ish and shaggy. And chewing grass.

A bit like this:

It didn’t seem to pay me as much attention as I did it. Maybe their eyesight isn’t great.

What did strike me was the fact that in all this frustration, chaos and anger, I noticed it. And I noticed that I’d noticed it. And it was good.

Natural history programmes show great herds of wildebeest migrating across the plains. There’s always an individual stood still for several seconds while the others blur past it.

Hollywood has the thoughtful protagonist standing still while all the others flow past him.

In this near-stationary traffic jam, that was me.

Crisis and woe all around, but I didn’t care. I took time out for me. I noticed the world. I was safe, warm and not going anywhere. Why worry?

The impact of this event was huge. I now have that picture as my desktop background, and now have a method to mentally put the brakes on when events threaten to careen away from me.

More importantly perhaps, my colleagues now understand why, when the work is threatening to pop, I can refocus us all with four words.

“I saw a goat.”

-Stuart Hayward, recently awarded QN, is linking nursing and military experience in his job as a Specialist Veterans Practitioner. He’s married with two energetic young sons, two quirky chickens and a neglected allotment! He occasionally tweets to @stunursefirst and is trying to improve life in his village through

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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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NHS – A New Charity Is Launched

This is a guest post by Sean Ledington, RNLD, currently on the Nurse First course.

I was listening to Roy Lilley at a recent Nurse First course block in Manchester and was intrigued. It got me thinking about what the NHS could look like if I had the power to change things.

The NHS is a bit like Woolworth’s in that everyone has a rose-coloured image of what they think it is but if you had been to Woolworth’s just before it closed you could see that it was not suitable for today’s type of retailing; it had failed to move with the times.  I think the same can be said of some parts the NHS: it is not suitable for the changing needs of modern Britain.

The last time I felt any real pride in anything British lately has been the Olympic Games. What made the Games great were the volunteers. It got me deliberating about what would happen if the NHS became a charity supported by a nation of volunteers.

Replace some reception staff who often can’t be bothered to even make eye contact. Replace them with volunteers who want to be there, maybe ex patients who want to put something back. What about instead of asking potential nurses to be HCAs for a year we set up a nursing volunteer scheme? It would allow potential students to get a feel for their new profession and also a chance for the NHS to assess the suitability of the person as a future nurse in a way that benefits the patient. It does not add large financial implications like the new Government HCA scheme would. Volunteers could work around their current work/study commitments like any other volunteer.

Patients being left to struggle with eating and drinking because nurses are too busy could be supported by a bank of volunteers who could give the time to support and chat with patients and make sure nutritional and hydration levels are maintained.  The 6 C’s of the Chief Nursing Officer would be instilled and the current rant about nurses needing more skills on the floor addressed (can I have my consultancy fee now, Mr Jeremy Hunt?)

There are lots of different roles both senior and at ground levels that could be undertaken by volunteers. The police now encourage all potential new recruits to spend time as a volunteer ‘Special’ why not ask potential nurses/doctors to show their commitment by spending a year as a volunteer health assistant? This would increase numbers on the ward dramatically and as an added bonus probably reduce financially expensive drop-out rates during nurse training as they would already know if they were suitable for the profession.

So that is my idea of a future NHS, a new charity with a bank of volunteers at all levels.

What do you think?

– Sean Ledington (RNLD) is currently working in the voluntary sector; a proud Nurse First student and project admin of Find him on Facebook, connect with him on LinkedIn, or follow him on Twitter @LDNurse1.