08.07.16
Time to effectively manage change
Source: NHE Jul/Aug 16
NHE’s Rosemary Collins talks to Professor David A. Shore, a former associate dean of the Harvard School of Public Health and one of the world’s leading authorities on managing change and gaining competitive advantage, who believes that internationally-used management strategies can help solve the challenges facing the NHS.
While visiting England to deliver a programme of seminars for change management experts Enable East, Professor David A. Shore, a former associate dean of the Harvard School of Public Health, told NHE that the problems facing the NHS are not unique and occur in healthcare systems in the US, China and the Middle East. He does believe, though, that his management strategies can help solve the challenges facing the NHS.
“I think we’ve done a really, really inadequate job on the preconditions,” he told NHE. “I have experience in healthcare systems on both sides of the pond and there’s a real amount of waste and reduced productivity.
“The reason why, for the NHS, productivity is so critical is that what productivity does is provides white space to do other things, and right now, when I have worked with NHS staff, they always talk about the fact that they have no white space.”
Better time management
NHS management, he argues, urgently need to get better at organising their time to deliver better care – especially when the NHS is so concerned with the need to deliver innovative ways of working to solve challenges, such as the deficit and the problems of a population with increasingly complex health needs.
“In terms of productivity,” he explains, “it’s what I call lateral productivity. You have productivity that is doing lots of stuff, you’re always busy, it just doesn’t signify a whole lot. You’ve seen this in the NHS in business meetings. I ask people in the NHS about how much time they spend in meetings. When we do what’s called a calendar analysis – that’s looking at their diary and how they spend their time – the single biggest amount of time is spent, on average, for managers and above, on meetings. It’s between 3.5 and 5.5 hours per day, which would be OK, except for the fact that they evaluate their time as largely boring and wasteful.”
Reframing meetings
Prof Shore suggests that organisations should reframe how they talk about meetings. If a one-hour meeting is attended by 12 people, it’s referred to as a 12-hour meeting, reflecting the human capital it takes up, or else a (for instance) “£193 meeting”, reflecting the potential cost in wages.
“That’s a shame, and a waste,” he said. “But there’s an ethical and moral issue and that is: what could you be doing with that time and money on behalf of the people you serve? It’s remarkable. That’s an example of how we can take something like the NHS, which is particularly burdened with business meetings in my experience, more so than other places, and profoundly reengineer that process and free up human and financial capital in ways which are extraordinary. And this is profoundly doable. This isn’t academic – it’s been done.”
Parkinson’s law & consent agenda
Prof Shore explained two concepts he uses to change productivity in organisations from lateral productivity to structural productivity, “things that actually make a difference”.
The first is Parkinson’s law which states that work will fit whatever time allotted for it. “Our research is very clear,” he said, “that there’s nothing, nothing, you can’t accomplish in a 60-minute meeting that you can’t accomplish in a 50-minute meeting.”
Cutting meetings from 60 minutes to 50 minutes gives managers an extra 10 minutes an hour for other tasks, such as answering their phone and e-mail, said Prof Shore, eliminating the problem where colleagues who need to contact someone can’t get hold of them all day.
The second is the ‘consent agenda’. Prof Shore’s research shows that 38% of meetings are spent on going through non-controversial items at the beginning of the agenda, such as appointments and the dates of the next meeting.
“Most agendas are upside down,” he said. In the organisations Prof Shore works with, he advises agreeing these matters in advance and only voting on them if there’s a disagreement.
However, he says that good ideas for restructuring management can face difficulties in the execution, despite enthusiasm from NHS leaders, if their organisation doesn’t allow them the space to make changes.
“Organisations need to give people permission to experiment,” he says, “and they need to create an environment that supports that.”
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