Health Service Focus

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.”

Tell us what you think – have your say below or email opinion@nationalhealthexecutive.com

Comments

Melanie Newdick   17/08/2016 at 17:06

Absolutely true. I spoke to an NHS Manager who spent 80% of his time in meetings, meaning he has to do all his other work in his evenings. I agree there is plenty of waste in this area. Nearly everyone I meet starts their day by checking their emails, and I regularly see people checking their emails in meetings. From a productivity point of view it's a bit of a disaster. Given that emails and meetings account for most of people's times there are some huge gains to be made here

Add your comment

 

national health executive tv

more videos >

latest healthcare news

Number of nurses increases by 8,570 in the past year

27/02/2020Number of nurses increases by 8,570 in the past year

The Government has announced nursing numbers in the NHS have gone up by 8,570 nurses over the past year, as they work towards their ambitious goa... more >
NHS Digital annual report shows increase in adult social care workforce

27/02/2020NHS Digital annual report shows increase in adult social care workforce

An additional 1,000 adult social services roles were filled in local authorities across England, according to the latest NHS Digital annual repor... more >
NICE recommends new treatment for follicular lymphoma

27/02/2020NICE recommends new treatment for follicular lymphoma

The National Institute for Health and Care Excellence (NICE) have published final draft guidance approving a new treatment option for patien... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us th... more > more last word articles >

the scalpel's daily blog

Too much emphasis on leadership development… and not enough

24/02/2020Too much emphasis on leadership development… and not enough

Words by Dean Royles and Kevan Taylor, who continue their regular contribution to NHE’s blog content. Kevan and Dean work in organisations and systems providing strategic support, advice and development. Every time the NHS goes through one of its many, many structural reorganisations, there is a renewed emphasis on the importance of leadership development. This is a good thing. We know the importance and value of good leadership a... more >
read more blog posts from 'the scalpel' >

comment

NHS England dementia director prescribes rugby for mental health and dementia patients

23/09/2019NHS England dementia director prescribes rugby for mental health and dementia patients

Reason to celebrate as NHS says watching rugby can be good for your mental health and wellbeing. As the best rugby players in the world repr... more >
Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Creating the Cardigan integrated care centre

10/06/2019Creating the Cardigan integrated care centre

Peter Skitt, county director and commissioner for Ceredigion Hywel Dda University Health Board, looks ahead to the new integrated care centre bei... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >

interviews

Mike Farrar, Swim England - Last Word

07/12/2019Mike Farrar, Swim England - Last Word

Mike Farrar Chairperson of Swim England Would you talk us through your previous roles within the NHS? I’ve held a number of ... more >
Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual conference, Matt Hancock highlighted what he believes to be the three... more >
NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >