Words that inspire me and why…

So my second blog…

Just noticed fellow tweeps mentioning a few of their favourite books and thought I would share just a few that have moved, inspired, educated and energised me.  Naturally they are mostly about patient safety, but not all as you will see from the first few…

New jobs

A must for anyone who is going for a new job; Perfect CV and Perfect Interview – both by Max Eggert.  Perfect CV provides really sensible help for writing a short but clear CV which has impact and gets you an interview, Perfect Interview helps you prepare for the interview and provides tips on all the things you should do and all things you should not to do for an interview.  I can vouch for this because I did all the things you shouldn’t do once and didn’t get the job.  Once you have the new job, then move on to ‘The First 90 Days’ by Michael Watkins who can ‘guarantee you success in your new job’ if you follow his 90 day plan. Worth a try.

Subjects that are difficult but shouldn’t be

A must for anyone in healthcare are Kate Granger’s books; The Other Side, and The Bright Side.  They are beautifully written and the true story of a young doctor’s experience of being diagnosed with cancer and then how she is coping with what is now a terminal illness.  Provides invaluable insight and especially good lessons for communicating bad news. On the subject of grief, I would also recommend a fictional book by Maggie O’Farrell, titled ‘After you’d Gone’ – stunning book about a love and loss.

Patient safety and change

You know I have to recommend Complications and The Checklist Manifesto both by Atul Gawande.  Complications was one of the first books I read that really captured patient safety but not in any theoretical sense, much more interesting than that; the story telling style ensures the reader is engaged from the start and truly understands the complexities of providing healthcare, how easily it can go wrong and the impact on both sides of the story, the patient and the clinical practitioner.  The Checklist Manifesto debates all aspects of the use of checklists far better than I ever could.  Both are written by a sublime writer, I have no idea how he finds the time to do all that he does – maybe that should be the subject of his next book!

To really get into the detail I have my ‘bible’; Diffusion of Innovations in Health Service Organisations – A systematic literature review by Trisha Greenhalgh et al. I tour de force (I think even Sir Liam Donaldson said that in the foreword) of a book on everything from innovation to implementation.  Also cant really mention Greenhalgh without recommending the wonderful ‘How to read a paper’ – the basics of evidence based medicine. I understand from twitter chat that she is going to publish an updated version soon.

Charles Vincent’s books titled Patient Safety and Clinical Risk Management provide all you need to know about the substance of patient safety and all of Jim Reason’s books should be on your shelf if you are working in patient safety and risk.

Others to contemplate

Malcolm Gladwell – The Tipping Point and Outliers both fascinating insights into the way people behave.

Sidney Dekker – Patient Safety: A Human Factors Approach

Kieran Walshe and Ruth Boaden: Patient Safety: Research into Practice

Joseph Badaracco Jr writes eloquently in ‘leading quietly, an unorthodox guide to doing the right thing’.

The Power of One, the Power of Many – totally sold me on social movements and by Helen Bevan, Jo Bibby and others. I wish there were more written on social movements and healthcare – and this one should be followed up with a second book on all that we have learnt about the ‘blended’ approach to transformation since.

And finally, if you just want a ‘laugh out loud’ read, then you have no need to go anywhere else other than to Caitlin Moran, ‘How to be a Woman’.

I absolutely love books for the way they can take you into another world, and transform your thinking. I dream has always been to write in the same way as Stephen Fry speaks… in the meantime at least I can have the pleasure of reading others who do.

The difficult art of implementation

From 2005 through to 2008 I undertook a doctorate in patient safety.  The focus was on implementation; the factors that help and hinder implementation of patient safety practices, interventions and guidance.

I have yet to publish articles (I know an academic crime) following my research, partly because I would add to the 2.5 million articles produced in healthcare every year and ironically therefore add to one of the main factors that hinders implementation.  I did however produce an implementation toolkit for developers of guidance and led the implementation year of the campaign, ‘Patient Safety First’ using all the lessons I had learned.  So I thought I would produce a serious of blogs for anyone who is interested in both patient safety and the difficult art of implementation.

Implementation is shorthand for how innovations, interventions and guidance are communicated, disseminated, adopted, and spread.  For the purpose of this blog I shall just refer to these as ‘change’.  The aim is obviously to do this effectively so that the new practice or change is sustained and embedded into everyday practice.  My research included talking to and observing leaders, managers, junior doctors, frontline nurses and experts. So what did I find?

Implementation is a process not an event, it is complex and requires both expertise and concerted effort, it most definitely is not about simply telling people to ‘do it’.

The following are key to successful implementation:

1. Demonstrating that the change is better than status quo and relevant, with tangible benefits – i.e. the answer to the question ‘Why should I bother?’ or put it another way, ‘there needs to be a need for the change’

2. The change is easy to do – i.e. it doesn’t need a 100 page manual or intense hours of training and there are lots of useful resources to help reduce the time it takes such as a set of templates or presentation slides already created for you to adapt

3. The change is adapted to local conditions – i.e. something that works in another country, another organisation or even another team will not automatically work for you – you have to test it, adapt it, and test it again to get everything to feel it fits for them

4. The change is liked by people you respect, often referred to as peer to peer influence or the use of opinion / role models – i.e. you will implement changes that are liked by people who do a similar job to you, and you think are sensible, possibly even charismatic, and you want to a) be like them and c) do what they do because if they like it, it must be good

5. The change matches your intrinsic motivators – i.e. presses the buttons that make you want to do things, like your beliefs, moral compass, ethics, desires, competitive streak, positive feedback, energising activities and so on

6. Reward and recognition – i.e. people are recognised for their actions, thanked and valued for their contribution to safer care

7. Measurement and visible results – i.e. I know obvious, but you cant tell how well you are doing, you cant offer recognition and make people feel good about what they have done, if you haven’t measured it

The things that hinder are:

1. Training – i.e. didactic training with no consideration of the success factors above

2. Simple dissemination with no support – i.e. a guidance passively disseminated expecting people to notice

3. Carrots or sticks in isolation – i.e. providing incentives or punishments without thinking about the success factors above

4. Lack of awareness – i.e. no recognition of the problem

5.  The wrong solution – i.e. the change doesn’t actually address particular problem that needs addressing

5. Lack of or poor preparation

The external factors that get in the way are:

1. Volume: the huge number of articles, policy documents, guidance, interventions  published daily – coming from all different directions including your own organisation

2. Quality: or seeing the wood for the trees – trying to figure out which are the ones to pay attention to and which are the ones to ignore

Increasingly as I attend meetings events or conferences the last line seems to be, ‘the key problem with improving safety is implementation of the things we know work’ with the assumption often that surely this must be easy.  It isn’t.  If we do ‘one thing’ it is for the ‘problem of implementation’ to be owned by the guidance developers, solution designers and researchers and not those that are expected to do the implementation.