Which deadly sin can help save the NHS?

Since antiquity, mankind has held a belief in the deadly sins. A list of seven infamous and destructive vices may not feel like the natural place to look for inspiration to help a health service creaking under a myriad of pressures and challenges.

But, there is one deadly sin that Doctors and other healthcare workers would benefit from indulging in more often.

  • Gluttony? – Those christmas chocolates in the staff room are delicious, but you will regret eating too many and it doesn’t set a good example.
  • Wrath? – We see injustice every day. However, revenge usually disappoints and escalates.
  • Envy? – Being jealous of your friend who made a million in the city won’t help anyone.
  • Lust? – Fraternising on the ward won’t help the patients.
  • Sloth? – Laziness and not doing what you should will harm patients and your career.
  • Greed? – Perhaps – Money is a good motivator, and pay is important, but the NHS is not the place to make millions.

I am thinking of course, of Pride!

The sin of pride is confusing.

We are proud of our children, our families, our heritage. Have you ever wished someone would take more pride in their work? Pride can motivate people to study hard and to do their best for others. Surely it is ok to be proud?

On the other hand, pride can lead us to be overconfident in our abilities, to believe that we are special and superior, and to ignore warnings thinking we know better. Pride can turn people into dangerous jerks.

Pride has always been part of the identity and perception of the medical profession. From the widely held image of the kindly and open minded yet educated and decisive physician to the stereotype of the arrogant and head strong old surgeon (sorry surgeons ;-)).

The Seven Deadly Sins: Hieronymus Bosch, circa 1500 or The Walt Disney Company, late 20th century – Choose your preferred cultural reference point

 

What is pride anyway?

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Anatomy of a Doctorpreneur: Doctor led Startups Part ⅖ The Idea

“Please report to the administrator’s office…”

It was the early 1980s and Dr Archie Brain was living in the nurses accommodation block. Whilst sprucing up his room, the cleaning lady had stumbled upon a collection of home made, orchid styled latex objects that had been hung out to dry. Suspicious of what use they might be being put to, she had reported the matter. Fortunately, Dr Brain was able to convince the administrator that it was all part of his legitimate research.

Prototype Laryngeal Mask Airways

Changing the world of medicine can throw up all sorts of unexpected problems!

Those of you with an interest in anaesthetics will recognise the name. Dr Archie Brain invented the Laryngeal Mask Airway (LMA). He took it from an idea, to a listed company (LMACO) and an essential piece of life saving anaesthetic equipment in use all over the world! His story holds some interesting lessons for would be health innovators.

Welcome back for part ⅖ of my series of posts about the world of health innovation and startup culture.  There is a hope and belief that through innovation and the application of emerging new technologies, medicine can continue to improve health and wellbeing outcomes whilst also meeting the challenges of rising costs, complexity and demand. Artificial Intelligence, Social Networking, 3D Printing, Smart Devices, the Internet of Things… The list and possibilities go on.

These posts are based on my notes and reflections from the Doctorpreneurs day conference held at St Thomas Hospital London on Saturday 5th November.

Today we will examine that most vital piece of the anatomy of a medical startup… The idea behind it all.

Part one in the series was an exploration of the “Doctor Founders” behind medical startups. If you missed it then catch up here.

 

Where do health innovation ideas come from?

In essence, a health technology startup is built upon a solution to a problem or more specifically a need.

Doctors are exceptionally well placed to spot problems and to innovate solutions. Those without the valuable of experience working at the “coalface” of patient care are not so well placed to spot the unmet needs in healthcare.

‘Well all this holding of facemasks does seem to me to be a bit awkward really.’ – Thought Dr Archie Brain

Continue reading “Anatomy of a Doctorpreneur: Doctor led Startups Part ⅖ The Idea”

Anatomy of a Doctorpreneur ⅕ – The Founder

I have always found the entrepreneur an intriguing character. Growing up in the 80s and 90s I held a fascination with figures such as the nerdy but supremely wealthy Bill Gates of Microsoft, or Britain’s own charismatic and adventurous Richard Branson. They have wealth, control and the confidence that comes from knowing that they made it all happen themselves.

Most impressively, entrepreneurs often use their self made fortunes to attempt to benefit mankind. Bill Gates intends to give away most of his billions to help cure disease and Elon Musk, founder of SpaceX, Tesla and Paypal, wants to colonise Mars within our lifetime.

Before entering medicine, I would wonder if one day I might become an entrepreneur.

Of course, I’m now contented and settled in my role helping my patients as a GP. But I still have respect for the entrepreneur and for startup culture. They are inventive, creative, hardworking and prepared to fail fast and fail often until the problem is solved and job is done.

Healthcare is facing a perfect storm of challenges. The list is familiar; increasing patient expectations, older and more medically complex populations, availability of more but higher cost treatments, and shrinking or static budgets. To continue to deliver universal care, good care and to also control costs, we will need to do things differently.

nhstrilema

Many believe that medical entrepreneurs and startups can help us face these challenges by using new and emerging technology to find innovative solutions. To allow us to improve care, control costs and treat everyone. To let us have our cake and eat it.

With these hopes in mind, I joined a hundred or so other medical, technology and financial professionals at the Doctorpreneurs day conference at St Thomas Hospital London on Saturday 5th November.

It was a great opportunity to listen, talk to and study that fascinating species, the Doctorpreneur. Over the next 5 weeks I will take you back to anatomy class and we will peel back the skin and take a look at what is behind a doctor led medical startup.

 Anatomy of a Doctorpreneur ⅕ – The Founder

Observations and insights from my notebook on the Doctorpreneurs event 5/11/16…

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8 tips for FOCUS – The modern day superpower

Results, incoming telephone calls, scripts to sign, screen messages, electronic tasks, supporting clinical staff, scanned mail, interruptions from reception, paper inbox… Let alone a new patient every 10 minutes….

Now add… email, online news, text messages, app notifications, eConsultations. Twitter is now a useful source of news and opinion. GP only groups such as Resilient GP and Tiko’s GP Group have even made facebook a (several times) daily work related destination for many GPs….

No wonder I find it so hard to stay on top of everything.

Dr Puddle has been using focus to unlock frightening new abilities...
Dr Puddle has been using focus to unlock frightening new abilities…

There is such pressure facing the modern GP to stay on top of multiple work streams. To be responsive. To stay connected. To be up to date with the latest news and developments. It can sometimes feel like we are drowning in work and information.

We know that if we just had some time and energy we could improve our practice systems. We could find better, smarter ways to work. But, life is just too busy. There are too many plates to keep spinning.

This week I stumbled across a useful concept which resonated with my feelings of information and action overload. Cal Newport is an academic Computer Scientist and writes about the impact of technology and how to learn successfully. I listened to a fascinating interview with Cal on James Altucher’s podcast.

Cal describes two types of work:

  • Deep Work: Activities performed in a state of distraction-free concentration that push cognitive capabilities to their limit. Deep work is rewarding, generates real value and multiplies the return on invested time.
  • Shallow Work: Non-cognitively demanding repetitive tasks often performed while distracted. Shallow work is procrastination at worst and fighting fires at best and generaly mundane.
“Shallow work stops you getting fired. Deep work gets you promoted” – Cal Newport

Do you remember that essay you left until the last minute and the intense rush to complete it? The grade was as good, if not better than the essay you spent much more time on. How did that happen?

You did deep work and focussed hard. You were selective about sources, prioritised and worked efficiently.

High quality work produced = (time spent) x (intensity of focus)

We need to tame shallow work. We need to do more deep work… This much is obvious… But how?

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The trouble with NHS Choices… And a better way to do feedback?

“This is the most mismanaged gp surgery I have ever had the displeasure to use. Difficult to get appointments, impossible to plan around work, rude receptionist…”

 

It is difficult to see how any surgery could use this sort of general criticism to achieve anything positive. More often I find that this sort of comment leaves staff demoralised and defensive.

The premise of NHS Choices sounds superficially sensible. Provide potential patients with honest, good quality testimonials about GP practices. These rational and informed consumers will then choose to take their business to the best practices. The good surgeries are rewarded with new business. The underperformers will respond to patient feedback and improve, or eventually lose patients and go broke.

In most industries and under normal circumstances this would make sense. But, General Practice is not a normal industry and these are strange times. In an environment of clinical staff shortages, many practices simply do not need or want to attract more patients. They simply cannot find or afford the staff they would need to look after them. In addition, due to practices boundary rules, patient choice may be limited to only a collection of equally poorly rated practices facing shared recruitment and demographic problems. 

Feedback is powerful. Thoughtful feedback given with good intentions by a skilled tutor or friend can encourage a student to improve and excel. But, careless feedback can hurt, demoralise and block progress.

Feedback is a useful tool when applied in the right way to a suitable problem…

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The 4 NHS Ways to Work Framework

The fields of management and leadership are full of simple schemes and classifications for understanding how people and processes tick. These can be a useful tool to turn to when planning change or when there is problem that is difficult to put a finger on. They provide concepts and vocabulary to help us explain problems to one another and find solutions together.

I encountered a new leadership concept this week…

 

4-nhs-ways-to-work-sketch

Kurt Gebhard Adolf Philipp Freiherr von Hammerstein-Equord, the Commander-in-Chief of the WW2 German Army, had a fascinating system for classifying his officers.

“I divide my officers into four groups. There are clever, diligent, stupid, and lazy officers. Usually two characteristics are combined. Some are clever and diligent — their place is the General Staff. The next lot are stupid and lazy — they make up 90 percent of every army and are suited to routine duties. Anyone who is both clever and lazy is qualified for the highest leadership duties, because he possesses the intellectual clarity and the composure necessary for difficult decisions. One must beware of anyone who is stupid and diligent — he must not be entrusted with any responsibility because he will always cause only mischief.”

This system is amusing for its frank, perhaps outdated, description of most workers as stupid and the image it conjures of that much mocked workplace character – the “little Hitler”. We all recognise that person who enthusiastically applies rules and regulation without proper judgement or understanding of the systemic harm they are doing.

However, I think it is too reductionist, rigid (and rude) for the modern workplace.

Continue reading “The 4 NHS Ways to Work Framework”