Everything…

primary_care_training_einstein

Is this the formula for everything?

T=c^2/ (2Dv^2VEd)

Why does it matter on a Monday morning?

Well, Einstein thought is was important and physicist John Ellis lays claim to the phrase; A Theory Of Everything (TOE).

The ultimate theory, or master theory.

A hypothetical single, all-encompassing, coherent theoretical framework of physics that fully explains and links together, all physical aspects of the universe.

Finding a TOE is one of the major unsolved problems in physics.

Without TOE we make do with;

Wave Equation, Maxwell’s Equation, Schrödinger’s Equation and Fourier’s Transformation. And, probably, String Theory.

I’ll leave you with Professor Google to figure all that out!

How everything links, fits together and works has baffled the boffins of physics.

I doubt a TOE can ever be complete because, by definition, it can only be the theory of what we know so far, and so far, we don’t know everything.

How stuff interacts?

Questions such as; if you push this, what happens to that over there… are massively important.

No more-so than in health, and probably never more-so, than right now.

The interconnectedness of the NHS has only recently come to the top of the agenda. We used to think competition was a good idea; levers-up quality, gets a handle on costs… except it didn’t.

Working together has often crumbled into finding new ways of shifting costs to someone else… hence it’s viewed with suspicion.

The direction of the LTP is clear. We are heading back to rebadged district health authorities; Integrated Care Systems.

One chunk of geography, one chunk of the budget, a pretty chunky organisation, making chunky decisions about a fair old chunk of population… chunky.

Sign, sealed and delivered by 2021; twenty five, Brexit distracted months… five hundred working days… super chunky.

Managers will have to get to grips with the theory of everything. Managing this level of everything, this level of interconnectedness needs huge skills.

Three in particular.

The first is a really clear view of the big picture. Don’t confuse it with a strategic-mindset. That’s wrong. Strategy evolves from a planning process which is invariably wrong. You can’t plan for ten years.

We know ‘purpose’ (what we exist to do) will become confused with ‘survival’. I can’t tell you how… but it will. It always does.

We have abandoned our strategic-purpose, getting people treated within various target-times, for the chaos of survival.

No one would have seen abandoning-targets coming, ten years ago.

Now, we have to develop Integrated Care Services, at scale and in a hurry, plus primary care networks.

No one knows how to do it. No one’s done it before. In which case, how can you tell anyone what you want them to do?

The answer; keep a clear view of the big picture;

‘We are going to make all this stuff work together, if what you’re doing or planning, doesn’t… don’t do it’

… and repeat it until you are blue in the face.

Which leads me to my second point…

Accept the fact there will be screw-ups, delays and things that don’t go right.

We’ve got some of the world’s best project management talent on HS2, look what’s happened to them.

In the NHS the situation is compounded by the fact that change is undertaken by people doing a day job. They have to keep services flowing and at the same time, change how they are run and by whom and where.

Spending weeks, preparing for an inspection from the CQC, takes managers off the run. They can’t do it all.

Decide what is important (and the answer isn’t everything) and tell them.

Here’s the third point…

Senior managers will have to learn to question their own decisions and have them challenged by the people they work with.

If you pay people to tell you what you want to hear… you’re paying too much.

Hire people who’re better than you and listen to their opinions.

There is a huge risk that all this change, going on at once, will turn into a bullying-fest, people will go off half-cocked in an atmosphere of conflict and threat. Or worse, false optimism.

It’s going to need a change in the management style of NHSE+I, who invariably resort to a toe-up-the-backside… to admitting they don’t have a TOE, a Theory Of Everything.

Contact Roy – please use this e-address – roy.lilley@nhsmanagers.net
Know something I don’t – email me in confidence.
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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.