This is my 11th year as a national improvement leader in the NHS. During this time, I have led or supported more than 70 major national improvement initiatives, in priority areas such as quality, emergency care, waiting times, cancer services, leadership and care closer to home. Yet I have never experienced a phenomenon like the Productive Ward. It has spread more quickly, made a difference to more staff and patients and created more energy for change than anything I had experienced previously. All the indications are that the other 'Productives' are going to follow a similar pattern.
The Productive experience made me reflect deeply on the whole process of implementing change. What can it teach other major improvement initiatives, such as the implementation strategy arising from Lord Darzi's next stage review? These are my top six lessons:
Get everyone at every level playing their role to make a difference for patients.
Productive Ward depends on the energy and talent of ward teams and managers, supported by matrons and executive nurse leaders. It is probably the best example I have seen of the magic that happens when senior leaders get firmly behind changes at the front line. It is also an excellent example of the positive role that strategic health authorities can play in supporting local change.
Productive Ward represents the NHS Institute at its most impactful, making powerful improvement ideas and skills available to NHS organisations.
Base it on the real world, not Disneyland.
Productive Ward is not a "magic bullet". It requires leadership will, resources and staying power. The executive training for the Productive Ward makes clear the resources and time commitments that will be required at every level of the organisation. Contrast that with many local change initiatives, where we start taking action without really thinking through the resource implications. Then we wonder why the change process flounders when we just have not got the time or space to implement or sustain the changes.
Work with improvement methods such as lean, but keep them in the background.
All the Productive programmes are firmly based on lean improvement principles. However, you will rarely hear the word "lean" mentioned. That is because improvement methods work best in healthcare when we keep them in the background and focus on the results we want for patients and staff. If the Productive Ward had been called "The Lean Ward" rather than "Releasing Time to Care", I doubt we would have had anything like the take-up.
Create pilots with pace.
We learned very early that it is more effective for trusts to start their Productive Ward programmes with just one or two wards, use this as an opportunity to really learn what is required, then systematically spread the approach to the rest of the organisation. We have a tendency in the health service to start pilot schemes that are much too large. If you start the Productive Ward with six or eight pilot wards, rather than one or two, it is much harder to manage and learn. The paradox is that by starting smaller, we can go faster in the longer term.
Work with "identity groups".
People are much more likely to embrace change when the message comes from someone in their own identity group - that is to say, other people who share the same values, beliefs and life experiences.
So a doctor is much more likely to change as a result of an interaction with another doctor than from an interaction with a non-clinical manager. In fact, a big factor in the rapid spread of Productive Ward is the impact and power of nurse identity groups.
We will be much more effective in our change communication if we work through and with natural identity groups, rather than trying to push messages down through hierarchical organisational structures.
Enable staff to bring their whole selves to work.
The best thing about the Productive Ward is seeing just how much energy can be unleashed by encouraging frontline teams to question how they work and providing simple tools and skills to do this. Yet it is also a tragedy that it takes an improvement initiative to unleash the natural vitality and creativity of our staff.
As NHS leaders, we typically don't go about change in a way that energises and inspires our people. If we could replicate the best of the Productive Ward spirit in every care delivery environment in the NHS, we could truly transform the system.
So, let's focus less on plans, strategies and controls. Instead, let's concentrate on enlivening and emboldening our staff to put all their energies, flair and talent into work and making a difference for patients.