Highlights of the Week - 14th November 2014

There is nothing as simple as taking turns; something we teach children from a very early age is the importance of everyone getting a chance and giving each person an opportunity by going one at a time.  However, I was struck again this week about the profound impact that a tiny bit of enforced turn taking can have on a group of highly developed, intelligent, genuine and caring people.

I have mentioned several times the use we make of Nancy Kline's Thinking Environment - a set of 10 principles that can create a space in which people can do their very best thinking, in order that they will then individually and collectively come up with their highest quality decisions and actions.  The principles are not in themselves complicated, but they do require practice.  For example, setting a rule that it is important to pay attention to the person who is speaking without interruptions is about as simple as it could get, but how many times are you really paying full attention in meetings, listening and seeking to understand the point of view of the speaker?  And how often are you waiting to jump in with the point that you have already formed?

The Thinking Environment has a set of conditions for effective meetings and one of those is "thinking rounds" the notion that the group is set a clear question to consider and then each person in turn, without interruption and with everyone else attentive, gives their perspective - or in other words, we take turns.  Everyone gets a voice (you don't have to talk, you can simply pass on your turn if you have nothing to add) and there is no battle for space.  In particular, there is no domination by louder individuals and there is a calm balance to the meeting.

We had a workshop this week to think about how integration may impact on the structure and operation of the CCG.  Everyone in the Governing Body is interested in the discussion, particularly me, I have a lot invested in our work in Plymouth, but there is a danger that 2 or 3 of us, usual suspects, will overpower.  Instead, with a bit of simple facilitation, we heard from everyone and had a much higher quality discussion as a result.

Sometimes the most profound ideas are simple and things we already know.

Highlights of the Week - 14th November 2014 (@jeclo)

Highlights of the Week 1: We're at Plympton Library - it is exactly where we need to be and perfect for our needs
Every penny counts and more importantly everyone in the organisation having a role to play in financial recovery and feeling involved is vital.  So counting the savings around venue costs, hospitality and other running costs is great attention for the business management and admin teams and we are making real progress.

So we found ourselves in a meeting at Plympton Library this week- a room big enough for our needs and a whole lot cheaper than a hotel booking.  We can't solve our financial problems on running costs (we are already over £2 million under our target), but another £500 in the right direction helps.  And there is something about being in our community, sharing the 2 minute silence with other library users, that helps to ground and remind about what we are here to achieve.

Highlights of the Week 2: Integration discussion @NEWDevonCCG Governing Body-it's happening everywhere, how do we live with different speeds?
Fantastic news this week as the Cabinet of Plymouth City Council passed a set of resolutions marking the next phase of agreement about how we intend to work together on integration.

We cover Devon and Plymouth local authorities and if we move towards integrated commissioning in one part of our CCG then it will impact on how the whole organisation runs.  We spent some time this week with the Governing Body exploring how we can move at different paces and, indeed, have different solutions within the same strategic intent; in short how do we promote integrated commissioning with Plymouth whilst working in a different way with Devon County Council.

Clearly it is not straightforward as we need to be consistent for our staff.  But if you start with the purpose - we are doing this because we are clear that integrating commissioning is a key element of driving forward the integration of service delivery and that in turn is about providing better and more joined up services - in fact the integration of commissioning only makes sense to the extent that it impacts on individuals - then it is an issue we need to resolve positively, rather than a barrier.

So we were finding ways to make this work and hopefully that leads us to a successful resolution in December about our next steps.

Highlights of the Week 3: We are taking some really challenging decisions; but hurrying slowly and making sure we get it right
Another week on and more consideration of the range of options that we are considering to help improve the financial position that we are facing.  I have been in turnaround situations before and it is easy to race to a set op decisions in the heat of the moment and then live with the implications later.

We are trying to take a measured and evidence-based view and the more we discuss what this might mean, the more people are having open discussions about whether many of the treatments we pay for and carry out really add value.  The process we are using, based on a marginal analysis approach used by Professor Cam Donaldson, gives us a rigour to the method and ensures we aren't caught in the pressure of the moment.

I have been impressed by how our clinicians have responded to the challenge - it isn't easy for those in the CCG as they represent a far wider membership who will deal with the impact on any decisions in more complex conversations in consulting rooms over the following months or years - but they recognise that not everything we do is equally valuable.

Highlights of the Week 4: IATC2 - more people in the room from outside the CCG; great to be spreading the learning
I ran a session this week to describe our Individuals at the Centre approach to a new group - setting out the importance of living the statements that you write on the wall on in documents - for us a vision that is "Healthy people living health lives in healthy communities" and a way of working by putting "Individuals at the centre"; in summary either "be it, change it or take it down".  In other words, don't have appealing strap lines that you have no intention or ability to deliver - understand what you are doing to get there or change what you say.

The great thing in the session this week (we have now got to over 75% of our staff in the CCG with an initial half day workshop over the last 18 months) was that there were more people from outside the CCG than our own staff.  We have attracted a team from South Devon and Torbay CCG which is great and within the partnership approach to the projects in the second year of the programme, we had colleagues from one of our local mental health providers, from a care home provider and from Plymouth City Council.

It is encouraging, not only that those people were there and interested, but that our staff when given the opportunity to think about projects for themselves naturally choose to look for a range of partners to deliver - integration has a macro and a micro face.


Highlights of the Week 5: A non searchable YouTube video, but delighted with the online support to our programme http://youtu.be/10Z6yVrc-K8

Have a look here IATC2, Module 1
We need to find increasingly efficient ways of engaging staff and in turning the second year of the IATC programme to an ambition of 15 teams we need options that don't rely on face-to-face contact that would impact on other business delivery.

So online messages are part of the answer.  We expect two change agents in each team to spread the message, but they are supported by online material with the content of the sessions, "nudges" that we send out every Friday reminding all the team of key headlines and then a few short videos that summarise key ideas from the programme, from either Tim Robson (from nowshowup.com who is co-running the programme) or me.

They aren't private, so appear on YouTube as the easiest way to share them, but are non-searchable as they are not primarily intended for a wide audience.  I think this one is really good and will support the teams as they work.


It will certainly encourage them to do some high quality thinking first, before they rush to action - Thinking Environment via a nudge?

You can read other blogs related to the work of the Western Locality of NEW Devon CCG

About our workplan: Western Locality Workplan

About our Locality business: Western Locality Business

Jerry Clough is Chief Operating Officer for Northern, Eastern and Western Devon Clinical Commissioning Group.  He is also Locality Managing Director for the Western Locality of the CCG covering Plymouth and the surrounding areas of South Hams and West Devon.

Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.