#WOL #NFTE – Notes from the edge

This is my first note from the edge and sets out my intention to seek, sense and share experiences from my journey across the emerging landscape of healthcare. Along the path there will no doubt be excursions down a different route to explore personal stories unconnected with health, yet important in their own way.  The intersection of diverse sectors and the ability to look beyond and into the future are to my mind what determines innovation value. The edge is a metaphor and I use it to determine a safe place to observe, study, learn and consolidate my thinking.

The notes from the edge will be short and simple.  My aim will be to challenge the norm, post a provocation or two and try in my humble way to hone my writing skills.  There is a risk in writing, but ultimately a risk worth taking as outlined by Seth Godin.  

To sum up my approach I will leave it to Banksy.  Follow your dreams, don’t let them be cancelled.


It would be great if you could join me on this project sharing your thoughts in the generous community who work ou loud.  The notes from the edge project will ship weekly and be captured under the hashtags #NFTE and #WOL

The trouble with busy

This week has been hectic balancing two very different jobs in the health service and trying to connect people across continents to deliver a project.  It’s great to hit the weekend and be able to get out in the open air, take stock  and centre myself on what matters.

Busy is the mantra of the 21st century – we have to say that we are busy all the time, that by our very busyness we gain importance.  I have a problem with busy!  As a word it is fine, but it has a cheeky little attitude – ‘look at me’ ‘pay attention to me’ a very demanding troll that needs constant feeding of ego.  I am trying to recognise when that little troll busy surfaces.  When it crawls out of the woodwork to go patiently to that angry, crying attention seeker busy and say ‘look it’s ok, we need to understand if others can help’ and ‘If any boundaries are being broken.’


To reach out across the void of busyness and through a transparent and honest dialogue with colleagues – share the work and how they can support.  This is not easy, but something we need to start doing if we want to encourage healthy boundaries and let people bring their authentic self to work.   Now more than ever we need to walk the walk and talk the talk equally.  This is essential in health and social care where work is a human business, people go the extra mile for others and the dial is set to constant change.

I am no expert, but suggest the following ideas which work for me:-

  • Reflect on a daily basis on how your work fits into the big picture.
  • Get back to nature by going on photo walks, exploring the unexpected and being creative.
  • Use a meditation app  like Simple Habits to take time out on the move.


Citizen power in the social age…..

I am sitting on my sofa typing up my blog whilst hearing that the new president of the USA will be Donald Trump.  A headline not predicted yet again by the polls.  We are starting to see that different power exists which run through formal and informal networks changing the dynamics of politics.  Social collaboration tools help to amplify the narrative for good or bad.  Whilst people connect, debate and challenge the norm.  Julian Stodd illustrates the tension that exists with new and old power in his blog and through this illustration.


New communication skills are needed in the 21st century and it is worth reflecting on the leadership styles of Trump and Clinton,  as highlighted within this article by INSEAD Knowledge.  Leaders now more than ever need to engage both hearts and minds in the social age to bring about change and connect.

Putting politics aside what learning can we take from the uprising in citizen power and change.  One learning point for me is that we have to seize the day and explore the opportunity in the moment.  Seth Godin succinctly covers it when he states ‘If not now, when?‘  There is a chance for everyone to stand up and be counted, to embrace co-creation and work generously with others for good.

This is work out loud week and if you follow the hashtag #WOLWeek you will see that all over the world people are connecting to share their learning and co-create projects in a generous way.  My sharing on the hashtag this week has been around the ‘Peoples Transformathon‘ #CoPro16 an event I am curating with colleagues which will share amazing examples of citizens working in co-production with health and social care to develop new ways of working. We are honoured to be the first UK event to be awarded the #EveryoneIncluded trademark and accreditation from Stanford Medicine MedX.   ei

The event was developed in response to a small group of citizens coming together with shared purpose.  The aim to make an event showing how patients, carers, volunteers, relatives, citizens could provide valuable insight for health and social care.  Working in co-production a virtual design team developed every element of the event.  Bringing alive the concepts within the following documents   The Five Year Forward View chapter 2 and the six principles for engaging people and communities.    A real example of Margaret Mead’s quote at the top of this blog.

It would be great if you could join us too on the 28th November 2016 at the People’s Transformation to make a different kind of change where everyone is included!  Why not sign up here today to be part of a fantastic free online event available to anyone across the world.


Alien vision…

Alien 2

We live in interesting times, change and history at its most raw state.   People are unsettled and craving stability.  Everyday the media present us with a story of someone resigning and the potential of disaster, yet as I write this blog post #LondonTown is still standing.  There are no aliens roaming the streets honest, it still looks the same. Maybe the June sky’s were not so blue this year, here’s the proof captured for you all.


What can we do when the world seems to tilt on it axis?  Is there learning for us in the moment?  I believe so.  We need to appreciate kindness and recognise that the world is still a place of hope and opportunity.

Everyday someone’s world is disrupted.  The tectonic plates shift and you can find yourself in difficult circumstances.  You want the world to care and for there to still be hope.  Perspectives change with circumstances.

People are shocked that whilst polls tell us one thing, the opposite happens.  They fail to recognise the subtle signals, that people don’t always tell the truth to pollsters and Facebook and Twitter give you content based on algorithms that don’t necessarily show diversity.   Seth Godin highlights how organised bureaucracies expect compliance when actually we need to be looking for contribution.

I want to finish this blog by capturing that everyday people contribute to the NHS – healthcare staff from all over the world, patients and volunteers – #HappyBirthdayNHS. For all the current difficulties the NHS strives to be that port in the storm for individuals whose world has been disrupted.


Whilst walking through the beautiful grounds of Mottisfont yesterday I came across the alien at the top of the blog. A strange creature that challenges you to think differently.  To consider the following:-


The artist David Breuer – Weil,  made me think about the essence of being human and compassionate.  How we need to all co-create together to make the world a better place?



Mottisfont walled garden


Mottisfont House





Care Design 2016 – A guest blog

One of my projects within the Horizons team is Care Design 2016, which has been to take the well researched design principles developed by Nigel Edwards CEO of  The Nuffield Trust and collaborate with an international expert group to fine tune these principles.  What makes this project different is that the Horizons team have gone one step further and crowdsourced the principles via a change platform by Crowdicity.

The results were fascinating  and one of the key points I would raise at this stage is that when we asked for the wisdom of the crowd, we considered all of the data received and incorporated important citizens concerns that resulted in enhanced design principles.  What we have now is rich data and terminology that resonates with everyone involved in the project.  I have written before about collaboration and how you may not receive the answer you expect when asking citizens to respond.  A point illustrated well by the BoatyMcBoatface story and the recent  EU referendum.

Citizen engagement is complex because of the multiple layers and thought processes, yet rewarding.  My colleague Sasha Karakusevic’s blog below illustrates through case study exemplars how excellence in healthcare can be achieved by design thinking.

Care Design 2016

We all know great service when we receive it.  But how often do we stop and think about how that magic moment was produced?  Was it a one off or if I return again next week, next month or next year will I still receive an outstanding experience?

Often, the difference between exceptional and merely good enough is a combination of small and subtle differences in approach.  Exceptional requires a little bit of magic and is often dependent on having the right people with the right training.  But that is often just the tip of the iceberg:  Designing, delivering and maintaining excellence is really hard.  As well as getting the design right in the first place there is a need to build in sufficient agility to change as knowledge, customs and fashion change.  This is one of the biggest challenges in health with the published literature increasing by at least 40,000 papers per month!

Exceptional goes well beyond delivering services safely or efficiently and is a judgement that people make in their heart or gut – its essence is about feeling and not analysis.  That is not to say analysis is not important, however unless that analysis leads to an insight that unlocks passion, excitement and understanding the resulting service is likely to be just good.

Over the last decade there has been increasing recognition that design thinking can contribute to improved health and care delivery.  However, in reality delivering this is tough.  Recent work by the NHS Horizons team and Nuffield Trust has identified eleven principles that people think are most important to consider.

Care Design Principles 2016

Understand who needs care and what they need – identify common needs across the population and design services to meet those needs

Design care so people can flourish

From supply side (service led) improvement to demand side (citizen-driven) change

Design care so that when people need it they flow effortlessly through the system

It’s a complex world: plan for emergent not just certainty

Technology enabled

Networks/sharing spaces and organisations

Measure outcomes that matter

Mobilising and valuing people and assets in the local place

Continuous improvement and attention to detail.  Standardise where you can, customise when needed.

Ensure environmental sustainability

For the most part these principles are about people and the environment they operate in.  Interestingly, the principles do not differentiate between people as patients, carers or care givers.  In healthcare each group needs to flourish to get the best results for communities and wider society.

How can this be achieved at an organisational level?  For boards the answer must be about creating the right environment in which excellence can emerge. The performance indicators for this look very different to those required to assess short term delivery and need to consider learning, innovation and team performance.

It is very difficult to introduce design thinking across a whole organisation or system. Therefore focussing on a few themes that matter locally is likely to be more successful.   Aligning these themes to mission critical challenges will help to ensure senior leadership interest and involvement.  Involving people with design expertise to build capacity and capability is also likely to be achievable at this level.

There are a growing number of examples emerging and I have been lucky enough to meet and talk through a number of approaches with people who are leading the design movement around the world and what follows are a few examples of what is possible:

Western Diabetes Institute

The team designed care around the needs of patients:  Recognising that patients can only deal with a number of issues at one time the team enable the patient to identify what their key issues are and address them. By working in a multidisciplinary way they can respond flexibly to the changing needs of their patients providing greater integration and better outcomes than previously achieved.

The team are collaborating with Newcastle University as documented here.


North Devon pathology optimisation

The pathology team recognised that by working with local GP’s and the CCG there was scope to improve the care of patients.  The team started work with individual stories to understand the patient experience of tests and how to improve this.  Their detailed approach involves looking at the complete patient experience.  As well as improving care the team are also saving money!

More details are available here 

Both of these case studies illustrate adoption of the design principles and delivery of high quality care for patients.  One of the challenges is how best to organise teams to provide care at the same time as supporting innovation and learning.  The Buurtzog example is very interesting.

Buurtzog Nursing

Buurtzog have developed a very successful care organisation by being very clear about what the patient needs and how teams design can be optimised.  The result is a very flat organisation that provides high levels of professional autonomy, builds on experience and is scale-able.  Read more here

These examples show that by being clear about the design principles, enabling teams to progress and keeping to a small number of rules the rate of improvement can be accelerated.

Think about changes in your own organisation.  Have the design principles been applied and what difference did they make?  In these examples teams started small and built up capacity and confidence as they developed and improved care.

If you want to apply the design principles in your work have a look at our resources for advice and guidance and if you need more help please get in touch.


Sasha Karakusevic

Project Director – Horizons NHS England

Twitter @Karas01









Digging deep into social leadership

What does social leadership look like?  I have been reflecting on my experience at the #socialagesafari a few weeks ago.  People from different backgrounds came together on a quest to deconstruct the term and untangle the elements.  It was incredible to meet face to face, people that I have previously met through serendipity on twitter and share experiences of social age learning.

I came to listen, share my story of international, national and local communities and learn from others.  Over the last year there has been an exploration of hacks and sprints in the Horizons team within the National Health Service.  We have led them, facilitated for others and shared our narrative of transformational change.   The first day at the safari was different as I fully immersed myself in the experience of being a participant, letting the waves of learning crash over me and challenge my perceptions of social age leadership.

To be honest, my aim was also to understand how other people run hacks and sprints listen to the conversation and watch how people use social media.  For an extrovert, my interaction during the day has been unusual.  My normal mode would be to tweet from the event capturing everything going on to share with a wider audience.  Working out loud through my twitter feed and sharing the key points from the day.  The first day I was introverted, observing others and saved my energy for the two day sprint.  Flipping my usual preference in behaviour to a polar opposite was a unique experience.  So what did I learn?

New terminology is a key area for discussion and misunderstanding.  Social age leadership is a great example.   This graphic by @gapingvoid sums up our group work around this term.


Our hack groups debated the essence of social leadership.  Is it about the tech or is it about how the individual uses their leadership and communication skills aided by technology.  The discussions could become about specific platforms such as twitter, facebook, yammer, instagram you name it, we probably talked about it.

Being introverted for a day was fun.  I could take part in the groups, but it felt very different.

The community of the safari came together to produce a newspaper several times a day.


This focused people’s reflections and learning from the event.  It gave urgency and meaning to the time we were together.  It made people stop procrastinating and start writing about subjects they were passionate about now and potential subjects for future blogs.   There was even a press office which diligently put the copy together led by @lauramalarkey.   I loved this element as I saw faces of concentration working on their copy for the day and was amazed at the creativity taking place.

So do I have an answer for – What is social leadership?  I have my view that it’s not about the tech but what you do with it!  Today’s Facebook may well be a distant memory in the future, a bit like Friends reunited is today.  Therefore, whatever tech we use will help us to be great social leaders by essentially going back to basics and telling better stories that people can believe in. leadership leadership



#Working out loud week 2

Thought it was worth sharing this blog from the Care Design 2016 project I worked on during WOLweek.   There will be further blog posts from the project as we move into design sprint 3.   Check out the update report with the new design principles and a call to action for case studies to be submitted that reflect good practice for each principle.

One wonderful aspect of the Care Design 2016 project was the way that individuals engaged with the crowdsourcing platform and contributed their thoughts and ideas generously to the project.

In the same spirit of generosity during #wolweek another Banksy mural appeared as a thank you to a Bristol school, which made me smile.  True working out loud Banksy!




#Working out loud week

Here’s the thing.  Sharing your work is scary and full of decisions.  What to share? Will people be interested?  How can you do this generously?

I have been sharing my work via twitter on health, innovation and social age leadership for the last three years. Connecting with people all over the world that give generously of their time and experience.   Blogging is fairly new to me although I have been an avid reader of many blogs which help me to develop my work in so many ways.

Seth Godin suggests that we read more blogs and filter the internet in our own unique way.  I subscribe to that plan. There is a lot of distracting noise from the internet and it is for us to curate and find the important stuff that matters.  The challenge is to ensure that you give credit to the authors and image makers at all times.  I will always try to do this and if I fail, will admit honestly and credit when the source is made known to me.   The featured image on this blog is from Boni Stachowiach Ed. D.  and the image below combines several individual’s work.  Curation brings challenges, but also a great opportunity to share tacit knowledge.


A great example above of combining knowledge from the internet – Helen Bevan, Harold Jache and Mitchell Kapour.

#Workingoutloud week is a great opportunity to encourage others to share their work online with Jane Bozarth generously offering her book in a competition that runs for this week.  Reflecting on my purpose for working out loud it is to learn from others and going forward develop a habit of writing a blog weekly to share my learning with others.  I guess that at the moment my blogging is a big experiment to find my voice and understand what works. Simon Terry covers the benefits of experimenting and that makes sense at this stage.

Does blogging fill me with fear?  Yes!  Do I want to curate the good stuff on the internet and make sense of it through my blog? Yes!  So I am starting a new habit this week, taking fear in hand and experimenting with freedom as outlined by John Stepper and the late, great Janis Joplin.  Would be great if you could join me.


own adventure



The tipping point – are we there yet?

Sometimes I close my eyes and imagine how in a perfect world innovation in health and social care would be easy.  Now don’t get me wrong I know how the system is being improved and that it takes time to really make changes.    The NHS is a mighty big ship to turn around in a short time.

I came into nursing to make a difference, to do what other had done for me when I was ill. Nurses that sat with me in the middle of the night, listened to my story and gave me hope.


Being a patient really focusses the brain, you notice things, recognise good and bad care and you understand the things that matter.  There were lots of painful experiences as a patient, too many to mention in a blog post.  Yet simple things such as reducing the times that I needed to have a new cannula needle inserted in my arm would have made a difference.


I remember the dread that washed over me if my IV fluids stopped flowing, or if someone removed the cannula too early when it was still needed for my treatment.   There were times when the IV would catch on something in the night and that could pull out the cannula, leaving the fluid to flow out over the bedclothes.  The challenge for the clinician was to get another cannula in my arm by hopefully finding a vein in the middle of the night.  It starts to become painful after a while when your veins decide they have had enough.

I started this post with the question – The tipping point, are we there yet?  Much has been written by  Malcolm Gladwell and others about the conditions required to get to the tipping point.  A combination of  factors that swing together as if by magic to make change happen.  John Stepper  work is a great case study for tipping points  covering how he started a work out loud #WOL movement..  Check out his TedTalk for more details.

This week  I started to believe that we have finally reached a tipping point for clinical innovators.  Why do I believe this?  Well,  Monday I was part of a national tribe of innovators, entrepreneurs and the go to team for innovation in the NHS at the launch of the first ever Clinical Entrepreneurs  programme.  The event   was inspirational and no one could doubt the passion for innovation in the room.  Talking with Dr Tony Young on the night I was pleased to hear that the plan is for future programmes to extend beyond a medical model and include other clinical professions and patients.  There is at last a real appetite for innovation in health and social care with a structure in place to support the difficult journey from having an idea to healthcare innovator and entrepreneur.  BBC Click covered more on innovation in health, interviewing Dr Tony Young and showcasing the great projects that are being supported.

To put the national picture in context with what is happening at the frontline I want to zoom down now to my role as Clinical Innovation Lead at Salisbury NHS FT where I manage an innovation portfolio of products.  As an innovator myself I have an understanding of the tenacity and enthusiasm you need to push through the challenges and finally ship a product. This helps me to challenge the status quo in a positive way and mentor other innovators.  I have worked with a brilliant clinical innovator Richard Laughton who has been shortlisted for a patient safety award.  patientsafetyawardsLinking back to my patient experience Richard looked at a real patient concern, safety and cost issue by developing his innovation whilst working on a medical ward.  The innovation called Safebreak, provides a low-cost way to prevent cannula being pulled out as identified in my narrative and ensure patient care not compromised.  I intend to ask Richard to blog on this site about the device in the next few weeks.   The device is incredible and shows that we need to support nurse innovators and give them the head space they need to develop their innovations.                        .

The Safe break device is unique in other ways too.  Normally we would develop a specification for a prototype company,  this would be an expensive and lengthy route to having an actual prototype in our hands to show to companies.  We have a 3d printing company on site and I decided to see if we could disrupt the normal prototype route by printing the device.  This reduced costs, enabled us to produce a prototype in a short time and adjust as necessary.  Real disruptive innovation happening at local level.

To sum up my week in two ways – National and Local innovation has been helpful.  It is my attempt to show that there is now a tangible tipping point with innovation in the NHS.  My challenge to you is to reflect on this blog post and see what you can do to think different!


RCT – A drop of serendipity

The Social Age Safari  is built on foundations of narrative and connection bringing people together and introducing the opportunity for serendipity.  The session on creativity that I presented on community touched on the way we have used RCTs (Randomised Coffee trials) in the National Health Service to spark innovation, transformational change and co-creation.  The RCT’s have been used as part of our school for health care radicals #SHCR and NHS Change Day .   Here are a few links to information on RCT’s from Horizons NHS/David Gurteen,  Nesta and The Red Cross all organisations have found the approach a simple way to generate innovation.

Carol 1

RCTs aim to introduce a drop of serendipity into everyday life connecting people who would not have met each other in any other way.   Greg Lindsay talks about how people who can serendipitously bridge gaps were more likely to generate great ideas and progress professionally.   Google and other organisations have looked at how the way buildings and working practices are put together to try and replicate serendipitous opportunities.

The audience at the safari wanted to know more about engineering serendipity as it formed part of co-created learning points developed by two participants Kurt and Kate at the event.  My aim is to add to this learning point  by blogging more evidence as I complete my MSC research on innovation and clinical innovators.  Anecdotal evidence from my own experience, innovators DNA research and from the Aspen Ideas Festival 2014 suggests that innovators need to practice the ancient art of serendipity.

So I have an open invite to you to watch this space as we move towards creating the biggest ever global RCT for the next Fab Change Day  with@RoyLilley.  Sign up details for the RCT are coming soon and you don’t need to be in health or social care to join in.