#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

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









#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.




Unlocking the power of fellowships

Maximising the impact and benefits of research and knowledge mobilisation fellowships for health and care”

A fellowship in health and care is an opportunity to expand your practice.  It’s a gift that needs to be reviewed constantly to ensure it brings challenge, hope and development.  My Transformation fellowship at Horizons, NHS England started in November 2014 and I have been involved in amazing projects so far The Edge, TransformathonCare Design 2016NHS Change day and lots of hackathons.  These projects have enabled me to work in partnership with a wonderful team, patients, clinicians, innovators and change agents throughout the world. During my fellowship, I have gained experience in a range of quality improvement methodologies, facilitated hackathons and undertaken research through a crowdsourcing platform.   As editor of The Edge, I have supported others to share their stories of change and developed a community profile for my writing.  The Edge – A free social platform for transformational change has gone from initial start up to 44,000 users in 140 countries in the first year. All fellowships are different and that’s what makes them so special.  They challenge you to step out of your comfort zone with supportive leadership and mentoring.

A fellowship can be a lonely and unique experience, according to the conversations I have had with other fellows.  I was lucky as Horizons supported several fellowships bringing individuals from a diverse range of backgrounds to work on transformational change projects and share their experiences.  At Horizons led by Helen Bevan, we are passionate about co-production and leading the way in all our work, with fellowships no different.  I have been in the health service for a long time but gained a different perspective working in close partnership with Alison Cameron – a Transformation fellow and patient leader on The Edge.  Fellowships give you a chance to develop and explore what makes you tick.          

One of the things I tried to do when I started my fellowship was to link with others fellows that I came across on twitter.   Little did I know that connection of fellows was already happening with Cathy Howe acting as lead fellow to pull us all together and set up #FellowsConnect.  The third FellowsConnect event took place on the 26th February in London and there was a real passion to connect, contribute and share learning from the fellows attending.  In the spirit of transparency and connection with others, Dave Hearn will be running twitter chats @fellows_connect  and the steering group will share reports from all events.  We want to reach out to other past and present fellows in health and care to offer support, connection and fast paced knowledge mobilisation.

If you want to be involved, have a look at the event report and contact Cathy on Twitter: @cathgreenhalgh or Email: c.howe@imperial.ac.uk

Event Report FellowsConnect Feb 2016 v2.1



Building products customers love (1)

My Trusty Sunflower cream is a great case study to show innovation in the NHS.  The original sunflower cream product was developed to be used by patients who had plastic surgery over twenty years ago.  My role was to take this basic product, innovate and build a product customers love.

There’s a whole raft of information on the product here which was featured on the BBC One show within a few months of launch because is was unique.  The brand is the first NHS skincare range and all profits are put back into patient care.

What I want to do in this blog is fill in the back story and piece together how innovation can be ignited in the simplest of situations.  To deconstruct my work on the My Trusty brand I will use the research of Hal Gregersen, Clayton Christensen and Jeff Dyer “The Innovator’s DNA” .  The book is a result of eight years of exploratory study by the authors to identify the key skill set for innovators.  The research identified five “discovery skills” used by innovative leaders that distinguishes them from the ordinary:

Questioning: Posing queries that challenge common wisdom

Observing: Scrutinizing the behavior of customers, suppliers and competitors to identify new ways of doing things

Networking: Meeting people with different ideas and perspectives

Experimenting: Constructing interactive experiences and provoking unorthodox responses to see what insights emerge

Associating: Drawing connections between questions, problems, or ideas from unrelated fields

Yet perhaps the most significant finding in the research was our ability to generate innovative ideas is not just a function of our minds, but of our behaviors. Thus, by changing our behaviors and regularly incorporating the above “discovery skills” in our daily lives, we can improve our innovation aptitude.  Here are a few key links – Mastery Video

The videos and research articles give you an insight into this work and I would recommend the book to anyone who wants to innovate. From a personal perspective, I would like to extend my gratitude to Hal Gregersen who has always shown an interest in my work as an innovator and has been generous with his support.

In my next blog post, I will cover the first discovery skill – Questioning and link to my work with My Trusty.  As a final takeaway here’s a great webcast on building products customers love and a video on lean start up.

If you want to find out more about the individuals behind the videos and products by following on twitter:-

@HalGregersen   @leanstartup   @ericries

@CarolLRead   @My_Trusty   @SalisburyNHS

From fear to flying

A joint blog with @JohnWalsh88

“Come to the edge, he said. We are afraid, they said. Come to the edge, he said. They came to the edge, He pushed them and they flew. Come to the edge, Life said. They said: We are afraid. Co…