Unleashing dynamism: reflections from the 2011 summit

The quest for better, more efficient health services requires innovation, new ways of working and new behaviours across every area of care. The message from the summit was that innovation and change will flow from everywhere – patients, individual clinicians, managers and large organisations.  

We were challenged at the start of the conference by two proponents of the Big Society, Phillip Blond of ResPublica and Geoff Mulgan of the Young Foundation. Phillip Blond argued that innovation would flow if the NHS can avoid capture by the private sector and instead actively foster social entrepreneurs, who can release social action from the bottom up. 

Geoff Mulgan called for the NHS to harness the energy and abilities of patients and carers to co-create health and health care for vulnerable groups. To move from token consultations with service users, to co-design and initiatives to develop skills to self care and to support them to care for friends and family.

In the closing stages of the conference we moved from the individual to the corporate and heard how Welsh Water transformed itself from a poorly performing monopoly supplier to an organisation which is highly respected for its quality and efficiency. They harnessed the passion and commitment of staff to provide an essential service, fundamental to the public health, to the highest standard.

In between these patient and corporate perspectives, we heard from Dr Marshall Ganz of the Harvard Kennedy School of Government (who organised the voter mobilisation that secured Obama’s presidential victory) about harnessing community action through dispersed leadership, organised social mobilisation and a narrative of hope.

Across all these examples there were common ingredients that will be familiar to those who have tried to drive change and innovation.  Clear goals.  A compelling narrative that responds to critical challenges by creating a vision of hope. Leadership as a practice that enables others not as a position of power.  Focused use of measurement to keep everybody aware of progress. Dynamic strategy that can adapt to changes in context and resources.  And so on...

As the QIPP agenda really starts to bite and the dissolution of PCTs and SHAs progresses apace, we were offered a word of warning by Mark Britnell.  Complexity can crush or liberate.  Welsh Water Managing Director Nigel Annett talked of the 20 per cent cost reductions he plans to achieve without so much as a drop of sweat on his brow, but talk of similar cost reductions in health care is inevitably accompanied by hand wringing and deep sighs.  The narrative of hope and a caution against becoming bogged down by complexity were implicit throughout the presentation.

We also heard from Marianne Olsson from Gottenberg, Sweden, who was hired in February 2009 to build and develop a new community hospital for the deprived multi-ethnic population on four city boroughs.  A previous set of plans for the hospital had been rejected by the health Board for being too conventional. Marianne started consulting the many population groups in the area in February about the services they wanted and the ways in which they wanted to be able to access them.  In September the health team saw its first patients.  The hospital was not yet built, but that didn’t stop them. They worked at street fairs, faith meetings and community centres.  Now that’s dynamism.