NHS Citizen Bristol workshop
29/07/2014
Last week I attended an NHS Citizen workshop. This was my first time at an NHS Citizen event. This note describes what I think NHS Citizen is, what challenges it faces and how it might succeed.
NHS Citizen is an active communication channel whereby the NHS England board will be informed about issues of English importance which they should address in their policies and strategies. An initial reaction to this statement might be: “But there are other organisations, such as Healthwatch, Patient Voices, the Patients’ Association and others who already do this.” NHS Citizen is different. The focus in NHS Citizen is on issues of health and care policy which need to be addressed by the board of NHS England. NHS Citizen is a communication channel for all, whether individuals or members of an organisation. I would expect organisations in the health and care environment to use NHS Citizen, once launched, as a channel to promote the policy aspects of subjects and to gain support for their positions through the mechanisms of NHS Citizen.
I see the active attribute of NHS Citizen in the operation of its three stage process:
- finding out what the national policy issues are;
- collecting support and evidence around particular issues to confirm they are national issues which can be presented to the NHS England board;
- deliberating on the most important issues to present a good case for NHS England to change policy, initiate a new policy or otherwise change its strategy.
NHS Citizen faces the challenge of clearly identifying what its specific role is concerning policy, how it is different to other organisations, how it works with other organisations in the pursuit of its goals.
Some of the statements that it should be possible to make about NHS Citizen:
- inclusive – anyone in England (because we are all NHS Citizens) can tell NHS Citizen their issue, concern, need for change; and take part in the following discussion
- enabling those who are not part of the digital environment to put their views forward through intermediaries
- transparent in the way it works, from defining the etiquette to be followed when using NHS Citizen to the protocols for deciding who attends meetings and how decisions are made
- adaptive to changes in the health and care environment to make sure it is still effective
- responsive to calls for change in the way it works
- a good communicator about what it does
- always provides feedback to those who contribute about how their contribution was treated.
[conclusions from post]
- Innovation in New Markets does not come from “overarching strategies”
- It comes out of opportunity, chaos and rapid experimentation
- Solutions are found by betting on a portfolio of low-cost experiments
- With a minimum number of constraints
- The road for innovation does not go through committee
For full post see http://steveblank.com/2012/05/01/why-innovation-dies/
What follows is from Mark Zuckerberg’s letter to shareholders, as posted by Eric Ries (http://www.startuplessonslearned.com/2012/02/hacker-way.html).
He calls their internal approach to continuous improvement and iteration The Hacker Way.
“…we have distilled these principles into five core values for how we run Facebook:
Focus on Impact
If we want to have the biggest impact, the best way to do this is to make sure we always focus on solving the most important problems. It sounds simple, but we think most companies do this poorly and waste a lot of time. We expect everyone at Facebook to be good at finding the biggest problems to work on.
Move Fast
Moving fast enables us to build more things and learn faster. However, as most companies grow, they slow down too much because they’re more afraid of making mistakes than they are of losing opportunities by moving too slowly. We have a saying: “Move fast and break things.” The idea is that if you never break anything, you’re probably not moving fast enough.
Be Bold
Building great things means taking risks. This can be scary and prevents most companies from doing the bold things they should. However, in a world that’s changing so quickly, you’re guaranteed to fail if you don’t take any risks. We have another saying: “The riskiest thing is to take no risks.” We encourage everyone to make bold decisions, even if that means being wrong some of the time.
Be Open
We believe that a more open world is a better world because people with more information can make better decisions and have a greater impact. That goes for running our company as well. We work hard to make sure everyone at Facebook has access to as much information as possible about every part of the company so they can make the best decisions and have the greatest impact.
Build Social Value
Once again, Facebook exists to make the world more open and connected, and not just to build a company. We expect everyone at Facebook to focus every day on how to build real value for the world in everything they do.”
In a world where…
03/01/2012
In a world where: <particular feature of the environment>
as a: <my role>
I need : <solution feature>
so that:<key activity>
and I will be happy when:<key attribute of solution or detailed key activity>
Storytelling
15/12/2011
Henning Mankell, the Swedish author, recently wrote in an article on his attraction to Africa about the nomads of the Kalahari and their storytelling:
“It struck me as I listened to those two men that a truer nomination for our species than Homo sapiens might be Homo narrans, the storytelling person. What differentiates us from animals is the fact that we can listen to other people’s dreams, fears, joys, sorrows, desires and defeats — and they in turn can listen to ours.
Many people make the mistake of confusing information with knowledge. They are not the same thing. Knowledge involves the interpretation of information. Knowledge involves listening.
So if I am right that we are storytelling creatures, and as long as we permit ourselves to be quiet for a while now and then, the eternal narrative will continue.”
I leave you to make the connections between storytelling in the Kalahari desert and the practice of lean and agile methods in western, developed society.
10 Ways Agile Improves Your Quality of Life
25/11/2011
From a Non-Techie: 10 Ways Agile Improves Your Quality of Life
1. Every team member contributes.
Since Agile empowers the delivery team, nobody can be a weak link. They’d get exposed immediately, and they’d get left behind. By definition, everyone has to produce strong work that contributes to project success. And it is fun to work with people you can count on.
2. Servant-Leadership teaches us better skills.
There is no time or place for micro-management or Command and Control in Agile. Since servant-leadership is the goal, managers are responsible for removing roadblocks to their teams’ success. Planning sessions prioritize the “what”, and team members are responsible for the “how”. Do we still get lots of feedback? Yes. But are we told how to do our jobs? No way. As a bonus, you’ll learn how to be a coach and mentor for your own teams.
3. Meetings have purpose.
We don’t meet unless we have to. Our daily standups typically last 10 minutes. Our planning meetings are tightly timeboxed, so we have to focus and then move on.
4. Decisions are based on data.
We measure everything that is important to the business. How else can you make smart decisions on where to spend your time and energy? Rather than succumbing to the whims and opinions of a few squeaky wheels, by measuring important factors, we have the knowledge we need to back up our decisions and stay the course, as long as it makes sense. Therefore…
5. Whiplash is minimal.
Have you ever worked with someone whose great ideas wagged your entire team back and forth until you could never complete a full project? If an excited, charismatic tail wags the dog, then chaos, frustration and anger result.
In an Agile environment, you put the great project idea in the backlog, prioritize it against other initiatives, and choose whether and when to work on that project. And you use your capacity and story sizing to manage expectations. Which leads us to benefit #6:
6. Politics are absent.
If you are making decisions based on quantitative results and you have a prioritized backlog, then there is no reason to make political decisions. What’s the point? You have the numbers, now go do your job.
7. The bar is high.
You know how one mediocre project can take you forever to finish, but three challenging projects can sometimes energize you? Agile sprints are more like the latter. Sprints can be intense and challenging, and also satisfying. Sometimes you can even point proudly to your results. Why waste your days doing boring, mediocre work?
8. The workday is intense and fast.
With all of that challenge, the Agile workday is short and intense. Do you want to feel like you are always working, or like you have to hang out at work to show face time? Work hard, play hard.
9. Change is frequent.
We hold retrospectives frequently (timeboxed, of course). With a commitment to changing what doesn’t work, we find ourselves altering our plans regularly, including deciding what tostop doing. This is refreshing. In Agile, you go along with the ride and breathe a lot, which is probably good practice for life.
10. You’ll be smarter.
Future colleagues and partners will want to learn from you. Your Agile skills will turn up in some unusual places. You might start timeboxing how long you clean your kitchen. You may choose to include words like ‘epic’ and ‘backlog’ in your everyday vocabulary.
But you also might do what I did and let go of some of your perfectionism, which has no place in Agile. And, like me, you might pick up some better ways of structuring your work.
Most of all, you might really enjoy your days more.
User stories
25/11/2011
With help from Agile Academy Australia , Versionone and Claudio Perrone.
PODSI and PDCA
25/11/2011
Plan, Orientate, Design, Select, & Iterate (PODSI)
Plan by identifying the potential target, vision, and feasibility of the project that will ensure the active participation of all stakeholders. Determine if the managers are indeed going to collaborate or are willing to learn to collaborate. If they simply want you to be an order-taker then, “run my friend run, run as fast as you can!” Find a project with people who desire to collaborate.
Orientate in order to recognize the level of the complexity of the environment (Cynefin) so that the initial learning architecture can be started to solve the problem. Use Exemplary Performers and/or Subject Matter Experts to help identify the complexity of the environment.
Design by using a collaborative approach or model so that only the minimum required knowledge and skills are taught that will resolve the problem. Build other useful benefits into the learning process during the final iterations.
Select the correct learning objects, processes, and tools that will provide the needed knowledge and skills that support both formal and informal learning — the use of small learning objects will increase the speed of iterations and allow you to more easily transform parts of the instruction into informal and nonformal learning.
Iterate by prototyping the initial design and to determine what other performance support technologies are required that will fully support the learners’ quest to better performance. Use After Action Reviews to transform deficiencies into actionable items. Transform the formal learning objects to informal or nonformal learning as possible.
Plan-Do-Check-Adjust
Plan-Do-Check-Adjust (PDCA) is known as the model for continuous improvement. The four-phase approach provides a simplified sequence to carrying out change. And, it is so much more: it is a cycle that doesn’t necessarily end. Instead, the cycle charts a course for follow-through and allows for true continuous improvement as work and processes evolve to meet the constantly changing needs and expectations of customers.
PDCA encourages us to constantly strive for a “perfect” process, with the understanding that as our customers change, so, too do their needs change. And so by constantly Checking and Adjusting, we can keep pace with our customers’ needs and provide products and services that are of value to them.
PDCA Definitions
Plan: Recognize an opportunity and plan a change. Obtain baseline metrics and gather information.
Do: Observe and analyze the current process, design an improved process, test the change.
Check: Review the change, monitor and evaluate the results. (What is working? What have you learned?)
Adjust: Modify and make improvements as needed. If the change didn’t work out, begin the cycle again.
Agile questions
25/11/2011
As A: I need to: So that: This means: What I find difficult now:
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For <type of person> who <has a particular need>, <product name> is a <class of product> that <primary value proposition> Unlike <competitor>, <differentiator>
(from Crossing the Chasm, by Geoffrey A. Moore)
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Musings after Agile on the Beach
25/11/2011
This post gathers together some of the strongest impressions made on me by the recent Agile on the Beach conference in Cornwall.
Agile is a mindset, a collection of methodologies and tools put together by people, predominantly involved in software production. It is strongly influenced by Lean Manufacturing methods and what Toyota did in developing their production systems, starting with Kanban.
Although Agile was developed in the software industry, its methods and lessons can be applied in any activity where there are customers, developers and producers, and deliverers.
Agile is also relevant to new activities and to those which are already established.
Since people and their relationships are more important than the processes and tools when being agile, personal experience, character and aspirations will influence what one finds rings true and makes sense. Each person following the Agile path will make their own journey, collect their own bits of wisdom, have their own favourites.
Product development
“Instead of “we can build it” we start with:
• Do customers have this problem?
• If we solved it, would they pay for it?
• Would they buy it?
Then:
• Can we build it?”
“Innovation Accounting
The Three Learning Milestones
1. Establish the baseline
– Build a Minimum Viable Product (MVP)
– Measure how customers behave right now
2. Tune the engine
– Experiment to see if we can improve metrics from the baseline towards the ideal
3. Pivot or Persevere
– When experiments reach diminishing returns, it’s time to pivot
Pivots
• A pivot is a change designed to test a new fundamental hypothesis about the product,
business model or engine of growth
• A startup’s runway is the number of pivots it can still make
• Pivots take courage”
Innovation
“Successful Innovation:
Make a little.
Sell a little.
Learn a little.
Innovation = 1% Inspiration + 99% Perspiration
1. Significant, focused technical expertise
A decade of deliberate practice.
2. Deep understanding of an important problem
What annoys people?
3. Passion, engagement, dedication
Obsessed with growing the idea.
4. Experimental approach
Build to learn. Learn to Pivot.”
Value Stream Mapping
“Map End-to-End Flow
Value Stream – The flow of activities that starts with a customer in need, and ends when that customer’s need is satisfied.”
Mary Poppendieck – Value Stream Mapping
Stories
“Format of a Story
As a <role, beneficiary> I want
<capability> so that <benefit>
+ <role> is the customer of the Story
+ <capability> is what
+ <benefit> is why
Conditions of Satisfaction
<Facts that would demonstrate ‘capability’ exists>”
Nancy Van Schooenderwoert
Lean and Agile - in organisations 