Prof Malby's Inaugural Lecture April 2016

1. The Next Generation NHS
#NextGenNHS
Prof Becky Malby
Inaugural Lecture
@BeckyMalby

2. Is the Future of the NHS…

3. How we are going to work today
“….an illuminating view of
their contribution to their field”

4. What I have come to know

5. What sort of work
What’s the
work?
Who does the
work?
Technical Apply current
know-how
Authorities
Adaptive Learn new
ways
The People
with the
Problem
Heifietz and Linsky 2002

6. What sort of work
Tame Wicked

7. Section 1
Its all about Data

8. What the Future Looks Like?
Who will have the economic power?
Agricultural Age – Land
Industrial Age – Iron
Information Age – Data
Alec Ross 2016 The Industries of the Future. Simon and
Schuster

11. What’s going on round here?
Data for Social Innovation
• What do we know?
• How do we know?

12. Data for Innovation
Question: Is it possible to predict the weekly
number of people coming to A&E with a
Fractured Hip and the time of day they will
turn up?
A Yes
B No
C Not sure

14. 2220181614121086420
60
50
40
30
20
10
0
Hour admitted to A&E
Numberofadmissions
_
X=28.54
UCL=51.44
LCL=5.65
1
1
Count Of Admissions to A&E by hour of day

15. Incoming Calls to GP
Question: How many calls do you
think a 5 GP practice in Leeds takes
on a Monday morning?
A 200+
B 500+
C 1000+
D 1500+

18. SYAJBSPGWSF
20
18
16
14
12
10
8
Minutes
Interval Plot of SF, GW, SP, JB, SYA
95% CI for the Mean
GP
appointments
In this practice
one GP takes
much longer with
his/her patients
than all the
others.
Question: Why
is that? Who is
the best GP?
A B C D E

21. If you want to change in a complex
system…first you have to perturb it
• Clarify the boundaries of the system (usually a
question)
• Provide more/different (or just some..) data
• Create space and time to make sense of that
data
• Diversify who is involved (new eyes/ emerging
leaders) – connecting the system to itself

22. Data Theme
1. Demographic/ Geographical – our health needs
2. How the system currently operates to meet needs.
3. How people behave in the system to meet their own needs
and that of their community.
4. How data is currently used for change
5. How this system learns
6. How adaptive and resilient is this system
7. Is this system fit for the future?

23. So far
• Without data we rely on personal
preference, assumptions, and prejudices
• Without data power rests with the few
• But data is all around us
• Perturb the system…
• Generate data that helps us know what is
going on here

24. End of section one – time for a
CHAT/ Tweet

25. Section 2
Being fundamentally curious

26. Innovation is……
Invention is new
Innovation is ‘new to here’

27. “The future is already here – it's
just not evenly distributed.”
William Gibson, 2003 William Gibson
2003

28. Intergenerational Learning
Centre

29. Bolton NHS Foundation Trust
• Unexpected deficit of £14.4m (2012/13) to
a surplus in 2015/16
• In the first year of activity they made
£18.3m in income and cost improvements
(6.4% of income), last year it was £21.2m
(7.3%), and this year £15.3(5.3%).

30. Guys and St Thomas

31. Rochdale Intermediate Care

32. Altogether Better

33. Action for Gipton Elderly

34. Talk Lab

36. Buurtzorg

37. Bromley By Bow Centre

38. Come and see….
“I urge you to take your colleagues down to
the Bromley By Bow Centre and let them
see what has emerged from nothing. Its one
of the most impressive displays of social
entrepreneurship anywhere in Europe”
Lord Brian Mahwinney

39. Qn: What helps innovation
happen? – the most important
1. Create incentives
2. Disseminate good practice
3. Have different people involved in working out
what to do and the doing it together
4. Require performance through commissioning/
contracting/ regulation
5. Trust professionals to find the best solutions
6. Learn from others

41. Innovating health systems
• Get out more to discover
• Know their own system
• Are open to learn
• Work with the assets of their communities
– really engage
• Are not threatened by diversity but see it
as strength

42. Your
Organisation
Outsourced /
subcontractors
Alliances
Strategic
partners
Delivery
partners
Joint Ventures
Franchise/
licensing
partners
Learning
partners
Work through Hierarchies and
Networks

43. The Leaders of the Next
Generation NHS
• Can grasp what the future could look like
• Are willing to give up territory
• Are prepared to do the work of generating a
shared view
• Can stay focused
• Are prepared to sort out the systems issues that
are their responsibility.

44. Change that Sticks
• Discover what others have done
• Be honest about what we (the system) has
energy for and can commit to
• Coproduce and prototype solutions, iterate
or let go.
• Test and Review

45. So far
• The future is already here its just not
evenly distributed
• Frustrated and passionate
• You can only do it together
• Through networks
• Diversity a condition of success
• Test out and iterate

46. End of Section 2, Time for ..

47. Section 3
What Gets in the Way?
What Can We Do?

48. What Gets in the Way?
1. The Old World Bites Back &
Culture Eats Strategy for
Breakfast

49. 2. Over-reliance on
performance management

50. Purpose
Goals
Results
Pathway 2
Innovation & Change
Pathway 1
Judgment and Choice
Measure to
assess, choose &
hold to account
Measure to
understand and
improve
Knowledge
about
Performance
Knowledge
about
process and
results
Consumers
Purchasers
Regulators
Contractors
Citizens
Care delivery
organisations, Care
delivery teams,
Professional practitioners.
inform
Enable
Adapted from Berwick, DM, James, BC and Coye, M. The connections between quality measurement and
improvement. Medical Care 2003; 41(1) 30-39 (Jan)

51. 3. Loss of Public Sector Values
Picture from Newsweek

52. 4. Confused Ideology
Devolution
and Localism
Centralisation
Coproduction Consumerism

53. Citizens
Choice
VoiceCoproduction

54. 5. No Shared Process for
Systems Change

55. What works for what?
• Performance Management
• Hold to accountSimple
• Improvement
Complicated
• Emergent & Coproduced
• PrototypingComplex

56. 6. Ignoring Emerging Leaders
• Generation Y (millenials) and Z (Digital
Natives)
• Citizens

59. Generating Spread

60. What is known about innovation
spread
• You need to be frustrated enough with the
status quo
• You have to have the capacity to adapt
• You have to diversify who is involved
• You have to give up power at the top

61. Health Systems Innovation Lab:
The Next Generation
• Data supported understanding
• Generating a possible picture of the Future
• Catalysing the conditions for system to change
• Connecting to innovators
• Enabling translation
• Prototyping and adopting

62. Our role here in higher
education
• Challenge the ideology
• Offer ideas and clarify what works
• Show you what’s possible
• Help you have courage
• Hold your hands in the fog of
implementation
• Help it stick

63. The Next Generation NHS
• Data, for Understanding, Rapid
prototyping, Citizen action
• Services delivered through networks
• Less reliance on institutions
• Has to learn
• With citizens as active partners and
leaders

65. What is the one thing you heard
that made you think?

66. @BeckyMalby
www.beckymalby.wordpress.com
r.malby@lsbu.ac.uk
https://uk.pinterest.com/beckymalb
y/health-systems-innovation-lab-
the-next-generation/