Quality initiatives in Wairarapa DHB

While scanning through background information on Wairarapa DHB north of Wellington, New Zealand. I came across these tidbits on continuous improvement and quality care.

The executive manager for Quality, Cate Tyrer has created a quality improvement team. Rather than a single person, responsible for this role, Cate has created a cross functional team of six people across six functions in the hospital. Each of these people have a fully paid day per fortnight away from their normal duties to meet and focus entirely upon quality of care and service issues. These people cannot be pulled from this role, their absence must be rostered for and their cost is covered by the QA budget.

Results to date have far exceeded expectations and are believed to be more comprehensive than had a single person been charged with the QA role.

Because the people involved in this continuous improvement team are highly experienced staff and clinicians, who work at the coalface on the other days of their roster, they experience the very things they talk about, they are respected by their colleagues and they are listened to. They also have to work with the ideas they propose.

Some of the ideas generated to date include empowering nursing staff to monitor and if necessary put a hold on medications if prescribing was below the standards requried for the national medication charts.

In one ward, minor errors of medication prescribing were noted, not life threatening but again below standards, missing signatures etc, boxes not selected when they should be. It was felt that staff preparing medications were being interrupted unnecessarily thus contributing to a lack of throughness.

A red duct tape square was placed around the medicine cabinet. A sign to all others that when two nurses were standing inside the duct tape square they were to remain uninterrupted.

The quality team identified that by adding codes to theatre lists they could identify those that had surgery cancelled and prioritise them when rescheduling theatre.

The quality team has also been successful in helping to develop an operating theatre orientation program for midwives, a midwives education program for theatre staff and coordinating service to improve the discharge process.

It’s the simple things that often have the greatest impact. I was reminded of this recently during a stay at our house in Hokitika on the West Coast, South Island of New Zealand. We are renovating. A slow and expensive process as it is very part time. Two little things we put in place recently had the greatest impact. A shelf in the porch to keep gumboots and outdoor shoes dry when the rain pours into the porch ($8) and a net curtain over the bathroom window ($3) – small, simple, inexpensive and with an impact worth a mint.

Those are my thoughts for the day (along with an apology for my absence from this blog over the past month, bad social media etiquette)

Let The Journey Continue

John Coxon


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Big Data

What would you do with 1.6 petabytes of data? Not much I hear some of you say. Might use it for a door stopper! Well you can do a lot with it.

Let’s take a step back. What is a petabyte? Lets put it in practical terms. The old floppy disc, remember those? Well they stored a few hundred kilobites, less than a megabyte. Not much in other words. Then came CD-Rom disks, they also stored around 700 megabytes but less than a gigabyte. Then we introduced flash drives and some of them can store a good number of gigabytes, which is a lot of megabytes. Then we introduced portable hard drives which have a storage capacity of one or more terabytes.

This is all very well but what about petabytes. Well when you have a lot of data storage and capacity to exchange data – a little ol terabyte just doesnt cut the mustard. Big storage is measured (at present) in petabytes. How much storage is in a single petabyte? If you could gather 1000 portable hard drives, each with a capacity of one terabyte, there you have it. To get a sense of perspective, I sat down with a bourban and coke with my ol mate Wiki (pedia). He’s a bit of a know all but he a good sort. Now Wiki tells me that back in 2009, Google processed around 24 petabytes of data per day. Is that a lot I asked? Wiki just nodded and poured me another drink.

Okay, now I can see some of you are yawning, wondering where this is all heading? Let’s return to my original question. What could you do with 1.6 petabytes of data at your disposal?

Let me tell you what a hospital in Berlin did with their data. http://onforb.es/wnoPzM  Charite University of Medicine, Europes largest university hospital, instead of relying upon historical data, have made real time data available to everyone of their 700 staff – on every computer, tablet, pda, smart phone and Maxwell Smart watch. While there is 1.6 petabytes of data available, in reality only about 5% of that is used for daily decision making. . It’s a bit like having 700 mini-Googles or Wiki-offshoots running around in a cloud of data. It’s enough to make your head spin.

Why is this unusual? Because the vast majority of hospitals, aged care providers and nonprofit agencies (that is 99.9%) don’t do this. They hide their data on servers in a back room, they create barriers to access, they segment users, they filter access. Most importantly they forsake one of their most valuable assets. They ignore the capacity of the human brain to process vast amounts of data, to identify patterns and to make decisions.

For the past forty or so years teams of scientists around the world have been trying to establish just how it is our brain actually functions. At the same time, other teams have been trying to create artifical brains. Yet at the practical, day-to-day, lets get stuff done level, we haven’t worked out how to bring the two sets of brains together. Each of our organisations is a vast repository of data. Each of our people has access to multiple means of accessing data. Each of our people has a 3kg brain capable of processing data.

Imagine at Charite University hospital, 700 x 3kg = 2 tonnes of physical brains sharing and processing billions of pieces of data on an as needed basis. Charite discovered this real time access to data improved how senior management obtained a ‘big picture’ of activities and enabled them to relate actitives to costs and revenue as they occured. I suspect also that making data available in real time to anyone that wanted to access it would also reduce the selective ‘filtering’ that takes place as information moves from one layer to another. Charite hospital also found that access to data in real time enabled them to better utilise resources and reduce wastage. It also lead to better medical outcomes for patients.

Information was always expected to be the great leveller. It was supposed to break down the barriers. Instead, many simply erected greater barriers in the mistaken belief that those with the information have the power. Maybe they do, but where is the value in power if you fail to use the tools in a positive and productive manner?

Your organisation can do the same as Charite. It will not be easy. There are numerous cultural and policy barriers to be overcome.

I leave you with this thought. We keep pouring money into service provision. We claim to need greater technology, more resources, more people, better facilities. I wonder if we are pouring money into the ‘right’ areas? I wonder if instead of ‘more’ we could do ‘better’?

Those are my thoughts for the day

Let The Journey Continue

John Coxon


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Culture is important to future volunteers

Research released today by Volunteering Queensland http://bit.ly/ycs9Pa illustrates the emerging environment for future volunteerism as generational change takes place.

A summary of the research findings show that culture, alignment, engagement, belonging and leadership are all crucial to creating a satisfying volunteer experience.

Young volunteers have a variety of commitments, they are highly mobile and project driven. They seek to see visible outcomes from their input and efforts.

Many young volunteers are university educated. They have a variety of interests and they align their volunterism with their interests. Volunteer managers cannot just plonk them onto a rag cutting machine and forget they are there. It is important to show interest in what it is that interests younger volunteers.

Younger volunteers are seeking engagement that carries with it some degree of responsibility, where they can make a positive and visible difference and which contributes to their knowledge base and skill development.

The next generation of volunteers want to belong. They don’t necessarily respond to the title ‘volunteer’. They want to feel that they are a part of your organisation.

Placing volunteers into leadership roles where appropriate, with responsibility for outcomes provides them with a sense of purpose and value.

What are some of the implications for our nonprofit organisations? Firstly the concept of volunteerism amongst younger people may challenge some of the traditional concepts held by Baby Boomer management and even some older volunteers. Existing volunteer managers may need to revisit their perspectives and ask what they need to be doing differently to attract younger volunteers.

Inclusion is becoming increasingly important. Volunteers want to be a part of your organisation. They want to be viewed in the same way as paid staff. In return they offer a high level of education and high levels of professionalism. Volunteer managers may need to review volunteer processes, in consultation with younger volunteers to help create a winning culture.

The report serves to remind us that nothing stays the same. Generational change is set to have the greatest impact upon our nonprofit organisations in arguably the past 30 years. The consequences of our actions in regards to volunteers will impact upon our organisations for the next 30-50 years. Now is not the time to get it wrong.

By the way, if you require some help developing appropriate volunteer processes for the future call John on +61 427 390 376, we have an experienced volunteer manager on tap to help and a further ten associates with lots of experience in volunteer management. Between your people and our people you will get what you need.

Those are my thoughts for the day

Let The Journey Continue

John Coxon

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Technology driven, dispersed workforce

Imagine this. You are a social worker, a home carer, district nurse, midwife or someone engaged in service delivery in the community. Your mobile tablet and telephone are your work station. This may be the future http://bit.ly/wHQGqB.

Yes you have a physical office, someplace, where you can access support, supervision and physical resources and when you go there you hotdesk, rather than own your space.

On your tablet and phone you have access to all the social media, online video conferencing, SMS, and even occassionally you make a phone call. All your team has the same equipment, all have their social media sites open at all times, communication between team members is constant and conducted in real time.

A patient or a client is in need of your help. You tap into client records, you share ideas with colleagues over a secure network, you utilise video to enable a colleague to speak directly with the client, you tap into an organisational wide repository of knowledge. Afterwards, sitting in a cafe, you update the client records and catch up with your supervisor for an online debrief before contributing an overview of your case study for your team to review in their own time.

Now there is nothing new in this scenario. All of what I have outlined can be done now. The driving force may well be generational change.

Where this gets interesting is in light of my post from yesterday. http://bit.ly/fR4rLp where I suggested there is value in mature workers, except where those mature workers were inflexible and unable to adapt.

Is it possible the barrier to a truly flexible workforce is our current bunch of ageing Baby Boomers, who like myself, think that using skype and SMS is cutting edge technology.

Which has got me thinking. How can I adapt to use this technology to better harness the collective knowledge of my consultant group? All and any suggestions gratefully accepted because when it comes to technology I feel I am always two steps behinds the rest of the world.

Those are my thoughts for the day.

Let The Journey Continue

John Coxon

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Are You One Of The 63% against mature workers?

Research released today by the Australian Human Resources Institute (AHRI) http://bit.ly/zkDHwC found that 0nly 37% of respondents could be certain their organisation was not influenced by negative perceptions of mature workers when recruiting or retaining staff.

This suggests 63% of surveyed organisations couldnt be sure or did actually allow negative perceptions to influence their decisions.

Okay, I am being sensationlist and I am using figures to get your attention. Or am I?

Someone who has been in the workplace for around 40 years has accumulated an lot of wisdom and knowledge. Between 20% and 50% of those responding to the survey, depending upon the question they answered, claimed loss of mature workers had contributed to a lack of competitiveness and a loss of key knowledge.

Think about this. In a hospital setting, if we fail to nurture those mature workers that remain working, if we fail to put in place appropriate processes for passing on knowledge and experience and we combine that with new entrants that have received only a minimum of practical training – it is possible someone will die as a consequence. Systems and processes are no replacement for decades of wisdom and experience.

Now I’m not suggesting every mature worker should be retained. As a management coach I have seen a fair number who are their own worst enemy and should be let go at the earliest opportunity. Changing environments require workers that are able to adapt. Those that cannot adapt are a barrier to effectivenss and service delivery.

Fortunately not every worker over the age of 50 is a dinosaur. Many have demonstrated their ability to adapt, to learn new skills, to work in a changing environment. These people are worth their weight in gold. I suspect many did so because they are personally motivated to succeed. I wonder how many other mature workers fall through the cracks; are mis-labeled as difficult and inflexible, simply because their employer doesn’t have in place effective processes for assisting them to change, to develop new work skills, to take on new responsibilities and to work within a more diverse workplace?

This research shows that it is possible that we don’t get the best from our mature workforce because we don’t have a positive attitude about mature workers. This suggests there is a need to develop greater awareness of potential and benefits amongst both mature managers and immature managers-in-waiting – as much as it is necessary for mature workers to adapt better to the emerging workplace environment.

If you feel your organisation might benefit from becoming more aware of working with diversity, please contact us to discuss how our specialists in workplace diversity might design a process for you.

Those are my thoughts for the day.

Let The Journey Continue

John Coxon

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CEO Muck Up!

Over the past six months I have watch as an experienced and competent CEO of a nonprofit organisation has stuffed up and appears unable or unwilling to admit to having made a mistake.

This CEO has a long history of financially prudent management and has a good repore with stakeholders, staff and clients. On the surface he ticks all the boxes. I have known this CEO for many years, have worked with him in the past, though he is not keen to ask for advice from outsiders or consultants. He suffers from a problem highlighted in a recent McKinsey report – he doesn’t ask questions and he doesn’t listen.

Recently this CEO made a hiring decision. In doing so he overlooked people in the organisation with existing talent and proven potential. The manager hired is an idiot. I know this because I have worked with this person in the past and I have been privy to this person’s behaviour since being appointed.

The newly appointed manager has failed to build a workable relationship with existing staff, resulting in discord between manager and staff.

Mature and experienced staff members have tried to facilitate conversations with the newly appointed manager, to no avail. Within the admin area, communication is rapidly breaking down at all levels.

Those same mature and experienced staff have met with the CEO. The CEO has acknowledged that all is not well. To date nothing has been done to change anything.

What is the outcome to date. The most experienced and versatile staff members in this department are seeking other employment. In the words of one staff member, “I have gone from jumping out of bed every Monday, wanting to go to work, to just doing my job, getting paid and going home.”

It is hard to admit to making a mistake. I know, I have tried and failed on numerous occassions, but there are times when you just have to bite the bullet and move on.

In this instance, every passing day increases the damage and the cost. Regrettably the cost will not show up immediately on the balance sheet and in there perhaps lies the real problem. The CEO’s vision and focus is just a tad too narrow.

Those are my thoughts for the day.

Let The Journey Continue

John Coxon

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The Greeter


Whenever I walk into our local Bunnings store, I’m greeted by a staff member at the door, with a warm welcome and sometimes even a farewell, please come again. I swear one day the greeter will remember my first name and offer me a discount at the sausage sizzle in the car park!

All jokes aside. What does it mean to me to be greeted in this manner? Two things. The first is I feel welcome and acknowledged. I an no longer anonymous. It makes me feel good. Secondly, I am aware that if I have a question as I enter the store there is someone right there to provide an answer.

I’ve been a weekly shopper at Bunnings for the past decade. I love Bunnings. Around me Mitre 10’s and independent hardware retailers have hit the wall. I don’t wonder why.

So what is my point here? Imagine if as I walked into a hospital, all concerned and nervous and just a little pissed off at having to pay for my car parking space and I am greeted by a warm, enthusiastic person at the front door. Imagine if my hospital made me feel as welcome as Bunnings does.

This could be achieved by using volunteers. It has got to be better than approaching an office worker hiding behind a glass screen bogged down with telephones and paperwork. It would enable the office worker to be more efficient due to less interruptions.

It just goes to show how the simple things can have the greatest impact.

Those are my thoughts for the day.

Let The Journey Continue

John Coxon

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