Posted by: ayrshirehealth | June 11, 2014

Reflections on #nhsscot14 by @SES3105 and @jasonleitch

A remarkable institution

Reflecting on two inspiring days at the NHS Scotland Event 2014 (#NHSScot14), it is apparent that NHS Scotland really is a remarkable institution. So often, we think of it as a complex system of services, all working together to keep the population of Scotland well. Thank youAnd this is true, but this is not the full story. The ‘system’ is not what makes NHS Scotland remarkable – it is the people that work in that system. Each and every person, whether a clinician or a porter, a therapist or a driver, an advocate or a manager – YOU make NHS Scotland what it is.

And an outstanding couple of days it was too… amidst numerous excellent workshop discussions, posters, launches and debates over coffee, two main issues were at the forefront of discussions:

  1. Strengthening and promoting the voices of our patients, and
  2. The reliable spread of quality across NHS Scotland and its partner agencies.

Listening to Patients

Both the Cabinet Secretary for Health (@AlexNeilSNP) and the Chief Executive (@PAG1962) spoke of the critical importance of actively listening to, and involving patients in their care – to quote Mr Neil “in  we do and at every level”. If we are to achieve an NHS Scotland that truly focusses on patients, we must listen and ensure that we give people the means for their voices to be heard.

Every personThere are countless examples of how NHS staff are listening to patients, how patients and carers views are being reliably recorded, and how staff are working alongside patients and carers to involve them on their care. However, there are also many examples of when this is not happening, for whatever reason.

The Patient Opinion Scotland website is an excellent resource, both for patients & carers to anonymously give feedback on their experiences, but also for NHS staff to hear real-time feedback on their services: Opinion (@PO_Scotland)

So, how can we ensure that we keep an ever increasing focus on listening to and understanding our patients. Reliably, consistently – every person, every time?

Reliably Spreading Good Practice – easier said than done?

This year’s theme of Spread and Sustainability gave us a chance to really get stuck into that issue that’s frustrating us all…why do we find it so difficult to reliably spread good practice? And, when we do manage to spread, why does it take so long?

The opening plenary on day one provided an opportunity to share an interesting new theory from Kotter in his latest book XLR8:

Kotter’s premise is that, for complex organisations to succeed in today’s fast-moving world, traditional corporate structures are, in fact, holding back organisations from being creative enough and speedy enough to deliver effectively. Typically, a hierarchical operational structure meets organisational demands using clear reporting relationships and responsibilities, minimising  risk, dividing work into departments, divisions and specialties. The trouble is, managers in hierarchical organizations find it hard to promote or reward risk and innovation—they rely on routine to deliver reliably high standards, and often turn to the same people to run key initiatives.

Kotter believes that what we need is an organisational design that has not one, but two “operating systems.” One system conducts the everyday business of business, the traditional hierarchy.  And the second system, more of an agile network, sits alongside the hierarchy to focus on the demands of the future.

These two systems NEED each other.

But, the best bit is that Kotter isn’t suggesting that the hierarchy structure should be removed. In fact, he refers to it as “one of the most amazing innovations of the twentieth century.” What we need is this second operating system, which is organized like a network next to the existing hierarchy.   This network based operating system complements rather than overburdens the hierarchy, freeing the latter to do what it is optimised to do.

Kotter's dual systemBasically, under the new dual operating system, all established processes and activities sit with the hierarchy.

High-stakes initiatives that involve change, speed, innovation or agility, go to the new agile network.

These two systems NEED each other.

They complement each other to deliver what Kotter calls a ‘Big Opportunity’ – an opportunity for improvement that has the potential to lead to significant outcomes if the possibility is exploited well enough and fast enough.

On consideration, this dual system has in fact, been operating over the past few years within the Scottish Patient Safety Programme (SPSP). The hierarchy role has been ably played by local boards, providing the structured framework that is required for the reliable delivery of services.

The network role has been hosted by the SPSP Collaborative – the system of teams with representatives from all divisions and all levels. Every person every timePeople who take time out from their day-to-day jobs to take part in the specifically un-hierarchical forum of the Collaborative.

Within this network, potential opportunities and changes have been identified, the urgency of the task is nurtured and sustained, learning is shared, barriers are recognised and addressed, and change is achieved.

What Matters to Me:

Utilising NHS Scotland’s Agile Network to Better Understand our Patients

And so, we have set a challenge for NHS Scotland.

What mattersWe were fortunate enough to have Jen Rodgers @jenfrodgers, NHS Scotland Nurse of the Year 2013, to explain her experience of introducing and spreading “What Matters To Me.

Led by the play service, the children make a poster/drawing of what matters to them and staff stick it up on the wall close to their bed so that everyone knows a bit more about them.

Listening to the patient voice.

Over the past few months, What Matters to Me has started to spread from children’s services to older people’s services, learning disability services, across adult care and further

We see “What Matters to Me” as our Big Opportunity…

Imagine if we worked in an NHS where what matters to patients was more important than anything else. Just imagine that.

We want to create something amazing across Scotland – and we need your help to do it:

Your challenge

We need everyone to join us with this challenge. Everyone…(yep that’s YOU!)

Good luck, spread the word, and let us know how you’re getting on. Let’s do this, not only for the children of Yorkhill Children’s Hospital, but for each and every patient across Scotland.

This week’s bloggers were @SES3105 (Selina Stephen) Improvement Advisor, Leading Improvement Team, Scottish Government and @jasonleitch (Professor Jason Leitch), Clinical Director, The Quality Unit, Scottish Government.

Comments on this blog, or any other of our blogs, are welcome – please click on the ‘Comments’ box below.



  1. Great blog- loved your point about Kotter’s work- really helped me understand what’s needed final push to get excellence in care. And have been asking people what mattters to them!! Well done both.

  2. […] Reflections on #nhsscot14 by Selina Stephen and Jason Leitch on the Ayrshire Health blog […]

  3. […] our health section we have two blogs, first up is Reflections on #nhsscot14 by Selina Stephen and Jason Leitch on the Ayrshire Health blog. After two inspiring days at […]

  4. […] Reflections on #nhsscot14 was the final blog related to the NHSScot14.  Selina Stephens and Jason Leitch reflect on excellent positivity evident over the two days. The blog also discussed Kotter’s Dual Operating System – the second operating system, is organised like a network next to the existing hierarchy.   This network based operating system “complements rather than overburdens the hierarchy, freeing the latter to do what it is optimised to do”. […]

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