Blue Sky Thinking

The skies over the Thames were decidedly grey and turbulent as I arrived at the Institute of Engineering and Technology to consider the theme - When Today’s Kids are Clinicians: 2030 Scenarios.  Meteorological misfortune or pathetic fallacy for the stormy topic under discussion? The ITW Health Service and Best Practice Symposium sought to provide a space where leaders from the NHS, business, academia and third sector could get together to discuss the many challenges facing healthcare over the next 18 years.  The Beatles wrote ‘will you still need me, will you still fed me, when I’m 64’. As this anniversary draws near, these questions are pertinent for the NHS now, but how will we answer when it reaches the grand old age of 82?

ITW is a small private enterprise, which works under the aegis of the Department of Health.  It originated as a private-to-private forum for the sharing of good practice, but this part of the business now operates as a separate company. ITW run three networks focussing on healthcare, labelled Health and Social Care, Procurement Strategy and Innovation Exchange.  They also run networks for Justice, Local Government and Central Government.  They remain independent, but their funding mainly comes from membership fees levied on their business clients.  This enables them to offer events free of charge to participants from public healthcare organisations¹. ITW circulate a summary of each event to participants, so that they have a record of what has been discussed.

The day’s structure attempted to capture the spirit of the original Platonic Symposium by creating an unrestricted forum for debate.  Didactic sessions were limited to three brief ‘inputs’ followed by the shared creation of an agenda, segueing in to ‘open space’ sessions.  This approach was first developed by Harrison Owen in the 1980s after a survey revealed that the part of conferences that people most enjoyed were the coffee breaks².  The central tenets were posted around the room ‘Whoever comes is the right people’, ‘Whatever happens is the only right thing that could have happened’, ‘Whenever it starts – is the right time’ and ‘When it’s over – it’s over’. 

To frame and fuel the subsequent conversations, three speakers presented their diverse points of view.   The first, a Professor of Public Policy, compared the NHS to a slow moving glacier, where meaningful reform, good or bad, is hard to achieve.  He sought to contextualise the current Government’s ‘re-disorganisation’ of the healthcare system as part of a cyclical process of fluctuating market influence.  He presented two future scenarios. In the first, marketisation triumphs and healthcare is regulated like a utility. The risk is of erosion from a needs to a demand based service, with marginalisation of the disadvantaged. The second possible system is a re-socialised one, which maintains the integrity of the patient journey and equality of access. Unfortunately, it cannot rely on professionalism alone to function, but needs targets and incentives. He warned that there is no funding panacea; more private funding would mean more pressure to cut taxes and a service for the poor is a poor service.

The second speaker, the Head of Business Development for Government at a software company, questioned the way we use health data.  He quoted the ill-fated Captain E.J.Smith of the Titanic who reportedly said ‘When anyone asks how I can best describe my experience in nearly 40 years at sea, I merely say, uneventful’, to highlight the need to avoid complacency.  For him the challenge ahead lies in how to visualise health data, integrate different sources and analyse patterns in order to open up new possibilities.

The final speaker, a Partner at a Management Consultancy firm expressed his strongly held belief that health providers need to run their organisations like businesses. He précised the numerous challenges facing future healthcare provision, from the rising cost of medicines to the aging population. He described the positive correlation between profitability and patient satisfaction seen in the United States of America, where more investment reaps greater mutual rewards. He used this to advocate for a move from an achievement culture to an innovation one, which values risk taking and change.

In constructing the subsequent schedule, delegates were encouraged to come to the central microphone to pose a question they wanted to discuss. The confessional quality of the exercise was emphasised when someone ended their introduction ‘and I am a chocoholic’, before drolly consuming a conveniently located Lindor. These ideas were posted on to a screen divided in to three time sessions for the day.  Each topic was assigned a letter that corresponded to a balloon. These in turn marked the location in the room where that particular discussion would take place, superintended by the theme’s proposer. There was no obligation to participate in any specific gathering and we were encouraged to exercise the law of ‘two feet’ to move between groups.      

The topics were diverse: ‘What will the mental health workforce look like in 2030?’; ‘How will we get truly innovative leaders in place by 2030?’; ‘What sort of doctors do we want in 2030?’; ‘How do we educate managers to enable innovation to happen?’  Some discussions were documented and scenarios formulated using flipcharts; others were conducted more informally. Several groups deliberated standing up, while the others chose to sit in a circle.  Conversation frequently digressed from the initial theme, as people introduced interesting and novel ideas, altering the flow of debate in unpredictable ways.

A final group discussion allowed each participant to reflect on their experience.  Most had enjoyed the involvement in the open space process, despite some initial apprehension. There was enthusiasm for the opportunity to interact in such a liberated framework with a range of professionals from different backgrounds.  It was noted that much debate appeared focussed more on 2013 than 2030; understandable in a time of such immediate uncertainty and imminent change. Concerns were raised that such events should not just be a ‘talking shop’, but should have an identifiable output.

Such networks create great potential for cross fertilisation of ideas between leaders from a diversity of backgrounds.  The unfettering format of open space events allows people to congregate and engage with each other on issues of common significance.  The key is ensuring that such interactions are for the ultimate benefit of the health service and patients.  It is vital that a balanced approach is employed and no single interest is given primacy.  The appropriate dissemination and implementation of outcomes is necessary to influence thinking about healthcare and effect real, positive change.      

1)       http://www.itwnetworks.com

2)       Co-creating conference agendas through Open Space Technology: Tapping the wisdom of participants. November 2008, Research Centre for Leadership in Action. Available online at:- http://wagner.nyu.edu/files/leadership/PracticeNoteOpenSpace1108.pdf