Podcast | Engaging the Board

Better Never Stops | Engaging Boards

Brenda: Thank you for joining us for Better Never Stops, our podcast for healthcare leaders and everyone committed to transforming healthcare. We interview leaders from our clients and partners around the world as well as leaders right here in Seattle who work to maintain a culture of continuous improvement at Virginia Mason Franciscan Health. In each episode, we hope to explore a philosophy of Go See, Ask Why, and Show Respect.

My name is Brenda McLeod and I am an Associate Executive Director at Virginia Mason Institute. I’ll be your host for this episode of Better Never Stops. Today, we are talking about engaging the board in continuous improvement.

We recognize that boards operate differently. In this episode, we are talking with board members within England’s National Health Service or NHS in the UK. An NHS Board is a key decision making body within the National Health Service and serves a crucial role in shaping the organization’s direction, ensuring effective delivery of services, and holding the organization accountable.

NHS boards are responsible for strategic direction, accountability, risk management, and governance and culture. They are a unitary board, meaning both executive and non-executive directors make decisions together and are led by an independent chair. Today we have a wonderful panel of guests from several NHS boards.

But first I wanna start by introducing Wendy Korthuis-Smith, who is Executive Director here at Virginia Mason Institute. Thanks so much for joining us today, Wendy. 

Wendy: Thank you Brenda. So for those who aren’t familiar with our journey at Virginia Mason Institute, just provide some context and background for this:

We embarked on our own journey of transforming healthcare in early 2000 with a vision to be the quality leader. And to do this, we adopted the Toyota Production System, where we took the timeless concepts, principles, and methods and applied them to healthcare, we say we essentially gave it a heart with the patient always being first, and a focus on the highest quality and safety, while engaging all employees and patients, and striving for satisfaction and maintaining a successful economic enterprise.

So our institute was formed in 2008 with a vision to partner with healthcare leaders. To really think about transforming healthcare across the globe. And we’re continually learning to date, leveraging over 20 years of transformation, not only within our centers of care, but also internationally across 27 countries.

And today, most predominantly, I would say, in partnership with NHS for over 18 years. Talking about the importance of board involvement and setting the tone for this conversation: we believe it’s so critical that board involvement and leadership for this work is front and center and that it can really make all the difference.

And so we’ve seen this, really shaped by. The strategic and hands-on engagement of our own board from the onset. They were not only supportive our journey, but really actively involved as stewards of a bold vision and catalyst for transformation. Kind of that model of engaged, accountable and mission driven governance.

And when we consider the work we do with our clients, it’s important that this transcends geography as well. And so real sustained improvement with leadership at the top. So I’m just gonna plant a few seeds for our discussion today about the why, and then really looking forward to the discussion from our experts and our guests today as well. 

One is: improvement begins with vision, and so a board is really uniquely positioned to set the vision or the strategic direction that places quality, safety, equity, and compassion at the heart of everything. And so championing improvement really crystallizes good intentions into system-wide priorities.

We’ve all also heard the phrase “culture eats strategy for breakfast.” And so thinking about how boards can shape culture and their visible, consistent commitment to really learning and openness and progress signals what’s most important. And if a board isn’t engaged in improvement, one might ask why anyone else should be engaged in improvement.

A third element: boards are kind of guardians of the quality of care patients receive. And this means not just reacting to opportunities and failures, but actively driving the systems, behaviors and innovations that prevent them. And then when boards are involved in improvement, they’re investing in their people.

And so building capability, innovation and creating space for teams to lead change, and this is all about that collective intelligence. Tapping into the insights of those at the front line and those closest to the work. My last point I’ll just say is that boards really are needed around navigating the complexity and the system change that’s needed today leading across boundaries.

And so improvement at scale really requires that bold system-level thinking where boards can lead by example. And so we believe that improvement has been a sustainable path forward for us and others and in our current landscape of rising pressures. Doing better is not a luxury, it’s a necessity. And we need boards who can look ahead to champion innovation and improvement and are really our active partners in change.

And we believe this is really one of our greatest opportunities. So while I could say more, let me stop there. ’cause I wanna hear from our guests today, their experience, their expertise in this really important work. 

Brenda: Thank you, Wendy. Next I would like to introduce Professor Andy Hardy, who is the Chief Executive at University Hospitals, Coventry and Warwickshire NHS Trust, one of the largest tertiary acute trusts in England.

Andy also sits on a number of boards as well as serves as the deputy chair for the National Improvement Board. Andy and his trust is celebrating this year, as it was 10 years ago this year, that his trust began the journey with VMI to implement their management system. Andy, you have two prestigious roles, both as Chief Executive and Deputy Chair for the National Improvement Board.

In your role as chief Exec, you have been on this 10 year very successful journey. We are curious how you would describe your experience with your local board on this journey. 

Andy: Okay. Thank you. Uh, it’s good to be here. Thank you for the invite. I actually do entitle it a leadership challenge because it really is, leaders have to change the way we lead.

And that’s true of the whole board. We’ve talked, so, you know, just heard in the introduction there the importance of culture. Well we, we, we set culture in the way we behave and what we do. People watch what leaders do, how we spend our time must be important and so we need to change what we do and how we spend our time.

I talk about the importance of leaders moving from being problem solvers. You know, we’ve all got to our positions because, you know, traditionally you’ve been promoted in NHS because we’re good at solving problems. We have to stand back from that and become problem framers. One important learning from working alongside with Virginia Mason Institute over these 10 years is, is that important.

Saying that those who do the work know the work, those who know the work, improve the work. So let those people get on them, empower them, give them the tools. Again, going back to Wendy’s point around the importance of education, then this our idea of leader standard work. Yeah. We all think we’re quite important and quite special when we get to board level, but actually we all have standard work to do.

So what is our standard work and, and my standard work includes importantly showing how I spend my time dedicated to improvement so people know exactly where I’ll be on a Tuesday morning, I’ll be in the main reception if I’m on site listening to short, sharp presentations around improvement work that goes on within the organization.

Standard work also includes going to board meeting every other month, being in certain places at a certain time. You’ve talked about the importance of Go See, Ask Why, and Show Respect, and, and the, and changing lead rounding to move away from traditional almost feels like you’ve got a clipboard and you do board walkabouts actually just going out there asking people what they do on a day to day basis, what’s their focus for that day?

What have they learned from the previous day, what they do better today than did tomorrow. And just talking to them about their production boards, their focus boards. So really it comes down to. The whole of the board changing the way it leads collectively for improvements and knowing that. There’s a big difference between our quality management system and having quality initiatives.

Because quality management seems, simply seems, this is the way we do things around here. Uh, it’s organizational wide. If we’ve got challenges, this is the way we tackle those challenges. We’ve got opportunities. These are the methods we use to take advantage of those opportunities. So I’ll hopefully that started to answer that question.

Brenda: Thank you, Andy. I would like to introduce Adam Sewell-Jones, who also brings significant experience to this conversation. Adam is the chief executive of East and North Hertfordshire NHS Trust, where they’re a couple years into their implementation and adoption of a management system. And prior to East and North Hertfordshire, he was director at NHS Improvement where he led the NHS-VMI partnership.

Adam pairing your role leading the NHS-VMI partnership alongside your current role as Chief Exec. I imagine you have a very insightful perspective about the board’s role when it comes to an organization’s improvement system. 

Adam: Yeah. Thank you Brenda. And thank you once again, um, for allowing me to join you on this podcast.

If I perhaps try my two different hats, uh, when I was at NHS Improvement. I think going back to the days in the NHS when we used to have oversight of, of hospitals and, and other providers by monitor who oversaw the foundation trusts, um, and the trust development authority that oversaw the non foundation trust and without boring people with a detail, they had a very similar role, which was to make sure organizations were working effectively and all the way back then.

There was a huge onus placed on the quality of the boards because there was a view at a national level. If you had good boards in place, then organizations will be successful. And so that’s where the real focus was. We’ve probably lost that a bit, to be honest, over recent years. But I guess what I feel is quite encouraging in the current changes within the NHS, there seems to be a returning to that sense of the importance of boards as, as the guardians of, of organizations.

But that really played through when the, the five trusts were chosen to work with VMI. Um, and I know an important part of that process was going out and meeting teams, like Andy’s teams at Coventry and Warwick to really test whether the board was up for this. And I think those that got through past that test in, in having a board that were committed and halfway through that.

The five-year partnership. Um, I remember going out to each of the organizations and doing a, a kind of check-in over two or three days where we did focus groups and interviewed people. And an important part of that for me was interviewing, uh, the chair of every organization to really understand where the board were.

And I always asked the question, if the current leader was to leave. You were choosing your next chief executive and you had a choice between a very experienced leader who, who didn’t really understand or, or support this way of working, and a and and a more inexperienced leader who really was very passionate about a quality management system.

Where would they go? Because it was a fundamental decision in the embedding a longevity of this work. And one story that sticks with my mind really back from the early days of Virginia Mason, um, and, and the medical center was when Gary Kaplan would often talk about the fact that 18 months into the journey things got a bit rocky.

Some things didn’t go in the way they were hoping. And it was the members of the board that said, stick with this, because human nature is that, particularly in management roles, we need to look for the next thing to try and fix the problem. And I think it really chimes with the. The national leadership’s view of the importance of the board.

Uh, I guess if I then put my other hat on and think about currently being the chief exec, I came into an organization that in their advert for this role was very clear. They wanted someone to come in and improve the culture within the organization and implement, uh, an improvement system. Um, so I knew I was joining an organization where the, the land was ready for this.

And, and fertile ground for this kind of work, which was really important. But what’s been encouraging, and I’ve been very lucky that uh, during my time here, Anita has joined as our chair who had some exposure to this in a previous organization, but was very clear during that process this was something she really wanted to support.

And I feel very confident I have that backing of the entire board in, even at times when some of this work feels a bit counterintuitive ’cause we move away from our safe space. Um, and Andy has already mentioned the idea of kind of the problem solving that we’ve all got very good at over the years. It’s really encouraging to hear members of the board say, well isn’t this what the production system’s for?

So I think it’s really important for the trust management to really feel they’ve got that support and the challenge, but the support from from other board members around the table. 

Brenda: Excellent. Thank you Adam. And finally, I’d like to introduce Anita Day, who brings years of NHS board experience, including years of chair and non-executive director experience with several NHS trusts and integrated care boards.

Anita is currently chair at East and North Hertfordshire Teaching NHS Trust and a non-executive board member at Lincolnshire Integrated Care Board. Additionally, Anita was on the board at Worcestershire Acute Hospital, NHS Trust, when they chose to begin working with VMI on their own management system. Anita, we are so interested in your perspective from being on or chairing boards that do not have a management system in contrast to ones that do.

Anita: Thank you, Wendy, Brenda, and again, uh, you know, delighted that I’m was able to join you today. Um, I think this is a really important topic and I think, and you, and you mentioned it in your intro about the fact that this is, uh, I think a, a unique challenge, I think in the UK where our boards in the NHS do look a little bit different there than, uh, other countries.

You mentioned the thing about the unitary board, and I think that what that means is that the fact that non-executives and executives work together to try and, and, and move the organization forward means that there’s an even greater need to have alignment of values, alignment of what matters. Um, Adam’s just mentioned about where, when, uh, you know, that he was pleased that I joined him.

Well, I was delighted to join East and North Hertfordshire. Because my background before the NHS was all about in improvement in the private sector with IBM. So it was important to me that I was, that, that, that I came to an organization who, uh, wanted the same things that I did. So, so that was part of my decision in terms of, of going there.

And I think that piece about saying that actually, and, and Andy’s referenced it, the bit about actually the board sets the tone, the board shows the whole organization what’s important, how this stuff works. Is, is, is imperative. An organization’s ability to really go places with this stuff is about being able to bring together two things, both the management system piece and, and we’ll talk a little bit about that in the moment, but also the cultural piece.

Because actually you can’t do one without the other. Or rather, the power is when you can bring those two things together. Um, so I think that cultural part about really setting the tone, showing everyone, regardless of their role in the organization, however senior or perhaps in quite a junior or quite a lowly position, a nonclinical position sometimes, that they, their voices are important, their experience is important, and they can help make our organization better, is hugely important.

In terms of the management system piece, and you mentioned my previous trust, I think that there is. For me, the success is about being able to bring those two things together, culture and management systems, and you need both of them together. I’m very fortunate. It, we, we, under Adam’s leadership at East and North Hertfordshire, we are actually in a really good place with, with both of those things and we, we value both those things and they matter to us.

I think that in where I’ve seen organizations struggle a little bit more is where, for whatever reason, and that could be because of operational challenges or perhaps some members of the board or the, or the consultant body perhaps not being bought in. Where there is, where there is resistance to either the culture or the management system, things tend to not quite go so smoothly.

And I think that would be my reflection that those. Both, you need both hand in hand. Um, and when I talk about management systems, I’m talking about the things that, that anyone who’s worked with VMI will will be familiar with. I mean, Adam does a fabulous weekly huddle with the execs in a corridor that anyone can join, and I quite often join it.

It would be great if we had more members of staff joining it, but, we probably need to do something about publicizing that a bit more, but it’s, it’s great that anyone can, can, can, can listen to that and hear what’s top of mind in the executive for the executives and, and what’s going on or what’s important.

We have lead arounds, positive lead arounds where execs go round and, visit areas and, and, and ask them about their improvement projects and what they’re doing and what their obstacles are and so on. And I try really much, and I encourage my non-executive directors to, to go along with those and do them as a joint thing.

Because I think the key thing, and I think Andy mentioned this is, um. You support, or I would say as board members, we support this by making it part of our everyday conversations with our people as we walk around the organization. It’s not about a clipboard. It’s not actually about having a checklist of things you have to ask.

It’s about using. Engaging with your staff in a meaningful way and listening to what they say and asking them specifically. So how did that go when I was here last time, you, you mentioned you were thinking about doing this. Well, how did, how’s that going? What, what, what, what are your obstacles? Is there anything I can help with to unblock it?

And so on. So you just make it part of everyday conversation. And I think if all members of the board executives and non-executives have that top of mind, I think. You create a really powerful culture, which then reinforces the kind of more formal parts of the system. 

Brenda: Thank you, Anita. So this question is, is generally open for all four of you, um, to, to jump in.

What were the prerequisites for success for you as you embarked upon implementing your management system?

Andy: I always said at the time we weren’t looking to become Virginia Mason in Coventry. We wanted to learn from the experience that Virginia Mason had had, and we saw it as a way of accelerating where we wanted to get to as a, um, to our door almost to our toolbox and our way of thinking.

And. That soon came through. And then actually, I think when we went into it anyway, we thought this was all about lean tools. A few used the word tools, but actually so much more than that. And very soon, so 18 months, two years into our partnership, we realized that what he was actually adding on is the importance of culture, the importance of discipline, the importance of, uh, empowering colleagues to make the change.

And actually the tools are really, really important. We learn. They are just the tools. So we’d started a change in the organization and I know to use the Japanese term, we’ve now learned. We were preparing the ground to be able to land on, and one of the things we often talk about now is that.

As you look to introduce a quality management system organization, you have to meet an organization where it’s at. And we were at, we were at the early points of development, but it meant we were also, we weren’t fixing our ways, we were open to change and this was, this helped shape that change. 

Adam: I guess for me it was about having an organization that wanted to do something.

It was interesting because as I say, when they advertised for the chief executive, they described these things. But I was quite surprised when I arrived and was walking around the organization, meeting people. Lots of them were saying, are you gonna be doing that improvement stuff here? So there was a desire, they didn’t really know what it was.

And some of them knew I’d been involved in Virginia Mason. I had to be very quick to say we will be, whether or not we work with Virginia Mason or somebody else, but we will be doing this stuff. And there was a real excitement. So I think, um, it didn’t have to mean that everyone was really, um, well in tune or educated about what this actually meant.

But there was a desire for change. There was a desire to do something different. And even I, I would say at a senior level, many of my colleagues, um, were keen followers at first, and I felt very much supported that they said, we should do this. We are right behind you, Adam. But for me it then became when they walked up alongside me and a game changer, it was actually our visit to Seattle and people actually being able to see and touch and talk to people about the experience.

And then that became really exciting. So we didn’t need to be in that place on day one, but there had to be that sense of excitement. That meant it wasn’t a new chief exec coming in saying, I’ve got this box of toys I want to bring and play with. It was more, what are the toys you’re gonna bring with you, Adam, because we’re, we are really up for something a bit different.

So a, a bit like Andy says, you have to meet an organization where it is, but I think sometimes, and I’ve had one or two conversations with chief exec colleagues that were keen to do this. For them, it was just not right now because they didn’t feel it was quite the right time. They needed that pull from the organization rather than something they felt was being, uh, pushed on them.

Which to be fair, in the NHS we were quite guilty of, we get lots of initiatives, so we push it out to people and say, you must do this. But I, for me, it has to be that desire. Um, at least that individual has got a kind of burning vision for, for what can happen and other people really being keen to, to follow behind.

Wendy: I have a question as a follow up, Brenda, if that’s allowed. At this point, I’m thinking that, you know, I heard from Anita and um, Adam and Andy kind of this, um, way of being or way of doing, and it’s part of, you know, built into the DNA of what you do each and every day.

And then to Adam’s point about, you know. Readiness for, for this thing, this improvement stuff, you know, how do you get a board to sort of. Understand that this is about a way of being or doing versus one more thing. Um, I know oftentimes when we do our diagnostics or with organizations, we try to meet them where they’re at, and some people will say, oh, I don’t feel like we’re ready for this yet.

Like it’s, we can’t do one more thing. And so I’m just curious from the three of you. How have you handled that? That this isn’t one more thing, this is a way of being or doing. Each and every day. 

Anita: Can I come in on this one first? Uh, um, I mean, you make a really good point because let’s be honest, and I think this is certainly true, the NHS, um, as others have said, you know, there is a danger that we get bombarded with a new initiative, new ideas.

New leadership comp, whatever it might happen to be. And this stuff keeps coming at us. And there is a little bit of, of, of fatigue just because you’re down there in the trenches and, uh, from executive colleagues, they’re having to do the day job and yet there’s more stuff. Absolutely. Um, there’s also, I think, and you see this across our, our our people, there’s a little bit of cynicism.

Oh yeah, that’s this week’s idea. Next week it’ll be something else. So it absolutely is, is, you know, it’s a real challenge that that’s a real thing that you, you, you’ve highlighted. I think that, um, there’s the obvious stuff about getting. Um, getting board buy-in up right up front, explaining, explaining what the idea is, what is the problem you’re trying to solve, what is it you think it’s gonna bring you, and there’s all that, there’s that kind of buy-in piece just as you would with your people.

You need to do that at board level, first of all, because they’re gonna be your advocates going out into the organization, so they have to believe in what you’re doing. So there’s that piece. Of course, there’s obviously stuff like education, be it introduction courses and, and master classes and all of that stuff.

Good stuff as well that which will be appropriate to people’s organization. Uh, uh, people’s roles. I. I think the other thing we’ve gotta recognize is that with, you know, at East and North Hertfordshire, we have a very good board in terms of there is, there is a unanimous support for what we’re trying to do. But that doesn’t mean to say that people are in exactly the same place because as, as.

We are all human beings. And there will be some people go, will say, yeah, yeah, I get all this culture stuff, but we need to fix this now. And we can’t wait six or nine months for something to happen. And there’ll be always, people say, this isn’t, this isn’t working fast enough, we need to do blah. And, and so there’ll always be, um, I would say constructive, constructive challenge.

And I think that’s really important to have that challenge. Um, to me, I think. What we have to understand, any, any organization that’s implementing something like this is, this is not a panacea that you hit a button and lo and behold, suddenly you’re gonna be way more productive, way more efficient, save loads of money, your patients will be safer.

It doesn’t work like that. This is an ongoing marathon. It’s a long term project you are gonna be making little strides all the way through and hopefully those little strides will become big strides over a period of time. But it’s really important to keep communicating the good stuff, communicating the wins.

So even those people that maybe are a little bit more skeptical or a little bit unsure about whether this is gonna get you to where you wanna be can go Well, yeah, I do still want things to be faster, but I do recognize that the stuff we did in ophthalmology was fabulous and was a game changer or whatever it might happen to be.

So it’s, it, it’s a communication, it’s an engagement task as it is for anything that we do, frankly. But I think that’s part of what that, that’s part of our job as leaders. 

Adam: I, I would just jump on, I guess and say, um, and Andy’s touched on this a bit with preparing the ground.

I think we are luckier now because. We have other places to look at. So there’s something when you are really the vanguard of this, um, I’m trying a very different approach. I’m, I must imagine in Toyota when they first started to do this, this must have felt very scary and very off the wall. It’s less so now because some of our team had been to see, um, what was happening in Coventry or Sussex.

There were people who had read the Virginia Mason Transforming Healthcare book. So there were people who knew some of those stories, and therefore the leap didn’t feel quite as bold as it would be, uh, for some of those early, uh, waves. Interestingly, I came to East and North Hertfordshire before I was here, I’d been invited by the previous chief to come and talk to the senior team around improvement and, and what it meant and, and some of the way.

So there was already an interest. I. So that bit around kind of, I guess not being ready, it felt that unless they took the plunge here, they might have never felt ready. And yet I saw the signs of the things being placed and said there was the interest, there was a good organization that felt stable and solid.

Um, I think one of the really interesting bits around the. Virginia Mason partnership with the five Trusts is that those five trusts were all in very different positions ranging from very high performers to, to ones that were really struggling. And it was almost an exercise in testing whether you could, um, make this work.

Now, there were different outcomes in terms of the amount of success, but I saw in every single one of those. Really great examples of improvement being delivered, staff being enthused, culture has changed. And probably part of the big problem, and this is one of the other kind of things I would respond to, to your question, Wendy, around kind of what are the conditions having a long term contract because there is this bit of saying, actually, yeah, we’re not, don’t fancy that.

Let’s try something different. When you are able to say, as a board to your staff, we’ve committed over multiple years. It says, so don’t think, if you don’t like it, you can see it out because this is the way we’re now gonna do things. And I do think for those that aren’t the enthusiasts, having something that really ties the organization and said, this is a big commitment.

We’re all over, this is quite different to, we’re just doing this thing and seeing how it goes. So I think it’s a, it’s a really important message for the board to be, to be backing the approach. 

Andy: I would just absolutely reiterate what both Anita and, and Adam just said, right from the off we were very clear with the organization that we were in a five year partnership and we saw this as the beginning, the first five years.

And as he said, you know, there are many people who were in the organization that thought it’s the latest fad. We’ll wait and see. But then he started to talk about five years repetitively. So people hear it and feel it. And I remember one of the areas we did some improvement in. Ophthalmology where actually there was quite a lot of resistance.

And there were often times we thought, I mean actually we’d deliberately chosen that area because we knew there’s some cultural challenge there as well as performance challenges. We deliberately chose that and there were times in the first couple years thought, oh, have we bitten off more than we could chew?

But no, we stick it out and we’re gonna show people this is what we’re serious about. And that was another leadership challenge. Now people, opthalmology, they would be great ambassadors for this, but they were very clear, or we made it very clear to them this was at least a five year partnership and this is where it started.

And kept repeating that. And it goes back to then, and they saw us as leaders constantly talking and acting that way. 

Anita: If I could just come back in on this, ’cause yeah, exactly that. But I think it’s interesting, it almost feels to me like one of the challenges today for us as leaders is actually working out how quickly you wanna move. How quickly do you want to do, get new, new cross-cutting themes or new value streams, how quickly do you move? ’cause there is always that balance between, there are issues, there are areas where you wanna fix. There are that you want to make progress fast.

You want to do it for your patients, you want to do it for your staff. It’s the right thing to do to make change quickly. But there’s also the thing about making sure that enough of your staff understand the process, understand the terminology, how can you train everybody in time? How can you, and then equally, if you train people, then nothing happens for six months.

They forget it all. So then you have to retrain them. And it’s actually, to me, that’s one of the big challenges we have. How do you move at the optimal speed across your organizations with these projects? Balancing the fact everyone has to carry on with the day job. Everyone has to get educated, but we need to do these things for our patients and our staff.

Brenda: Thank you, Anita. This question is probably for all of you, but coming from very different places, right? Um, and your journey started 10 years ago now, um, and Anita and Adam more recently, but what would you do differently next time? 

Andy: We have given this some thought and, and two, three or four things that spring to mind.

One, we’d be talking about a quality management system much earlier rather than about this bringing in quality improvement so people knew it was that whole organization wide, this is the way we do things around here. So we’d’ve used that title much earlier. We’d have focused on, um, training a different way and training in teams rather than talking into individuals because this is really a team game.

And um, thirdly, we’d have talked about daily management standard work much earlier. ’cause they are this, uh, to me the, the, the, the sort of like the real foundation stones of this and really sort of embedded that as early as we could. I think those three things,

Brenda: Thank you Andy. Those are good. Adam or Anita?

Adam: This is a difficult one because I think we’ve had the advantage of learning from Coventry and Warwickshire and others. So if I reflect on some of the learning now, and I think in honesty, Virginia Mason Institute have learned from some of that process as well. So, um, in the trust, they weren’t mandated that the executive team all went through trading very early, and I think that was probably a mistake.

And I think we saw some of the trusts just do that themselves. And other leaders hadn’t been through the training. So we made sure that that was one of the principles that we started off with. We need to role model this and, and put the execs through the training, I think it is very much as we are going along, we’re thinking, can we nuance things rather than.

Oh my word. If we could roll back a year, we’d have done things very differently. Just that balance between how much of the KPOs time do you spend in training staff versus getting on and doing events? How visible do you make some of the standups and report out? So when you haven’t got that much activity to report out yet, and I think we’re, we are just working through some of those things rather than maybe reflecting that we made some big mistakes and we would go back and, and do it differently, but I’m content with the path. I think there’s also the balance between listening to the wisdom of, of our coaches from VMI when they say, I wouldn’t do that, and yet we really wanna do that. And working through how much do you passively follow versus how much do you say, no, we need to show some leadership.

I think we’ve just about got that right, but it’s a constant challenge because as somebody said earlier, we want to go kind of further and faster. But I also think a really important principle that I’m sure Andy would agree that we were taught as a group of leaders when we were going through the program is sometimes there was the answer that Virginia Mason had already discovered, but they weren’t gonna tell us.

Because a really important part of this process is learning. Learning yourself and not just being given the, the cheat sheet to avoid the pitfall. So I think there will be more things that we get wrong, but I think it’s an important part of that journey that you work that and then understand for yourself why they went wrong and, and how you would’ve done it differently, and how you learn from the experience.

Anita: And, and I think if I were to add a few things, uh, as, as I think we’ve said already actually at East and North Hertfordshire, I think we’re in a good place. I think we’re going at a good pace, and it feels, it feels, of course, there’ll be stuff that with hindsight we’ll say, yeah, we should have done X or Y, but it doesn’t feel like we’re getting things horribly wrong.

Touch wood and I’m touching my desk as I say that, but if I think back to my experience at other places, I would say that, that the things that could have been done differently. I think there is something about making sure the organization own. It this, it shouldn’t be a VMI thing that’s being imposed on the organization.

It has to feel like it belongs to the organization at East and North Hertfordshire, we’ve done that. We call it the NH Production System. It’s based on VMI principles, but it’s ours, and I think that. It culturally, it sits much, much better. If it doesn’t feel like, oh yeah, this, this, yeah, some American hospital is gonna tell us how to do stuff kind of thing.

You know what I mean? Um, so I think the thing about ownership is really important. I think the thing about really understanding that, how. Having the kind of formal management mechanisms versus the, the empowerment culture piece. Having those hand in hand is, is, is essential. I probably have said this far too often, but you know, I love the big value streams.

I love the big RPIW projects. You can see some fabulous things. I also love it when a housekeeper decides that if she reorganizes her cupboard, she can save 20 minutes a day getting her trolley out, or a ward clerk realizing that if they did this, this would help, or the, it’s the little stuff. It’s getting everybody feeling they’re part of it and I think, um, also.

Um, respecting both those things and valuing both the big and the little, and encouraging both the big and the little I think will be really helpful because. You asked earlier about, you know, how do you keep people motivated and things, you keep them motivated by showing them that it works, showing them stuff is changing, that think it’s making a difference to our organization.

And the reality is, the only way you can do it is by saying, well, this is our general approach, but actually we’re gonna go for little stuff. We’re gonna do this. We’re gonna go for low hanging fruit when we can, because everything makes our organization better. So I think. Linking things, not treating them as separate, not treating, not saying, well now we’re gonna do a culture program, empowerment program, and now we’re gonna do management processes.

No, it’s part and parcel. It’s the same thing. 

Adam: And if I could just come in for another bite on that question. Um, ’cause while Anita was talking it, it reminded me of one thing I guess we’re currently grappling with, and particularly with the, the thought of this podcast being around board involvement. Probably there’s something we are reflecting on the moment about how do we involve the board to keep them up to speed. And we’ve had a bit of a change in our non-executive board members. So some weren’t, weren’t around at the beginning of this journey. Fortunately, a couple of them have come from organizations that have used the same or a similar approach.

But we’ve also got a board that’s very visible and hands-on and wants to be involved. But the, the steer has been very much, now this is a management system. You need to have it of the operational management, so you don’t draw your non-executives too much into the doing. But the risk is then you find that they’re not being brought along beyond reports of the board.

So one of the things we’re, we’re lucky we have Chris from VMI with us this week doing a three p, project, but he’s also gonna spend a bit of time with us just talking through some issues, including actually what would be the right next engagement with the board, uh, to make sure they’re feeling. As much as part of the journey as everybody else, but clear on what the board’s responsibility is in this work.

Wendy: I love all those comments. Brenda, I just have to chime in with, you know, your, your question about what would people do differently and I think, you know, as I hear Anita and Andy and Adam share, the one piece that comes to mind, um, is the Go See. And I think, Adam, you might have broached this earlier as well, and, um, I think it relates to what Anita commented about making it yours and, and Andy’s comment about daily management because I think, you know, if you can’t see it and you don’t have a picture of what it looks like in action, there’s nothing more powerful than going out and seeing it somewhere. And I think we’ve seen this as well with our clients where, you know, we haven’t been as encouraging, I guess as starting out and Go Seeing early in the journey. And I think there’s something so powerful about, we can say like, make it yours, but until somebody goes and sees somebody like, you know, Coventry or Leeds or East and North Hertfordshire, you know, who is making it theirs. They go, oh, that’s what you mean by making it yours now I get it. Or, you know, daily management and standard work. You know, until you see that in action, sometimes it feels theoretical. It feels academic. And so when you see, oh, it’s how you do your, your, your day to day. It’s like you said, Andy, it’s every Tuesday, this is what you do and it’s nothing more or nothing less than that.

And it adds this simplicity. I think that’s so needed. It recognizes there, there’s complexity behind the scenes, but. At the front level, it feels very simplistic. So I just felt compelled to add that piece. 

Brenda: Thank you. And I know we are getting close to the end of our time today. One last question I would have.

Is there anything you wish I would’ve asked you around board involvement in this work? That I did not? 

Andy: I think just building on some of Anita’s comments particularly. One of our early lessons was because that’s significant different board here in the NHS compared to other parts of the world. This was all very much aimed at the executive side in the first instance.

And one of those lessons, which I think we’ve all learned out now to the NHS is actually, it’s the whole board and it’s the whole board from day one. So we speak in the same language. We’re talking the same way to people. 

Brenda: Great. Thank you. So I think the biggest things I’m taking away from this conversation are that the board sets the tone and shows the whole organization about what’s important and that culture really is key to this work. Another comment that stood out to me, having engaging conversations using the language as part of everyday conversation. And that this is so much more than just lean tools. There’s vision and strategy, culture and leadership behaviors. There’s the prerequisite of an organization needs to, you know, want to do this work while also then balancing meeting an organization where they are.

It’s important to get the board buy-in right up front so they believe and understand and can champion and lead the way. And then lastly, the importance of an organization owning their own management system and making it their own. I think that’s about all we have time for today. Thank you so much, Wendy and Andy, Adam and Anita for joining us on the podcast today.

If you have any final comments that you would like to share before we end, they would be most welcome.

Adam: I would just say we talk a bit in these kind of things about some of the challenges, which is quite right. ’cause this isn’t easy work, but it is so rewarding work and the real pleasure in seeing conversations around the board table feel different. To see leaders throughout our organization, lead in a different way, makes the effort and the challenges all worthwhile because we know ultimately it’s making a difference to the patients we’re here to serve.

Andy: Absolutely echo Adam’s comments. I know that myself and my fellow board members lead in a different way. The fact that after 10 years, this is here to stay, and somebody mentioned this earlier, but if we all left tomorrow, it would still be here. And this is the way UHCW works because it’s best for the patients we serve.

Anita: Yeah, and I will just add as others, as Andy and Adam have said, I mean, to me this is one of the, if not the most important thing that we and lead as leaders need to focus on. Because actually, if we get this right,  it changes everything. It changes quality of care for patients. It changes motivation and experience of our staff.

It changes our ability to use our financial and other resources in the most productive and efficient way. It eliminates waste. It basically changes everything. So we get this right, we get an awful lot right? 

Wendy: I love how you said that, Anita, and you know, stealing from Andy’s comment at the beginning, I think you phrased it as the leadership challenge, and I love that thinking about his opportunity at hand and recognizing the power, as you said, Anita of the unitary board and the NHS and that opportunity and the three of you are so inspiring in sharing your lessons learned and your wisdom and this topic, and I think it’s just such an opportunity for the rest of, of not only NHS, but the globe to hear your perspective on this. So thank you for inspiring me today.

Brenda: Thank you for listening to Better Never Stops. You can stay up to date with our latest episodes by subscribing on Apple Podcasts, Spotify, or wherever you get your podcasts. You can also find us on social media or at virginiamasoninstitute.org. Thanks again for listening and remember, transforming healthcare is not just about a pursuit of perfection, but a mindset that we can always do better because better never stops.