Working with patients to transform care – learning from Global Digital Exemplars

Horizons team member Sasha Karakusevic writes about an NHS Expo session led by the team: 

Designing and implementing large scale digital transformation in healthcare is difficult!

We don’t often pause to understand the complexity involved in moulding the expertise of multiple disciplines to create services that do the jobs our patients want – and that are easy and intuitive for the workforce to use.  And we are aiming at a moving target – many of the tools we are learning to use today did not exist even five years ago.  The Global Digital Exemplar (GDE) programme is providing an opportunity to accelerate the learning process.

Patient involvement is an area that many providers find challenging. Our Expo session gave an insight of how two providers are successfully involving patients to create new services.

Alder Hey

Being in hospital as a child can be an unsettling experience.  Quite apart from the change in environment, there are the inevitable fears about what is happening. There are also the challenges of helping children learn about managing illness to stay healthy.

Children learn through play, and using the idea of ‘gamification’ (put simply, turning boring processes of recording stats in to a game that is fun) the team is working to develop an app that builds familiarity with the hospital and rewards positive behaviour.

The GDE has enabled the team to work with an experienced app developer using an ‘agile’ process. This enables prototyping and rapid development on a two-week cycle working towards a goal, without needing to know all of the detail at the beginning.

Input from users is weighted to roughly 70% children; 20% parents and carers and 10% staff.  The process is allowing rapid progress to be made and it is envisaged that a “white label” app (allowing local customisation and branding) will be available soon.


Patient engagement underpins all work at Merseycare.

Merseycare has set themselves the challenge of achieving zero suicides.  This is massively ambitious (there were 5688 suicides in the UK in 2016).  The team are working to bring together international evidence of best practice, making full use of the potential of mobile technology to support vulnerable individuals and seeking to tackle difficult ethical issues regarding the balance between support and privacy.

Both stories were inspiring, and demonstrate the potential to provide increasingly personalised services at a scale and reliability not previously possible.  These providers clearly understand the value of the knowledge and expertise that patients as well as health care providers and technologists can bring in order to co-produce a successful product.

To summarise the messages from our session, with some tips for sharing similar successes in your organisations:

As designers

  • Actively involve patients and staff in the design process, recognising their distinct and individual needs.
  • Think about how to create a user experience that helps the patient manage their own care – help the condition fit in with their lives.
  • Consider the key messages coming from artificial intelligence and the deployment of chat bots to ensure steps are broken down to easy to interpret stages and reduce unnecessary process steps.
  • Think about how the technology will work virtually, and how it will enhance the effectiveness of face-to-face encounters.

As change leaders

  • Spend time creating a vision or goal, ensuring you consider how to involve key stakeholders such as patients in the process from the very beginning.
  • Create a process that supports emergence. This might require a very iterative approach incorporating what is known about delivering large scale change and agile approaches to software design.
  • How will your project scale? New technology enables global reach, but unless the detailed design is right your intended users are unlikely to use it, so a lot of work to co-create the user experience is critical – and this needs time to emerge.

As technologists

  • Recognise the challenges of designing and developing in the health sector.
  • Spend time with the patients and staff to build solutions that address a need.
  • Be ambitious, but understand what your value proposition is – simply put, why should or would your intended user use your product?
  • Adding more technology and features is rarely the best solution.
  • Create a space to test learn and iterate.
  • Apps and digital solutions are a crowded market, do your market research and understand whats already out there.
  • Question what  the purpose of your digital solution is, and why your solution is better than what is currently available. Focusing on the people and not the technology will give you a better platform to go for the much more disruptive and technologically advanced ideas that you may have.
  • Think like a startup with no money and you will find you will have the creativity to get to solutions that have an impact quicker.

The last word goes to the patients.

If we are to make the most of the GDE process, we need to recognise that patients are part of the solution.  To adapt the old saying from medicine: ‘first do no harm’ …doing something is the best way of achieving this!

There is much to learn… and the GDE exemplars in Alder Hey and Merseycare are clearly taking action and making great progress.


Building energy for change: improvement as an unstoppable force – our Expo 2017 Pop Up University

The Horizons team presented a Pop Up University at the 2017 NHS Expo on the topic of “Building energy for change: improvement as an unstoppable force”. If you missed the event, you can view our slides. Rosanna Hunt, who is an Organisational Psychologist and part of the Horizons team, has written a blog about the session:

“What’s it like to be part of a high performing, high energy team? Can you think of a time, when you worked in a dysfunctional team? What was your experience there?”


These were some of the opening questions posed to the audience at Horizons’ Pop-Up University “Building energy for change: improvement as an unstoppable force” at NHS Expo.

The responses resonated with some key descriptors on the high and low ends of the SSPPI five Energy Scales (below).

High energy teams were supportive, had a shared purpose, felt safe, passionate and stimulating. Low energy teams were exhausting, competitive – places where blame and mistrust were rife.

Research shows that organisations with high positive energy do better on every dimension of performance (Bruch and Vogel)[1]. Change leaders who can tap into the positive energy for change that exists among the people involved and unleash it for the benefit of achieving large scale change (LSC) are more likely to achieve their goals.

Large-scale change, however, requires sustainable energy – the majority of systems-level change projects fail, or aren’t sustained because insufficient consideration is given to the five energies required for change [fig 2]. Failed change programmes have consequences for patient safety, outcomes and care for our people in every sense: burnout and fatigue in our teams are increasingly prevalent where inadequate attention is paid to energy management.

Our research shows that senior leadership teams in the health and care system have disproportionate levels of intellectual energy. This reflects change efforts that are often dominated by logical, rational planning efforts where the social and relational aspects of LSC are underplayed and where shared purpose may not be strong. An over-dominance of intellectual energy spells trouble for LSC. On its own, intellectual energy cannot be transformational. It keeps leaders in their comfort zone, intellect-to-intellect.


Google’s Aristotle project – the most in-depth longitudinal study ever conducted on high performing teams – showed that the key to being a high performing, high energy team is ….being nice. This is more important than having the most knowledgeable, talented people on the team.

There is a growing understanding of the importance of psychological energy at work[2]. Without strong psychological energy, people do not feel safe to innovate and try new things that might fail. The most effective way to build psychological energy is by building social and spiritual energy.

Diagnosing energy for change in teams is itself a dynamic process that enables individuals, teams and organisations to make sense of their own drivers and resistance to change. Many teams we work with find that the tool [fig 3] gives them the platform to start conversations about crucial issues hidden under the surface of change programmes.

Teams can rate their energy scores under each domain of energy, and the energy level for a specific change initiative is calculated on a scale from one to five. What are the most dominant energies in your team? Do you trust each other? Do you have a sense of direction? Is there a sense of solidarity amongst all involved in making the change happen no matter what professional background they hail from?

Mintzberg stated that “leadership is about releasing the energy that exists naturally in people”. There has never been a time when this is more pertinent – given the challenges we face in Health Care today.

Five domains of energy for change

Energy for change is defined as ‘the capacity and drive of a team, organisation or system to act and make the difference necessary to achieve its goals’. The five domains of energy within the model are:

Social energy: that is, the energy of personal engagement, relationships and connections between people. It is where people feel a sense of ‘us and us’ rather than ‘us and them’.

Spiritual energy: that is, the energy of commitment to a common vision for the future, driven by shared values and a higher purpose. It gives people the confidence to move towards a different future that is more compelling than the status quo.

Psychological energy: that is, the energy of courage, resilience and feeling safe to do things differently. It involves feeling supported to make a change, and trust in leadership and direction.

Physical energy: that is, the energy of action, getting things done and making progress. It is the flexible, responsive drive to make things happen.

Intellectual energy: that is, the energy of analysis, thinking and planning. It involves gaining insight as well as planning and supporting processes, evaluation, and arguing a case on the basis of logic/evidence.



[1]Bruch H, Vogel B. Fully Charged: How Great Leaders Boost Their Organization’s Energy and Ignite High Performance. London: Harvard Business School Press; 2011.

[2] Edmonson A and Polzer J (2016) Why psychological safety matters and what to do about it


Harnessing New Power: Reflections on the NHS Horizons Seminar

Health leaders and activists (the very embodiment of old and new power!) gathered in London on the afternoon of August 24, 2017 for a seminar about new power in health and care. Horizons’ team member Sasha Karakusevic has written about his reflections about this event, full of energy and optimism about health and care transformation:

Helen Bevan’s introduction reminded us of Bertrand Russell’s famous saying: “Power is one’s ability to achieve goals”.  The saying remains true, but the environment and context has changed.  This means the nature of power and how to exercise it is changing, and needs to be developed.

We were extremely lucky to be able to bring together members of our network to spend time with Jeremy Heimans and Henry Timms, who are leading thinkers in this area.  Their focus is on old and new power. Following their Harvard Business Review article in 2014 they have been researching the topic; our seminar was a great opportunity to explore emerging themes ahead of the publication of their book next year.

What struck me early in the session is the great strength of people working in our field to manage complexity, nuance and the politics of change.  When we looked at where we were on old and new power values and approaches the consensus was towards new power values and new power approaches. The rate of progress is governed by our ability to work with old power values and models. People in the room were clearly leaders and shapers of change, recognising and responding to what is happening in the world today.

Jeremy and Henry highlighted different approaches to using new power, in particular the importance of ‘shape shifters’ – people with the knowledge and experience to understand the present and use this to create the future.  They compared this to ‘disruptors’ who understand where they want to get to, but do not have the connections and subtlety needed to consistently achieve their goals.




As we all know, being a leader isn’t always a comfortable experience! Themes that resonated in the room and on Twitter were the power of relationships and the need to build connections to get things done.  This is one of the biggest challenges…being nice to people works!

Another interesting theme from the discussion was that REMOVING structure to create more creative space is likely to be more effective than adding more structure.  This highlights one of the biggest challenges in transformation – if the structures are designed from the perspective of the current world view they may block our ability to see and create the future.  This is one of the reasons that we increasingly use ‘unconference’ techniques to allow new ideas and approaches to surface.

Our unconference surfaced four key areas to focus on for those working on transformation:

  • Message
  • Movement
  • Measurement
  • Method

We identified that old and new power approaches will use the same tools but in different ways.  So the final thing to highlight in this blog is the need for transparency as one of the key levers for building trust.  I highlighted the Edelman Trust Barometer results showing the loss of trust in many traditional institutions.  Rather than seeking to define the ‘what’, senior leaders may well be most effective developing the ‘how’, so more people can be involved in creating the future we want.

We will be sharing more thinking on these topics in the forthcoming update of the Guide to Large Scale Change (developed with the Sustainable Improvement Team) and look forward to developing out thinking and practice of new power approaches with Jeremy, Henry and the Horizons community.


Slides from the day can be seen below;

The Plaformification of Banking

A new way of doing business is shifting traditional mind-sets in the banking sector by encouraging the introduction of new technology that holds potential to increase and respond to changing customer demand. Why is this important? Just look at what is happening with Amazon right now and the way it uses platforms to increase its market share of products and services on line. Platforms, whether we like it or not is transforming relationships by connecting people to products in real time. The NHS is now uses a range of platforms which promote the latest tools with special features to encourage self-managed care. The impact of this is described by Ron Shevlin as ‘reachitecting the hierarchy of needs’ and ‘debungling of services’. The message is that we need to develop new platform capability and instead of relying on traditional business models develop platform strategies. People are looking for platforms to connect with new ideas and approaches to doing meeting their needs and that is where the power lies. Innovate or die is the litmus test pushing the limits on how we imagine our future to be. Have your say; connect and share your ideas on platforms you find most useful.

How an NHS Trust is encouraging social media

Such a brilliant visual example from Barking, Havering and Redbridge University Hospital NHS Trust of a social media campaign.  Lots of ways to really get people thinking differently and boldly about how to get on social media.

We’d love to see your examples of changing the culture in healthcare around social media.  Check out our simple animation from @theedgenhs and @anniecoops on getting started and this session from the Transformathon for more inspiration and resources.

Care centred communities

In the past few weeks my focus has been on finding content that truly illustrates good and kind transformational practice.  Individuals coming together to demonstrate that care starts and finishes with all involved in the process – health and social care staff and patients and carers.  The world has seemed a place of chaos and it is worth highlighting that still there are people that come together with a shared sense of purpose.

There is so much to learn within this article that it would not do it justice to capture in a short commentary.  My suggestion is that you read through and see what resonates with you.  A kindness culture to my mind is not a ‘nice to have’ tick box, but essential for all today.

Death – let's be more open, more kind, more caring.

Zoe raises many good points in her deconstruction of the care around death of a loved one and life with a critically ill child.  As a previous change agent for The edge her honesty and courage in tackling a very personal situation to bring learning forward for clinicians and others is to be commended.

We need to talk about these issues if we are serious about providing patient and carer centred care in the NHS.  True leaders share their learning and they lead by doing.  A message for all change agents and a call to action.

Meet the 2016 new radicals

If like me you love embracing new ideas, so what better than to look at the list of new radicals for 2016 from Nesta.  Within the list there are fifty radical thinking campaigners, entrepreneurs and social innovators from all backgrounds.

Last year the school for healthcare radicals was on the list and we could learn from others going forward into the future.  Reading about all the different approaches this year gives me hope that there is still a culture of kindness, hope and community.

Perhaps you are creating a new vision in health and social care that tackles a thorny problem that others could learn from.  Or you would like to nominate an individual or group as a change agent/s at the edge.  We’d love to hear from you and feature your contribution on our change platform.  Contact us via @theedgenhs or @CarolLRead

Challenged by innovation? Someone may have solved your problem

There are lots of different opinions on innovation and this article seeks to support the argument that you can reapply existing solutions to solve new problems.  The Transformathon covered a session on TRIZ by Marles Van Dijk and her team which you may want to review to see the ideas which Mattieu Mottrie explores in healthcare.

How to be a leader in digital

A great article which supports the case for being a digital leader.  The NHS has big plans for transformation and sustainability with digital playing a big part.  There is a need to be aware of breakthrough technology and work in different ways.  Whilst the article is not specific to health and social care we cannot dismiss the points as irrelevant.

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