35 Formal Problem Structuring Methods • Soft Systems Methodology • Strategic Options Development Analysis • Soft Systems Methodology (SSM) is also one of the • SODA (Strategic Options Development Analysis) is most widely used Soft OA methods. It follows the one of the more popular Soft O.R. methods. It is logic that every problem is like a system that needs to essentially a way of making sense of a complex be understood. Checkland felt that these systems problem through the eyes of a client group. As a (problems) could be better understood if compared problem structuring method, SODA aims to channel to reality in a model which could structure a debate the cooperation of a variety of stakeholders into focused on the differences, and could later identify addressing a problem. where changes need to be made. • Scenario Planning • Theory of Constraints • Scenario planning is a method for learning about the • Theory of Constraints is one of the most recently future by understanding the nature and impact of the developed Soft O.R. techniques. It aims to overcome most uncertain and important driving forces affecting the fact that any organisation has a constraint, or a our future. With this method, you can use stories or number of constraints, that dominate the entire scenarios to find out more about near, medium and system and the secret to success lies with managing long term futures. It is a group process that uses these constraints, and managing the system as it techniques in workshops and the transfer of interacts with the constraints, to get the best out of knowledge to understand the nature and impact of the whole system. According to Goldratt, there are a those driving forces that will affect the organisation number of key steps involved based on the fact that or a particular problem – which are most uncertain goal achievement is limited to at least one constraint. and have the most impact. With this method, it is important to gain a deeper understanding of the central issue important to the future. Definitions from ‘Soft OR Techniques’ – Seagriff
36 Soft Systems Methodology (Peter Checkland) • CATWOE • Seven stage description • Customers • 1 The problem situation : unstructured • Actors • 2 The problem situation : expressed • Transformation process • 3 Root definitions of relevant systems • Weltanshauung • 4 Conceptual model • Owner • 5 Comparison of 2 & 4 • Environmental constraints • 6 Feasible Changes • 7 Action to Improve the problem situation • PQR • Do P by Q to contribute to achieving R. • P What • Q How Checkland, P.B. & Poulter, J. (2006) Learning for Action: A short definitive • R Why account of Soft Systems Methodology and its use for Practitioners, teachers and Students
37 problem data method
Population Health Management The Cynefin framework: (a speedy) introduction and exploration Fraser Battye, Strategy Unit NHS England and NHS Improvement
We need to know what kind of situation we’re in before we decide what to do "I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.” Maslow The Cynefin Framework can helps us orientate ourselves and so inform actions
Weight loss for someone Population level efforts trying to eat ‘more to reduce obesity healthily’ Population level nutrition Weight loss for someone with food system in following a diet / plan crisis
Diagnosis and guidance Diagnosis and guidance for multiple LTCs and for single LTC lifestyle factors Self-care for stable long- Managing LTCs in term condition (LTC) context of crisis
Where analysts are called upon the most?
Uses of the Cynefin Framework for analysts? • Shared frame of reference for analysts and decision makers? Using to orientate decision makers (similar to Ackoff hierarchy) as part of problem structuring? • Help prevent Maslow’s hammer problem? (Bureaucracy’s hammer is ‘the need to correct failures of process’ – it wants a ‘Clear’ world). The analyst as advisor? • Designing analytical approaches / strategies? Would be very different if ‘Clear’ to if ‘Complex’ Oth thers? ers? Over er to y o you ou!
Just in case a 20min intro hasn’t been utterly comprehensive… • Grab me over coffee • Video introducing the Framework: http://cognitive-edge.com/videos/cynefin- framework-introduction/ (lots of resources on the Cognitive Edge website) • Harvard Business Review article: https://hbr.org/2007/11/a-leaders- framework-for-decision-making
Population Health Management Break NHS England and NHS Improvement
Population Health Management Knowledge to Action (K2A) Nicola Dennis and Gareth Wrench, Public Health England NHS England and NHS Improvement
Knowledge to Action (K2A) Using K2A essentials January 2020
Learning Objectives • To develop an understanding of what “Knowledge to Action” (K2A) is. • To understand how to use this approach to support effective use of your analytical outputs by decision makers • Work through a practical example using the K2A grid. K2A Training Resource – December 2019 51
The journey so far… • 2013 – PHE Knowledge Strategy - knowledge translation a priority • 2017 – Warwick University commissioned to review published evidence on effective knowledge translation • 2017 – identified systematic review of the evidence Using Evidence What Works? (from Science of using Science programme) • 2017 – PHE worked with Jonathan Breckon (of Nesta, an innovation foundation), Director Alliance for Really Useful Evidence to test application of evidence to translation of health intelligence products • 2017 – established internal K2A Enabling Workstream – outputs being presented here • 2019 – roll-out of training & K2A essentials materials K2A Training Resource – December 2019 K2A Training Resource – December 2019 52 52
…or will they? “If you build it they will come” K2A Training Resource – October 2019 53
The Breckon & Dodson Framework A robust, evidence-based approach. Describes 6 mechanisms for enabling the use of evidence in decision-making: • Awareness - building awareness & positive attitudes towards evidence use • Agree - building mutual understanding & agreement • Access & communication - providing communication of, & access to, evidence • Interact - facilitating interaction • Skills - support decision-makers to develop skills in accessing and making sense of evidence • Structures & processes Source: Using Evidence What Works? (from Science of using Science programme) K2A Training Resource – December 2019 K2A Training Resource – December 2019 54 54
What is Knowledge to Action (K2A)? An umbrella term encompassing knowledge translation, knowledge mobilisation, knowledge exchange, knowledge brokering… K2A aims to ensure that decisions about local or national population health and healthcare are based on the best data and evidence available … includes activities that help to ensure that evidence and data can be understood and actioned. K2A Training Resource – December 2019 K2A Training Resource – December 2019 55 55
K2A aims to bridge the ‘know - do’ gap ‘Know–do’ gap between what is known and what is done Policy and Health practice intelligence/ evidence What? Why? Who? How? K2A Training Resource – December 2019 K2A Training Resource – December 2019 56 56
K2A aims to bridge the know-do gap K2A Training Resource – December 2019 K2A Training Resource – December 2019 57 57
What is K2A’s purpose? To support you to: • reach the right audience • at the right time • in the right format • with the right messages K2A Training Resource – December 2019 K2A Training Resource – December 2019 58 58
The product – K2A Essentials It helps support us to: • Reach the right audience • At the right time What? Why? • In the right format(s) • With the right messages After going through the different Who? How? areas of the grid you should have enough information to form a knowledge mobilisation plan. K2A Training Resource – December 2019 K2A Training Resource – December 2019 59 59
The product – K2A Essentials K2A can be used across the Knowledge Cycle (4 stages) Helps bridge the gap between the knowing and the doing by assessing: • Who – audience/collaborate? • What are the key messages? When? • Why is this work important? • How to mobilise – what methods? • When to take action? • Does “it” need to align with the release of other outputs? Repeat for different audiences K2A Training Resource – December 2019 K2A Training Resource – December 2019 60 60
When? K2A approach - update 4 March 2019
Why? Consider: Why will you undertake this work? Why is it important? Why should your audience see or use this product? • What is your timescale for these activities? When? • Are there any other activities taking place that might influence the uptake of this knowledge? K2A approach - update 4 March 2019
Who is the audience? Consider the role they bring: Who? • Champions • Partners • Users (general, technical) • What organisations are they from? • What ‘day job’ do they have? • Who would it be helpful to collaborate with? Consider: • What they bring to the table • How they can assist in planning, doing, evaluating • What is your timescale for these activities? • Are there any other activities taking place that might influence the uptake of this knowledge? When? K2A approach - update 4 March 2019
How will you get your message(s) across to this audience? How? Consider: • Format • Methods of dissemination • Forums and stakeholder groups • What is your timescale for these activities? When? • Are there any other activities taking place that might influence the uptake of this knowledge?
It’s important to have a clear vision of the main message you want to communicate and the lessons you What? want to share. What do they need to know about – what level of detail/type of knowledge? General content, functionality, methods/caveats, interpretation What health issue(s) does this product address? What makes the message meaningful to this audience? What do you want to achieve with these messages for this audience (inform decision making, change attitudes, change behaviour/practice, raise awareness, share knowledge of tools)? • What is your timescale for these activities? When? • Are there any other activities taking place that might influence the uptake of this knowledge? K2A approach - update 4 March 2019
Any questions? K2A Training Resource – December 2019 66 66
Group work 1) Think about your PHM core team product (or another recent piece of analysis) 2) Consider the main audiences for whom this is intended (the Who? ) Then consider the following for each audience using the K2A essentials grid: 1) The Why? 2) The How? 3) The What? Report back K2A Training Resource – December 2019 K2A Training Resource – December 2019 67 67
When? K2A Training Resource – December 2019
Population Health Management Problem formulation Lucy Hawkins and Alysia Dyke, Strategy Unit NHS England and NHS Improvement
What are some of the common analytical questions that you get asked?
What are some of the common analytical questions that you get asked? We are going to use the 1-2-4 4 all ll method! We will let you know when to move on to the next stage. 1. 1. Alone one - Think for 1 mi minu nute 2. 2. Pai airs rs - Share for 2 mi minut nutes es 3. 3. Sm Small all grou oups ps - Share for 4 mi minu nutes es
Using what you’ve heard this morning how might you approach these questions?
Using what you’ve heard this morning how might you approach these questions? We are going to use the Wis ise Crowds ds method! We will let you know when to move on to the next stage. 1. Sp 1. Split lit into o 6 mai main n grou oups ps 2. Eac 2. ach h grou oup p needs eeds: • To identify a challenge / question to address • Someone to be the ‘client’ and act as the person posing the question • Consultants to listen, pose clarifying questions and offer advice to the client based on what you have heard this morning (and other experience!)
Using what you’ve heard this morning how might you approach these questions? The steps are as follows. We will let you know when to move to the next stage: 1. The client presents the challenge / question – 2 mi minute nutes 2. The consultants to ask any clarifying questions – 3 minu nutes es 3. The client turns their back to the consultants and get ready to take notes 4. The consultants discuss with each other, offering advice and recommendations on the challenge – 5 mi minu nutes es 5. The client turns to face to consultants and explains what they found useful and what they will take away from this – 2 mi minu nutes es 6. Debrief to the room
Based on what you have heard this morning, how could you use these frameworks in your own work?
And finally…what would be your top tip for problem structuring? Write your thoughts on a post it note and stick onto the flip chart over lunch!
Population Health Management Lunch NHS England and NHS Improvement
Population Health Management The time for a chief analytical officer is now Mark Farr, East Kent Hospitals NHS Foundation Trust NHS England and NHS Improvement
Agenda 1. Reflections • Let your lunch go down, look out of the window, pick your nose. A silly game. 2. Models, Frameworks • Begin to think about who does what, which tools should you pick up each day. Some examples. 3. Disruption • Consider how we should shake things up. Provide some specific ideas. 4. Next steps • How do we need to change the people above, alongside and below us. List some practical steps.
Making a name for yourself → → Data is the new oil Big data is like teenage sex • • Dan Ariely, Duke University 2013 Clive Humby, Tesco, 2006 • Marc Farr, East Kent 2016 • Meglena Kuneva, ECC, 2009 • Marc Farr, East Kent, 2017 • Richard Titus, AND, 2010 • Marc Farr, East Kent, 2018 • Peter Sondergaard, Gartner, 2011 • Marc Farr, East Kent, 2019 • Bill Diggins, Diggit, 2012 • Ann Winblad, Hummer-Winblad, 2012 • Gary Wolf, Quantified Self, 2012 • Virginia Rommetty, IBM, 2013 • Kevin Plank, Uner Armour,2016 • Qi Lu, Microsoft, 2016 • Piero Scaruffi, Author, 2016 • Abraham George, Kent CC, 2018
Board assessment Analytics team assessment
Hilarious conference cartoons
Analytics Strategy 3.0 A. Information function as a new independent think-tank. B. Remember why we are here. C. The emerging interest in advanced analytics. D. Exponential change in technology and media. E. Development of STP wide thinking. F. Data is the new oil – who manages the pipes? G. Workforce is key. H. Communication. Communication. Communication.
An Information team as an independent think-tank
Conversations “I don’t want the CEO to know something before me” COO “I see.” Director of Information “I don’t want the COO to know something before me” Divisional Director “I see.” Director of Information “I don’t want the DD to know something before me” Specialty Lead … Director of Information
Conversations “I don’t want the CEO to know something before me” COO “I see.” Director of Information “I don’t want the COO to know something before me” Divisional Director “I see.” Director of Information “I don’t want the DD to know something before me” Specialty Lead “Do you know what? – you lot are such a rabble and you change so often that, in our patients interests I’m just going to make this the most transparent trust in the country. I’ll telI everyone everything all at the same time. See you in hell.” Director of Information
Remember why we are here
Conversations “I heard a CEO speak at a conference saying that baggage handlers are as important as pilots – as an analogy for clinical staff and analysts.” Senior Analyst “I see.” Director of Information “It made me feel really valued.” Senior Analyst “I see.” Director of Information “What do you think?” Senior Analyst … Director of Information
Conversations “I heard a CEO speak at a conference saying that baggage handlers are as important as pilots – as an analogy for clinical staff and analysts.” Senior Analyst “I see.” Director of Information “It made me feel really valued.” Senior Analyst “I see.” Director of Information “What do you think?” “I think you’re an idiot. Senior Analyst There is a saying in India that you are either the doctor or you are there to serve the doctor. Clinically led, professionally and managerially supported.” Director of Information
The emerging interest in Advanced Analytics
Conversations “Have you heard? – lots of senior people are saying that more people than normal are dying in our Emergency Department .” Deputy COO “I see.” Director of Information “It’s really bad isn’t it, I think we should do a case note review and raise it with the CCGs and NHSI.” “I see. May I do some Deputy COO analysis first.” Director of Information “OK. Weirdo.” Deputy COO … Director of Information
Conversations “Have you heard? – lots of senior people are saying that more people than normal are dying in our Emergency Department .” Deputy COO “I see.” Director of Information “It’s really bad isn’t it, I think we should do a case note review and raise it with the CCGs and NHSI.” “I see. May I do some Deputy COO analysis first.” Director of Information “OK. Weirdo.” Deputy COO “Simple SPC charts show that it’s about the same as last year. We’ve also build a model that can forecast flu spikes accurately two weeks ahead. You could use it to plan staffing rotas this winter. ” Director of Information
Exponential change in technology and media
Conversations “The board report is a bit boring isn’t it? I find it difficult to get into.” Chair “I see.” Director of Information “I agree. I also really struggle to find the time to read it as I’m constantly travelling.” CEO ... Director of Information … Chair and CEO … Director of Information
Conversations “The board report is a bit boring isn’t it? I find it difficult to get into.” Chair “I see.” Director of Information “I agree. I also really struggle to find the time to read it as I’m constantly travelling.” “Would you like me to summarise it into a CEO podcast and a vlog that you can access while travelling.” Director of Information “Blimey. That would be cool, just like the BBC, sort of.” Chair and CEO “Yes, sort of.” Director of Information
Development of STP wide thinking
Conversations “I think STPs are just the latest talking shop, nothing will get delivered.” Finance Director “I see.” Director of Information “But you have to be at the table. We need a presence.” Finance Director “I see.” Director of Information “So how much money have you saved?” Finance Director … Director of Information
Conversations “I think STPs are just the latest talking shop, nothing will get delivered.” Finance Director “I see.” Director of Information “But you have to be at the table. We need a presence.” Finance Director “I see.” Director of Information “So how much money have you saved?” Finance Director “Actually, a lot is possible. We can reduce the cost of external management consultancy by linking our best analysts together. We can develop economies of scale in warehousing, analytics and begin to solve region- wide issues.” Director of Information
Data is the new oil – who manages the pipes?
Conversations “We’re going to run an exciting programme to transform flow in our emergency department, it’s going to save money and improve outcomes.” Transformation Director “I see.” Director of Information “My team need some data so that we can build a case to recruit more staff and buy some new sytems, the rotas themselves are probably fine. Number of attendances and number of ambulances by month please.” “I see.” Transformation Director Director of Information “We don’t seem to be making any progress.” Transformation Director … Director of Information
Conversations “We’re going to run an exciting programme to transform flow in our emergency department, it’s going to save money and improve outcomes.” Transformation Director “I see.” Director of Information “My team need some data so that we can build a case to recruit more staff and buy some new sytems, the rotas themselves are probably fine. Number of attendances and number of ambulances by month please.” “I see.” Transformation Director Director of Information “We don’t seem to be making any progress.” Transformation Director “We’ve found that when Dr Jones and Nurse Smith are on we achieve the national standard but when Dr Gardener and Nurse Evans are on we don’t – it’s now statistically significant. The number of attendances and ambulances are irrelevant. Get out of the way, we’ll do it. ” Director of Information
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