The office digital maturity check-list

So a couple of days ago we found out that patients at a NHS HIV clinic in Dean Street London had details of their attendance widely broadcast because someone used cc rather than bcc in an email to patients www.bbc.co.uk/news/uk-34135866

The commentary rather misses the point - nobody should be using the bcc option for a mass email whatever the case. It is idle, incorrect and just like this is error prone. What it really highlights is that nobody has taught the staff at the clinic to use the basic features of MS Office - in this case email mail merge. All over the NHS and more widely I find staff at all levels using what are now commonplace office tools without the basic training to get the most out of them. This leads to errors and a significant loss of productivity. 

So here is my own basic office digital maturity check list (or pet-hate list) - what are yours?:

You are in an office and all you can hear is the ping of the notifications of incoming emails and people's eyes sliding to the screen while you are talking to them. Because they have not been taught how to switch off notifications and how to change scheduling of send and receive. I suggest twice a day - programme time in diary to do review and action mail twice a day. Otherwise switch it off. It will transform your productivity. 

You get sent a beautifully colourful spreadsheet but you are unable to analyse or manipulate the data or use it for a mail merge. That is because nobody has been taught to use the basic 'Table' (used to be called a 'List' in older versions) functionality of Excel to capture data fields and records in simple databases which you can then use Pivot Tables to analyse or just filter it for simple analysis. Oh - and you can use it as a mail merge database source. So something that is taking someone hours can be done in minutes.

You get  sent a PowerPoint presentation which needs to have the font colour changed to suit the projector and lighting in the meeting room but you have to change the font on each slide in turn (and there are 40 slides!). That is because nobody has been taught how to use and apply Masters and Layouts. Just choose any slide and select Reset and see what happens. Or modify the Master slide font colour and see what happens to the whole presentation (usually very little). 

You get a Word document that needs to have the font and headings restyled to meet a house style but need to go through it line by line to do so. And it is impossible to generate a Table of Contents. So this person has not been taught how to apply styles consistently across a document or indeed how to modify them if necessary.

You sit in a meeting and the action list is laboriously recorded for the minutes which are published a week later and only then do people remember the actions required. Alternatively they are captured and allocated there and then as they emerge by the Chair or project lead as delegated Outlook tasks   So people leave the room with a trackable task list they can integrate into their workflow. (I might be hoping for too much here I know).

Your inbox is flooded with large attachments and you completely lose track of the email trail of comments, revisions and versions. Because this organisation is not using a document sharing tool and if it is you and other key stakeholders cannot access the document to view and contribute. Indeed if they are using 'shared drives' then it is likely that different offices cannot see the same documents. How about using Box!

And as for project collaboration...only one person can see the project as a whole and that is the project manager on his version of MS Project who prints off Gantt Chart art once a month. Because this is not an organisation that believes in project collaboration, transparency and agility and has blocked access to any of the project collaboration tools widely available in the 'cloud' so teams cannot experiment and evaluate for themselves.

Oh - and they still have XP on the desktops and non-HTML5 browsers!

Nobody can learn about any of this or how to do any of this because access to Youtube is blocked. You can learn to do all of this in short-order because you are not alone. There are 1000s of useful, short 'how-to' and intro videos on the web about how to do these simple things. 

Email bloody email - oh how I laughed (and now regret it)

Oh how I felt superior and laughed when, as an early email adopter (compuserve - remember that?), I was told that a colleague was getting his emails printed out and brought to him in a file twice a day. What a dinosaur! How wrong I was…bloody email!

How very prescient he was even if he did not know it. The younger amongst you may not know that Royal Mail used to deliver twice a day. The mail arrived, was opened by your secretary, sorted and then provided in an incoming mail folder to you at about 1000  and 1430 each day. Another folder might have come in alongside it with any internal memos.

Each document had an action and distribution box stamped on it or stapled to it. If the letter had a reference then it came attached to the relevant file if it was available. Junk was sorted into a separate file which you could glance at if you had the time - or dump it in the bin.

So at 1000 and 1430 (after your lunch which was not at your desk) you sat down with a coffee and biscuit (which normally came with the correspondence) and worked your way through the mail and internal memos. 

In between you normally had a pile of files in your in-tray (you had marked them with a bring forward (b/f) date which your secretary had put in her diary. You worked through them until the in-tray was empty and the out-tray ready to be emptied when the mail came in. A nice immediately visible workload measure.

Days had a rhythm to them. A colleague who was head down in a pile of files was probably not going to be keen on being disturbed. On the other hand if the in-tray was empty and the out-tray stacked then that was normally a good indicator that there was space for a chat.

So how about just doing your emails twice a day? Book an hour in your diary twice a day to ‘do the mail’. Switch off automatic send/receive, push email and any desktop email notifications. 

Go on - get some proper work done.

Meetings, bloody meetings

Have a look at your diary for the next 4 weeks. Do a little exercise for yourself.

For each meeting in there check how you really feel about it. Which of them can you honestly say you are looking forward to with pleasure and/or anticipation because they are going to really add value to your role, are really interesting, really well run or just going to be good fun?

What proportion of all of them does that constitute? What does that really say about you? Just why are you letting this happen?

Let's bust a widespread misconception here - that diaries are for scheduling meetings. Wrong, wrong, completely bloody wrong! 

They are for scheduling work. Stuff that is going to add value. 

Look again at your diary. Just where are the entries in your diary which set aside time for you to do real work on something that matters? You might need some others to help you with your work so you might invite them to contribute. But that is not the same as a meeting.

Bet that most of you do your work in the slivers of time between meetings. Or when you should be resting or spending time with your families or on the things that make you a more interesting person.

So take a stand and fill your diary with useful stuff and let the meetings happen in the gaps. You might suddenly find that it is the meetings that take the hit and not the work. And then you will have to prioritise the meetings and not the useful stuff. That is a better way around. Try asking the person organising the meeting - 'why should I come to this meeting?' Or indeed asking yourself that question if you are organising it!

But then my guess is that most of you who read this will sigh, recognise it but do absolutely nothing about it and head off to your next 'heart-sink' meeting and do your emails during it.

Prove me wrong - please.

Raising your sights - imagining digital futures for the NHS

Updated 21 July 2015:

So the NHS has hired Martha Lane-Fox 'to boost patients use of digital technologies'. Might I humbly suggest that she also think about boosting NHS staff's use of digital technologies as well! The NHS is incubating a culture of low expectations and self-limiting assumptions about the possibilities of digital technologies whatever the central rhetoric and the proclamations of the proportionately very small and incestuous group of  NHS 'twitterati'. 

The NHS has always been safely far enough behind the digital curve to avoid early adopter risks but given the pace of digital development has fallen even further behind what is possible. For example a significant proportion of the NHS is still using XP desktops and non-HTML5 compliant browser which severely limits access to modern digital tools on the web.

Out of date desktop software combined with restrictive security policies prevent access to, and experimentation with, tools that are increasingly pervasive within the private sector such as web-conferencing, project collaboration tools and communication tools such as Slack. The ability to use technology to work collaboratively and agilely across organisational boundaries (and to engage patients and service users) is almost non-existent. Email is still seen as the default collaboration tool! 

The result is that NHS staff have insufficient grounded experience of what is possible to be able to imagine or articulate an ambitious vision of what the digital future could look like. Staff have also grown increasingly resigned to the limitations and constraints of local IT infrastructure to the extent that they are governed by self-limiting assumptions about what is possible. The contrast with how they experience technology in their private lives simply amplifies this dissonance.


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The original post

I have just come off a Skype call with some folks from a NHS Strategic Clinical Network. By their nature these are widely geographically dispersed set of participants who are often under a lot of time pressure and whose ability to get together in one place is limited.

We were talking about ways they could improve collaboration using some of the tools that are becoming more familiar to the private sector but less so to the NHS. I thought I might summarise the discussion here - both as a note for their benefit but also for anyone else who might be thinking about exploring similar opportunities.

The first thing is to get out and experiment with what is out there. Actually really I mean play. Until you and some like-minded adventurers actually get hands-on with some of this stuff then you will not know what is possible and from there be able to be more articulate and demanding about what you need to do your job better. 

If you want a diagram then here is one. If we simply project forward from past (usually poor) experience in the NHS then our aim is going to be low and we are going to miss a lot of opportunities. If we can provide some new insights and experiences we might be able to lift our sights and imagine different futures.

So what can you do...? Lets be honest about this - if you go to your IT department first you are likely to be told 'All too difficult' (ATD). Its the easiest answer in a risk averse system still locked onto XP desktops and/or out of date browsers. You are going to need to do your homework first - and you may need to go into 'insurgent mode' to do so...

• Find a small group of like minded adventurers, friends, colleagues. People with a spirit of inquiry. People who relate to words and terms like  'discover', 'explore', 'play', 'experiment', 'disruptive', 'there must be a better way', 'insurgent'. These words also allow failure as a learning opportunity as well as successes.
• Be prepared to go 'off-grid' for a while. Use mobile devices (iPads and iPhones) which do not have as many access or browser restrictions. 
• Try and get a modern browser on your laptop or desktop (if you are locked to IE7 will they let you have the latest version of Chrome?)
• Or be prepared to test if at home on your own PC or laptop over a cup of coffee one evening.
• Find people (like me) who are down this path, are passionate about opening up new horizons for people and ask for some pointers (but you are going to have to Skype me or ask me for a Google Hangout to do it - regard it as your first challenge). Put out an all-points call on Twitter or other Social Media channels. You might find others who want to experiment with you.
• Be prepared to change the way you work in order to test the potential of these technologies - a simple example is to start using shared and delegated task lists to track progress. This can be quite a leap - most people and organisations do not use the core task functionality of Outlook for example. So during a workshop or meeting try and log and allocate actions as they arise direct to your collaboration tool.

Some basic tips that might help:

• HTML5: An internet browser standard. Almost all modern cloud based collaboration tools need a compatible browser to work if on a PC/Laptop. So you need IE 9 or above or current versions of Chrome or Firefox or Safari. Mobile devices should be fine. Do not take no for an answer from your Trust IT department - I bet they have it on their desktops!
• Connectivity: almost all this stuff works well off a normal broadband line or 3G/4G. But if you are using Skype, Hangouts or any other stuff the requires you to stream 'up' as well as down then remember that many connections have slower upload speeds than download. Check your connection speeds up and down using Broadband Speed Checker
• Access: If at work or connected through a work VPN then check the access restrictions. Can you access streaming media such as YouTube, TED or Vimeo - there are lots of useful help videos on the web? People like you explaining useful stuff. All the stuff you are going to test has useful help videos. Learn from them. How can you share and learn if your Trust actively prevents it? Does your Trust prevent access to anything that looks like a File Sharing site - which usually covers all Project and Document collaboration tools on the web?
• Always debrief - if you are going to test something then always take time afterwards for a shared learning session. What worked for you might not have worked for someone else.
• Online: Get everyone who are experimenters onto Skype or even better onto Google+ so you can use Hangouts. Its a great way to collaborate on-line face to face - and you can even broadcast workshops and seminars live through Hangouts Live. A Google+ account is really useful. You can sign up for an account using your current email address - you do not need a gmail address.
• Twitter: Get everyone on Twitter and choose a hashtag - build a wider community around your experiments.
• Choose the platform to support the community. Choose one simple collaboration tool to hold you together as experimenters while you experiment with other tools. Maybe a free Basecamp trial or Asana.
• Sharepoint warning: If someone mentions Sharepoint then reach for the baseball bat....or run a mile! Don't even go there...
• Email: Is not a collaboration tool. Why make your lives worse by adding to the email pile while you are working on this together?
• Agile: You might want to explore different ways of working on projects and how these tools can support more effective project delivery. An example is Agile - additional posts on my blog cover how Agile can be translated from the software environment to change projects.

Here is some stuff you might like to start with (links to Basecamp and Asana above):

• Trello - a simple visual way of organising a project
• Realtime Board - an online whiteboard for real time collaboration. Virtual post-it notes, draw, comment
• Mindmeister - collaborative mindmapping
• Google Hangouts - voice and video calls for team collaboration

Physical space shapes the way we behave - change the space to help change behaviour

The way we design physical working space has an enormous impact on the way we engage, behave and think. Imagination, creativity and energy can be enhanced by well designed, simple space. And yet rarely a day goes by when I do not walk into a meeting room or potential workshop space that is the antithesis of all these things.

Earlier this year I designed and ran an Accelerated Event for a national project. To make best use of the space we dispensed with any tables, set up group work areas or 'pods' around the perimeter of the room (created by mobile partitioning - Screenflex is great), with a cluster of chairs outside each 'pod' for plenary briefings.

There was no seating in the pods - just  a coffee table for resources and plenty of wall space for working on.

Groups were self managing - they were set tasks, a timeframe and told that when they had finished they could break for refreshments.

What proved interesting was the difference we observed between the groups that moved the chairs into the pods and sat in a semi-circle and those that simply stood and clustered  around the walls to work on the task. The latter were out and having coffee a good 10 to 15 minutes in advance of their seated colleagues. The difference in energy, engagement and indeed imagination of outputs of the different approaches was noticeable. 

Research at Stanford 'Stanford study finds walking improves creativity' provides more detailed evidence to underpin what we simply observed.

The design of the spaces we work in is something we all too often ignore. I walked (nope- sidled crab-wise is more accurate) into an Exec's office recently. 70% of space was a single big meeting table with minimal clearance even for chairs. With another 6 people in the room movement was impossible let alone getting up to work on a whiteboard. Nothing like the space below...

Next time you walk into a meeting room make a quick mental calculation of how much of the space is occupied by table and chairs. 

• Do you have to creep in around the edges of the table and chairs to get to your place? 
• How much space do you have to be able to work as a group on a run of wall space? 
• Do you have useable wall space or is it covered in fine portraits of your founders or pictures of your latest building development? 
• Is there plenty of whiteboard space or space to stick instant white board
• Is over 50% of the available wall space available for working on? Are you actually allowed to use white-tak on it?
• Is there a resource pack of working dry-wipe pens, large post-its (not the scrotty little squares or rectangles), bluetack.
• Can anyone send their laptop or mobile device screen to a projector or big screen without wires (Apple TV, AirServer)
• Take a picture of the table before you start, then one part way through the meeting an then one at the end. What do you observe? Not a pretty sight I guess.

Carefully designing space - whether it is for a workshop or in normal meeting rooms - is something we often overlook and yet its impact on the way we engage and think is significant. Are we trapped or do we have room to roam? Are we locked in place or can we cluster? Are we working with uncluttered space or are we sitting around a rubbish tip? Are we giving ourselves the space to be creative or are we restricted by our own physical orthodoxy? 

Poorly designed space is a black hole for energy, engagement and creativity. Tables create table behaviours - even round tables. It is better to have no table than one that has been shoehorned into a space it was not designed for.

So next time you run a meeting or workshop where you want people to work creatively, with energy and engagement - get rid of the tables (even if it means you carry your own screwdriver!). and to the cry of despair 'But where do I put my stuff?' the answer is 'leave your stuff, bring yourself'.

SEPs and SLAs

As we begin the journey of recovering control of our time lets divert for a moment and reach for our copy of the Hitchhikers Guide to the Galaxy.

Somebody Else's Problem (SEP)

The late and great Douglas Adams described the concept of the Somebody Else's Problem Field (SEP).

Within the novel Life, the Universe and Everything of Douglas Adams's "The Hitchhiker's Guide to the Galaxy" his character Ford Prefect describes Somebody Else's Problem as:


An SEP is something we can't see, or don't see, or our brain doesn't let us see, because we think that it's somebody else's problem.... The brain just edits it out, it's like a blind spot. If you look at it directly you won't see it unless you know precisely what it is. Your only hope is to catch it by surprise out of the corner of your eye.

The narration then explains:

The technology involved in making something properly invisible is so mind-bogglingly complex that 999,999,999 times out of a billion it's simpler just to take the thing away and do without it....... The "Somebody Else's Problem field" is much simpler, more effective, and "can be run for over a hundred years on a single torch battery."

This is because it relies on people's natural predisposition not to see anything they don't want to, weren't expecting, or can't explain.

In this case, the Starship Bistromath ("a small upended Italian bistro" with "guidance fins, rocket engines and escape hatches") has been hidden from the crowd watching a Cricket match at Lord's by an SEP field. People may see it, but they take absolutely no notice of it due to the shielding mechanism that does not allow them to view the unique structures of the particular bistro.

Humour aside there is a sound pyschological basis for the SEP field. Whether cognitive dissonance or optimism bias or the perfect solution fallacy we all have blind spots. And like any blind spot we have to change where we stand and how we view the problem to uncover the real dimensions of the challenge. 

Self Limiting Assumptions

In some cases we did actually notice the problem initially but because we did not think we could do anything about it - a Self Limiting Assumption - we devised workarounds that allowed us not to notice it any longer. This is even though the 'cost' of maintaining the workaround is still there in psychological and physical terms and is greater than if we had 'named' the problem and taken ownership of it until something was done about it. Whinging about 'bureaucracy' and not actually getting a grip and doing something about it is a classic example.

In other cases we are not equipped with the correct lens to see through the SEP field. We have no alternative reference points. Again we use Self Limiting Assumptions - helplessness, lack of curiosity, 'We are unique' and 'Not Invented Here' syndromes to blind us to the art of the possible. In this case we have to break out of our singularity and ask ourselves where we might find other analogous examples in other industries or organisations or how fresh eyes might see our challenges and possible solutions. We need to ask ourselves how we can best get a good 'triangulation' on the challenge. And we need to 'have a go'. Nothing ventured nothing achieved.

The solutions are remarkably simple:

• Name the problem out loud and keep it firmly in view - own the problem. 
• Share the problem - rally others to your cause. It is easier to tackle this in company rather than alone. 
• Ask yourself how other people in other organisations might tackle this successfully? You are not unique and there are 1000's if not millions of people who have been faced with the same or analogous challenges. 
• Have a go. Do something about it..what will your first PDSA cycle be? Once you have got through three of four PDSA cycles you will be surprised about how you will feel more in control of the context rather than vice versa. Once you break the chains of SLAs and bring the SEPs into clear focus then you are well on the way to feeling a damn site better about yourself.

But of course you might be really happy on your wheel so why bother...

Knowing how we are doing - the Dyson inspiration

If we are going to find the time to think differently then there comes a natural but oft overlooked question - how do we know that we have succeeded? Lets be honest about this - would you invest your money (or your organisation's money) in a project that could not demonstrate its return on investment both quantitatively and qualitatively? So how often do we as individuals set out to do something differently without considering how we would be able to measure what we have achieved - and indeed demonstrate it to others? 

Here is a question for you to consider. What is the key feature that has made the Dyson vacuum so successful and has been the one that virtually every other upright vacuum maker has adopted? Take a close look at the picture below. 

Of course the technology is important but not earth shattering whatever anybody says about cyclones and bag less cleaners. Nope - its the psychology of the user that has been so carefully handled in the design. Still cannot spot-it? That's because it is so obvious you often miss it. Look again at both of the devices above. They are transparent - you can see the amount of dirt you are picking up - transparent measurement in action. You can measure your success, get that warm feeling of achievement as you see the dust (and in my case the labrador hair) fill the container. Next time you use your hoover - think about how you feel as you see the results of your labours build up. How the objective measure of achievement influences how you feel about the effort.

So sit back and watch Mike Davidge telling us more about Measurement for Improvement. You are going to be your own Improvement Project. You are going to learn and apply the techniques to yourself that you can use in any improvement project.

Cannot see the video because your organisation has blocked access to YouTube? Then do something about it - challenge, kick and sort. I will be talking about Self Limiting Assumptions (SLA) and Somebody Else's Problems (SEPs) in a later post..