Matthew Syed. Black Box Thinker

Oh dear. Too many quotes, too quickly at this particular Roy Lilley NHS Health Chat event.  Matthew – I apologise already if I misquote you – especially as you are a journalist. (Journo’s never misquote, I am told).  So scary.  Usual health warning – as ever, this will be my views of the evening. If you were there, or watching the event live, on the Periscope feed, or the whole thing on You Tube link, then I apologise.  (You Tube link herePeriscope is easy to add to mobile devices and computers – and now you don’t need a Twitter account to get it)


…and so, it begins

I didn’t really expect so many sound bite quotes from a table tennis ace, of Pakistani and Welsh decent, who left school very early to pursue the love of sport, then taught himself “A” levels, went to Oxford and got a job as a writer for The Times by phoning Directory Inquiries and phoning the sports editor directly.  Not a lot surprises me except that sort of powerful self-belief, when it actively works.  Matthew doesn’t seem to know no as a concept.  Or “You can’t”.

He continues to be enlivened by sport. “Sport is a very broad canvas.  It is the tapestry of life.  And it has beauty.”  There you have it.  This is a man who not only showed impeccable emotional intelligence during the session, noticing when his metaphors had gone too off tangent for much of the audience, and redesigning them so we got it, but also showed and shared an awful lot of passion.  His own and other peoples.

(He had to rush off, as a working journalist, to write a piece on the passing of Carlos Alberto, who scored one of the best goals at any world cup, in 1970, for Brazil.  And he did so impeccably.) (I would normally say “death” not “passing”.  But if you watch the goal on lone from the 1970 World Cup, you will see why I chose the word…)

Roy and he agreed about Positive Deviance, and about sharing, and about learning from things that go wrong.  Matthew was quite outspoken about the reticence to be open in Healthcare – I felt he felt it worse than most professional environments?  Get the culture right, and you create success.  Roy begged to differ.  “You can’t change culture”.  I got the impression that they agreed that some things could be changed – there may be Marginal gains (like Sir Dave Brailsford and the British Cycling team) or big, disruptive change.  It doesn’t matter what we call it, guys, but if the atmosphere changes and the positively noisy angry individuals keep at it, we will get both marginal and major disruptive change.  I don’t care if you call it cultural change, micro or macro change, learning from failure, sharing, openness to change or whatever….just do it and stop trying to define it.  Not is a word that does’t help us move on.

How do we create high performance change?  “You can’t improve your golf in the dark”  Great metaphor.  Let’s switch the lights on!  That means valuing whistle blowers?  I think so.  We need to get beyond self justification protectionism and Group Think. (Please find out more about Group Think – wiki link here.  Janis will make you think differently…).  Continuous Improvement culture, openness and collaboration and the underpinnings of positive change.  And sharing.  We know we are not already perfect.  So that means trying to do things better.  Always..

You need data too.  And root cause analysis.  Central line infection caused 45 000 deaths per annum in USA.  Analysis showed that not sterilising the catheter site was the root cause.  Change in procedure – and the infection rate became zero.  It sounds like many people may have died unnecessarily whilst professional testudo was in place?  “These infections are due to a complication of the procedure itself”.  No, it wan’t it would seem.  I wonder how many things are going on today that this sort of knee jerk circling of the wagons, group think and not listening to voices of concern, is preventing better patient care and outcomes?

So, a few more quotes:

“You cannot create high performance through high blame”

“The organisations with the strongest learning culture have the best balance sheets”.

“Healthcare has real difficulties with senior people not admitting their mistakes and becoming defensive”

“We need to create openness to track unintended consequences”

Yes, if we change the model, if the noisy ones can stay noisy (and keep their jobs), if we are not threatened by our mistakes but use them to improve, we may get the behaviour change to keep happening.

One last thought from me?  What if we banned gagging orders from compromise agreements between Trusts and whistle blowers who have been pushed out?  Or at least, the Press Release must say “There is a no comment order attached to this case”.  Then the Press could speculate.  And I bet the Trusts would be more open, because the speculation is likely to be wilder than the truth…