Tuesday, 14 July 2015

Cutting through the myths: NHS Scotland and QUBE by Mark Blayney

18 months ago, NHS National Services Scotland embarked on a change plan called QuEST. This created eight core objectives for new ways of working, one of which was innovation. It was decided to use QUBE to set up a steering group to see how an innovation framework could be developed.
     There were several reasons for using QUBE. The first is geographical spread – people based all over Scotland are involved, and travelling times can be extensive. Added to this there is job spread; clinicians, operations managers, and other people who might not normally communicate with each other frequently, if at all. And thirdly, the NHS is under pressure to use space more economically. Office space is at a premium and managers are encouraged to find other ways to meet. That space can be hard to find; so QUBE offers a solution.

“We are made up of six distinct business units that don’t have much to do with each other,” says Dr Tammy Watchorn, Head of Service Improvement & Innovation
in Clinical Directorate, NHS National Services Scotland
. “None of the team knew each other and we wanted to test the environment.” One of the problems with meetings can be getting everyone organised to be in the same place at the same time. "With QUBE we use ‘drumbeats’ – you set the time and place and it happens, regardless of whether everyone shows up or not. If they don’t attend, we can update them later; all of the work done is on the whiteboards for them to see. After eight weeks we had a framework that built trust and quickly felt like a natural way of working. We presented it to the executive team, who were impressed enough to give approval to further projects after the pilot using QUBE.”

“You’re talking to an older user, and I’m not a particularly tech-savvy person. I thought, if I can use it, then anyone can!”

Generally, there are two key challenges that can inhibit take-up; one is cultural, and one is technological. The cultural issue is that it can be hard to explain QUBE unless you try it out for yourself; and there can be resistance from people if they think it’s merely a sophisticated version of conference calling. “Once people have tried it, however,” Dr Watchorn says, “they quickly convert. I don’t think there’s been anyone who really hasn’t bought into it.” Technologically, the NHS is a huge organisation with different directorates, and some were more positive about allowing the new technology past the firewalls than others.

“So it would be wrong to say there were no teething problems,” says Fiona Genasi, Nurse Consultant in Travel Medicine for Health Protection Scotland. “But once everyone is there together, the possibilities QUBE offers become clear.” For example, several of the contributors to the project agreed that the necessity of face-to-face meetings, as opposed to meeting on QUBE, is actually something of a myth. “The CEO of NHS National Services Scotland visited the team on QUBE,” Fiona says. “Because of the ‘spin casting’ – where you go round the room and everyone has their say – people said things that you’d never dream of saying in a formal setting. For many of these people it would have been the first time they’d been in the room with the Chief Executive.” Jane McNeish, Senior Nurse Epidemiologist for Health Protection Scotland, agrees. Face-to-face is good, of course,” she says, “but actually QUBE brings some significant advantages by actually not meeting face-to-face.”
Another myth is that the technology will not appeal to the older user. “You’re talking to an older user,” says Jane, “and I’m not a particularly tech-savvy person. I thought, if I can use it, then anyone can!”