'Nakamura invented the light bulb'

Would Nakamura invented the light bulb if he was working in the NHS?

Nakamura invented the light bulb, that is what we might probably say one day, that Nakamura invented the light bulb or to put it correctly that Nakamura re-invented the light bulb. Shuji Nakamura's inspiring story has been told before but here is an ultra-short version of it

Nakamura gets a masters from a relatively small university in a small city in Japan, goes off to work in a small company in a lab competes against the big companies, discovers many right things and makes products that would not sell.

Times get difficult, his department shrinks. He goes to his boss and wants to make a product that the big boys have tried to make and failed; with his record, he gets turned down. He goes to his boss's boss and gets some support to make it, despite his record of making nothing that sold, his company chairman gives him money, $2mil actually and he reinvents the light bulb. Well, he actually gets the blue component of the LED to work and the rest is history.

What is interesting is that Nakamura was a non-PhD working in the industry as a lab scientist who then gets a doctorate from his local university and within 5 years is head hunted by University of California and becomes a professor.

Nakamuras in NHS?

Let us imagine a scenario of a doctor who becomes a consultant in a DGH in the NHS and wants to do something that the big boys tried and failed.Then the DGH consultant fails as well, fails repeatedly - what are the chances that he will not be performance managed out of his/her activity and driven to the end of his wits.

What are the chances that the medical director or CD will be over-ruled by the CEO or Chairman and a doctor provided funding to carry on despite a record of 'failure'? What are the chances that even after this doctor discovered something interesting a big place will head hunt and make him/her an 'academic'? In fact he/she should be grateful if the GMC and the rest of the regulation did not land on him/her and crushed him/her out of existence.

Getting real

Now a lot of you are going to say that reinventing a light bulb while surely profound is unlikely to involve any damage to real human beings. You might say that any lurking Nakamuras in the NHS if supported could end up hurting patients. Good logical argument. Is that what is really hurting patients? Probably not. It is not any innovation by enthusiastic people that harms patients, it is the bureaucratic nay sayers who use the language of clinical governance and risk yet know very little about process capabilities, refuse to learn shared baselines, practice unimaginatively poor leadership who perpetuate harm in healthcare. They refuse to fix the system instead try to 'fix' the people in the system. Of course the medical profession does not do itself any favours by its ego, jealousy and macho attitude which will aim to shoot down anything that arises outside its hierarchical constraints by treating them as bad apples and recommending the use of evidence the origins of which  can probably attributed to the Abilene paradox.

In healthcare especially in the NHS it is pretty much impossible these days to take an extra breath without CD, CG, R&D, GCP, LREC, NREC, NICE, and every other alphabet in the soup wanting to spoil it for you, while claiming to support you. It is when people who are typically NHS managers and every other hierarchical bureaucrat stops behaving like researchers and most doctors who are not researchers begin to look at operational evidence as a valid method of creating a new practices, innovation and improvement that healthcare will be truly successful.

Allowing and managing 'Nakamuras' in healthcare is not easy but will be rewarding; eliminating the healthcare 'Nakamuras' will allow the managers to sleep peacefully but might push true healthcare innovation into a coma.

If you know of any 'Nakamuras' in the NHS please let me know by leaving a comment below.

©M HEMADRI 

Follow me on twitter @HemadriTweets

Links & reference
The dream of the blue laser diode
http://engphys.mcmaster.ca/undergraduate/outlines/4e03/Nichia%20%27s%20Shuji%20Nakamura%20Dream%20of%20the%20Blue%20Laser%20Diode.htm
Time magazine short feature on Nakamura
http://www.time.com/time/magazine/article/0,9171,1604891,00.html

Bad Apple Theory in healthcare

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We know how bad apples can spoil the barrel, i.e. negative members can cause dysfunctional groups. I came across Will Felps work on it, will be very interesting to check out.

Felps et al say that there are 3 types of ‘bad apples’ (negative member of a group)

- withholders of effort

- being affectively negative,

- interpersonal deviants (violating important interpersonal norms)

They then go on to describe the groups responses to the negative member as

- motivational intervention (changing the negative person’s behaviour)

- rejection (removing the negative person)

- defensiveness (protecting one’s own self)

Felps says that ‘Each of these three responses have a common foundation; the desire to improve an aversive experience, but their intention varies’ as mentioned in parenthesis above. They  say that if motivational intervention or rejection were successful then a negative member never becomes a bad apple.

The work is mainly analytical rather than aiming for any resolution of the issues but they do touch on how the bad apple effects are moderated by determining perceived impact severity –

(1)    intensity of the negative behaviors exhibited

(2)    the group’s interdependence,

(3)    whether outcomes are successes or failures,

(4)    and the team mates’ coping abilities.

They also talk about the group’s ability/inability to cooperate and how low power groups looking to leadership to resolve the issues.

Here is the interesting radio link for an introduction to the work http://www.thisamericanlife.org/radio-archives/episode/370/ruining-it-for-the-rest-of-us

This is the link for the full academic paper http://books.google.co.uk/books?id=RKkxJnn73UoC&pg=PA175&lpg=PA175

My short commentary:

While the bad apple theory is very attractive I would reflect on whether the 'bad apple' behaviour and effect is topic dependent or person dependent. It is possible that a particular topic brings about a genuine principled disagreement from a team member who is so affected by the inability to influence the team hence shows 'negative' behaviours resulting in negative effects. History is equally full of examples where entire groups and even nations have been wrong and at that time any voice of wisdom would have been identified as a classic bad apple. A 'bad apple' in one topic might be the best bet team player on a different topic. However, the negative behaviour may not be topic dependent but entirely person dependent; this brings to fore a new set of issues on why such a person was employed or brought into the group; if the behaviour is recent/new an exploration of the team dynamics that brings forth such behaviour from individuals would be worthwhile.

I also caution that sometimes 'bad apples' can be early lone warriors too. These often tangential maverick thinkers and doers are also important for any societal or organisational progress.

Felps description of the 3 types of bad apples and the 3 ways in which groups respond to negative members are certainly seen in healthcare including amongst clinicians. The peculiarity with healthcare arises from the need to practice evidenced based medicine in the face of lack of good evidence by these precious resources called clinicians. This conundrum is compounded by rigidly hierarchical structures and high regulation in healthcare posing very unique and highly complex leadership challenges. Bad apple behaviours and effects as described by Felps are very naturally observed but allowing it in healthcare or dealing with it by either motivational intervention, rejection or defensiveness as we may be currently doing is likely to have as yet not understood exaggerated negative outcomes. Throw in the highly individualistic style of practice amongst doctors and mix becomes even more unstable. That cannot be good for healthcare.

Felps does not attempt to resolve it, quite rightly so, as this is more complicated than it seems.

There are times when system issues would be exhausted and a purely personal behavorial issue remains. The problem comes when bad apples do not recognise themselves despite well meaning evidence and advice. More worrying is when they recognise it within themselves but fail to acknowledge it - that will be breath taking arrogance usually leading to a big fall.

In democratic groups, due to its political nature the NHS could be called a democratic group, the success of the majority is judged by how well the minority is treated and a quote misattributed to Voltaire is 'I disapprove of what you say, but I will defend to the death your right to say it'. Perhaps these apply to the ‘bad apples’ as well. Real life is full of very mixed people, we could disengage (easy option) and lose valuable opportunities to develop ourselves. We could remain engaged and learn a mature way of thinking. Whichever we chose it will not be easy.

©M HEMADRI 

Follow me on twitter @HemadriTweets

  My mini e-book 'Standardised Management Conversation' is available - click http://www.amazon.co.uk/Standardised-Management-Conversation-Hemadri-ebook/dp/B018AWBJTU