SATYAGRAHA – A STORY OF OUR TIME

At a time of resurgence from COVID restrictions, we look at the relaunch of the Satyagraha Opera by Philip Glass, by the ENO English National Opera, on their first day back at their home London Coliseum after 19 months – and look at why this is both an Opera and performance for the moment.

It is a full twenty minutes before I fully understand why it is that people of all ages, aims, backgrounds, ambitions, love being part of the ENO Family, and what is the single thing that draws us all together.

It is not necessarily the music. True, this performance, its direction and delivery, is brilliant, stunning, mesmerising. My two colleagues next to me, the young lady with her teenage daughter are spellbound – they described it as “resonant” – and the introduction itself had rich luscious vocal lines, even though this was no Verdi. But it was the moment when the full chorus, from somewhere in the shadows suddenly came alive and you got this fabulous wall of sound. It was as if we had all been waiting for this, and it did not disappoint.

The depth and intensity of the desire to communicate – the continual hypnotic orchestral themes and continual variations of time signature – left me uncertain, and the hesitating steps of the protagonists on stage, as each carried their own line of music and text, was confusing.

But that did not matter. This was ENO saying; “look, we are here for a reason. Nobody smiles in this ‘Satyagraha’. We are taking a solemn story and winding it around new dimensions and images in ways that you might not have seen before. And we know how to do it.”

The girl in the interval, told me that there have been some preparatory sessions, to explain the thinking behind the staging, the strange larger than life puppet characters, etc. And I can understand the need for that. I spent the first two Acts unsure of what was going on, sitting on the edge of my seat, sometimes – particularly in act 2 – actually scared. Did I really come to the Opera to be scared? And simultaneously intrigued, drawn in.

They say that “Satyagraha” is what they call a “marmite” opera; you either love it or hate it. And talking with members of the audience generally, that division is still there, The complicated story line and topics it is trying to explain, create a sort of Bach on steroids musical structure, or a Big Burger with nineteen different layers, there is just so much going on.

And there are so many clever aspects to communicate. The key points are brilliantly highlighted by the very clever use of Newspapers from the time, that assemble and re-assemble to form impromptu screens that display key words on stage as we go. The symbolism of frankly everything is just too much for one evening alone, for an average opera goer who just wants a night out with some music.

But that itself misses the point. To deliver this sort of cohesion and perfection requires absolute singing and musical quality and I am not going to single out any particular artist or group. It just all works.

Or maybe it doesn’t. Maybe this is simply the formula, perhaps redolent of when I first saw “Two Boys” with Mary Bevan, that I first understood ENOs prowess with modern opera. But that too is unfair.

This “Satyagraha” is an opera that reflects a different age of how we communicate themes that are as relevant today as they have always been. Did I like it? No, I don’t think so. Did I love it?. Absolutely!

IS HEALTHCARE TOO COMPLICATED? AND WHERE DOES THE PATIENT FIT INTO ALL THIS?


We look at the increasing importance of Informed Consent as the key driver for delivering a better patient experience and better healthcare overall.

It is a truth universally understood, that if you ask any Director of any UK Hospital as to what drives him/herand their Team to go to work in the morning – it will be “better patient care and outcomes”.

And yet if you ask those same Directors as to the yardsticks that govern his performance – the concept of “a better patient experience” – will be nowhere nowhere near as high on that list.

In a digital age of tick boxes, financial targets, “transformation”, etc you could argue that the provision of healthcare, is a contradiction, and that somewhere, a long time ago, the practical focus on reassuring the patient from the start, plus the subtle mental and wellbeing improvements that this in itself creates – has got lost over the years. We are victims of the buzzwords and where clever tech is often felt to be driving in the driving seat when healthcare requirements should be digitals’ master, not its servant.

Patrick Chapman looks at me intently across the table. Fractional Chief Marketing Officer at EIDO Healthcare, Patrick himself is a contradiction. He is dressed in a pastel-coloured rugby shirt, built as a prop-forward 2nd row, but has never played a game of rugby in his life. I am expecting a slow delivery of answers, but his words are urgent, already well thought, almost invasive. He drinks a glass of water.


“Informed Consent”, he says – “is central to the patient experience, journey and procedure outcome itself . It’s a shared decision-making conversation (a continuum not one-off), and it reassures the patient that they are in good hands throughout, and they know the alternatives, risks and predicted outcomes”.

And yet the birth of EIDO, as a young start-up 20 years ago, could also be described as chance – the insight from one of its clinical founders that “I need to have something to inform the patient”, is similar to so many UK based healthcare start-ups.

This wasn’t and very definitely isn’t a tech company playing at healthcare. Yet the difference between EIDO and so many others, is that EIDO have maintained and extensively that singular focus throughout their journey from UK centric single paper driven solution paper – now with fully digital delivery as an option, and is global in its outreach. They supply a vast range of procedure specific information, all of which created, peer-reviewed and regularly updated by speciality specigic medical professionals. EIDO remains a medical and clinical company, embracing technological delivery, not being driven by it. Content rightly remains King.
And yet – whilst, – as Patrick continues “no patient has ever said they value the integration process” – the fact that EIDO already integrates with most other systems, itself is an increasing benefit with “collaboration” and “interoperability” key NHS tenets.

We continue talking. The discussion has become less fluffy, so to say, more commercial, and we move into the comparison of costs versus value.
Patrick says; “there’s essential importance in a truly informed consent process to the patient, but also to the hospital, with often faster recovery with patients taking advice re their pre and post procedure health and habits.,
There’s is also the upside for the hospital in mitigating and reducing risk of the procedure going wrong. Litigation payouts by hospitals using EIDO content, are some 25% less than those that do not.


The decision by EIDO to be resident at this year’s HETT Conference, in September at Excel London – is part of this growing reach-out, to make EIDO directly to Trusts and hospitals and integrated into technology system providers who’s products cross patient journeys where consent conversations ensue.

You could argue that the global focus on “digitalisatIon” takes EIDO way from its roots.
Patrick does not answer this question directly, but his answer is to the point; “no – we already know the benefits of digitalisation and it is a journey we are embracing – but ‘ content not digitally led is the constant ethos’ and we know that patients appreciate this as despite the pandemic increasing (and speeding up) digital adoption, the majority of hospitals are still far earlier on their journey of digital transformation than people realise. Patient well-being shouldn’t be needlessly complicated and it’s vital we avoid patient disenfranchisement by only offering digital solution many still can’t engage with.”. We run the risk that a digital system step forward could be a step backwords for what should be informed consent best practice.


I sense this is the end of our time together this time. The waitress is hovering and there is only so long you can drink a continual flow of cappuccinos. Patrick is still sipping – but I have a train in 5. I pick up my Notes. “Gotta run” I say.

IS DTX THE NEW PLACE OF LEARNING?


As things apparently return to normality, and we start doing proper face to face trade conferences and I could go on – is it time to realise that there is no more a sense of ”normality”. Has the upcoming DTX and its focus on all things “Digital” become a place of learning, and not a place of selling?

Of course it is a place of selling. There are people called Vendors, and people called Visitors, who would not be there if there was not some sort of commercial benefit to both parties. But there the similarity ends. As we all emerge from nearly two years of COVID enforced hibernation, the one thing that is clear, is that nothing is clear.

Sure, we have heard of digitalisation – but there is little consensus as to what that means or what it can guarantee to deliver. We know that “transformation” is a Good Thing. But why is this simply restricted in people’s minds, to technology? At a time when people are rejecting to go back to the commute driven road to work – where do people come into all of this?

What people do clearly need is not information. You and I need a RoadMap. And that’s why I shall join the queue and go spend a day at the Digital Transformation EXPO, at the beginning of October, in London. If the key benefit of this Conference is one of difference – a new way of looking at things, – then this also extends to the choice of key speakers, with investigative journalist Louis Theroux, and Adam Steltzner, fresh from NASA JPL to give me their take on where all this is going.

How so?

Because I am confused by the sheer pace of change. And I want to hear from others, how they solved this bridge into a new future that I am not sure I really “get”. I understand why DTX segments itself into little bubbles of “Cloud based security”, or “AI new advances”, and I could go on. But I believe the real benefit is the mix of experts, and as DTX promises, the opportunity to “exchange ideas with the best in the business”.

This is important, because the concepts mentioned at this Show are hardly new. One of the biggest problems in AI, for example, is that people have heard of AI before.

What people have not heard of however – is how others have used their technology and delivered outcomes that in some cases have been stellar – or have simply not worked. This equates with what we have found in our own research, that technology per se means nothing unless there is a human benefit.
I will listen to the anecdotes as much as the tech. And as any businessman knows, the chat in the coffee queue is often as valuable as the stand out presentation.

So I will learn a lot. The only question is – I just don’t know from whom.

NEW LAWYERS. TRANSFORMATION OF A PROFESSION

The subtle movement and shift of emphasis from today’s lawyers into Business Partners and strategic advisers – has changed the view that we have of them – and them of us. The question is; is this a difficult sell?

Nora Teuwsen is looking at me across the screen. She is dressed in Swiss minimalist chic, dark grey modern clothes, long auburn hair. As former General Counsel for Swiss Railways, and surrounded by the financial areas of Zurich, she is well placed to make a perceptive judgement.

“It used to be”, she says. “But now, Corporates are waking up to the fact that their in-house Lawyer is also a modern facilitator”.

Like so many young lawyers starting out, Nora had little clue of what a legal profession entailed. Her motivation had been more a belief in justice, integrity, that she still regards as valuable of all skills to have. What she was not prepared for in those early days – was the lack of client contact, and to work out and discover an understanding, that her preferred role was one of explanation, to explain the “why” things need to be so.

She is calm but animated in her delivery, you can see the entrepreneurial spirit that is driving her responsibility to take her client on a journey. The legal background has no longer become the prime reason for being retained, it is the structure of thought that can open other commercial discussions.

It is no surprise that after 15 years with Swiss Railways, it was obvious that the next step was to create a vehicle that could embrace all of these attributes and competences, into one, that could be offered as a package so to say.

What she says is; “companies are underestimating the value of their legal department”, and in many ways that department needs to be courageous in pushing for creative and pragmatic solutions which are taking into account the company’s strategy and focussing on longterm value.

Nora continues: “The role of the legal department is expanding. Areas of sustainability, social responsibility, are becoming the go to areas of importance for corporates of all sizes, and the legal department can assist in handling that interest.”

It is also a focus on use of Data. Surprisingly, Nora is not convinced by use cases in Artificial Intelligence in the legal industry. There is a great transformation going on, but so far, results are limited. So far, it has not come up on her radar as a priority.

The “BeyondLegal” Boutique Firm, Nora’s brainchild – from a single Zurich base – is already international clients. “What we are trying to do, is build a network of like-minded legal professionals. We live in an international world”.

I turn off my screen and take a moment of reflection. In a technology driven marketplace, human values are still the bedrock of our corporate growth, which we always had but somehow had been forgotten. Some things remain the same.

IS DIGITALISATION THE SUICIDE NOTE OF BUSINESS?

We look at SEO and the epidemic of digital solutions in Biz Dev, and ask; are we missing the point here?

I have a colleague, who is Head of Procurement for some large areas of Scandinavia. And what he says is this; “Richard” – he says – “ I have deliberately stopped answering any emails, or any calls, from anybody I do not recognise. If you want me to talk to any of your people, just let me know in advance and I will put their number in my personal contacts.”

In the same way that the freedom of the internet has given us multiple information choices that should have given us a broader outlook – and the reverse has been true – that we only focus on those news feeds that say the things we already believe, – and made worse by algorithms that proactively feed us those restrictive views. So – the same is with SEO and all things digital.

We can now reach out to anybody on this planet. But so can everybody else. Which means that the people that we need and want to talk to – for our business growth, our customer service, etc – have long since made the decision not to be available, at all.

What that means is that, far from being simple to grow a business by finding a person who we do not know, and just giving them a call, has now become more than four times as long and four times as expensive, and now involves, pre-sales people, post-sales people, all manner of IT support and analysis, to do what used to be the straightforward and simple task of just phoning a friend of a friend.

But what is worse, is that this has given acceptance and justification, to being proactive in not making human contact possible at all. Woe betide any receptionist who passes on yours or mine contact details!

This means that both sides are the losers. Vendors of great solutions give up, because they cannot support the increasing drain open their marketing spend. And Corporates or our Public Services continue with their outdated practices because nobody has been able to show them otherwise.

If COVID restrictions have taught us anything, it is that human nature needs human involvement, and yet we seem to be travelling at warp speed in the opposite direction. It is as if we are scared about the whole process of actually talking together in a business environment, or being”sold to”. How terrible.

In our own business here at Profomedia, we research a lot and are continually building personal relationships. Whenever we want to find out something, we reach out and phone someone we already know, – who then introduces us to someone who we don’t.

There. It wasn’t so difficult, was it.

DIABETES MANAGEMENT FOR ALL PEOPLE WITH DIABETES

As part of our series of Case Studies for The HETT Show (www.hettshow.co.Uk) – we look at the rise of the Nipro Diagnostics company in Diabetes healthcare and ask, – from a standing start (with the new 4SURE portfolio), in just a few years, has their time come to be a major UK player?

For many people like you and I, the realisation that many people with diabetes do not have their condition out of choice, is a hard one to accept.  And yet its management requires a complex understanding.  

Let’s try and set the scene. In the last 10 years, the cost of treating Diabetes in the UK, has almost doubled. Looking at it another way – some 13% of all the NHS spending, is diabetes related. It is the largest slice of spending in the NHS cake.  And for type 2 diabetes there is no shortage of blame. Everything from the UK government’s lack of practical steps – through to you and I for eating the wrong food and an ever increasing sedentary lifestyle . 

Or maybe, there is no blame? Maybe, despite the fact that 10 years is a long time, and long enough to change both personal and NHS day-to-day processes, is it only now that we need to take a deeper look?

Is it therefore time? Time to reassess, and look again at what do we really need, now, to bring the diabetes epidemic under control and into the 21st century with technological advancements?

10 years ago, and with a Nipro global headcount of some 29,000 people – the NiproDIAGNOSTICS company was not a known player in the UK. Two years ago, they set out to furtherfocus their attention to help people living with Type 1 diabetes, by launching the 4SURE range of glucose meters and partnered with the revolutionary Diabetes:M App. With the aim of being the single one stop shop for every person requiring blood glucose monitoring, Nipro set about bringing into a needy market, a combined process that was affordable for the NHS, and easy to understand for you and I.

Tom Atkinson, Country Manager of Nipro Diagnostics UK, looks corporate cool – with a fashionable soft northern accent, dressed in an open white shirt, he leans into his screen and talks fluidly about his Insulin Pharma background, and the wish to be part of a complete solution. 

“What we understood from day one, was that we have to work the same way as our patients. They don’t want a meter that the NHS cannot afford; they want one with Bluetooth connectivity.And they want an App, which has got to be their Dashboard – everybody wants an App. Our big plus is that access to our new innovative technology, is obviously free, along with the Starter Pack from their diabetes clinic – which includes their initial consumables.”

We talk about the pandemic. It is an irony that, at a time when the NHS and health service provision has been desperate for so many – the essential acceptance overnight of remote diagnostics and monitoring by NHS nurses, has been a game changer for the better, for Nipro. 

“Clearly, we had not forecast a pandemic”, continues Tom, “but it was obvious that it was only a matter of time before common acceptance and a desire for remote diabetes monitoring. What has helped, is that our meters have an accuracy rate of 99.3%, and we are the fastest growing provider of diabetes solutions”.

The corporate ethos of a sales pitch is creeping into the discussion, and I don’t have a problem with that. What is equally evident is the pride of helping the ordinary person with diabetes, just being available, at the end of a phone line if a patient needs help or advice.  But that does not address the basic issue of human behavior. A diabetes meter can only be reactive to a patient’s condition.

Not necessarily. By giving the patient an affordable, information-driven, platform to manage their condition, patients themselves can change their lifestyles armed with the facts and see the benefits of their condition improving by relating to their life choices.

Tom interrupts; “yes, this is true – we are “part” of the solution – but for the patient, we are the major part – as it’s our technology they are using every day and we are the link between them and their own clinic or doctor, as we are providing the vital remote monitoring bridge to keep a patient in touch with their HCP so they can monitor their glucose levels remotely in real time and change their medication and other variables, there and then, if needs be”.

The focus of the discussion goes back to that of patient-provider relationship. “We don’t want diabetes to be the affliction for everyone – but we do want to provide the all-embracing solution for those that need it”. Tom looks at his watch. We have been engaged in academic discussion for nearly an hour, and it is Friday afternoon, end of July. He is taking his family on holiday. 

I closed my screen and take a moment of reflection. Innovation is not necessarily about technology. The patient also has a role to play. The Innovation at Nipro is the approach, taking the fear-factor, the newness, and combining it to tech that simply delivers, and communicating that to the person in the street.

INNOVATION AND THE COMMON MAN! YES, WE CAN NOW TALK FACE/FACE WITH THE PEOPLE WHO PLAY AN IMPORTANT ROLE IN THE DELIVERY DIGITAL INNOVATION.

We give a long overdue and welcome to the upcoming HETT Show, taking place on 28-29 September, at the Excel London, as an essential platform for our UK digital healthcare providers. 

The HETT Show (www.hettshow.co.uk) – as the Uk’s leading health event, opens its doors in a couple of months. The HETT Show is one of the first serious events to greet us all, in person, and it is like when you have to hand your courtesy car back at the end of the day when your usual vehicle is being serviced. “No, I don’t want to go back to my old car, thanks! I prefer the new shiny one you lent me instead.” 

Because – let’s face it – face-to-face events are the perfect place to gain insights and network. We miss the being there. And now we are back. Yes, we can indeed keep the courtesy car with the new number plates, after all. We can now justifiably drive off, and talk about Innovation.

HETT believes that innovation is the sauce that will empower the workforce in our hospitals and surgeries. The Show promises to herald a “new era of transformation”. And indeed it may well do so, for two surprising reasons. First, we are indeed, so fed up with the isolation of the past 15 months, it was fun in the beginning, true – but not now. And second, the success of any Innovation roll out, depends on precisely this, the motivation of the individual, to get up and actually “do something”.  

It is a realisation that if Innovation is to deliver for the common man, the patient, then this is not a technology process, but a human experience process, that involves all of us, at each individual level in the workplace. And for that single reason, HETT has a unique advantage, it is first, in bringing us all together. 

Over the past year and more, there have been significant differences in quality of care and even interest in delivering quality care, geographically throughout the UK. We see HETTshow (www.hettshow.co.uk) as an opportunity to re-examine where we are, and to meet people who can help this journey. 

We will be publishing a Series of Case Studies of those Hospitals and Surgeries who have made Innovation work for them in the past year, despite all the odds. At a time when queues and delays for procedures are at an all-time high, this is a clear moment to get back on track.

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DIGITALISATION; HERE’S AN IDEA YOU MIGHT LIKE!

Does success in “becoming digital in our workplace” mean we are all techies?”  We interview Katie Trott, Chief Nursing Information Officer at the Royal Free Hospital, Uk, fresh before her HIMSS Discussion on 8th June, to see how they do it at her Hospital.

I am sitting in my office – I pick up the phone, and I call Katie’s Hospital, and the Reception immediately connects me, there is a sound of some children in the background, and then I realise – Katie is at home, this is her mobile line. 

“I’m sorry”, she says, there is a hint of amusement in her voice “I have the kids at home”.  No matter. And so I get straight to the point – you have been responsible for some major large clinical tech initiatives in your past – does this mean you have a technical background?

“No, “ she says immediately. “But I do know how to wire a plug”.

This is all going well.

So we start again, and you could say it gets worse. When Katie started in the NHS as what  was then a Nurse Auxiliary, at 16yrs old – there was no discussion of technology per se for people at the front line. Patients were patients and treatments were treatments. Katie’s background is clinical. It just so happened, like so many chance encounters in life, that she was rather good at explaining to patients and colleagues “what was going on”.

This facility to communicate, to bring things back to their essential levels, has been the secret sauce of what – looking back – has been a step by step process over the years, ie, the innate ability to communicate benefits and to lead others into new pastures. As clinical care has inevitably needed more and more clever toys  and cool IT, so somebody has to engage with the people who have to make it all work. At the Royal Free, under her direction, they delivered a new EHR in just 11 months.

Katie is self-deprecating; “I was just in the  right place at the right time” she says. “We sort of made a decision that we need to do this or that, and then sort of figured it out as we went along”. Clearly this is not true – but what is standout is the motivation to go forward – even though at the time, you might not be sure of what that “forward” can actually deliver.

And it has created some changes in attitudes.

“When I first got into delivering digital or clinical solutions, the mindset was definitely that “big is better”. If we want to do something else, we just got some velcro and stuck on a new module”. But our view now has changed to  scaling down, and adopting “best of breed”, a sort of FHIR approach, for the specialist areas that have specific needs.”

Katie continues; “Perhaps I was naive, but I remember when I first started, I thought that fast means better, that you just plug new solutions in. But over time, I discovered the benefit of taking it step by step. That testing and safe empowerment is a process. Sure, we can plug it in, – but everyone needs to be involved before we go play”.

What it seems is that there is a shift in areas of influence. The clinical demands of patient delivery , are becoming the driver of the IT requirement, as opposed to the other way round, And that IT per se, may not understand the clinical needs it is trying to address.

Two things are  becoming clear – and that tie in with what we have seen from other NHS Leaders that we have talked to.  That success in digital delivery, depends on the individual, and not being scared of appearing to be the idiot. It is a phrase that Katie uses a lot in our discussion – and  also the recognition that we are every day in a brave new world, and we have to sort it out.

It is time to end our discussion. We could talk for much longer, but Katie is at home, and there are noises in the background.

THE PURSUIT OF EXCELLENCE

We talk with Dr Minesh Patel, Partner at the Moatfield Surgey in the UK, and ask – how come they are so good at delivering healthcare for the common man?

Why is it in the UK NHS, that there are good surgeries, and not so good ones, and well, rank awful ones? Why are some standout – and others not so? If human nature is a common denominator, why are there not a set of standard rules, a sort of “go to guide for repairing a surgery”, a recipe book for getting it right, that we all can apply, and that’s job done? And if human nature is indeed the common linking factor, – does this explain why some surgeries are so terrified of change? And others embrace it.

At a time when “innovation”, and “digitalisation” are this year’s buzzwords, can these be imposed by some higher authority – “look, here’s some money, go and start this or that process?” – And if that is the case, then why do we not all have standout surgeries?

The answer is that my human nature, is not your human nature. In short, the success of a surgery, depends on the individual, and the mix of individuals, in each case. You’ve got to “want” to be innovative, to deliver excellence. The only question is whether this is nature at all – or nurture, can we “learn” to be innovative?

Minesh Patel hesitates as he answers this one. In his case, there was never much choice. His father was a doctor, his own daughter is a student doctor, so this is a family tradition so to say, The choice of working in a hospital, or running a surgery, was the freedom to improve and innovate given within a surgery, but it was a journey, taking in improving PCT performance, being Chair of a CCG, leading the clinical strategy development of a developing iCS, before settling and developing the Team at Moatfield, in East Grinstead.

Minesh readily admits that he cannot change or improve everything. Sometimes, the structures themselves do not lend themselves to change. And health inequality from one region to another, one person to another, is a life reality. Having said all that – is there a “process”, an attitude of mind, that is the difference , and what would be the roadmap for other surgeries to follow?

“The answer is little steps, all the time”, answers Minesh.

“At Moatfield, we have a daily huddle, we analyse all of our processes, and we act quickly. Our new website took just 4 days of re-tooling. We are not afraid to act if we believe in something” Minesh uses the word “innovative” a lot. 3 years ago, he became Chair of the National Association of Primary Care (NAPC), which he says has brought him into contact with a lot of like minded and talented people around the country, both within other surgeries and other providers, who are beacons of excellence, and who are learning from each other. It’s a case of seeing “what are the neighbours doing”. so to say. But it is also visionary.

Although we are talking about the daily routine, there is a focus also on the wider picture, why can’t we do things in a different way.

We are getting ahead of ourselves in the discussion.

As if on cue, I look at my watch – we have been talking for 29 minutes. “I’m really sorry!”, Minesh says…. “I have a patient call in a minute”