Archivi Categorie: Leadership in Medicina

HTA in Italia: pessimismo dell’intelligenza, ottimismo della volontà

Il 24 ottobre scorso sono stato invitato da Giovanni Morana, dinamico direttore della radiologia dell’ospedale di Treviso, ad un convegno sul tema della TAC Dual Energy. Il programma prevedeva una parte dedicata a questa interessante tecnologia ancora in fase di sviluppo e ricerca e una dedicata all’HTA.

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L’incontro si è tenuto all’Ateneo Veneto, una fondazione istituita da Napoleone dopo il disfacimento della Serenissima Repubblica di Venezia, in uno splendido palazzo a fianco del Gran Teatro La Fenice.

Per un accidente della storia, il 9 ottobre 1996, nella stessa sede avevo organizzato un workshop, alla presenza dei politici e direttori generali della aziende sanitarie del tempo, dal titolo: “Razionamento o razionalizzazione dell’assistenza sanitaria – il ruolo dell’HTA”, starring Renaldo N. Battista al quale il collega direttore generale di Venezia (il compianto Carlo Crepas) aveva tributato gli onori che la Serenissima Repubblica tributava ai Capi di Stato e agli Ambasciatori in visita a Venezia: il corteo in barca lungo il Canal Grande.

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L’invito di Giovanni Morana ha suscitato in me due sentimenti: il piacere di discutere oggi con i clinici (italiani, stranieri e un brillante giovane collega italiano che lavora a Charleston, Carlo De Cecco) e i produttori di tecnologia i metodi e le opportunità offerte dall’HTA; l’amarezza di toccare con mano la lentezza con la quale in questi vent’anni l’HTA si è diffusa in Italia!

Quanta strada ancora da percorrere! Se smettessimo di buttarci a pesce sulle cose urgenti e ci occupassimo un po’ di più delle cose importanti (De Gaulle) …..!!!

Il XXI secolo non ci ha portato ancora superare lo storicismo gramsciano: “Tutti i più ridicoli fantasticatori che nei loro nascondigli di geni incompresi fanno scoperte strabilianti e definitive, si precipitano su ogni movimento nuovo persuasi di poter spacciare le loro fanfaluche. D’altronde ogni collasso porta con sé disordine intellettuale e morale. Pessimismo dell’intelligenza, ottimismo della volontà”. (Q28, III)

Anzi…..

 

A pediatrician gives vaccine advice to presidential candidates

A pediatrician gives vaccine advice to presidential candidates

 | CONDITIONS  

First, I’d like to thank you for taking the time to read this; I know you’re busy fund-raising and campaigning, so I’ll try to keep this brief. It’s recently become quite apparent that several of you have some misconceptions about our immunization program. That’s unfortunate for people who are seeking such a prominent position. I know science can be complicated, but public health is a pretty important topic. (It’s especially disappointing that the physicians among you don’t seem to fully understand this issue, but I suppose immunizations are outside your specific fields.)

Anyway, the following are a few brief facts about vaccines that I hope you will find useful in your next debate.

1. Vaccines do not cause autism. Numerous studies have demonstrated this, and a huge meta-analysis involving over 1.2 million children demonstrated that pretty clearly. Evidence doesn’t get any better than that.

2. The guy that started this whole autism/vaccine thing lost his license because of his fraudulent study, which has since been retracted.

3. “Too many, too soon” is not a thing. Children encounter many viruses and bacteria every day, and their immune systems are not overwhelmed. (And they don’t develop autism.)

4. Although a popular book about alternative vaccine schedules has been quite a hit, the guy that wrote it didn’t bother to prove that his schedule was effective or safer than the schedule developed by the most knowledgeable infectious disease experts in our great nation. He just made it up.

5. Spreading out immunizations has been shown not to reduce the risk of complications from vaccines. All it does is extend the time period during which children are at risk for these infections. And since the most significant risk of immunizations is driving to the office to get them, it creates some indirect risks as well.

6. While we obviously disagree about some of those points, I support your assertion that we shouldn’t bother immunizing against insignificant diseases. So I’ve narrowed the list down to the diseases that cause “death or crippling.” (The links are from the CDC, a government organization made up of people who know more than you do about infectious diseases. You should get to know them; they will work for one of you some day.)

7. Since you’re probably not familiar with the CDC vaccine schedule that you think people should avoid, I just listed every one of the vaccines it recommends. All of those diseases kill people. Fortunately, they don’t kill very many people anymore. (Because of vaccines.)

8. And since I know your world isn’t all about saving lives, vaccines save money, too. That might be a good talking point.

I could go into more details, and I’d be happy to speak to you personally if you’d like to hear more. In fact, there’s a huge network of pediatricians that would be happy to field the vaccine questions while you tend to your more important affairs. (We were actually going to talk to these families anyway, because their children are our patients.) But hopefully, this basic information has been enough to allow you to speak a little more intelligently about the topic–especially since one of you will be running our country.

But in the future, if you’re unsure about similarly complicated topics, please feel free admit your lack of knowledge and defer to the experts. That’s what real leaders do.

Chad Hayes is a pediatrician who blogs at his self-titled site, Chad Hayes, MD.

http://www.kevinmd.com/blog/2015/10/a-pediatrician-gives-vaccine-advice-to-presidential-candidates.html?utm_content=buffere6c81&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

 

Basta attenzione solo alla struttura, lavoriamo sul cambiamento dei sistemi organizzativi e della cultura

Sir Muir Gray ci ha offerto un (apparentemente) semplice schema di interpretazione dei servizi sanitari: ognuno di essi è caratterizzato da una struttura (istituzionale, giuridica, economica, geografica, fisica), da sistemi organizzativi (idealmente impostati per realizzare le finalità dei servizi sanitari), dalla cultura (generale, professionale, organizzativa).

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Dobbiamo riconoscere che in Italia, e in tutte le sue Regioni e Province autonome, l’unica modalità per introdurre un cambiamento dei servizi sanitari è quello di pensare a una riforma: cioè a un cambiamento della struttura (istituzionale, giuridica, economica, geografica, fisica). Nessuna attenzione, invece, viene dedicata alla necessità di cambiare i sistemi organizzativi e la cultura sottostante.

Il recente libro di Roberto Perotti (ex Commissario alla spending review) “Status quo” affronta il tema del “perché in Italia è così difficile cambiare le cose (e come cominciare a farlo)”.

Una frase, in particolare, mi ha colpito: “E’ proprio della mentalità giuridica attribuire importanza spropositata all’impianto istituzionale, compiacersi dell’eleganza formale e dell’equilibrismo di un compromesso, e immaginarsi che piccole variazioni a uno statuto possano portare benefici strutturali al paese. Se solo il mondo fosse così semplice…” (pag. 170).

Lavorare sui sistemi organizzativi e sui necessari cambiamenti culturali significherebbe “chinare la testa e lavorare” (R. Perotti, ibidem) sui problemi veri, sulla loro dimensione quantitativa e qualitativa, ipotizzare nuove soluzioni praticabili (socialmente e politicamente) e sostenibili (economicamente, professionalmente e culturalmente).

Certamente è più semplice fare una nuova legge, una nuova deliberazione, un nuovo atto aziendale pensando che un atto legislativo o amministrativo possano di per sé determinare il cambiamento.

Chissà se ce la faremo? Si dovrebbe cominciare smettendo di raccontarci bugie!

 

Può la Serenissima Repubblica di Venezia aiutarci a nominare “politicamente” direttori generali delle aziende sanitarie competenti? @WRicciardi @leadmedit @drsilenzi @redhenry88

Il recente convegno sulla corruzione in sanità ha riportato alla ribalta il problema delle nomine dei direttori generali delle aziende sanitarie, ritenute oggi troppo legate al potere discrezionale delle Regioni che non valuterebbero correttamente requisiti e competenze dei nominati, dando priorità all’affiliazione politica e alla nomina di yes men, semplici esecutori di desiderata politici più o meno leciti.

La lettura del libro di David van Reybrouck “Contro le elezioni: perché votare non è più democratico” mi suggerisce di proporre il metodo usato per una decina di secoli dalla Serenissima Repubblica di Venezia per “eleggere” il Doge. Si trattava di un sistema misto di sorteggio e di elezione, al fine di designare, comunque, una persona competente senza che la nomina fosse oggetto di liti anche cruente tra le famiglie nobili. Tutti i membri del Maggior Consiglio (oltre 500) scrivevano il loro nome e lo riponevano dentro una ballotta di legno (da cui deriva il termine ballottaggio); il più giovane consigliere si recava nella Basilica di San Marco dove chiamava il primo bambino tra gli otto e i dieci anni che incontrava; questo ballottino, innocente, estraeva 30 nomi che venivano ridotti a 9 con una seconda estrazione. I nove estratti, con una procedura di elezione a maggioranza (in realtà una cooptazione) allargavano il collegio elettorale a un totale di 40 persone. I 40 venivano ridotti per sorteggio a 12. Questa procedura di riduzione per sorteggio e d’incremento per elezione/cooptazione veniva ripetuta con lo stesso meccanismo fino al nono e penultimo “turno” dal quale si ottenevano 41 grandi elettori che si riunivano in conclave e eleggevano il Doge. L’intera procedura durava cinque giorni e si articolava in dieci fasi.

Potrebbe questo metodo essere utilmente usato per designare i direttori generali che devono gestire il servizio sanitario nazionale? Non vi è dubbio, a mio avviso, che i direttori generali, che amministrano ingenti risorse pubbliche, debbano essere nominati da chi risponde ai cittadini elettori. Per arrivare a una nomina “politica” che, tuttavia, assicuri la competenza dei nominati e sterilizzi gli effetti ritenuti negativi della attuale discrezionalità, si potrebbe costituire in ogni Regione un “Maggior Consiglio” composto da tutti i consiglieri regionali, da 20 consiglieri comunali estratti a sorte e (opzionale se si vuole coinvolgere il mondo professionale) da 10 rappresentanti delle professioni sanitarie (estratti a sorte dagli albi di ordini e collegi). Per sorteggio questi potrebbero essere ridotti a 31 persone, ulteriormente ridotti a 11 con una seconda estrazione. Questi, con un meccanismo di elezione/cooptazione, potrebbero coinvolgere altre persone fino a un massimo di 25. Proporrei di stabilire 5 turni di sorteggio (per ridurre il numero) e di elezione/cooptazione (per allargare il collegio). Al penultimo turno, si eleggono/cooptano 21 persone che si riuniscono e designano i direttori generali facendo riferimento all’elenco nazionale la cui istituzione è stata recentemente decisa dal Governo.

Naturalmente, l’intera procedura di sorteggio e di elezione/cooptazione dovrebbe essere attentamente supervisionata da un organismo di garanzia super partes: la storia ci insegna che, nel passato, le procedure pubbliche per l’estrazione dei commissari delle commissioni di concorso hanno mostrato poca trasparenza.

L’elenco nazionale dovrebbe, tuttavia, assicurare non solo il possesso di requisiti formali (laurea, anni di lavoro direzionale, ecc.), ma anche di standard di formazione di base, specialistica e continua e di competenze motivazionali, manageriali e di leadership senza le quali le nostre organizzazioni sanitarie non possono prosperare. Ma sul tema dell’elenco nazionale varrà la pena di offrire una riflessione a parte.

La procedura è solo apparentemente farraginosa: tutto si potrebbe risolvere in pochi giorni.

Questa riflessione potrebbe sembrare una provocazione. Se vogliamo lo è, ma in senso positivo: ha l’ambizione di suscitare una discussione che aiuti il sistema sanitario a selezionare i migliori, mantenendo la responsabilità della designazione in capo alla politica.

E’ solo un’idea preliminare che deve essere necessariamente affinata, discussa, criticata, sostituita magari da un’altra più brillante. Non affrontare il tema determina conseguenze negative sulla percezione che la pubblica opinione ha su chi gestisce ingenti risorse economiche e ha grandissime responsabilità nell’erogazione di servizi molto delicati per la vita stessa dei cittadini.

http://www.quotidianosanita.it/lettere-al-direttore/articolo.php?articolo_id=38656

 

Ten Simple Rules for Chairing a Scientific Session @WRicciardi @RSiliquini @drsilenzi @redhenry88

by Alex Bateman1, Philip E. Bourne2* 1 Wellcome Trust Sanger Institute, Cambridge, United Kingdom, 2 Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego, La Jolla, California, United States of America

Chairing a session at a scientific conference is a thankless task. If you get it right, no one is likely to notice. But there are many ways to get it wrong and a little preparation goes a long way to making the session a success. Here are a few pointers that we have picked up over the years.

Rule 1: Don’t Let Things Overrun Probably the main role of the session chair is to keep the meeting running on time. Time is a strange and elastic concept when people are under pressure. Some speakers will talk much faster than normal and finish a talk in half the expected time. Others will ramble on without knowing that time is running out and they have only just finished their introduction. Timing is important to ensure that a meeting runs smoothly. Delegates should leave the session at just the right time so that lunches are still fresh, bars still open, etc. Timing is particularly acute if there are multiple parallel sessions and delegates would want to switch between talks in different sessions.

Rule 2: Let Your Speakers Know the Rules A session will run more smoothly if you let all the speakers know how you plan to run your session. This could be done by email before the event or you might want to gather up the speakers just before the session. Reminding them how much time they have to speak, how much time to allow for questions, and how you will let them know time is up will stop confusion later on. Beyond the rules, encourage speakers to review what others in the session will say. The less redundancy, the better the session will be for everyone, including the chair.

Rule 3: Be Prepared to Give a Short Introduction Be prepared to give a short introduction to the session, and, of course, introduce yourself as well. Be sure to review the abstracts of the talks and then give a succinct summary of what will be presented. It is your job to excite people at the session and have them stay in the auditorium. Regarding the speakers, introduce each one before they begin, providing their background and highlighting their major accomplishments. Speakers love to be properly introduced and the audience likes to feel they know the person speaking. But for the sake of both the timing of the session and your speakers, do keep it brief. Are you expected to give any housekeeping messages or to remind people to switch off their phones? Allow time for that if so.

Rule 4: Write Down the Actual Start Times of the Speakers If you don’t know what time a speaker started, it is difficult to know when to ask them to stop. So always write down the start and finish times of speakers throughout the session.

Rule 5: Do Have a Watch It sounds obvious, but it is very difficult to chair a session if you don’t have a watch and don’t know the time. Yes, one of us has done this! It is embarrassing to have to ask your neighbor for a watch. Actually, it is probably best to have two watches, just in case.

Rule 6: Communicate How Much Time is Left to the Speaker Letting the speaker know their time is up is crucial in keeping time. A simple sign held up at the right time is usually fine. Have one saying, ‘‘5 minutes to go’’ and another saying ‘‘time is up’’. Beyond that time, standing up on the stage is a good sign that the speaker should wrap up.

Rule 7: Don’t Be Afraid to Move on Without Questions

A good scientific session is characterized by a lively question and answer session. In fact, some speakers believe it is their right to expect to answer questions even after their allotted time is up. If you are running over time, you should not be afraid to move on to the next talk without questions. You will be more confident in enforcing this principle if you have warned the speaker beforehand that running over will require foregoing taking questions at that time. You can stay on schedule by diplomatically saying that the speaker will be happy to take questions at the break.

Rule 8: Get to the Venue Early and Be Audiovisually Aware Make sure to know where everything is, like pointers, microphones, projectors, and computers and who to turn to if it all goes wrong. It is worth checking that all these things work so that you can swiftly fix them yourself. Knowing ahead of time any unusual requests from speakers to show movies and sound clips requiring special attention. Be sure the venue supports the needs of speakers. If not, let them know before they get to the venue. If each speaker is expected to load their presentation on a single computer associated with the podium, allow time for that and have the speaker run through their slides to be sure everything is working properly.

Rule 9: Prepare Some Questions in Advance

It can take an audience a few seconds to digest the contents of a talk and think of questions. So, it is always good to have one or two ready to ask.

prepared beforehand from the abstracts and supplemented from ones that occur to you during the talk. This is a very good reason for paying attention during the talk. Also, it is worth thinking of one or two general purpose questions such as ‘‘What do you plan to do next?’’ Rule 10: Keep Control of the Question and Answer Sessions It is difficult for the session chair to keep things on time if the speaker is in control of taking questions. Make sure you are the one who selects the next questioner. Also, be prepared to step in if the speaker and questioner are getting into a long-winded, technical discussion. Hopefully with a bit of preparation and a little luck, you will get through the ordeal of chairing a scientific session unscathed. And remember, if no one thanks you, you have probably done an excellent job. PLoS Computational Biology | http://www.ploscompbiol.org 2 September 2009 | Volume 5 | Issue 9 | e1000517

These can be Citation: Bateman A, Bourne PE (2009) Ten Simple Rules for Chairing a Scientific Session. PLoS Comput Biol 5(9): e1000517. doi:10.1371/journal.pcbi.1000517 Published September 25, 2009 Copyright: 2009 Bateman, Bourne. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Competing Interests: The authors have declared that no competing interests exist. * E-mail: bourne@sdsc.edu PLoS Computational Biology | http://www.ploscompbiol.org 1 September 2009 | Volume 5 | Issue 9 | e1000517 prepared beforehand from the abstracts and supplemented from ones that occur to you during the talk. This is a very good reason for paying attention during the talk. Also, it is worth thinking of one or two general purpose questions such as ‘‘What do you plan to do next?’’ Rule 10: Keep Control of the Question and Answer Sessions It is difficult for the session chair to keep things on time if the speaker is in control of taking questions. Make sure you are the one who selects the next questioner. Also, be prepared to step in if the speaker and questioner are getting into a long-winded, technical discussion. Hopefully with a bit of preparation and a little luck, you will get through the ordeal of chairing a scientific session unscathed. And remember, if no one thanks you, you have probably done an excellent job. PLoS Computational Biology | http://www.ploscompbiol.org 2 September 2009 | Volume 5 | Issue 9 | e1000517

What is the system? (Systems Leadership)

heartoftheart

What is the system? is part of our Systems Leadership series, wrote by John Atkinson.



To a definition…. and beyond

Systems leadership has come to mean working beyond organisational boundaries to address issues of mutual concern.

This raises questions that challenge many assumptions about how to address issues that are of interest beyond the individual. Particularly it raises questions about the nature of society, what we choose to do together and thus the role and function of public services.

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Rebel Jam LIVE! – Rebels wanted

So who was Kurt Lewin?

heartoftheart

Kurt Lewin’s influence on modern thinking about change is often underestimated. Simple phrases like ‘the whole is greater than the sum of the parts’ and ‘group dynamics’ have their origins in his work. Invalided out of the front line in WW1 he returned to Berlin to complete his PhD. There he was involved in the schools of behavioural psychology and an influencer in the Gestalt school of psychology.

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I tagli alla sanità del governo sono l’applicazione dell’austerità espansiva

Keynes blog

austerity-george-osborne-desktop

In genere i keynesiani rifiutano la dottrina dell’austerità espansiva come ricetta di applicazione generale. Tuttavia va detto che in alcuni casi essa ha funzionato. Ad esempio è accaduto con Clinton negli Stati Uniti e ora con Cameron in Gran Bretagna. Ma come funziona l’austerità espansiva? 

Supponiamo che lo Stato decida di tagliare la spesa sanitaria. Poiché la salute è un bene irrinunciabile, i cittadini saranno costretti a stipulare assicurazioni private. In genere le polizze sono piuttosto care, pertanto lo Stato può incentivare i cittadini attraverso sgravi fiscali e garantendo i prestiti necessari alle famiglie per stipulare le polizze. Lo stesso principio può applicarsi a molti altri settori della spesa pubblica come l’istruzione, l’edilizia popolare, la previdenza. L’esperienza anglosassone sembra indicare che le garanzie pubbliche per i prestiti sono una ricetta quasi infallibile per alimentare una bolla immobiliare o i debiti studenteschi.

Lo Stato quindi da un lato taglia la spesa, ma dall’altro incentiva i…

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Contro l’ideologia islamista – Cameron insegna. Cultura e consapevolezza delle radici culturali

renalgate

Contro l’ideologia islamista.

Per l’intellettuale islamica Hirsi Ali, Cameron, che ha tenuto lunedì un discorso sull’estremismo, è l’unico leader occidentale a capire che il cuore del problema è la riforma dell’islam.

L’endorsement di Hirsi Ali al discorso di Cameron sull’islam.

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Move over teamwork: other forms of co-operative working? @pash22 @leadmedit @muirgray

Taken very broadly, there are two kinds of management or business research thinking when it comes to teams: perspectives that think teams are a decent functional way to organise workers to work effectively, and perspectives that are much more critical of the very concept of teamwork.

Instinctively, anecdotally, and from much research over the last few decades – we all know that teams often don’t work. ‘Dream teams’ of exceptional individuals can turn out to be nightmare units, groupthink and other faulty decision-making biases can make the whole less than the sum of its parts, and sometimes people end up in too many teams or don’t even know whether they’re in or out. I would argue that this is because teams are relatively artificial constructs; they are often no more than idealistic ‘boxes’ that exist unevenly only in the minds of some managers and workers.

Frequently, organisations are not like traditional sporting events or the inside of rowboats – they are much more variable, overlapping, organically changing configurations of people. Being inside a team or outside a team is not a neat shift from one state to another – teams or groupings vary continually in how ‘groupy’ or cohesive they actually are. Most management research, however, has focused on teams as neat boxes or islands that sometimes conflict a bit, but generally agree in their perceptions, have stability of membership, and have a relatively fixed relationship with their external environments. In short, it has been a romance of teams, a science of convenience, and an exercise in wishful thinking.

However, none of this is to say that teams are always doomed or flawed. With the right culture, tasks, and aligned sets of HR practices, teams can innovate and achieve highly effective working patterns. As with all social and workplace issues: it depends on the context and getting the conditions and circumstances right. However, many of these favourable initial ingredients or conditions for optimising teamwork either remain elusive or appear in an implausibly long list. It is no mean feat to ensure the selection of diverse members, extensive team-building and clear unifying goals. Teams themselves are also a moving target; in general they are changing: members come and go more often, technology encourages collaboration over almost any distance, and traditional hierarchies have become much flatter.

What I wish to say is that teams should be considered more dynamically as sitting within a broader spectrum of many cooperative working options simultaneously; as one work arrangement among many. The guiding word here being cooperation. There are multiple ‘building blocks’ of cooperation, from small-scale to large-scale, guiding how people work together, that managers can consider as part of a broader, customisable repertoire. I tend to refer to them as a ‘cooperative value chain’ or a ‘high-cooperation HR menu’. This cooperative toolkit consists of the five following components:

1) The individual. I want to be alone. Many job descriptions, rewards packages and other parts of the psychological contract bestowed via HR practices still revolve around individuals and their needs or talents. Many artists, technical problem-solvers, leaders and so on, may find they work most effectively as a demarcated, unique individual. Western, individualistic cultures may also favour personalised working this way, for at least significant portions of employees’ time, as proactivity, autonomy, and flexibility are emphasised in their roles. Single individuals are still cooperating, but in their own reflective way; they may also occupy special positions in social networks (see below) or fulfil boundary-spanning roles, where they are the individual link bridging units of cooperation that would otherwise have no way to interface.

2) The dyad. Two heads are better than one, but three’s a crowd. Some work roles explicitly involve pairs – software programmers check each other’s work, police officers patrol in pairs, and mentoring and other partnerships can occur in this way. But more exploitation of this unique two-person unit may be possible in workplaces than is currently realised. Some would argue that a dyad/couple is a small team, but I would argue it constitutes a special relationship. Two people cut a fruitful compromise, a middle ground between the egoistic isolation of working alone and the potentially biasing social pressures of a larger group.  Of course such pairs need to be carefully matched to each other and the workflow to get the most out of the pairing.

3) The classic team. The whole is greater than the sum of the parts – go team! As discussed above, in some situations, a neatly bounded, interdependent team with a clear goal may be possible. But a team charter or checklist should be carefully put in place to ensure the key conditions are right before proceeding with what is a larger, more elaborate cooperative endeavour in terms of the numbers of people involved. Social and task criteria to keep it working effectively together will need to be addressed, including a meaningful shared purpose, a differentiated mix of suitable members, clear rules or norms, wider resource-based support, and adequate coaching. Leadership, technology, lifespan, and competing teams or other boundary memberships in the wider environment will need to be addressed, in line with the other cooperative options above and below.

4) The multi-team system. Teams don’t exist in a vacuum, but in a ‘team of teams’.Beyond single teams, research is increasingly considering multi-team systems (MTSs) or ‘teams of teams’. Army, Navy, and Air Force; or Police, Ambulance, Fire would be obvious examples, but of course most organisations contain multiple groups, divisions, functions, layers etc. with potential for forming and/or recognising MTSs. One commanding team might lead several subsidiary teams, or teams with specific goals might come together to achieve a higher goal. As with single teams, structures need to be made crystal clear and cooperative flows and linkages choreographed and monitored carefully. People may need to be cross-trained, or to attend multiple team events, but without taking on too much workload. The relationship between the immediate goals of one team and the higher goals of the set of teams need to be clarified, as well as prioritised in various scenarios.

5) The social network. The wisdom of crowds. In a sense here we come full circle as individual employees occupy distinctive positions within collaborative networks, but in an increasingly interconnected world with more permeable communication boundaries, anyone can be meaningfully connected with up to 150 others at any one time. We enter the realm of crowd-sourcing, flash mobs, consortia, and other self-organising forms of social movement or widespread cooperative organisation. The boundaries of entire businesses and sectors may be transcended, co-operators may never meet or be totally aware of each other, and finished products may be complex mosaic or snowball outputs, difficult to link directly back to the inputs and processes of diverse contributors. Yet impressive tasks and economies of scale can be achieved, sometimes on goodwill and intrinsic motivation alone.

In conclusion, HR practitioners should try to take advantage of mapping this broader array of cooperative building blocks simultaneously. Rather than simply asking ‘to team or not to team?’ they should consider offering employees a greater range of performance opportunities via these other cooperative value chain options, enabling them to work more naturalistically and fully unlock their talents.

http://www.hrzone.com/feature/people/move-over-teamwork-what-about-all-other-forms-co-operative-working/141116

“Per App sanitarie prevedere l’obbligo di supervisione del medico”

Andrea Silenzi, MD, MPH, PhD

Da prevedere obbligo supervisione del medico per App a scopi medici. No a video visite e riduzione relazione interpersonale. Per le applicazioni a scopi medici (diagnostici, terapeutici, assistenziali) per il Consiglio Nazionale Bio-Medico “dovrebbe esserci un obbligo di supervisione del medico (informazione al momento di scaricare la app/condizione per scaricare app)”.

Leggi tutto su QuotidianoSanità

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General Practice after the election

A Better NHS

General Practice after the election. (First published on the LMC Newsletter)

In 2008, Professor Don Berwick wrote in the British Medical Journal,

Reinvest in general practice and primary care—These, not hospital care, are the soul of a proper, community oriented, health preserving care system. General practice is the jewel in the crown of the NHS. Save it. Build it.

His advice was ignored. The NHS has an unprecedented funding-gap of this governement’s own making and it has no credible plan to fill it. General Practice is in a parlous state one in three training posts and one in six vacancies unfilled while older GPs are retiring early and younger ones are emigrating or choosing to work part-time. The loss of MPIG could force dozens of practices to close. The consequence is that the remaining GPs cannot cope. Something has to give.

What GPs want, according to the recent BMA…

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How to do a SWOT

thinkpurpose

In the most strategic of rooms in my building, I found an agenda on a flipchart. It is not exceptional, it is typical. This probably happens in your building. This is how decisions are made….


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*the photo is real
**the words totes stolen from the brilliant W1a and 2012 .

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Il movimento fisico è indispensabile per la salute fisica e mentale

Girolamo Sirchia

Il WHO (Organizzazione Mondiale della Sanità) definisce come “insufficiente” l’attività fisica moderata di 150 minuti la settimana o meno per i soggetti adulti. E’ a queste persone che bisogna rivolgersi in particolare perché aumentino anche di poco la loro attività fisica, ricordando loro che il movimento promuove la salute fisica e mentale a tutte le età e previene malattie croniche e disabilità. Le persone totalmente inattive sono circa il 25% della popolazione e queste presentano i rischi maggiori in termini di mortalità globale, diabete di tipo 2 e alcuni tipi di tumore. In un gruppo di 252.925 adulti statunitensi è stato osservato che un’attività fisica moderata anche modesta (1 ora la settimana o meno) riduce del 15% il rischio di mortalità da ogni causa, e valori analoghi si sono ottenuti anche per la mortalità da tumore o da incidenti cardiovascolari in altre popolazioni. E’ l’inattività totale quindi il vero rischio…

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