Dr John Milton – Always walk on the grass

A short way down from the Department of Health building on Whitehall stands the statue of Field Marshall William ‘Bill’ Slim. Much beloved by his troops from the Burmese conflict in World War Two, there are stories that Slim was unusual in getting things done. One tale about setting up a new camp was that he would insist that sappers delayed laying paths and roads until it had become clear which directions had attracted the most use, usually the paths of most convenience or efficiency.

In a way this tale expounds both a ‘custom and practice’ approach as well as exhibiting innovation. After all how often have we seen organisations or systems insisting on doing things in a way that seems long-winded or inefficient? Human nature sometimes overtakes procedure and staff adapt an approach to save time or effort. Of course, one person’s short-cut is another’s health and safety nightmare. Knowing when it is safe to take a short-cut to improve a pathway is the key.

On my way to my office I get the chance to alight from the tarmac path onto the spongy turf. It isn’t far from the path but that briefest of periods puts the spring back in my step, changing my mindset and for a split second I feel and think differently about things. In his new book ‘Imagine: How Creativity Works’[1] Jonah Lehrer notes how new ideas and solutions to problems often arise from such a change of context, particularly when we are relaxed or off-guard.

So, what am I saying? That we should all stroll randomly about the lawns of our organisations? The gardeners would hate it; our shoes would get muddy too. But there is something about pathways that is fundamental to integrated healthcare in the twenty first century, both in terms of utilising existing flows between hospitals and community care but also allowing ourselves to think differently about going metaphorically off-piste. Now is the time to use a Slim (or should that be ‘lean’ – to adopt the management term) approach to examine what works well and strengthen those pathways as well as looking for other paths across networks that cut off the corners. The trick of course, as with all new ideas, is to get the right meld of innovation, pragmatism and efficiency. Easy to say….

Posted by:
Dr John Milton
Consultant Forensic Psychiatrist & Forensic Research Lead
Rampton Hospital Nottinghamshire Healthcare NHS Trust
E: John.Milton@nottshc.nhs.uk


[1] http://www.jonahlehrer.com/


1 Comment

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One response to “Dr John Milton – Always walk on the grass

  1. Interesting article. Architects call these ‘desire lines’ which I think sums them up perfectly.

    There can be a couple of dangers in this approach:

    1) People will look to move around obstacles, both literal and metaphorical, whilst leaving the obstacle in place. Sometimes a higher level view should instead look to take out the obstruction altogether.

    2) Sometimes the obstacle is there for a good reason, which might not be obvious to the casual observer. Again a high level view should be taken to determine its legitimacy or otherwise.

    Otherwise, I’m greatly in favour of the power of the crowd (aka as ‘ask the audience’ in Who Wants to be a Millionaire).

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