by David Wylie Head of Podiatry NHS Greater Glasgow & Clyde




The Leadership Blog of Wylie Coyote



What drives The Coyote to never give up may never be known, however his will to succeed serves as an inspiration to us all. It’s also fun to watch him get crushed by a boulder. 



There is a popular adage often attributed to Benjamin Franklin, the father of time management, “Failing to plan is planning to fail.” Many of our greatest intentions come to nothing simply because we have never actually gotten around to planning how we will deliver whatever it is that we intend to achieve.

Professionally, this failure is epidemic within Health & Social Care services, and surely lies at the root of sub-optimal performance. Here are 7 key plans utilised by the NHSGG&C Podiatry Service during its 6 year redesign journey that has delivered:

  • Waiting time improvement of 437%
  • Sickness absence improvement of 41%
  • Workplace culture improvement of 18%


This provides everyone within the service, and all within and outwith the organisation with a clear, detailed description of what is provided by the service. Importantly, it also clarifies what is NOT provided by the service. The service specification also outlines the service model (Fig 1) utilised to deliver the service, and describes what levels of care are delivered within each tier. This is vitally important since it enables service managers to clearly articulate the triggers for escalation between each tier, thus ensuring that only more complex cases are appropriately escalated to higher tiers within the service where resource is more expensive.


This work requires to be completed in partnership with staff and their partnership representatives in order to ensure that there is full service engagement. This engagement requires visible intentionality in the Organisational Development plan.


Having established a service specification and service model, these can then be taken into a workforce plan. The purpose of this important document is to assist in service redesign and future service delivery based on what we know about the service, future demographic and public health factors that may impact on the service, and the competencies that are required at each tier within the service to deliver services that are safe, person centred and effective – fully congruent with NHS Scotland’s quality ambitions. Following the allocation of resource, costings can then be attached showing present and future costs. The Workforce plan also provides an objective framework within which to manage vacancies and savings pressures.



Once competencies have been matched to what requires to be delivered at each tier, a Learning & Education plan requires to be developed to ensure that any self-assessed deficiencies in knowledge or skills can be addressed across the service to ensure that each member of the team is operating at the ‘top of their license’. This plan also requires to include information from individuals’ Personal Development Plans that can be aggregated up into a service wide approach. Many of the skills required will be resident within the existing workforce, and these should be maximised by running internal clinical support sessions wherever possible in order to keep attendance at expensive external courses to a minimum. This approach also utilises the leadership and education component within the B7/8 job descriptions for maximum organisational effectiveness. Elements from incident recording action plans and patient complaints will also be incorporated into this plan to demonstrate the closing of the learning loop.



As well as clinical skills development, there requires to be intentionality around the need for staff engagement and participation in organisational change. This is particularly important during large service redesigns, but should not be neglected even when small changes to ‘the way we do things around here’ are implemented. Ideally, this plan should incorporate a systematic approach to addressing change management with particular reference to culture and behaviours.  Without intentional planning in this area, changes to processes and structures run the risk of failing due to the impression that they are imposed rather than agreed. This plan also requires to adopt a ‘you said – we did’ approach to link each OD session or activity together into an integrated process rather than simply running a series of disconnected ‘events’ that aren’t part of a co-ordinated process supporting the redesign journey.



The Staff Governance Standard, published by the Scottish Government in 20121, requires NHS Boards to ensure that their staff are:

  • well informed
  • appropriately trained and developed
  • involved in decisions
  • treated fairly and consistently, with dignity and respect, in an environment where diversity is valued
  • provided with a continuously improving and safe working environment, promoting the health and wellbeing of staff, patients and the wider community.

In order to ensure that the service is demonstrably mindful of its responsibilities in this area, the Staff Governance Plan contains those workstreams, agreed in partnership with Trades Unions, that require monitoring and reporting each year.

This creates internal accountability within the service for joint working and provides a framework for implementing changes within other plans that are designed to support the service to ensure that staff are adequately supported and developed in the workplace.



These are the main deliverables against which the service is held accountable within each financial year. These require to be measurable and should include ‘softer’ elements from Staff Governance (eg The eKSF and PDP % within the service will not drop below 80% during any month) as well as ‘harder’ elements from service delivery and financial performance.



The Service Improvement Plan should include aspects of the service where performance during the previous monitoring period fell below the required benchmark or target. It should specify the desired performance and the means employed to achieve it. It should also include Quality Improvement element in each of the QI domains of safety, person centredness and effectiveness.

All of these plans combine to create a culture of support, challenge and mutual accountability. ‘Failures’ are not viewed as blameworthy, but are opportunities to better understand inequalities and variations in service delivery, gaps in learning, sluggishness is adopting new cultural norms and improved transparency to drive mutual learning and self- awareness both in terms of personal and team behaviours.

Accountability against these 7 plans provide the basis for every senior team meeting and allow performance and progress to be managed and monitored by the senior team as part of their organisational citizenship responsibilities, thereby de-personalising issues that arise and providing a constructive framework within which to deliver improved performance.





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