really thinking

colourful pile of books

I hope the resources on this page will challenge you to think differently about issues and events on which you already have views. I mean ‘think differently’ in two senses:

  • coming to different conclusions perhaps, or redefining the issue
  • considering the issue in a different ways, looking through the lenses of different academic specialties (e.g. some of the humanities), and exploring your underlying assumptions.

These resources are here to be helpful so you are welcome to use them in any way you like as long as you credit  the author(s)  involved and this Really Learning website.

And do please email your thoughts, critiques, suggestions and improvements!

If you would like me to consider including yours here too, do let me have a look at them.

You’ll find other resources on the really irritating, book and podcast reviews and blog pages.

Why Reforming the NHS Doesn’t Work: the importance of understanding how good people offer bad care.

Unless we understand what is happening to care, and why, we cannot support those giving care or design care systems to meet our needs. Unless we do, we will continue to see care diminished and costs rise. We will introduce rationing of inefficient, poor care and blame the care givers who are simply victims of a system created out of our own noisy, passionate ignorance.

Dying is the most grown-up thing we ever do – so let’s take it seriously

This paper was written because I find the current discussio on death and dying cowardly, or alienating, or proprietorial, or all three! I characterise them to myself as a kind of irrelevant hybrid of Enid Blyton and Pollyanna. And yet this is such a vitally important part of our lives.

So I suggest that all of us will benefit greatly from taking dying seriously, and that NHS professionals can play a key role in helping us to do so -and currently fail to do that.

Before I draw on my own experience of my mother’s last months  and reflect on how I would approach that differently now, I pick up  Atul Gawande’s challenge that HCPs can deny patients their last moments being meaningful and enjoyable and suggest that this extends to the last six months of life in which typically between 1/4 and 1/2 of our lifetime call on NHS resources is made.

I suggest that a very large proportion of that resource is spent on trying to deny us access to care from a range of different services; and, often, a person’s last six months of life is characterised by a care experience that offers little comfort, little reassurance, allows them to think they don’t matter, can leave them feeling frightened and unwanted. At the same time the same fearful and unwelcoming system automatically, reflexly, puts great efforts in to expensively keeping them alive if they show any signs of dying: blue light ambulances; A and E; Emergency hospital admissions.

I reflect on how this can be so, and what alternatives we can put in place.

What is happening to leadership in health care?

A paper written for the International Journal of Leadership in Public Services.

This introduces key arguments from Why Reforming the NHS Doesn’t Work, including

  • the distinction between care as a set of auditable transactions  and care as a covenant between care giver and care receiver: Two Kinds of Care
  • the contextual factors over the last 150 years that we take for granted rather than exploring and
  • the nature of leadership that is constructive in health care organisations

Really Managing Health Care

My first book, written because I couldn’t find one to offer busy clinicians trying to manage their teams and services. Really manage: influencing behaviours and performance, understanding how to improve quality and cut costs, how to make the most of their time …

Managing People and Teams

A short introduction to some of the key ‘simple hard’, concepts, written for the excellent Health Care Management edited by Judith Smith and Kieran Walshe 


Authors Diane Plamping, Julien Pratt and John Harries explore how bidding for time limited money for projects looks ‘like a fairly harmless and temporary organisational device but [are] in fact a paradigm, a whole way of thinking about the world which can distort the priorities of the organisation and play havoc with the delicate balance of internal relationships and managerial accountability. 

Luminous Words

As the meaning of many words in use in healthcare organisations becomes diminished, contributors describe a word they feel deserves to remain luminous.

Developing Change Management Skills

A tool kit for implementing different change management methods written with Steve Cranfield.

Organisational Change – a review  for healthcare managers, professionals and researchers

Co-authored with Kim Sutherland, a review of the evidence about managing change in healthcare organisations 

Beyond partnership

What kind of partnership do you want to create? What are its chances of succeeding? This paper describes different kinds of partnership adn the circumstances in which they can succeed – and allows you to diagnose your bet course of action by answering four thoughtful questions

Making Strategy Work

There are thousands of books on strategy – but at heart they can be divided into three very different approaches. All have some research evidecne to support them – so which should we choose when? This paper explores how and when to use which – and how to use them all together!

Systems thinking

Before complexity theory there was systems thinking – its fore-runner. And before we forget the value of systems thinking and some of its many uses when applied to organisations, here is a reminder of just how useful it can be.

Organisational learning

How do organisations learn? There is some brilliant observation and theory to support us in hel;ping them to.

Ethical Traps for NHS managers

How were a thoughtful  group of NHS managers and practical philosophers describing the ethical traps they came across, in 2007? 

Images of the NHS

What happens when you ask an architect, a political philosopher, a psychoanalyst, an anthropologist, and an organisational analyst to describe what they see when they look at the NHS? 

Conversations about Trust

Is it important that organisations of the NHS trust each other? The relationship between SHAs and PCTs provided a vehicle for discussions.