really thinking: books and think pieces

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 include books, major think pieces, chapters and journal articles, book reviews, and shorter provocations. You are welcome to use them in any way you like as long as you credit me 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.


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.

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 …

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 

Major think pieces

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.

We need to talk about Francis – if Ronseal made Inquiries, what would they say on the tin?

How much credence should we give to the views reached and the recommendations made by the Francis Inquiries into the events in Mid Staffs? Not a lot, I suggest ……

Chapters and journal articles

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

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 

Book Reviews

The Joy of Tax: Richard Murphy, Bantam Press 2015

Richard Murphy challenges many attitudes, assumptions and claims about tax and the tax system. He makes a case for relishing a society that takes tax seriously and shows us why and how. Much much more interesting than it sounds – and important too. Read the full review here

Little stories of life and death:  David Drew, Matador 2013

There are many reasons for recommending this book although, sadly, not all of them will please the author. Drew gives a fascinating insight into his relations with his patients, peers and managers, and of his fight to be recognised as a whistle blower. There are lots of lessons for clincians, managers, ediucators and boards that it is well worth a read – as long as you approach it with a mind more open  than Drew’s. You can find it here

Health policy reform: global health versus private profit. John Lister. Libri Publishing. 2013

What makes this book book different from many others castigating the direction of current health policy is that its disappointment is as great as its anger, and that its remit takes us beyond our own parochial interests. For those of us who have lived through the last 35 years of health care reform in the UK it is not only a reminder of how hopes and ideals here have been dashed but also an instructive look at the impact of similar reforms on a more global basis.

…. do I recommend this book? Yes I do……… partly for the opportunity to think about how to take the argument beyond what is presented here. Lister wants to take us back to 1978 to a world before Reaganomics, but what we need now is some thinking about what policy alternatives might get us to somewhere new and not to an outdated past.

See it here

NHS SOS. How the NHS was betrayed and how we can save it – Ed Raymond Tallis and Jackie Davis. Forward by Ken Loach.

… So if we look underneath the goodie/baddie story that these authors are presenting here we find a very vivid insight into the frustration of being dismissed as naïve and idealistic, by the BMA, the Royal Colleges and the Academy of Colleges, or by the leadership of their own political party. These are rich and useful descriptions of how members of the technocratic elite gather others into their fold, and help them neutralise dissent, by conversing with them as adults dealing with problem children……                        Read it here


Shorter provocations to thinking

Let’s stop believing in magic – instead of trying to wave a wand to change NHS culture lets stop to think about this

IS it the economy stupid? This was written in response to yet another declaration that ‘its the economy stupid’. It was first published as a guest editorial for nhs managers.

Some rules of REAL commissioning – clinical commissioning can’t be interpreted as a chance to fight old battles with new powers

Building Tales – couldn’t we commission health care this way?

An alternative BERWICK report – with seven committees supporting him Don Berwick suffered from an overload of advice. Here was mine, from the outside …


Some older thinking that has stood the test of time


This is such a useful book and not easily available elsewhere so I’ve included it here although its not one of mine.

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.

Beyond partnership

What kind of partnership do you want to create? What are its chances of succeeding? This paper describes different kinds of partnership and 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.