NHS Startup Part XV – “It’s Up To Us Now.”

We launched a new phase of our app for our patients and Primary Care services this week.  The build for this phase was huge and we have been steadily working on it for the previous four months (designing, building, testing, messing up ad nauseum).

I think we’ve really nailed what we intended to do.  As we collect more data, it should show that we’ve increased how efficient things are running at the practice, that more revenue is being made and that patients also prefer our new app to the existing means.

My main fear for this launch was actually the practice and the number of staff that work there.

As our app continues to expand and increase in its abilities it requires a concerted effort by everyone at the surgery for it to really work to its full potential.

I was initially worried about this.  Up to now, a small number of staff at the practice have been doing everything and they didn’t even need to do much to make the app as successful as it has been.  Now everyone in the practice has a small part to play to make it really grow and have a bigger impact.

Could they do it?  Would they do anything wrong?  What happens if they simply don’t want to?

These were the questions running through my head.  Although the launch itself went without a hitch, I was leaving the surgery still thinking that someone may mess something up.  That’s when someone from the team said:

“It’s up to us now”

At that point I just felt a massive sense of relief.  I truly do believe that the team are all bought in now.  I realised that giving people something to do with regards to my app isn’t bad.  It’s actually good, because now everyone is bought in and involved in the mission.

I guess being a leader is about leading from the front, aligning people and then creating change.  Maybe I was trying to create change from the back and by not leading all this time.

One thing’s for sure though – if someone does mess up.  I won’t be upset or angry.  I’ll be grateful they tried.


The decisions you’ve made so far have gotten you to where you are.  

However, the decisions that you make now, going forward, don’t need to be and in a lot of cases should not be influenced by what you’ve done in the past.  

Every decision is an opportunity to stand still for a second, look at where you are currently and decide “Right now, what’s the best way forward?”.  

NHS Hacked! The Great FHIR Wall Of The NHS Is Broken.

It’s ironic how badly the NHS has been affected by ransomware.  I’ve been having talks with people about this a lot recently.

Right now my startup is jumping through hoops to comply with (outdated) data compliance issues and get access to the NHS N3 network, which is supposedly the NHS’ secure server system.  The actual fact is that N3 is just like any other network infrastructure which is connected to the internet.  And thus it has many access points.

It’s clear to any outside observer how insecure the whole thing is.  The Information Governance aspect of creating software for the NHS is just a case of paying some lawyers thousands of pounds to create documentation.  A money making scheme…

Others who I’ve spoken to, who already have access to N3, are saying that once you’re on N3 it’s very easy to move about from one organisation to another, hack data and plant lots of back doors.

What does this mean for budding NHS startups?  

I think that much like any other NHS issue which comes to the public conscience; an overhaul will be due.  This may mean that any startups who have already engaged in the process of getting access to N3 will have to pay even more to jump through more compliance protocols.  This obviously won’t make things safer, but will look good for the NHS as the public will see that something’s being done.  

My advice would be that anyone already engaged in the process should try and get access within the next three months, which is definitely doable.  Otherwise you may risk having to jump through the extra hoops with no support from the NHS.  

Mind Your Language!

Which column do you fall under?

Victim Proactive
  • There’s nothing I can do
  • That’s just the way I am
  • She makes me so mad
  • They won’t allow me to do that
  • I have to do that
  • I can’t
  • I must
  • If only
  • Let’s look at the alternatives
  • I can choose a different approach
  • I control my own feelings
  • I can create an effective presentation
  • I choose an appropriate response
  • I choose
  • I prefer
  • I will

Which column would you rather fall under?

Boss, Can I?

Here’s your typical employee mentality in a sentence:

“Boss I’ve got this great idea, please can I start a project?”

Often this question is followed by a quick “No”.

I’ve seen a lot doctors/nurses/admin staff etc rant and whine about being told “no” by their boss.  What I find baffling though is that I haven’t met a single one of them that really turns around and thinks about why they were told no.  They often go down the path of “blaming the system” or how their genius isn’t “appreciated”.

This is a classic case of Ignoratio Elenchi.

Here’s what your boss actually hears when you ask permission to do a project:

“Boss, I’ve got this great idea!  If it works then I get all the fame and glory.  If it doesn’t work then you’ll get all the blame for wasting time and money.”

Probably the main reason employees don’t ever come to realise that this is what their boss actually hears is because they can’t face the reality – that no one’s going to hold their hand.  After all, most employees have had their hand held through school, then university and then well into their professional lives.

The fact is that if you want to do something big in your life, then there has to be a moment where you take the leap and accept full responsibility for what happens.  You cannot demand authority, but you can accept responsibility.

If you’re in an organisation (not necessarily just healthcare) your options are to either just do your project and not let your boss know, or leave the organisation to do it.

Not willing to take the leap?  Then stop whining.

Be Selfish

What little I have accomplished in life is borne out of being completely selfish.

When I went to medical school, strangers would say what a good person I was for choosing such a noble career.  Similarly when I picked a specialty, people would go on to say what a good person I was for choosing such a selfless career.  When I used to throw rock concerts at my school for charity, I would get awards and local recognition for my work.

In business I often hear the phrases; “don’t do it for money” or “don’t be selfish”.

However this is quite an odd outlook to have if you actually have a business.  A business has to focus on sales and get some revenue coming in, or it will inevitably die.  Also, If money represents the value that the market is willing to pay you for your work, then it stands to reason that you should focus on money as one of the key metrics.  If you can figure out a way to make even more money, then by definition you are making something more valuable for the market.

So why such a disconnect between normal life where you can be selfish and business, where people actively tell you to stop being selfish?  Why is it that in your personal life people tell you to “follow your passion” and “do what you love”, but the opposite is true in business and making money?

I think that there are two reasons for this.  The first reason is that people confuse money with “value”.  People don’t realise that you can’t chase money, because it is merely a representation of “value”. So what people should be chasing is creating more “value”.

The second reason is that some people seem to lose their reasoning skills when trying to make more money.  In the same way that alcohol can be quite intoxicating, so too can money blunt people’s judgement if one is not careful.

To expand: In normal life, people generally aren’t actively looking to harm others for their own selfish gains.  When I chose medicine as a career, I was being selfish insofar as wanting to learn more about science, the art of medicine and how to help people.  But I was also acutely aware that the pay would be very good.  With my rock concerts I wanted to play music, get recognition in my community but also help others by raising money.  I could have chosen to not raise money for charity and I could have also chosen to do work which was (in my opinion) unethical in the private sector earlier on in my medical career.  I think most people in life choose a career and do work for the greater good of society rather than try to make easy money – which often does not result in the best outcomes in the long run.

Business is the same.  You can go down the route of an easy pay out in certain circumstances, which will likely be to the detriment of your company in the long run.  This may be very tempting.  If someone comes and dangles millions of pounds in front of you, your reasoning skills may go out the window.    However it is often better to take an alternative approach and consider the greater good.

When it comes to money-making decisions a lot of people think: “If I do X now, then perhaps I can get a few million very soon”, however the logical person would think: “If I do X, then I may get a few easy million now, but in the long run the business will be worse off, also the employees and customers will suffer.  It’s actually better to do Y instead of X”.

It surprises me how many people choose to take a course of action which belittles others, causes friction and as a result causes a worse outcome for everyone involved.  From what I have experienced and seen in life so far, there is pretty much always an option or opportunity to take a course of action which will make it win-win for all parties concerned.  This applies to life in general, but also in business.

My conclusion is that life is not a zero sum game.  You can be as selfish as you want because if you win, it doesn’t mean that others have to automatically lose.  As long as you take a course of action where everyone involved wins, whether that be your customers, friends, family members, employees etc then it’s OK to focus on making more money.

When people say “don’t do it for money”, what they mean to say is; “don’t let money blind you from the greater good”.  A much more apposite phrase in my opinion.