Nobody gives a gift of an eBook. Leaders, discuss!

More thoughts on the digital transition, and the need for enlightened leadership in difficult times


WHEN BOOK PUBLISHERS are discussed in the media, it is almost always the big fiction houses that are at the front of mind, bidding millions for the top authors and carpeting the world with big advertising budgets. But this sort of bestseller activity is the tip of a publishing iceberg. The book, as my good colleague Bob Bolick would often say, is a resilient piece of technology that ain’t going anywhere soon. It does its job very effectively, in print and in digital forms. In particular it is interesting to note that despite predictions, print is hanging in there. Nobody gives a gift of an eBook, whereas the printed issue is still a very attractive and welcome present.

I’ve recently given my Kindle to my daughter as I found I wasn’t using it any more. It was a welcome partner in my daily commute, but is an unattractive option compared…

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Thinking like a patient, acting like a taxpayer, behaving like an emotionally intelligent leader

Emotionally intelligent leaders required in the NHS…


THE NEW NHS England CEO, Simon Stevens, is a breath of fresh air. He is offering new perspectives on the challenge to leaders, and one key message, recognised by the Nuffield Trust, is the need for organisations to work across boundaries, and to abandon a top-down approach in favour of establishing new models of care that work locally.

This is demanding for board members – how can you get the right sort of change while devolving decisions about that change? The answer Simon Stevens offers, and he is right, is to develop “values-based leadership” to create a climate conducive to the right sort of change. This will take emotionally intelligent leaders, and a questioning and challenging board, working in the interests of the public and not within organisational silos.
See Simon Stevens’ speech to the NHS Confederation here

And we have provided the response from the Nuffield Trust also.


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Good medicines information saves lives

A recent seminar involving stakeholders from across the USA discussed the benefits and latest research on the latest developments in patient information. The Food and Drug Administration is pushing for improvements in patient information which we all come across – a huge sheet of tiny print that offers little to help people make best use of prescribed medicine. This is important because research shows as much as 50% of medication errors occur after a medicine has been dispensed to a patient.

Work conducted at LUTO in Leeds contributes to the debate. A couple of years ago I worked with them and colleagues at the British National Formulary to test wording of the cautionary and advisory labels used on medicines when dispensed from a pharmacy. The changes made then were tested with patients and understanding confirmed. These are the sort of changes in thinking that save lives.

When designing patient information of any kind, the key measure which matters is whether the person taking the medicine gets a benefit. That depends on engaging them, giving them accurate and appropriate information, and motivating them to take a medicine correctly while being appropriately alert to side effects and warnings.

Work on better patient information will save lives, and research in this area will reap great rewards.

Amazon, Publishers and Us

First of a series of thoughts about the impact of Amazon and how publishers might respond.


FIRST, LET’S AGREE – Amazon is not a bookseller, though that is how it began life. It is a multiple retailer, a Walmart of the web and an internet chainstore of everything.

Amazon is one of the dominant commercial powers of our age, though not consistently profitable it has the ability to be so at the flick of a switch. It can and does put competitors out of business. It has ambitions and has made forays into product development as well as retailing. It is a behemoth, straddling the world right now. But can it be a successful book publisher? A new article in the New Yorker discusses its progress in the world of books.

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Professional Associations and the Strategy Gap

This article and the comments provide a very useful overview of the importance of strategy for any organisation, and a discussion of the difficulties in professional associations. To this I would add two things. First, a strategy has no focus unless it is in pursuance of clear and explicit aims, or mission or vision (call it what you will – it is the answer to the questions “Why does this association exist? What are we all trying to achieve here? If we succeed what will be better about the world and specifically our common domain of interest?”)

Second, the leaders and future leaders within the organisation need to become highly skilled in leadership, and developed as a team to work together and drive change.

My own experience of developing strategy, in public organisations, local authorities, publishing companies and policy settings, chimes with the steps outlined by Michael Clarke but with those additional points addressed beforehand.

Prescribable information – the key to shared decision making

Intuitively it makes sense that patients do better if they are involved in the decisions made about their health and care. Research indicates that this is true, as outlined in this article from the New England Journal of Medicine.

So what role can well designed patient information play in improving outcomes? Examples of well designed patient information include excellent handbooks and ebooks that have been around for some time like those from Family Doctor publications, websites like or Bandolier, and specialist resources such as the parent and carer resources at and the radical children’s animated series Medikidz.

I would be very interested to hear from anyone who would like to measure the impact, in reduced consultation time, improved patient outcomes and satisfaction, or more efficient use of resources, as a result of using prescribable information.

Evidence at the UK party political conferences

Can you spot me asking about the Olympic Legacy in the clip above? (About 38 minutes in I think!)

In September 2013 the political parties in the UK meet for their annual conferences. First the Liberal Democrats, then Labour, then Conservatives, with Greens and UKIP and Scottish and Welsh Nationalists, the end of summer means the start of a new year for politics. Some question the value of these events: in a modern connected world do we really need to get together in person? Aren’t they just uncritical rallies for the leadership?

Marina Hyde of The Guardian has described them as “a Powerpoint presentation in a parallel universe” which may be what they look like. I think they are more than that. I think they CAN be lots more.

The fringe at Conference is where there is serious discussion going on. In recent years there has been a noticeable shift away from rallies towards workshops. Meetings give way to discussions. Could the next step be using evidence to inform best practice, and build policy on the basis of values and research in equal measure?

If you know of examples where this happens in practice, please get in touch.

Duncan Enright launching the NZ Formulary

Duncan Enright launching the NZ Formulary

Based on the BNF, a new online source of prescribing guidance in New Zealand was launched in 2012. This project uses the heavy lifting done by the BNF team to shortcut a new resource; makes work for one country relevant and useful in another; and creates two connected teams who can improve and enhance the work of the other. Evidence-based Networks in action! – now that’s a good idea – now that’s a good idea

Take a look at this. Instead of a collection of dry guidelines sitting in a library or database, what the team at OpenClinical are doing is putting together a toolkit to convert such guidance into machine-readable decision support routines, which are then stored in an open access library called Repertoire. has been going for some time and provides a wealth of material relating to knowledge management in healthcare. 

Medicine is a field that has been very keen to exploit the use of evidence to improve decisions for many years. Many other fields can also benefit from a more rigorous approach to the use of evidence, and I hope to discover more active work in other areas. Let me know if you come across any,