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Mark

@markouthwaite.bsky.social

69 followers 480 following 140 posts

Supporting senior teams make sense of complexity. Joining the dots and sometimes getting the right picture. Sourdough. RTR Exile

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Mark @markouthwaite.bsky.social · 1d

It’s the political ramifications in the US and then wider knock-on political effects that are a potentially significant consequence if this ecosystem fails.

Mark @markouthwaite.bsky.social · 29d

That should be ‘on referral flows…’

Mark @markouthwaite.bsky.social · 29d

A long time ago I did a big piece of work for DH on impact of the then ISTC programme of referral flows and choice. TLDR: nothing significant

Mark @markouthwaite.bsky.social · Sep 9

This... for non-acute trusts (excl Ambulance trusts)

Mark @markouthwaite.bsky.social · Sep 9

Have replied on Linked In as well

Mark @markouthwaite.bsky.social · Sep 9

and this one is interesting. It takes average score and plots it against rank and coloured by segment. This shows the effect of the financial deficit yes/no flag forcing deficit trusts into segment 3 and a lower ranking. So there are two Trusts who would be near top of segment 1 but for deficit.

It takes average score and plots it against rank and coloured by segment. This shows the effect of the financial deficit yes/no flag forcing deficit trusts into segment 3 and a lower ranking. So there are two Trusts who would be near top of segment 1 but for deficit.

Mark @markouthwaite.bsky.social · Sep 9

To be fair the Framework itself makes no claims that it is for patient choice - simply that publishing it is 'to support transparency'.

Mark @markouthwaite.bsky.social · Sep 9

It is not for patients. The fact that if a Trust fails the financial flag it is cannot be above segment 3 and its rank is adjusted accordingly. Patients not interested in financial position by and large.

Plot of NHS Trust league table ranking against average score. Shows that there are a cohort of Trusts that would be much higher ranked if their rank had not been adjusted because they fail the financial 'rectitude' test

Mark @markouthwaite.bsky.social · Sep 9

Agreed

Mark @markouthwaite.bsky.social · Sep 9

Impact of the lock-out to segment three for Trusts that fail the financial test. Plotting average score against assigned ranking

Mark @markouthwaite.bsky.social · Sep 9

I suppose the issue is whether there is any evidence that patients use this information to make choices

Mark @markouthwaite.bsky.social · Sep 9

Plot for acute trusts by subtype

Mark @markouthwaite.bsky.social · Sep 9

In this set of metrics a Trust in deficit cannot be above segment 3 'A Yes/No flag to indicate if the trust is in financial deficit or in receipt of deficit support (when a trust is flagged as Yes, their segment can be no higher than 3).

Mark @markouthwaite.bsky.social · Sep 9

Interested that there are no weightings within or between domains. This implies that an MRSA infection and a late discharge survey score have identical impact.

Mark @markouthwaite.bsky.social · Sep 5

www.linkedin.com/pulse/cuttin...

Cutting the anchor - what happens when a network 'anchor' leaves

A conversation with a friend triggered some reflections on another use of Organisational Social Network Analysis or at the very least thinking about the consequences of your actions through a network ...

www.linkedin.com

Mark @markouthwaite.bsky.social · Aug 30

Comptoire sur Mere?

Mark @markouthwaite.bsky.social · Aug 30

Looks familiar - about 10-15 minutes walk from Gare du Nord? Tiny restaurant. Trying to wrack my brains for its name.

Mark @markouthwaite.bsky.social · Aug 27

I see what you did their and am not rising!

Mark @markouthwaite.bsky.social · Aug 26

I like frameworks and the Cynefin Framework helps me think about the responses to challenges like immigration and where people like Farage and Starmer are framing their response in the public domain.

Cynefin Framework applied to immigration:
Simple / Obvious
Framing: Immigration is seen as a binary issue (good vs bad, legal vs illegal). The narrative lends itself to slogans (“Stop the Boats”, “Take Back Control”).
Response mode: Apply best practice; assume clear cause and effect. Tight rules, rigid enforcement, one-size-fits-all.
Limitations: Ignores nuance—why people move, how labour markets function, and the interplay with international obligations. Solutions break down quickly in practice.
Complicated
Framing: Immigration as a technocratic policy problem. Experts debate visa categories, quotas, processing efficiencies, or fiscal impacts.
Response mode: Use expert analysis, cost–benefit modelling, and detailed regulations. “Good practice” solutions—visa points systems, digital border checks, bilateral agreements.
Limitations: Risks becoming reductionist. It handles the mechanics (processing times, cap levels) but neglects cultural narratives, legitimacy, and emergent consequences.
Complex
Framing: Immigration as an adaptive, emergent system. Push and pull factors vary by region, conflict, climate change, economics, and networks of diaspora communities. Communities react in unexpected ways.
Response mode: Probe–sense–respond. Small, safe-to-fail experiments in local integration, community dialogue, and adaptive asylum processes. Build coalitions across agencies, localities, and civic groups. Learn iteratively what works in different contexts.
Strength: Recognises that no single solution works everywhere. Encourages plural, experimental approaches and continuous learning.
Challenge: Politically difficult to sell because it resists simple targets and timelines.
Chaotic
Framing: Sudden mass displacements—wars, famines, climate disasters. Borders overwhelmed, systems collapse, public fear spikes.
Response mode: Act–sense–respond. Rapid humanitarian action, emergency housing, deployment of resources before order can be restored. Clear leadership essential, but impro…

Mark @markouthwaite.bsky.social · Aug 26

And they are never a single source of the truth. Needs to be triangulated. As we found with the 3 star RUH Bath in the early 90’s - all fell apart when you looked under the bonnet. And there had been signals well before that had been ignored.

Mark @markouthwaite.bsky.social · Aug 25

Thanks for the inspiration - just made a sourdough rugbrod and it is excellent. Thought I had baked a brick but not all.

Mark @markouthwaite.bsky.social · Aug 23

Check out my latest article: Complexity and Networks - applying the Cynefin Framework www.linkedin.com/pulse/comple... via @LinkedIn #OSNA

Complexity and Networks - applying the Cynefin Framework

I am something of a fan of Dave Snowden’s Cynefin Framework. It is a great way of shaping a discussion about a challenge or a context.

www.linkedin.com

Mark @markouthwaite.bsky.social · Aug 21

👇🤔👍

steve the skeptic @policyskeptic.bsky.social · Aug 20

There is a conflict in the NHS between naive attempts to cut costs by firing admins and managers and actual productivity. The result doctors have less time with patients: www.bmj.com/content/390/...

Administrative overload harms patient care

This month, 7000 new resident doctors have started their foundation training in the NHS. It is not uncommon for a resident doctor to wait 20 minutes for a ward computer to boot up, only to spend the n...

Mark @markouthwaite.bsky.social · Aug 17

Had to buy reservations from Istanbul main station. Cannot do it online.

Mark @markouthwaite.bsky.social · Aug 17

I did that journey a year ago in searing heat and no air con. Joined by adventurous US Colombian siblings (av age 60!) not prepared for no food on train. Shared my meagre rations. Had broken journey for a night at Veliko.