• Big Win: As a company operating in multiple European countries with different xmas traditions, week 3 was the first week back where everyone has returned to work. What better way to start it other than a open space/unconference session?
  
  Hat's off to Martin in the platform team who arranged the whole thing with help from Claudius and Ivan. The whole day ran so well, they put a lot of effort into the Miro board and creating all the teams rooms and disussion boards for the topics. The thing I like about doing this right after the break is everyone came back a little lethargic and throughout the day you could see the energy and excitement building. My personal favorite topics were around AI and how we are utlising it and documentation.
  

• Medium Win: I haven't been on the tools working with code for some time, I decided to change that this year and spend time getting my development environment running how I like it. I use Neovim, Lazyvim, Lazygit and have a set of dotfiles for my mac. I wanted to refine these and remove a lot of useless things I have accumulated over the years. I also wanted to ensure that my development experience is as identical as can be on my work mac and my Omarchy linux machine. I got this to a good place by the end of the week and hope to have it good enough by the end of this week.
• Small Win: We made a decision on the technical architecture we would be aligning with for our occupational health services that we are developing in Sweden. We already have some great products we have built and want to evolve these into a service offering that will delight our partners and also work well for our clinical and administration teams. We are now in the process of hiring a couple of roles to move things forward.

🧠 The brain buffet

• What I Learned: I learned about opencode which is a TUI that sits in front of AI Agents. I set it up with Claude Code and had a play around with it. Using some tmux foo I was able to get it to popup over the top of neovim when coding. It looks and works really well. I still love coding in terminal as it gives me old school vibes and I like having the tools right alongside the code instead of in seperate apps, windows/browsers etc.

🎢 The Emotional Rollercoaster

• Current Mood: I've been hitting the gym and doing structured training on the bike regularly so I am feeling pretty good in that sense. My mood is still a little on the downside given what happened last year but that's another post.

🔍 Discovery Lab

• Man's Search for Meaning - Viktor E.Frankl: I am not sure what I can say about this book to do it justice. I am surprised I only just discovered it. How a man can go through such a struggle for survival in the Auschwitz camps and come out of it finding meaning is remarkable. It's an outstanding book. Everyone should read it 10/10
• Writing to Learn - William Zinsser: Currently reading this

🛠️ The Toolbelt

• Meal Prep is a game changer. I now only make things if I can make 6-10 portions of the same thing, macro balanced as breakfast, lunch or dinner. I no longer think about what to eat, worry about the time to make it and it makes shopping so much easier. I also don't waste anywhere near the amount of food I used to.

🎯 Looking Ahead

• The Main Goal: I am working on something strategic with regards to the technology we have built and aquired over the years. I can't say much more about it right now but I am going to enjoy putting the effort into this next week.
• Long burn: This is an area that we can improve on, we have great documentation and some not so great. Some is managed really well, some not to much. This is an area everyone wants to improve but is difficult due to many reasons - time, tooling, process, value, ROI. I will be putting some thought and structure into this next week.
• Anticipation Level: [7/10] - The physiological progress I have made since food prepping, lifting weights and structured cycling is showing significant change. It's addictive. After what I can say is the worst year ever [2025] behind me, I am hopeful 2026 will be a better one full of growth and learning. I am cautiously optimistic.

Have a great week

/T

When learning to fly airplanes I came to know and love two very important documents. The POH (Pilots Operating Handbook) and the Checklist.

The POH has all the details of that very specific aircraft. It's weight, mass and balance calculation, take off distances, fuel loads and lots of other technical details that need to be studied and referenced from time to time. Some pages are referenced on every flight such as the mass and balance charts.

The other document which is used every single flight and at all stages of the flight is the checklists. There are three modes of running a checklists, read along and perform the action, I use this mode when performing preflight checks, startup, power checks, pre take off checks and shutdown procedures.

The other mode I use from memory and then confirm I have performed the correct actions. Typically useful for emergency procedures, after takeoff checks and things like that. We also use acronyms as a third way to memorise some elements of the checklists such as BUMFREDA (said out loud as bum freda) which is performed prior to landing, this reduces the need to flick through checklists at a critical stage of flight when the workload is already high, especially for a single pilot.

BUMFREDA

Brakes - Check for pressure
Undercarrage - put the gear down
Mixture - set to fully rich
Fuel - fuel pump on, set tank to the fullest
Radio - tuned to talk to the correct frequency
Engine - temperatures and pressures are in the green
DI - Direction indicator and compass aligned
Altimeter - set for the correct atmospheric pressure setting

Use Checklists Everywhere

I love creating checklists, they make it so easy to do what needs to be done in the correct order. They significantly reduce errors, have saved countless lives, improved  performance and many other  positive outcomes.

Recently at work we have been reviewing our incident management process for the applications we have built and maintain as there was significant room for improvement. I read all the documentation we have for the process and it was very comprehensive and well thought out, but we weren't achieving the outcomes we expected. Communication was sporadic, duplication of efforts, and a number of other basics were being missed or misunderstood. It was too complicated. The process has now been somewhat simplified, the details of the how and why we do things are still there in all the levels of detail one would need. Just like the POH.

However, along side this now sits a checklist that is the first thing any incident commander should have on their person while acting in this role. Non negotiable. This prompts what needs to be done and in which order. Things have improved significantly.

Here is a list of some of the checklists I have created recently and use often:

• Incident commander
• Church Media Desk Setup and Service Streaming
• Upgrading and maintaining this blog
• Christmas Dinner - turn those recipies into checklists, much easier to follow and execute
• Pre holiday checklist
• Pre festival checklist
• Pre bike ride checklist
• Playing 8 ball pool - I have memorised this but check it before I start a game
• My Morning and Nightly Ritual
• Preflight planning and equipment list

Some of my checklists are just using a To Do app such as my Morning Ritual:

Others are just documents that I can print and laminate to keep in situe such as the Church Media Desk Checklist:

Another example is my pre-flight checklist that I run at home while in the planning phase of a flight:

Do you use checklists in interesting ways? I would love to hear about them.

I am writing this post to help anyone who may need it if their Shimano Ultegra or Durace Shimano Di2 derailleur will only shift in one direction and need to fix it to get home.

This hack will not work with Shimano 105 Di2 shifters as they do not have a hood button.

TL;DR; You can remap the hood button to perform the shifting function that is not working using the Shimano e-tube app.

A couple of friends and I were doing a 77km ride around the Snowdonia mountains from Capel Curig to Stwlan Dam and back in a loop. I was riding my new Bianchi Specialissima for the first time which I absolutely love. This is the first time I have owned a bike with the Shimano Di2 electronic shifting system and I was very impressed by the capabilities and crispness of the shifting.

At around 34k while at the furthest point from the car I completed a descent and approached a climb. Trying to shift down (up the rear cassette) into lower gears I could hear the rear derailleur trying to move but not completing the shift. I could shift up though and found myself in 12 gear. Not ideal for climbing a steep climb.

I tried the following to resolve the issue without success:

• Checked the status of the battery for all the components (system battery, shifters and derailleurs)
• Checked if the derailleur needed a crash reset. This checks the tiny cam on the motor is locked into position to be able to move the mech up and down the cassette, all looked fine and engaged properly.
• I disconnected the power from the derailleur and waiting a minute, reconnecting it did not resolve the issue
• I removed the seat post and disconnected everything from the battery, reconnecting it did not resolve the issue
• I asked some cyclists passing by for help, they laughed politely and said "that why we stick to mechanical shifting mate"

After a call with the excellent team at Ron Spencer Cycles I downloaded the e-tube app, pressed the rear derailleur button for a second to enable Bluetooth (blue light starts flashing) I was then able to communicate and configure the Di2 system.

Updating the firmware

The app was able to see and communicate with all the devices, this was a positive start and I could see there was a firmware update for the system battery, both derailleurs and both shifters. Great. I started with the rear derailleur as that was having the issue, still no resolution, I then updated the battery and front derailleur to ensure they were all running the latest firmware.

I then tried to update the shifters I couldn't update the firmware, this is because they are wireless and need to be cabled to the battery to ensure the update occurs safely without a power loss. I will still in a broken state and unable to get home.

The workaround

The e-tube app allows you to customise what the shifters do, so I swapped the function of switching to lower gears with higher gears and vice versa. Boom, now shifting to higher gears wouldn't work. This meant the rear derailleur was shifting ok but there was something going on between the typical lower gear switch and the rear derailleur responding to it. Shimano Ultegra and Durace both have a third button on top of the hoods which I usually map to Garmin functions, so I tried to map this to shifting into lower gears and it worked fine.

This narrowed down that there was a problem with the switch and that the other two worked fine. I went with this configuration hack as way to complete the ride. It was a little strange shifting using the hoods and pressing the 'wrong' button for lower gears which meant I often did the wrong thing but it was fine and saved waiting hours to be picked up.

Since this happened the bike has been back into the shop for a more thorough diagnostics which confirmed a faulty shifter that was replaced the same day and I am back on my way.

I hope this helps someone get home if stranded someday.

Thanks

Special thanks to Dan Philipson and Mike Stanton for waiting in the cold with me and helping me diagnose the issue.

• I gave some feedback to our platform teams about an initiative to improve our services we call this WAS (Well Architected Service). They have done a great job planning things and defining a scope but I felt it was starting to feel like a death star so gave feedback on how to reduce the complexity and get started sooner.
• Clarifying our offer and GTM strategy in the UK for the next 6 months, what we will stop, continue and start doing. We have an operating model that works really well in other markets, it's mostly applicable to the UK too but the  EPS problem I wrote about last week is hampering us deploying it having a negative impact on us, partners and patients, so we are thinking how we work around it while we wait for the assurance process to open up again.
• Discussion about an experiment we are trying which is no meeting and no product work on Wednesday's for solving tech debt problems or improving parts of our architecture to help with the WAS work but also tackling some of those TODO's in the code base; we are running this until the end of April and I am looking forward to seeing what the outcome will be. This is inspired by a firebreak that was run with the NHS.UK teams but over a longer stretch to allow time for things that will take a while to work out and execute.
  
  We are also trying different ways of working too. As a company operating across Europe, we have access to a larger talent pool which is a great upside, also the working day spans 9 hours instead of the typical 8 with a one hour overlap. The downside is trying to optimise developer flow time, we find that it is typically what is left after everyone else has taken a slice of time.  I have set the teams the challenge of trying different approaches and reporting back their findings. That doesn't mean 8 hours a day constant developing with no meetings, but it does mean designing a schedule with intent.

What did I read?

• RIP Redis: How Garantia Data pulled off the biggest heist in open source history An interesting take on the usurping of much loved Redis by Garantia now known as Redis Labs. I am looking forward to seeing how AWS reacts to this one, I don't see open source changing licensing terms any worse to someone acquiring a company that owns software you depend on. At least you can make a fork and continue.
• A Bronx Teacher Asked. Tommy Orange Answered. I loved the part the teacher played in this, so nice to see the impact of books in a world of social media. I've added 'There, There' to my reading list.
• Lynda Barry - I don't know who she is, but I enjoyed reading this article about her creative process and teaching methods. Especially the parts about less technology.

Something Personal

• I spent the bank holiday weekend in Anglesey with my family and got out on the Jetski for the first time this year. They battery was flat when I first tried firing it up but an overnight charge sorted that out. I took my daughter and her friend on with me as it's a three seater and while doing a slow rate turn we all leaned out of the turn a little too much which threw us in the bitterly cold water. Our bodies were fine because of the wetsuits but our feet, hands and head was freezing. I promptly ordered wetsuit socks and gloves ready for the next outing.
  
  

At our local church, technology is used extensively in conjunction with the audio setup. These are co-located on the AV desk that is typically managed by two people. One for audio, one for the computer. This is used to ensure lyrics for the worship songs, church notices and sermon material can be shared on the large projector screen at the front situated behind the band or pastor.

How hard could it be to join the Rota?

I decided to help them out and join the Rota after a significant drop in the number of people who could perform the role. As a techy I wasn't at all phased by this, but after doing a training session and shadowing a few people to learn the ropes of how things are setup and it became clear that the role was highly stressful. Often reducing people to tears when things went wrong.

Typically, it's such a seamless and almost invisible part of the church services, but when it goes wrong it's very noticeable, many heads turn to look at the desk if the slightest issue crops up. The lyrics need to be switched at almost millisecond like precision. No one ever wants a tech problem at a funeral service.

After soloing the service for a number of months the system was sluggish, crashing all the time and needed quick reaction times and fault finding to keep on top of things. On the whole it was very unreliable and on the days I wasn't on the rota, I would often get a flurry of messages full of desperation to help fix issues and I felt powerless to help. It didn't take long for me to get to the point where I wanted to quit myself.

I thought about it for a while then made the opposite decision and decided to use my god given talents to try and tackle these issues even though I wasn't the IT guy for the church, that role didn't really exist and the entire setup is a result of many enthusiastic helpers over many years, many who have since left.

Fixing the hardware

The computer is pretty old, an Intel i5-7500 CPU with an old school HDD and 8GB of DDR4 RAM. Boot times were shocking taking around 4 minutes, loading software such as Song Show Plus took minutes too. It was awful to use. When things crashed which they often did, it would take an uncomfortable amount of time to reload the software and hope things would be working again.

I took the computer home and after cleaning all the dust out of it and taking stock of the hardware I looked in my box of discarded parts to see what I could possibly use. I had two sticks of 16GB DDR4 RAM so I popped those in which made a notable difference.

I also found an SSD to pop in but the capacity wasn't big enough to perform a disk to disk image, I really didn't want to do a full reinstall of everything as I wasn't comfortable with all the different things on the computer that have accumulated over time. I decided to order one at my own cost (a whopping £25) to arrive the next day, a quick image from one drive to the other using disk duplication software with partition table setup and the machine booted first time. I decided to leave the old drive in the machine but disconnected in case I needed to revert to it at any point. I jumped in the BIOS, checked all the settings, made the new SSD drive the 1st boot device and enabled fast boot. New boot time 20 seconds from cold to fully up and running. Bingo!

Fixing the software

When logging into Windows I was greeted with many things auto starting, Spotify, Power DVD software, Song Show Plus, Edge, Skype, OneDrive, and Google Drive to name a few. This added overhead time to close or minimise the things, stole valuable resources from other applications and was just annoying. I disabled all these. Logging in felt much snappier.

I cleaned up the desktop removing unnecessary files accumulated over years to an archive folder. A trip to windows update, turning on all the security settings that had been turned off and turning on auto update resulted in a lot of updates and reboot cycles, but at this point things started to feel very snappy indeed, especially for an old machine. I installed the awesome TailScale so I could create a VPN connection to the machine from my laptop and also installed the awesome UltraVNC to be able to remote control the machine; this would allow me to support the machine if people were having issues and I wasn't onsite or nearby.

My work here was done, I was delighted by how quick the machine was and fully anticipated an end to all the stress and anxiety relating to using the PC to support the church services. I was wrong, very wrong. The problems continued, an investigation into the network was required.

Fixing the network

The machine seemed fine for extended periods of time, but every now and then Song Show Plus would not start and OBS would crash while streaming the church service to YouTube which requires a stable connection to continuously upload the video stream. It didn't take long to see that the connection to the network wasn't present and then would pop back into life. Super strange. I naturally replaced the network cable which was looking worse for wear. Nada. I tested the socket on the wall with a network cable tester. All good. I then decided to map the current network infrastructure to see if there was anything obvious but it looked fairly standard.

Those network over powerline extenders needed replacing with a cat5e cable but nothing out of the ordinary there. I also found it impossible to UltraVNC into the machine from home for anything longer than a few minutes, but an immediate reconnection was fine, for another 5 minutes or so.

I then patched the network cable from the PC directly to the Virgin Media Router, things seemed stable, but then more issues started happening. Strange. At this point I was scratching my head. I decided to ping the router for an extended period of time and could see the following which indicated the router was losing connectivity to the internet or experiencing intermittent connection issues. The DNS settings of the router were standard and supplied by Virgin Media. More head scratching.

An exploration call to Virgin Media resulted in them saying they could see an issue, or more so they couldn't see the router on their network at all, hurray! Almost 10 days later after various engineer visits with wrong router installations which was a saga in itself; I had a new router in place with everything checked by VM and working.

The next Sunday Service came along, I wasn't onsite, I fully expected everything to work out fine, then the messages of panic started. The issue was still there. The PC kept losing it's network connection, the live stream was dropping despite being on a direct cable to the router, I felt awful for the team.

I ran a second cable, brand new, tested for a long duration, the issue still kept coming back. I was puzzled. I was starting to think there was a rogue device on the network kicking the machine off, typically Windows would inform us of a conflicting IP address though. Then it I had the realisation the router was replying saying it couldn't reach the destination so it had to be a problem with the router.

At this point I started to become suspicious about what was on the network, it's a large building, and even though the diagram looks simple enough, I had no idea where all the cat5e cables going and what other devices could be interfering with our connection.

I wrote a quick PowerShell script that would capture the mac address of the router by repeatedly looking at the arptable and appending it to a file every 5 seconds. The arptable caches the hardware address of a network card and maps that to an IP address. It allows switches and other networking equipment to know which physical network devices to send intended IP packets to. I left the script to do it's thing. Boom, another device was claiming the Virgin Media router's IP address, to which it quickly reclaimed. Whatever the device was, it wasn't as quick at reclaiming from the Virgin Media router which gave is long periods of a workable internet service but not stable enough for the Church Service.

Finding the device wasn't an easy task, but using an online MAC Address lookup service I could see it was a Netgear device I was looking for. Was it one of those switches? Nope, I removed them and the problem persisted. Eventually I went into every room and traced from the power sockets to try and see what devices were on the network and boom. I found it. Someone along the way had plugged in an old internet router thinking it would behave like a switch, as it was a router it too was trying to claim the often used default IP Address of 192.168.0.1 causing a conflict with the Virgin Media router.  It was well hidden under the desk and behind the PC in the office for the purposes of giving the printer connectivity. It worked when whoever installed and tried it and as the issue it introduced wasn't immediate and permanent it went unnoticed for months if not over a year causing all kinds of chaos.

I took the opportunity at this point to clear up things and not reconnect the switches I had removed while diagnosing the issue. I'll be running a new cable to remove the powerline devices.

Conclusions

My conclusions are that well intended enthusiasts don't always appreciate the impact of changes they are making. The network architecture was way too complicated for what it needed to be. Keeping things as simple as possible is typically best.

It also made me appreciate how difficult this was to find, I have decades of experience in these areas and it took a lot of first principle thinking to get to the bottom of this with lots of driving back and to from home to the church. I am sure if they had gone to a professional they would have ended up buying lots of new network equipment they didn't need, new computers and no lessons learned. I feel privileged to be able to help get things back up and running and more stable, I'm praying that the many Church Services planned for Easter go without too much trouble.

I met the amazing Tara Humphreys and Dan Bunstone in a workshop to learn more about PCN's and General Practice in General. We have a product that partners love but our brand awareness is in need of some work. We are often referred to as like Babylon which is frustrating as they don't seem to have a positive association with them with regards to the NHS.

It was also good to see the UK leadership team to align on our priorities for next quarter. We are investing heavily in the UK and have a huge program of work ahead of us which will improve our primary care offer even further.

I met with one of our project teams for a project we call Precious.
The theme of the discussions were quiet depressing as they revolved around the central assurance process for EPS. It's stifling innovation and facilitating the duopoly of EMIS and SystmOne in relation to Primary Care, we believe the small assurance team is focussing on secondary care but the updates on the website indicate nothing, an update is expected end of 2023 (not a typo).

The NHS has done the hard work in this country on the technical side of things with EPS, we’re way further ahead than Sweden, France and Norway for example, however the box ticking assurance process is closed meaning it's little more than a useless innovation. Our product impact in other markets is clear to see, but unfortunately in the UK we’re having to pay excessive license fees for bloated tech at the point of primary care prescribing when everything else required is delivered in our own system. The clinician experience sucks too, having to jump out of a fast, modern, user need driven application so they can prescribe in one of the two is painful and inefficient.

What did I learn?

I learned a lot from Tara and Dan about Primary Care that challenged some old assumptions I had about General Practice. I also came to the realisation I have been very inward focusing from the UK perspective over the past few years while adapting to my role from UK specific to a European focus.

I learned how we build API's these days in our MJOG product, work that Leander has been leading. It will be great to see this approach roll out across our stack as we evolve some of our architecture.

What did I achieve?

We have been planning on reorganised ourselves in a reverse Conway's Law configuration recently and I am pleased to say that is now in production for beta testing. While doing so I wanted to redefine parts of our expectations in ways of working. During our significant growth stage we didn't always make the best technical decisions in favour of expediency, so creating the conditions for people to tidy up our technical estate is important to us, but it can often come second over features. The engineers are loving the new setup, the feedback has been very positive around the ways of working and the impact they are having is surprisingly immediate and significant.

I wrote a blog post on how we tackled a product market fit problem in the UK for General Practice which should be published this coming week.

I also wrote a post for my personal blog about blogging,  I feel a real sense of urgency to write more and regret I haven't done more, this came from a 5 minute conversation with my son.

What could I have done better?

• I received some feedback about not turning up to a meeting (declining close to the start time), this went straight to my boss and not to me which I find frustrating, not that this caused an issue, but I prefer feedback immediate and directly to clear up any confusion and to be able to address it promptly.
  
  I have spent 2 days in France end of last week, 4 at Centre Parcs with my family for a much needed break,  followed by 2 days in London, which is a total of 8 consecutive days where I haven't had the usual luxury of playing calendar Tetris as I have been back to back busy. In hindsight I should have put an Out of Office on with auto decline to new requests during the whole period.

What are you looking forward to next week?

• A week without travel, after living out of a backpack for a chunk of time I am looking forward to sleeping in my own bed and a more typical routine.
• Writing down the expectations around ways of working taking into consideration more feedback from trying things out.
• Spending time with my team, we have all been so busy lately we haven't spent as much time as I would like with my team and direct reports.
• My plane has been awaiting a new magneto for a while now meaning it's been grounded. It's hopefully going to be installed and approved as airworthy again this week. I only have 2 weeks before I lose 90 day currency in a complex aircraft (retractable gear and variable pitch prop) which would mean another check ride. I have been flying other aircraft though and picked up my night rating and instrument rating while I have been at it.

Things I read

• I finished reading "It doesn't have to be this crazy at work" - this was a quick and easy read and has some extreme views on office culture in a tech company. As we have been making changes I wanted to read perspectives that challenge the status quo.

The other day, my eldest boy surprised me by talking about one of the posts from my blog. I wasn't aware he had even read anything on it. I asked him how he discovered it. His response was rather amusing "I know you are famous for building 111 so I searched Tony Yates 111" 😂 bless.

The conversation continued and it was clear he had read most of the posts, we discussed a number of them, he liked the one about being like the flower. We then talked about him discussing some of the posts with his teacher and the wider class and it suddenly became clear that my writing allowed him to know things about me I probably wouldn't have shared in general discussion, he gets to know me from the perspective I publish.

My grandad recently died and I miss his stories, they are gone forever and live only in the memories of those he told. There was no place or book to go and look at his life through his lens, I scrambled to recall as much as I could and write it down so some of him could live on.

I recently read a quote somewhere that note taking is the nearest thing we have to time travel and I couldn't agree more, it has had such an impact on me I wrote it down and it sits on a post it note under my screen. It's given me a new sense of purpose to blog more. If the audience is just my children then it's already worth the effort to take my thoughts, write them down and publish them for all to see.

A list of things I am grateful to my Grandad for:

• His love ❤️
• How to be generous with your time ⌚
• His hard work and sacrifice in his younger years ⚒️
• Always being there for me, my brothers, and cousins 👪
• Loving my Nannan his entire adult life👵
• Having high standards for how I interact with other people 👴
• Teaching me good manners 🙏
• Teaching me how to fish 🎣
• Teaching me how to be resourceful, recycle and make useful things to solve problems ✂️
• Taking me fishing, every weekend for over a decade of Saturdays in the bullet fishing club 🐟
• Your used copies of Angling Times Magazine 📰
• The packed lunches 🥪
• The stop off at the sweet shop 🍬
• The word 'Mester' aka Mr 👨
• Teaching me fly fishing techniques on a field 🪰
• Teaching me how to fish for trout, fillet and cook them 🍳
• Teaching me how to grow food 🍅
• Teaching me how to make a fire safely 🔥
• The endless tales about working down a mine ⛏️
• How to cook 'Ash' - usually corned beef 🐄
• Never letting me leave the house without a gift, even if it was just an apple 🍎
• Showing his pride for his family 🌈
• His generosity and always open house 🏡
• The fishing trips to Ireland 🏝️
• Showing how to make people laugh 😆
• Showing what a Spitfire Airplane was - my love for aviation started there 🛩️
• The trip to Silverstone to watch the F1 🏎️
• The Trip to Cleethorpes in the caravan with my brothers 🩴
• Taking me golfing on the weekends ⛳
• Teaching me that when I fail, to just keep at it and it will come 📈
• Showing me how to tie a Tie (properly) 👔
• The walks in the woods gathering chestnuts 🥜
• Roasting the chestnuts on the fire 🔥
• Reading your Britannia Encyclopedia's with me📚
• Teaching me a range of useful knots 🪢
• The last time I saw you and the big hug you gave me🤗
• The last time we spoke, on your birthday 🎂

You were a superb role model, I'll always miss you x

I have an everyday carry (EDC), in my family we refer to it as the emergency pack. My family make fun of me for having it, yet they benifit from it more than I do. When I show people my emergency pack, my family roll their eyes.

Most people are impressed, some are in awe, some think I have issues.

I think it is too good to keep to myself, so I am sharing what it is, and how I have set my one up and some of the actual uses and hypothetical use cases are.

Without further ado, let me share what is the emergency pack.

It all revolves around the Maxpedition Mini which is a fantastic pack. I absolutely love it. It has lots of pockets, things to clip to, elastic retainers, a strong zip and is very light weight. It is slightly bigger than my hand. This thing goes almost everywhere with me, I only leave it when it really isn't practical to take with me, like a night out for dinner with my wife, unless it will fit in her handbag.

Here it is open with some of it's contents on display.

Moving from left to right on the left hand side.

The greatest charging/data cable ever invented. This has USB/USB C at one end, and at the other end USB C/Micro USB and Lightening giving a total of 6 permitations. I use this all the time.

Nail file. A bit random but I like short nails and smooth edges. It's also useful for filing anything you need to. I have used it on a snooker tip, sharp plastic edges and of course my nails. It sits next to it's close friend the nail clippers which can also be used as mini cutters of string, wire etc, great for removing tags from clothes.

The next item is a bundle of zip ties. I have used these so many times to fix things. I've used them to keep cables tidy, to secure things to my bike, my bag. I even use them to let my two year old daughter pull them all out and put them back in the heat shrunk wire cover one by one. It keeps her occupied for a good 15 mins, very handy on a plane or out for dinner.

Behind that first row is a few meters of ducktape folder and stowed behind the elastic. I have used this many times too. One of the most frequent uses is to cover the annoying lights in hotel rooms on the TV or aircon units that keep me awake. I have also used it to stop draughts, cover the aircon unit in a room with a pillow case because it wouldn't turn off and was making a racket. I have fixed a hole in a tent with it. Brilliant stuff to have on you at all times.

On to the back row of the left hand side.

I have a thin pen. Obvious uses, I like to always have one with me, there is nothing special about this one other than it is really thin and light.

In one of these packets I have 2 meters of micro cord that is tested to withstand 100lbs, I have yet to use this but it's so light and will work as a temporary belt or shoe lace. I suspect it will be used for the kids before myself. I can also imagine using it to tie things down if needed.

I have a mini sewing kit, from a hotel. I've never needed it but would rather have it than not, if I pop a shirt button I would prefer to fix it than use the ductape.

Medication, I have  paracetamol,  ibuprofen and a pack of immodium. I also carry a couple of rennie just incase. These are in another packet like this one

Alcohol wipes these are good for cleaning cuts before using one of the plasters if needed. I have used them to clear a grimey screen mainly as they work great on that too.

A round 3m Sticker. I don't know why I carry this, but I do, the first time I remove it there will be a desperate need for just that item so it has to stay now.

I take cash, both euros and pounds. Usually there is £100 of each, just in case. I also have a credit card should I lose my phone. I have used all these payment methods many times over.

A Foldable USB/USB C 3 pin wall charger, it's 20W so pretty fast and has got me out of a few pickles.

These little things are awesome and about the size of an extra strong mint, I carry three of them, wet them with water and it turns into a wet towel. I use these all the time mainly for the kids but they are useful if I end up with dirty hands as I did when fixing some blokes bike who's chain had snapped.

The Right Hand Side

I have a small bic lighter, this comes in useful more than I thought it would, disposable bbq's, stopping threads from fraying that kind of thing. Coupled with the glue stick next to it though it's super powerful. I have stopped penny floater footballs deflating after a detour into rose bushes. Fixed signs and glued a trainer. I just use the lighter to melt the end and use it like a fast setting glue/wax.

A nitecore headtorch. This is super powerful, usb powered and has red light modes too. I use this a fair amount but the main reason for getting it is Swedish hotel rooms which are often windowless. I like knowing if something goes wrong I can find my way out of the pitch black. It's also been used as a bike light when riding home in darker than expected conditions.

The Victorinox Swiss Army Knife needs no introduction. I keep this sharp as a razor and use it almost daily. The scissors are used all the time, the knife for opening envelopes. Screw drivers. Tooth pick, Tweezers. It's just the best tool ever and has 15 functions. I buy loads of these as Christmas presents for friends.

Having a mini sharpie always comes in handy.

Mini notebook by moleskine. It contains a list of peoples numbers I would want to contact if I was to lose my phone as I can't remember them. I also use it to jot things down to remember for later. The sheets are tearable so I can write notes to leave for someone if required.

I also have a USB Micro SD card reader and SD card that is encrypted with some files I would need in an emergency situation that would allow me to show a scan of my passport, driving license, insurance documents and a few other personal files that can help me get access to some systems and services.

So that is the tour of my emergency pack, I hope you like it as much as I do, if you have a similar one or inspired to create one please let me know your setup. It is carefully thought out and put together, heavily inspired by youtubers but tailored to my own needs. I'll be sure to post updates as I modify the contents further.

This is mainly for my teams and direct reports to understand how we will work together.

Feedback

I like it quick, if you spot something and think I handled it wrong or could improve please let me know. If you need extra support from me, please reach out, don’t sit in silence. Positive feedback is welcome too if I do something you think I did well. A quick message will do initially if I feel I need to understand more I would welcome a more in depth discussion via F2F or similar.

I like to address any disagreements rather than them fester and become something more. Not agreeing is part of life, we can agree to disagree and move on it won’t make me respect you less, we all see things differently.

Direct Reports and Teams

25% of our time I am your boss. I will keep you accountable for goals, quality, growth and how you are performing with your peers and teams.

50% of our time I am your peer. Bring decisions that need my input, get my feedback, learn from my mistakes and experience. Let’s put our minds together to solve real problems.

25% of our time I work for you. Given your goals and our mission, how can I help you. What do you need from me to do your job better.

%'s are guidelines, of course different challenges and situations need different ratios.

Decision Making

Use this decision tree model:

Leaf Decisions: Make them, act on it. I don't have to know about them. They are usually reversible.

Branch Decisions: Make them, act on it. Let me know about them and share your heuristics so that we can learn. Reversible with some effort.

Trunk Decisions: Share your decision and heuristic before acting on it. Get some feedback from me and a peer. These decisions will have broader company impact.

Root Decisions: We will make the decision jointly. These are decisions that when poorly made can cause major harm to the company.

Conditions I like to work in

• I like to work in cooler environments, I don’t like it too hot, it makes me grumpy.
• I can work from anywhere, but I love my home office as it is my personal bliss station with access to lots of books, notes and scribbles. A balance of home & onsite works best for me.
• I like large screen real estate. I often have my left and screen where I work and my right hand screen for reference material or video calls. Not always ideal for looking into a camera which I put in the middle of the two.
• My deepest thinking happens best in a morning, after lunch I am better at more administrative tasks.

The best ways to communicate with me

• I use a mix of email, slack, F2F, phone and WhatsApp. If it is urgent and needs immediate attention use Phone or WhatsApp.
• We have too much slack activity, I can miss things, raise in 1:1’s if I haven’t responded or see point above.
• I like people approaching me at my desk, if I am wearing headphones/earbuds I usually don’t want to be interrupted.

Things I need

• Opportunities to collaborate with people and teams, co creating things.
• Time to think - making fast decisions is sometimes required, good decisions take more time.

Things I love

• Making decisions, when I see analysis paralysis I really like to get the facts required to make a decision and make it. Examples would be should we chose x or y? We don’t know what to do about x? anything that has uncertainty surrounding it I like to resolve by working through it with people collaboratively. If it becomes unclear, I will make a decision so we start and correct course rather than wait for everything to be perfect.
• Learning, if you have something cool to teach, I always want to learn about it. I like to know how things work under the hood, fundamental things. Learning is a life long journey and I like to take the time to understand the work people do. This helps me help them by making better decisions.
• Solving problems together on a whiteboard/miro board, solving code problems in IDE's together.

Things I struggle with

• Unkindness - there is no need to be mean to people
• Meetings where people are suppressed and don’t want to speak up
• Massive long messages when a quick call can do
• Not taking the time to understand different perspectives
• Not getting time to think
• Analysis paralysis, I would rather act, learn and correct course than plan for hypothetical situations that may not transpire

I often think about green screen terminals, they were prolific in hospitals in the 90's. I have collected some thoughts I have about terminals with respect to clinicians and admin teams, which are what I describe as users:

Green Screen Terminals were fast.

Text and input boxes is all there was, it's kind of the same now, but with images and video added.

Green screens immersed the user in the task, there was no multi tasking, pop ups, slack, email, notifications.

Sometimes green screens were slow, but they buffered the users keystrokes, this meant the user could be quicker than the system.

A keyboard was the interface, it is quicker than a mouse, navigation and data entry were done using the same device.

Touch typing is one of the fastest things our brain can turn from thought to action.

Introducing the mouse and UI actually damaged the UX, the system slowed down the users, the system was quicker than the user, who has to deal with added gloss and complexity.

The new systems slowed the workforce down, the people building them weren't thinking about how people used the systems.

Engagement went down, users were no longer able to look at the patient, they were focussing on the system.

Their jobs had now changed, they became a system user rather than a person that primarily engaged with patients.

The system could now capture data about everything that happened within it, this became performance analytics.

The managers were happy, they could now monitor and performance manage people, everyone however got slower for the price of more visibility.

New technology did however give access to the worlds information, which if used correctly can be a good thing, such as looking up medical databases.

We don't want to go backwards, just rediscover some of the things we lost, such as immersing the user with the patient and giving them just enough technology to do their job.

Remove everything that is not necessary. Do not build things for delight or perceived value that does not exist.

Make clinicians jobs faster, you help more people if you do the hard work to make the system simple.

This article was originally published at Interoperability Saves Lives (vix.digital) in 2019. It has been migrated here as VIX Digital will be shutting down after the acquisition by KRY/Livi.

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Last weekend we attended UK Health Camp as gold sponsors. I ran a session called "Interoperability Saves Lives" with the aim of sharing some of the experiences I had when leading the development of the NHS 111 interoperability landscape and hearing about other great interoperability initiatives people had seen in practice.

As we discussed the work I had been involved in from NHS 111 it was apparent that there was a lot of value in what I was sharing and a question came about blogging, had I done any regarding this stuff? The answer was unfortunately no, but I did commit to writing some and sharing them.

As the service integrations are so wide and varied I need to split them into individual case studies. The first one is on Ambulance Dispatches.

A Case Study on Dispatching Ambulances

When I joined the Department of Health team in 2011 to be the country's Interoperability Subject Matter Expert, I had already embraced the service specification and what it aimed to do. One part stood out to me more than all others “Providers must have the ability to dispatch ambulances without delay”.

My initial thoughts, this was going to be a breeze, tell all the people to tell all computers to talk using standards, that would do it. Or so I thought.

You’re Going to Do What?

Ambulance Services, that’s right there is an s on the end, 13 of them at the time, they are simply the most loved service in the country, because when you need them, you really need them. The teams save lives, every single day, from the phones, in the vehicles, on the road, you name it they do it. I will never forget witnessing a 999 call where a baby was born at home, lifeless, blue, through the work of the team they instructed the mum to bring the baby to life and the cry of the baby still rings in my ears to this day. It was the most overwhelming emotional day at work in my life, I had tears streaming down my face, I do now just thinking about it again.

I had the privilege of speaking to every Ambulance Service to inform them that not only are they going to need to let a foreign organisation dispatch their most precious resources, but we were going to all do it in the same consistent manner using technology that didn’t exist yet. You can imagine the response, the risks were huge, but so were the rewards if we managed it properly. Here we are now, 7 years later with circa 12 million ambulances dispatched electronically using interoperability in every part of England.

Here is the playbook of how it happened from my perspective.

1. Put Some Controls in Place.

All providers were required to meet the service specification and a specific section referenced that compliance with a national interoperability specification that would be produced, must be adhered to, my job.

They needed to meet both specifications, assessments were done and if they failed they didn’t go live. It wasn’t easy and there were many challenges but the controls worked, in the same way spend controls at GDS are used as a mechanism to stop bad things happening. My job was to ensure that the technology wasn’t smoke and mirrors and worked properly from day 1. If you were a supplier who wanted to operate in this space then you would comply, or not be involved in the service.

Mandates are not big and not clever, I personally hate them if they end up closing markets and I did my best to ensure everything was as open and as fair as possible, everyone who expressed interest made it, thankfully. However the minimum requirement was the minimum.

A technical go/no go decision would be compiled into all the other areas of assessment clinical governance, operational service design, training, etc passes were needed across the entire service. It was a big decision and I had the backing to make it on the technology front.

2. Understanding the Problem You’re Trying to Solve.

The reason this requirement was in the specification is because if prior to NHS 111 if you called NHS Direct or an Out of Hours service and needed an ambulance, then in many cases you would be told to hang up immediately and call 999.

This could take minutes (2.5 was the average measured) for the patient to do this and get to a point where a vehicle was on its way to them. That is a long time if you are having a cardiac arrest, clinical colleagues informed me that things don’t look to great after 8 minutes.

There was also the risk that the patient never actually did call 999. Not a good outcome.

Those minutes matter, you need them on your side. It now takes a just a few seconds for an ambulance to be dispatched from NHS 111 without the patient having to do anything other than follow instructions to help them while the ambulance is being dispatched.

3. Understand the Existing Service.

It’s called user research now, I didn’t realise I was a researcher being a technical architect type, but I found myself in every ambulance service operating room in the country along with the operational service designer.

So much time was spent observing how call handlers, dispatchers, paramedics and the management teams ran such a critical service. I took notes, a lot of them, as did the rest of the team, we found the friction, drew diagrams and shared them with colleagues, we circulated them with everyone affected.

It didn't stop there, they were refined time and time again until they represented reality and the many unpredictable elements of the service. It was really hard work but we understood intimately what the people receiving these calls needed in order to act. So we built it exactly like this right? Wrong.

4. Build the Prototype

What is the minimum we could do to learn? Well we knew there would be some trust issues, I mean 999 staff go through some very rigorous training, how could an ambulance service feel assured bad things wouldn’t happen?

111 call handlers would receive very similar training to 999 call handlers and would be proficient in the same professional language. To be safe we had to design the technical architecture for failure, be prepared to ‘take the service offline’ in newspeak. A minimum dataset was created for when the technology failed, a secret number would be provided to the 111 call handlers and a verbal handover would occur without having to repeat all the questions and answers the patient had provided.

This was pretty cool, it was something we could use and test without building a single thing and that is exactly what happened. Small cohorts of calls were passed between the services in a verbal manner, closely monitored, lots of controls were in place to cover all scenarios and the patient received a service that met the design intent, dispatching ambulances without delay.

People began to trust it, and guess what, we learned a tonne that would not have made it into the technological build had we not done this. Special access code to get into the block of flats? That wouldn’t have been in. Scene safe to attend? Could have missed that too. How about the primary reason the patient thought they called? Nope, just the prognosis and some questions and answers.

There is nothing like seeing things in action in a low fidelity manner to understand the needs of the users. Seeing it work in this way was interoperability but instead of computers people were using telephones. Minutes were saved, lives, money, things that matter.

5. Build the Thing

It’s quite a surprise to me that I don’t have much to say in this section being the technical person designing something so critical, but to be honest it wasn’t the hard part. We designed some messages, thought about how they would interact, built some things and asked a lot of suppliers to build some things that matched our things. The key thing with interoperability it that it's not about technology, it's about workflow and working seamlessly as one for the benefit and safety of users.

The one thing I guess I can say here is that this section is why the majority of interoperability programmes fail, and will continue to fail. It’s not about FHIR, CDA, HL7 or any other standards. They all come with the same promise of solving the problems of the past, but it was never the standards that were the problem. Sure there are better ways of doing things and the above standards are important, but to be perfectly honest with you, we could have used CSV files over TCP and it would have worked.

The big problem is that, interoperability programs start with step 5 most of the time.

6. Test It in a Small Area

What could we possibly learn by testing? Well a lot as it happens. We learned that the way Java and Microsoft Web Services handled SOAP was different.

We found bugs that were safely handled as we dual ran with the ‘prototype’ handover process in place for good measure until we had sufficient data, scenarios and volume to feel assured the technology was fit for use. It wasn’t perfect, but was safe, it works and it saves lives and could be iterated.

There is nothing like testing in the real world, simulations are never like the real world, people test with perfect data and scenarios, rarely the edge cases that are very hard to imagine creep into testing.

7. Sell It

Hurray it works, if you build it they will come.

Unfortunately not, the next year of my life would be travelling the country, giving people access to my knowledge, helping them understand the whole technical design, give them time to be heard, learn and contribute where we had missed things.

I didn’t do much architecting this year, I was evangelising for the thing I had designed. Guess what though, after it had been running for a few weeks it didn’t take long for the benefits to speak for themselves and help me in my mission.

You see, ambulances need to attend within 8 minutes if a patient is thought to be having a cardiac arrest or other serious conditions requiring that level of response. The minute the phone rings the call is considered ‘connected’ and the clock starts ticking for the ambulance service they need to answer the call when they have someone available, identify the location first and set the vehicle off screaming down the road while they continue to ask questions and work out what is wrong, they need to meet the target for themselves and for the sake of the patient.

Sometimes though it doesn’t need that level of response and once that is determined the vehicle goes back into patrol mode and stops screaming down the road returning to patrol mode, that's why you see them do that. This highlights that there were savings to be made.

Let me walk this through with you:

• So, if a patient calls 111 and is determined to need an ambulance.
• They don’t have to call 999 and repeat themselves.
• They don’t have to add 2.5 minutes to their wait time.
• The message takes a few seconds to be sent and a positive acknowledgement sent back to the call handler.
• The outcome is already determined at this point.
• 999 Call handlers don’t have to answer a call, meaning the line is free for the next 999 caller.
• The most appropriate vehicle response is dispatched first time.
• Extra minutes for everyone, lives saved, £ saved, I would call that a win win.

Conclusion

It was the start of a brand new service that would evolve over time and still is doing to this day.

I learned so much and of course there are things I would do differently if I had to do it all again. But the result, that I would not change for anything. It’s the most important work of my life so far. I am so grateful to give it the years I did.

The key takeaway message is that interoperability is super hard. It’s not about messaging, it’s about trust and that trust has to be earned between the parties involved, you need a shared goal, someone empowered to make decisions and a lot of elbow grease by talented folks. There are so many people who contributed to this work to make it a success, I just had the privilege of leading the technical parts of it.

When I hear the words 'single source of truth' I often pause and think for a moment to understand the context of the sentence. Here are my thoughts on what it means to me using the healthcare domain.

Often what we mean is a single place to go and find out everything we need to know about a patient. The main focus being on the word 'single'. I want the many truths and I want to go to a single place and find it. Sometimes we have to combine single sources of truths though to build up a more complete picture.

Some examples of this are GP records, the GP has a longitudinal view of  a patient healthcare record. It has a view of the truth and is a single place we can go for it. It doesn't necessarily hold all the data we need though, just a view of it so not always the full truth.

This is different to the source of a single truth where the focus is on the word 'truth'. The truth is where the data originates, usually tied to an event of some sort. It may be replicated to other places, but the truth still rests at the source.

Examples of this would be an episode of care in a hospital in a particular specialty or a laboratory. This is where the truth is recorded, it can be replicated, summarised, shared or accessed via API's or sent back to a GP, so they have the most complete holistic picture but they don't always get the whole truth.

There are a lot of sources of truth when it comes to healthcare data, I find it really helpful to know if I am dealing with a single source, or a single truth when using data for specific use cases.

I don't believe a single source of the truth (and nothing but the truth) exists in healthcare, even if many people believe this can happen, I am not sure it will or if it should.

Manchester Barton airfield is a lovely place. It has a great vibe to it, a play area for the kids and plenty of inbound, outbound flights to keep any aviator happy.

The café is lovely too. Looking forward to landing here myself in the future, probably my first grass landing.

A few pics from the visit

I often hear the words "delight our users", but what does it really mean? I am not an expert in user research or delight, but it is a word I too have used a lot in the past and  I am going to try and work out what I think it means for me.

I don't think delight means:

• Show visually appealing designs - UI
• I don't think it is about creating baby steps and holding users through a complicated process, this feels like a Microsoft wizard - UX
• I don't think it is about telling people exactly what to do and leaving them to do it - Instructions
• I don't think it is about having lots of features that give users infinite possibilities
• I don't think it's necessarily giving people additional things they didn't want

I do think delight means:

• Ensuring the user can do what they came to do with the least amount of friction or distraction
• Making it so simple anyone can use it, no wizards, instructions required
• Solving their problem fully and completely, in a way that makes you the default way they would solve it again in future by choice
• Doing it efficiently, fast, authentic and reliably
• Going beyond expectations - different to additional things they didn't want

Additional things and going beyond aren't the same thing. If I buy a new car, I want to pick up my car, I want the experience to be great, ready on time, minimum paper work and process, no issues with the car. I want to get my keys and get on my way.

If I get flowers, you gave me additional things I didn't want or need, it's nice, it doesn't provide me with delight.

You will delight me if the fuel tank is full, I didn't expect it, you went beyond my expectations, you removed the friction of me needing to fill up the car right away.

The big difference in these two is the need, I didn't need flowers, I did need fuel, I expected neither. You can still delight me without extras though.

When I was running VIX Digital, I used to always say to the team we 'delight the clients'. The team knew what it meant. It meant we did whatever we could to ensure the client was left happy that they chose to work with us in the first place.

That could be the thing we built, how we operated with them, our pricing, documentation, our manners. It didn't mean going in a smart Hugo Boss suit with a Monte Blanc pen, looking the part. That would have been all UI, the UX would have been horrible and it would have made us look like we were hiding behind the gloss.

In reality we did the following things to name a few:

• Turn up on time
• Tested our tech before meeting with them
• Fair pricing, transparently
• Taking great notes and following up with them when we said we would
• Doing the hard work to make things as simple as possible
• When we built our products, every pixel was important and needed a purpose that would contribute to solving a problem, if it didn't we tried to remove it

I can't say I have always delighted people with what I do or the things I have produced, but I always try to start with the problem and highlight the friction that can and should be removed. I prefer to start with that, not with fancy designs and visual propositions.