How timebanking helps you to improve quality of care by Hesham Abdalla

The first time you experience the NHS as a patient or a carer you realise that a single national health service is no more than a beguiling myth. In fact, it is a health and care system that is as fractured and discontinuous as any other in the world. For me, this became distressingly obvious when my father was admitted and eventually came to die in my local hospital. Even though I had worked as a doctor in the NHS for over 20 years, I found it incredibly frustrating as he was turfed from one service to another and I could do nothing to prevent the avoidable harm that he endured. Looking back, I can only imagine how much more disorientating it would have been for someone with less knowledge of the service than me.

Reflecting back on my experience, I came to realise that a root cause of this service fragmentation and the crevices in the patient pathways through which my father has fallen is the fact that each service or organisation is broken into a myriad of pieces. Separate line management and professional identities meant policies and guidelines could be significantly different to other teams down the road or even down the corridor. Separate budget lines meant departments and organisations were competing for scarce resources exacerbating a destructive sectarianism. The leading management thinker Edward Deming, stated that “Every system is perfectly designed to deliver the services it delivers” and in this case, it was perfectly designed to fail my father.

I wondered what would happen if we took the question of money off the table. What if no money changed hands when resources moved from one department to another? What if we rewrote the rules so that for the purposes of healthcare and professional improvement, everyone’s time was valued equally?

Four years later, I co-founded Hexitime with a senior NHS manager to achieve exactly that. Hexitime is a collaboration platform that uses a time banking currency and thereby allows skills to be shared across divisions, whether real or imagined.

Hexitime has only three rules:

  1. All activities are for health and care improvement
  2. No money changes hands
  3. Everyone’s time is valued equally

Hexitime now hosts a thriving and growing international community of purpose, comprising thousands of colleagues from across health and social care whose shared aim is to improve the quality of care for patients. Skills available on the platform vary from coaching and mentoring to coding and medical statistics. Everyone joining the platform is gifted 2 free credits to take up offers or post their own requests. They can also earn more credits by uploading offers or responding to others’ requests, thereby initiating a virtuous circle of improvement.

It has been a fascinating experience rewarded by a bevy of innovation awards and narrated in my TEDx Talk. It will form the basis of a series of blogs by John Lodge (co-founder), Myra Malik (Hexitime ambassador) and me over the coming months and will include topics from leading racial justice, becoming a pirate and influencing international relations.

I encourage you to join Hexitime at, take up one of the generous offers or post one yourself. This pools our collective expertise, experience or enthusiasm to support colleagues we may never have met. In doing so you move health and care from competition to collaboration and help more people like my dad.

Hesham Abdalla

Hesham Abdalla is a consultant paediatrician and director of medical education and quality improvement lead in Walsall Healthcare NHS Trust. He has over 10 years’ experience of leading service improvement seen through the twin lenses of patient and staff experience and has led teams to a number of Patient Experience, Patient Safety and Quality Improvement awards. Twitter: @hesham_abdalla @hexitime

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Co-founder and director of Hexitime Community Interest Company, Trustee at the Point of Care Foundation.


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