Leadership, System Leadership

How do you lead when you’re not in charge?

The world of health and care has changed and is almost unrecognisable from a decade ago.  People are living much longer but with increasingly complex needs.  This means that they navigate across the health and social care boundaries and often into the voluntary sector as well, and more often than not the system does not act as such and makes it even more difficult for patients to get all the care they need.

Place-based care is looking to address these difficulties with the advent of Sustainability and Transformation Partnerships (STPs) and Accountable Care Systems to try and integrate the system for the benefit of patients.  This means that the traditional delivery of care within organisations and led from the top is no longer fit for purpose and the dawn of a new style of leadership is required; one that can lead across organisational boundaries and professions – one such as systems leadership.

So what does systems leadership actually mean? Traditional organisational leadership was very clear cut; the buck stopped at the top of the organisation and it was very clear who was in charge.  Now we are working in a complex, ambiguous environments that include many different agencies trying to work together to solve often intractable problems and therefore no single person is in charge, and moreover it’s a collective effort across a system.  The simplest definition I have seen of systems leadership is from the Leadership Centre who simply defines it as ‘how you lead when you are not in charge’.

This new way of working defies how we have understood leadership for decades, if not longer, and so requires a shift in mindset in order to move to this new way of leading. According to the research done by the Leadership Centre there are 6 key principles that can be applied to lead in this new world:

  1. Relationships, relationships, relationships – this is all about building trust with others so that you can collectively get things done.  Do not underestimate the time this takes and you really must invest the time with the right intention and level of commitment.  You do not have the same levers that positional power and hierarchy allow you to pull within an organisation and so you need a different approach. However, this is not about bending people to your way through manipulation of relationships, but working as a collective and building trust and commitment over longer periods of time.
  2. Start small – to build relationships you actually need to work on things together, but you will also need to see the fruits of that partnership very quickly so as to demonstrate that you can get things done more effectively together.  Start on something small and eminently achievable and start from where you currently are not where you aim to be in the future.  This way you will build relationships and demonstrate results quickly.
  3. Go where the energy is – if you want change to happen quickly, find the people who have great ideas and enthusiasm and champion them.  It is amazing how quickly people who are given support and encouragement can drive forward change.  The coalition of the willing is the best option to help you to start to reach a tipping point and then you can bring more sceptical and laggard people on board.
  4. It’s all about the conversation – when you think about your organisation and how things get done, often it’s about the informal organisation that nestles within the formal hierarchy and governance where the real work gets done.  It’s the relationships, networks and connections that people have that drives forward change.  This is the same at the system level.  It’s all about having the right conversations; building the right networks and developing trust and commitment right across the system.  So, go out for that coffee with your counterpart in another part of the system, it’ll be amazing what you might learn.
  5. Be brave and experiment – solving intractable, ‘wicked’ problems that are complex rather than complicated requires all parts of the system to have courage to try things out and seeing if progress can be made with a particular issue.  Cross organisational; cross boundary; cross profession challenges will not be fixed in one fell swoop and will require the learning to be iterative.
  6. Systems leadership is everywhere and anywhere within the system – there is a mistaken belief that you can only lead the system by those at the top of the organisations getting together.  This is the old-world thinking imposed onto the new problems.  Systems are everywhere and at all levels and are made up of thousands of connections and so people at all levels of the system should take these principles and lead from within the system to really make change happen.

 

I have been putting these principles into practice over the past two years as the joint lead for the development of the Foundation Healthcare Group; a collaboration between Guy’s and St Thomas’ NHS Foundation Trust (a teaching hospital and tertiary centre in London) and Dartford and Gravesham NHS Trust (a local hospital in Kent).  The core principle has been that we can develop a sustainable solution for the NHS provider sector through acute care collaboration to ensure we make best use of scarce healthcare resources to continue to deliver high quality healthcare for local populations.

The focus has been both on patient pathways and overarching governance for how to formalise our collaboration.  The principles of systems leadership described above, were echoed in a recent report we published which described our learning for how we brought the clinical teams from both hospitals together to design better clinical pathways and better outcomes for patients.  This work is starting to demonstrate really excellent results for patients after only a year of being up and running.

The conclusion for me is that systems leadership takes time, energy and commitment but the results are worthwhile.

It relies on patience and the core values of the individuals involved to be able to put ego aside and to concentrate on the greater good, as often the answer does not clearly emerge and cannot be forced no matter how enigmatic and strong the leaders may be.

Dealing with the volatile; uncertain; complex and ambiguous world that we now find ourselves in will take a brand new set of skills that will require personal and organisational investment so that we can collectively all lead when we’re not in charge.

 

Systems Leadership conference for GSTT senior leaders held on 20 July 2017 opened by Amanda Pritchard, Chief Executive

2017-07-20 13.09.35

About the author

Sarah Morgan is the Director of Organisational Development and Programme Director for the Foundation Healthcare Group (Acute Care Collaboration Vanguard) for Guy’s and St Thomas’ NHS Foundation Trust and passionate about leadership and organisational development and the development of innovative strategic solutions for the NHS

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Health and Social Care Leadership, Organisational Design

Where does the future of the NHS lie – competition or collaboration?

Ever since the first purchaser/ provider split in the 1990s, patients and the NHS have been told that competition is the best way to drive up quality.  This has led to different systems over the years such as payment by results (the tariff based funding system) that have created incentives resulting in providers often competing with each other to provide patient care. All with the aim of driving up quality to attract more patients.  So far, so logical.

These principles worked to a degree when the problem was long waiting times (although arguably to the detriment of those services still on block contracts such as mental health and community); however the problem has changed.

Today demand has increased due to the advances in modern healthcare helping people live longer and survive premature birth and severe illness where previously this was sadly not the case.  This is at a time when social care has seen unprecedented reductions in funding, with 900,000 fewer people in receipt of social care than 2010 coupled with funding in the NHS not keeping pace with demand.

Patients have more complex needs due to chronic long term conditions and co-morbidity and so the logical solution can no longer be applied.  A more sophisticated funding mechanism that can cope with complexity is required.

In today’s world it is clear the pseudo-market economy logic and mechanism no longer works.  It’s yesterday’s solution.  Too often patients fall through the cracks of bureaucratic systems; clinicians are forced to find workarounds every day and managers are trying to make a square peg fit into a round hole so to balance the triumvirate of finance; quality and safety.

Another policy to cement competition was the creation of businesses or Foundation Trusts.  When this idea was first conceived in around 2004, the aim was to establish them as public benefit corporations.  Although a great idea in principle, Foundation Trusts ended up becoming legal business entities meaning that not only did they fall under the Enterprises Act 2002 and become subject to competition law but legally the first duty of the Board is to the organisation.  Great for competition, potentially not so great for creating a cohesive health and care system.

It is feasible that if health and care organisations had a first duty to their population, as a public benefit corporation suggests, then collaboration would not only be far simpler, but absolutely essential to deliver the right level of care to the population served.

All in all, it seems the competitive approach has served its purpose and now we need to move to a new world which sews back together fraying seams and in some cases, great gaping holes of the health and care system.  The needle we need to use is collaboration.

Sustainability and Transformation Plans (STPs) are going some way to address this conundrum and could start to pave the way for much greater collaboration if the incentives are aligned and executives are not forced to put their own organisations before the benefit of the wider STP.  It is crucial that the STPs give the proper time and attention to building the relationships and designing the clinical models that will become the bedrock of the new health and care system.  Tempting as it is, rushing into a new organisational form before this work has been thought through could actually worsen the situation.

In a previous blog post in 2015 I explored whether or not organisational form was seen as the silver bullet for the NHS.  It is dangerous to underestimate the impact of a restructure as often an organisation’s value is found in the informal structures created through internal relationships, shared history and the stories that are retold within the organisation, rather than the formal structures.  The risk becomes that in creating something new, the value is unwittingly destroyed.

Form follows function and therefore it is crucial to spend time creating shared purpose, building partnerships and strong relationships both at the top of organisations and also through bringing clinical teams together to ensure the clinical models are right.  The final step is to design the right organisational form to wrap around these new arrangements to cement in the new ways of working.  In this way we will find new organisational forms that are better able to solve the complex issues emerging today.

In order to ensure the NHS can not only survive this decade but thrive in the next decade of its existence, we need to find a way to manage the complexity in which we find ourselves in.  The only way to do this is through seeing the system as a whole and starting to form the relationships we need to design not only new ways of delivering care supported by new structures that make it easy to do the right thing, but most importantly, we need to find new ways of being so we can change things for the better.

As the old African proverb says; if you want to go fast, go alone. If you want to go far, go together.
Guy’s & St Thomas’ partnership statute outside St Thomas’ hospital 


About the author
Sarah Morgan is the Director of Organisational Development and the Programme Director for the Acute Care Collaboration Vanguard Programme (developing one of the first hospital Groups in the NHS) for Guy’s and St Thomas’ NHS Foundation Trust.

Sarah was previously the Head of the Dalton Review which examined organisational form options for providers in the NHS

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culture of compassion, Diversity, Leadership, NHS Leadership, Organisational development, staff engagement, wellbeing

Staff engagement – a matter of life and death part 2

The world of work is changing and our expectations of organisations and how we experience the 40 hours or more we spend working every week is changing.  Organisations that do not create environments where people can bring their whole selves to work will quickly find themselves without a workforce as people will make different choices.

Creating environments in which people feel their purpose is fulfilled, their passion is ignited and are proud to work in is the role of leadership in the 21st century.

My last blog post described the importance of staff engagement for the health of an organisation.  For an organisation like the NHS, it vital to have happy, proud, empowered staff as the levels of connectedness that staff feel in a healthcare organisation has been linked to the mortality of patients.

The happiness of our people is something that we work on every day however my personal belief is that the term ‘staff engagement’ is a passive term and instead we should talk about how we nuture our people to ensure that our staff feel involved, empowered and proud to be part of of our oganisation.

The 2016 NHS staff survey results are due to be published on 7 March 2017 and last year we took the approach that despite being the top in our category of acute and community provider, we were restless to improve our scores and so as well as celebrating and amplifying what went well we also acknowledged that there were 3 key areas that we scored in the bottom 20% on that we wanted to make a difference in, which were:

  1. Equal opportunities to career progression
  2. Staff experiencing discrimination from staff or patients
  3. Staff working long hours

We identified ways to support this at both a Trust-wide level as well as within the individual directorates.  Each directorate came up with their top 5 actions to support improving in the areas that their own staff had identified and as an organisation we have focussed on the top 3 listed above.  Througout the year we introduced the following:

Equal opportunities to career progression

  • managers to have ‘career coaching conversations’ with their team members during appraisals or other suitable times
  • Realising Your Potential conference for a cross section of staff with our partner trusts
  • Surveyed and ran focus groups with different generation groups (Baby Boomers; Generation X; Millennials and Digital Natives) to find out what is important to them to inform training and development (with more to come on this next year)

Staff experiencing discrimination from staff or patients

  • Leadership masterclasses on inclusion and unconscious bias
  • Unconscious bias training introduced into different training courses across the Trust
  • Violence and aggression campaign run in conjunction with the Metropolitan Police to support keeping our staff safe

Staff working long hours

  • Reduce our email usage culture and encourage ’email free Fridays’ and managers spending time out about in clinical areas with their staff
  • The Model Ward (Nightingale Project) which is rolling out standardised practice on the wards for the first hour and last hour of the day with a safety huddle in the middle of the day to ensure all staff start and leave their shifts on time.

A couple of weeks ago I took part in a webinar for the UK Improvement Alliance along with Caroline Corrigan from NHS England, talking about how to engage staff in change.  This webinar and introductory video focussed on some of the things that we have put in place to ensure that Guy’s and St Thomas’ is a place where staff feel proud to work.  If you missed it you can catch up here.

I hope that some of the things that we have experimented with this year have made a difference to our staff and to test this we have made sure we are full census for the next three years to ensure every one of our staff has a voice.  Watch this space for the feedback!

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust.  An organisation in the English NHS with 15,000 staff that cares for patients in the London Boroughs of Southwark and Lambeth, across the South of England and both nationally and internationally.

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Authentic Leadership, culture of compassion, Leadership, staff engagement

Staff engagement – a matter of life and death?

Most of us spend more time at work than we do with our friends and families.  Ensuring that the workplace is somewhere you can bring your whole self to work is incredibly important for our wellbeing.

In the 2015 NHS staff survey nearly 40% of staff reported feeling unwell due to work-related stress.  This suggests that staff are not able to bring their best to work and deliver high quality patient care.  In fact, in the same survey 41 % of staff would not recommend their trust as a place to work and 31% did not feel they would recommend their organisation to a friend or relative as a place to receive treatment.

These are stark figures, particularly when staff wellbeing in the NHS is proven to have an impact on patient mortality rates and patient care.  The Royal College of Physicians published at report in October 2015 stressing the need to improve work and wellbeing for NHS staff to keep patients safe.  Proving that in the NHS happy staff really is a matter of life and death!

I’m passionate about the need to create organisations that enable people to flourish.  I am not particularly keen on the phrase ‘staff engagement’ as I think it’s more about building organisations that people are proud to work at and can bring all of themselves to work.

On Monday 30 January 2017 at 10am I’m presenting a free live webinar on the topic of engaging staff in change.  I’ll be talking a bit about how we’ve been working hard to really make Guy’s and St Thomas’ an organisation that staff are proud to work for and recommend to their friends and family to receive treatment.

As a taster I’ve made a short video talking about some of the approaches we have taken over the past ten years, starting with our values and behaviours in 2006.

If you’re passionate about bringing more love into the workplace, have any questions or your own approaches to share then on the webinar, you can still register here.  It would be great to see you.

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust and the lead for staff engagement and leadership for the Trust.

Sarah’s eight part blog series on ‘How to get more love into the Workplace’ was nominated for a UK Blog Award – healthcare in 2016

 

 

 

 

 

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Authentic Leadership, culture of compassion, Leadership, Motivation, NHS Leadership, Organisational development, Resilience, wellbeing

2017 – My year of Focus

I was asked at the beginning of the year what my word for 2017 is and I decided it is ‘Focus’.

Just before Christmas I found myself in a complete state of overwhelm and was working inefficiently, flitting from task to task; meeting to meeting and trying to juggle too many variables at the same time.

Over the break I took time out to reflect and think about what I wanted to do differently in 2017 and came to the conclusion that less is more and I needed to re-prioritise.

I realised that in order to stay resilient I need to be more discerning and disciplined with my time, to not give it away too easily and spend more time on the things that energise me and make me happy in life including my spiritual and physical wellbeing. Most importantly I need to prioritise my time with my friends and family and ensure that I’m not taking them for granted.

I have decided to prioritise to five key things to focus on, which are:

1. The creation of a diary management system to prioritise both my work and social to have a much better use of time. This includes saying no more often and builds in protected time to think; write and research to ensure we stay ahead of the curve in leadership; OD and new models of care. This will ensure I can dedicate the right amount of time to the three major programmes that I am currently leading. I’ve designed a colour coding system so I know what is a must-do and what I can delegate or drop if necessary.

2. Limiting my social activities to only having one to two nights a week when I’m going on to an event after work. Prioritising things that I’m really passionate about. I became a Fellow of the Royal Society of Arts in November last year and am keen to connect with their Reinventing Work network as is connects with my passion of creating more love in the workplace – the theme of my 2016 blogging year.

3. Leaving work on time to go to the gym and making time to get enough exercise. Particularly reconnecting with the activities I love such as yoga; climbing and recently I’ve gone back to High-Intensity Interval Training (HIIT) . Even after a few short weeks it’s making a real difference to how I’m feeling.

4. Improving my sleep as before Christmas I was only getting 5 hours a night and I was finding it was affecting my decision-making and judgement. I’m experimenting with making sure that I’m winding down and in bed for between 10pm and 11pm to make sure I’m getting enough sleep aiming for between 7 and 8 hours a night to try and maintain my ability to stay focussed

5. Writing To Do lists is something that I have to really discipline myself to do. I’ve been lucky enough to have been able to rely on my memory for keeping me on top of my workload for my working career. However I noticed that as I became more overwhelmed, coupled with getting less sleep I found that I was starting to forget to do things until the last minute, which is very out of character. I find writing a To Do list quite cathartic and am using magic white board paper on the wall to write things down as well as using a To Do List book and a daily ‘plan of attack’ to make sure I prioritise every day. I find the discipline hard but rewarding when I do it.

I’m hoping that by putting in place these simple changes I’ll stay resilient; passionate; achieve more in my working day and have a greater sense of wellbeing. I’m starting to see the shoots of improvement and I’m encouraged to stick with it for now.

I hope you’ll stay focussed with me in 2017!

 

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust

Sarah’s blog was nominated in 2016 for a UK Blog Award – healthcare

Sarah is passionate about getting more love into the workplace which was the theme of her 2016 blog series and nominated for the UK Blog Award

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continuous improvement, Leadership

Listen with fascination – How to get more love into the workplace – part 8

When was the last time you really listened to someone? Not just listened to give advice or to respond; not half-listened but really listened? Apparently we only retain 25% of what we hear as we are not actively listening. That’s 75% of what others tell us, we miss.

Giving your full attention to another person, is an extremely compassionate and human thing to do. We talk about compassion as a significant part of how we treat our patients in the NHS, however we talk about it less so in relation to how we treat each other.

To me, building a culture of compassion is crucial to ensuring that organisations enable people to bring their whole selves to work. If we truly want to build cultures of continuous improvement, where staff are enabled to make change in their own areas, then leaders and managers must learn to really listen to staff and support them to make that change. As Andy Stanley warns, “Leaders who do not listen will eventually be surrounded by people who have nothing to say.” This is a dangerous situation to be in as groupthink can creep in.

Recently I had the privilege of talking to Professor Michael West about our leadership development programme ‘Leading for the Future’; due to be launched by our Chief Executive in the Autumn. The aim of the programme is to support our most senior leaders to create the enabling environments within every directorate that will allow staff to make the change they want to see. We have identified the competencies we believe our leaders will need to create the right conditions for staff to take the organisation forward. We have categorised these competencies into our three pillars of leadership with the first and foremost being Culture of Compassion.

During our conversation West talked about the importance of leaders really listening and told me a fact that I found alarming which was that it has been proven that the more senior people become the less they listen. This appears to me to be paradoxical as surely the more senior you become, the more you need to listen so that you really understand your people and your organisation. There is a real danger that leaders become fixated in their own social construct and rely on their memory of what life was like when they were on the frontline earlier on in their careers. This can lead them to become out of touch; lead from a place of fear and put forward directives or initiatives that are based in historical success rather than on what the organisation needs today.

West identifies that compassionate leadership, the type required to enable a culture of continuous improvement to flourish, is supported through:

  1. Attending – paying attention to the other and ‘listening with fascination’
  2. Understanding – finding a shared understanding of the situation they face
  3. Empathising – feeling how it is to be in their situation
  4. Helping – taking intelligent action to help them achieve their purpose

This can really only be achieved well through visible leadership; that is leaders going out and about meeting with and listening to their staff to really understand their views.

So, next time you are talking to someone in your organisation, I urge to you to stop, pay attention and listen with fascination. What you learn may surprise you.

 

 

With thanks to Professor Michael West, Head of Thought Leadership for The King’s Fund and Professor of Work and Organisational Psychology at Lancaster University

 

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust and passionate about building more human organisations

Follow Sarah on Twitter @SarahMorganNHS

 

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Authentic Leadership, Diversity, Inclusion, Leadership, NHS Leadership

One conversation at a time – How to get more love into the workplace – part 7

We all dream of days at work that uplift, inspire and fill us with good feelings; however the reality is that they don’t come along as often as we would like. On 13th July, we had a day just like that, with 130 staff from all parts of our organisation, discussing how we create an organisation that is ‘fit to house the human spirit’. It created a positive energy and vibe that lasted throughout the day.

At Guy’s and St Thomas’ we have the highest staff engagement scores in the country, but we still have some dark spots. We’re focussing on shining a light on these key areas, one of which is improving staff feeling a sense of inclusion in the organisation. We have been running a series of Staff Engagement Inspiration Masterclasses, starting with Professor Michael West in May, and most recently we invited Eden Charles PhD to talk to staff about inclusion.

The amount of enthusiasm for the session was unprecedented. We had 100 places but were packed to the rafters with 130 staff wanting to take part. Eden delivered a key note speech and through the use of ZOUD – zone of uncomfortable debate – really got everyone to think about how we all have the ability to exclude others and to precipitate micro inequalities without even realising it. Leading on from Eden’s inspiring speech our Chief Nurse led a series of discussions both in thinking pairs and at a table level, to help participants to really engage with thinking about what they value about their own characteristics and how they might also lead them to accidentally exclude others both in the workplace and outside. This engendered a real energy and engagement of the participants really wanting to engage in thinking about how they could really start to understand others better.

In thinking about diversity overall, thought diversity emerged as a key topic; a conclusion of the Masterclass was that inclusion and understanding of others takes place “one conversation at a time.”

After only 2.5 hours of talking about inclusion, the atmosphere had changed and the energy carried out of the room with the participants. Some challenging points were raised such as ‘what will be different’ and the response is clear; “embracing diversity and being inclusive is everybody’s business”.

Having authentic conversations can often feel quite daunting; especially in the workplace. There are often cultural norms guiding what is considered appropriate and what is a taboo area, and if you are brave and do challenge the status quo it can often feel psychologically unsafe. This means that the culture prevails as people protect themselves by not challenging the norms, and those that feel differently will often leave as they do not feel comfortable or understood within the organisation. This leads to the unsafe practice of groupthink and can lead to poor decision-making and a stunting of the potential of an organisation to progress.

Moving to a place where diversity of thought is not only accepted but positively embraced is the way forward for the NHS and the wider public sector. We are living in a very uncertain and ambiguous time and therefore having a linear approach, based on the thinking that has always prevailed at the top of organisations, will not enable us to navigate the complexity of our new environment. We need a new way of thinking and being that will engender new, evolving conversations and inspire new approaches to enable us to re-invent our workplaces.

Back to the Masterclass; you could argue 130 staff out of our 15,000 is not many, however this is only the first step on the journey for us – a small step but an important one nonetheless. We want to start a completely different conversation in the organisation that encourages diversity and enables our leaders to create enabling environments that supports all our staff to bring their best to work every day. This will help us to continue to deliver high quality healthcare to the in excess of 2 million patients who access our services every year. We will do this one conversation at a time.

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Left to right: Sarah Morgan, Director of Organisational Development; Eden Charles PhD, People Opportunities Ltd; Yadveer Kaur, Staff Engagement Manager; Amanda Pritchard, Chief Executive; Dame Eileen Sills, Chief Nurse at Guy’s and St Thomas’ NHS Trust at the Inclusion Staff Engagement Masterclass held on 13 July 2016

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 Participants of the GSTT Inclusion Staff Engagement Masterclass 13 July 2016

 About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust and passionate about changing the world of work

 

 

 

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