COVID-19, Leadership

Love (in the workplace) in the time of Coronavirus – Part One

In 2016 I wrote a year-long blog series called How to Get More Love in the Workplace, which was nominated for a UK Blog Award that year.  Through this eight part blog series I examined different ways that organisations can create cultures that allow staff to bring their whole selves to work.  I focussed on healthcare – as this is my industry – but also as research has shown that staff happiness has a direct correlation to patient outcomes.  The key principle of the series was that staff wellbeing should be a focus of leaders and organisations.

At that time, I could not have imagined how important staff wellbeing would become.  Fast forward to 2020 and the COVID-19 worldwide pandemic.  Ensuring all our staff are kept safe and well, both mentally and physically, at this critical time is of paramount importance and one I have been dedicating myself to.

I thought it would be helpful to document this experience and so this blog series will complement the original ‘Love in the Workplace’ series and have a renewed focus as ‘Love in the Workplace in the time of Coronavirus’.  I will attempt to set out my thinking and our approach as it shifts and adapts in line with the needs of the staff.

 Where it all began

As a leader in the NHS, my role has had to adapt so I can support our organisation to meet the needs of our 17,500 staff.  Our organisation is a High Consequences Diseases Unit and looked after the first patient from early February, so we have been in this crisis since the very start.  When this first began to emerge as a world-wide issue I was just back from a 3 week trip to Australia.  I came back from holiday and within a week we had declared a major incident and life became very different overnight.

I had to ask myself what role I needed to play in this new environment.  My role as the Director of Organisational Development has needed to flex to be what the organisation and staff need right now.  I realised that purpose, identity and legitimacy were really important to me, so whatever I did needed to add value to others.  It took me a few go’s to work out where I could be most useful and where the gap was where I could add the most value.  Staff wellbeing was where I found my home.

Finding out what’s important

In the first few weeks of the pandemic, we had received a lot of generous, but relatively out of the blue donations from kind well-wishers.  This was fantastic however the reality was that there was the huge logistical challenge of moving the gifts around to have fair distribution across our 2 main hospital sites, 27 community sites and 4 office buildings at a time when our estates and facilities teams were focussing on keeping the hospitals and clinical sites running.  We decided that distributing the donations would be a key plank of our wellbeing offer.

I worked with a couple of nursing colleagues and we decided to use the donations as an opportunity to undertake the first of our Wellbeing Walks to find out what staff needed.  We visited all the COVID-pathway wards to give out the donations and talk to staff about how they were feeling; what life was like and what was getting in the way.  Staff told us stories of crying in the supermarket as they could not get the basic supplies they needed for their families.  They also spoke about fear of ‘taking the virus home’ on their uniforms and being worried about travelling on public transport.

At this point we realised that our wellbeing offer would need to support the basic physical needs of our staff.  Maslow’s Hierarchy of Needs (1943; Fig 1) gave a framework to work from to ensure that we were attending to the right needs of our staff at the right time.  There was no point trying to offer psychological support if people were anxious about being able to feed their family.

Figure 1:  Maslow’s Hierarchy of Needs (1943) cited in Simply Psychology https://www.simplypsychology.org/maslow.html accessed 28 March 2020

Using this as a framework it was far easier to start to articulate what the different levels of the offering would be and then how this could support staff to have the niggly stresses removed so that they could focus their energy on their patients rather than working around the system.  Figure 2 sets out the framework of the wellbeing offer.

 

Figure 2: Staff wellbeing offer against Maslow Hierarchy of Needs, as at 3 May 2020

Starting with the physiological needs

For our staff who were onsite delivering services, clinically and non-clinically, we realised that the basic needs of food, laundry, showers and changing rooms was of significant importance to them.   Within a week of going to visit the wards we had set up a laundry service for staff uniforms and, with thanks to our Charity and supported by our Catering & Hospitality Teams and our Dietetics Team, against all the odds, we opened an emergency supplies store.  This provides staff with fresh fruit and vegetables; pasta, rice, bread, tea, coffee, tinned tomatoes, tuna, baked beans, toilet rolls, washing up liquid and access to gluten free alternatives and vegan milks.  To date over 14,000 contacts have been through the emergency supply stores on the two hospital sites, in the community and the satellite sites with over 100,000 items given out to staff.

One size does not fit all

What we have learned very quickly is that even in the health service, the world of work has rapidly shifted.   Even though many of our staff are working clinically every day, we have many staff who are doing their bit to protect their colleagues by working from home.  This is equally as challenging, trying to juggle home-working with home-schooling and coping with a working life that has become a series of online meetings.  Ensuring that each staff member is looked after in this difficult and challenging time is a key leadership challenge.  There are now so many more categories of the type of ‘worker’ people have become and it is potentially easy to forget those staff that are not right in front of you.

Thinking about what each staff member will need in each of the categories they may fit into is a daunting prospect.  Knowing that one size does not fit all and ensuring staff have their personal needs are met is not easy, but will be essential for leaders and managers to get right.

Staff are on a spectrum ranging across a variety of descriptions some of which include:

  • Shielding – those staff who have been identified by the government as vulnerable and asked to stay indoors for 12 weeks. May experience anxiety about coming back
  • Working from home – staff who are still working their normal contract but from home and completely online. May experience some anxiety about coming back to work.
  • Redeployed staff – Staff who have been trained to work in the critical care units or on the COVID-19 wards who may have not worked in those environments for a long time and have experienced distress as part of this work.
  • Black, Asian and Minority Ethnic (BAME) staff – data is emerging that has identified that people from a BAME ethnicity appear to potentially have worse outcomes from COVID-19. Many staff are anxious and need support to help them feel safe.
  • Staff working in ICU and COVID-19 positive areas – the Personal Protective Equipment (PPE) is uncomfortable and hot and if worn for long periods can cause skin irritation and damage. The relentless nature of the work can also take its toll physically and mentally on staff.

This list is non-exhaustive and we know that every staff member is an individual and therefore our offer is wide ranging but targeted so it is meaningful for staff at the point they need to access it.  Our poster is set out in Fig 3 which aims to support staff to have the information they need, especially the contact details of helplines etc, exactly when they need it.  We will also be distributing credit card sized versions for staff to have the numbers wherever they are.

Figure 3 Guy’s and St Thomas’ Staff Wellbeing Offer as at 3 May 2020

Where next?

Our offer has developed as we understand more each week. We started with the ‘physical’ and ‘safety’ offer at the beginning of April and have now started to move more into the wellbeing area supporting staff to recharge and decompress.

This blog series will attempt to journey through our wellbeing offer as it progresses into the medium and longer term.  I will share our learning as it emerges and any evaluation for what worked and what didn’t.

We would also love to learn from you so we can develop these approaches as a community so please share your thoughts with me as we go through this together.

Figure 4: Our first week of wellbeing leading to opening our emergency supplies store on 1 April 2020

 

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Trust and passionate about creating organisations where everyone can flourish.  In her ‘spare time’ she is a steering group member for the Royal Society of Arts, Reinventing Work Network and the Chair of the Board of Trustees for Sunday Assembly, a charity focussed on developing community

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Authentic Leadership, Connection, COVID-19, culture of compassion, Health and Social Care Leadership, healthcare, Leadership, Mental Health, NHS Leadership, Organisational development, Resilience, self-care, Staff development, staff engagement, wellbeing

Love (in the workplace) in the time of Coronavirus – Part Four

Introduction and recap

I started this blog series four weeks ago in an attempt to capture the wellbeing journey that we have been on over the past ten weeks of working in the NHS throughout a sustained major incident, tackling a global pandemic.  Things were changing and time was passing so quickly that I wanted to make sure that the learning and the experiences that we had were chronicled so as not to move on too quickly and forget and to also share and learn with a wider community.

This blog series has been inspired by my original blog series from 2016, ‘how to get more love in the workplace.’  This examined the importance of creating organisations where everyone can flourish.  This remains my passion and now that we are moving into our stabilisation phase, the key question is how do support our staff to grow from this experience?

The previous three posts focussed on the approach that we have taken to staff wellbeing and the different support we have put in place for our 17,500 staff.  This has ranged from the physical such as laundry service and emergency supplies store, through to our rest and recharge zones that provide a sanctuary for staff and for those staff who need it, access to psychological support.  This post focuses on our move into our next phase – learning and growth.

Moving into Learning and Growth

Since March 2020, when Professor Neil Greenberg and colleagues wrote an article in the BMJ on managing the mental health challenges faced by healthcare workers during COVID-19  the term ‘moral injury’ has started to enter the vernacular within healthcare.  Originating in the military, the term moral injury is defined as ‘the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code.’  Although it is not a formal mental health condition, those who develop moral injuries are likely to experience negative thoughts about themselves or others as well as develop intense feelings of shame, guilt or disgust.  However, it is not a given that healthcare workers who have contended with a traumatic experience will have a negative effect, it can actually develop into post traumatic growth which leads to a ‘bolstering of psychological resilience, esteem, outlook and values.’  The key point made in the article is ‘whether someone develops a psychological injury or experiences psychological growth is likely to be influenced by the way that they are supported before, during and after a challenging incident.’

This is incredibly important and means that how our organisations respond and support our staff is vital to their ability to learn and grow from this experience. Our approach has been rooted in ensuring we meet staff where they are.   We have moved our wellbeing support into a more organised, evidence-based and sustainable approach.

Thematic approach

Our series of Executive Thankyous and Wellbeing Walks have been a crucial part of our approach over the past two months.  From our wellbeing advisors we were identifying that a number of staff were reporting struggling with disordered sleep.  Many complained of insomnia and when they did sleep they had nocturnal panic attacks, nightmares and incredibly vivid dreams.  We decided to have a focus on sleep and created Sleeping Well Week the second week in May.  We had ordered our sleep pods for staff to take a proper rest on shift and we combined it with an Executive Thank you with three Executives on each site at the nightshift handover, giving away 750 sleep packs including top tips on sleep, sleep mask, ear plugs, herbal tea, face mask, face cream and a leaflet on where to find our sleep pods.  Just having that opportunity to say thank you to staff and check in with them is vitally important.  Seeing their faces light up as you hand them a thank you pack as they start or leave their shift is amazing.

The Executive Wellbeing Walks are also a crucial part of showing staff that they are appreciated and we are in this together.  The most important part of the walk is to have a conversation with staff to hear their stories and their feedback.  The Executive Out and About visits are part of our normal approach to visible leadership within GSTT, however the specific focus on wellbeing has been far more powerful and the conversations much deeper, which has helped us to further refine our support.

Figure 1: Wellbeing Walks to nuclear pharmacy, interventional radiology, medical physics and clinical devices, community ‘at home’ team; bereavement team, ICU nurses and Executive Thankyous for Sleeping Well Week

Mental Health Awareness Week

The week of the 18 May 2020 was Mental Health Awareness Week and for us, it also signified a time when we are starting to prepare to start our elective (planned) procedures again, which will start from 1 June 2020.  This is operationally challenging as in order to comply with social distancing and ensuring that our patients and staff are kept safe, we have to re-design the patient pathways and use our estate in a completely different way.  Many of our surge nurses, who moved from clinical areas all around the Trust to support in critical care, have started to return to their normal role.  However, life is  anything but back to normal so supporting our staff transition is vital.

Evidence shows that the most predictive time for people experiencing post traumatic mental ill health is just after the traumatic experience is over.  Ensuring that we are able to support our staff as they start to reflect and make sense of their experience is crucial and getting this wrong now could be detrimental.  Showing our appreciation of the sacrifice and dedication the staff have shown as well signposting them to all of the support available is a key factor in enabling staff to move into the post traumatic growth stage of their experience.  Not all staff will suffer moral injury or post-traumatic stress, however many will and many more could if the key components are not there to help them process this experience effectively.

Over the course of Mental Health Awareness Week we organised 26 Executive Wellbeing Walks and visited 55 teams across all corners of our organisation.  We took thank you wellbeing packs with all of our information and checklists for how staff can support their own wellbeing including advice on sleep, eating on shift, resting and managing anxiety.  Each pack also contained a thank you gift and sleep mask and ear plugs.  Each Executive was supported by a trained wellbeing advisor so that as well as the Executives being able to personally thank staff, a safe space was created so staff could share their experiences and to also talk about what support might help them.  Over the week, we distributed wellbeing packs to teams totalling over 2,000 staff including new lanyard cards with vital emergency phone numbers and contact details for them at the point they need it the most.

Leadership and Management support

On the visits, many staff talked about the support from their team and their line managers, which was really encouraging to hear.  There is irrefutable evidence that the support that staff receive from their line manager and immediate team has the biggest impact on their wellbeing.  This has been recently blogged about by Derek Tracy, Mark Tarn and Neil Greenberg in the BMJ and in early May Neil Greenberg wrote further guidance for the Royal College of Psychiatrists on ‘going for growth’ in which is also encourages NHS managers and clinical leaders to model making use of support processes to emphasise the ‘all in this together’ message and to protect their own mental wellbeing.

As part of mental health awareness week we also launched the Leading Compassionately in Extraordinary Times offer from NHS England and Improvement.  This is based on supporting leaders and managers to support staff who have been working through a crisis and is based on the moral injury research.  There are ten evidence-based behaviours, which have been identified for compassionate leadership and each behaviour has a module that participants work through.  There is a short pre-read and then the methodology is based on the Schwartz Round and facilitators create and hold the safe space for participants to have the conversation they need to have.

 Figure 2: The 10 leadership behaviours for leading compassionately in extraordinary times https://people.nhs.uk/support-for-leaders/ accessed 25 May 2020

We have trained Faculty of 20 facilitators who are currently supporting the national offer and once that is sustainable, will focus on supporting our internal leaders and managers. 

We have also launched our own People Management offer, which is an online bite-sized learning and webinar approach to the key people management skills.  Our COVID-19 leadership and management development intranet pages also feature top tips for supporting staff who are shielding or permanently working from home as well as support for checking back in with returning redeployed staff to ensure their wellbeing is supported. 

We recognise that we have 17,500 staff who have had 17,500 different experiences.  Some experiences may be shared in the workplace, however adding in home and personal circumstances and everyone will have had a unique experience and therefore ensuring that the right level of support is available for everyone is crucial and delivering that support through our leaders and managers and ultimately our teams is going to be the only way we can move into our learning and growth phase.

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust.  In her ‘spare time’ she is a member of the steering group for the RSA Reinventing Work Network and the Chair of the Board of Trustees Sunday Assembly, a Charity focussed on building community.

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Authentic Leadership, Community, Connection, COVID-19, culture of compassion, Health and Social Care Leadership, healthcare, Leadership, NHS Leadership, Resilience, self-care, wellbeing

Love (in the workplace) in the time of Coronavirus – Part Three

Introduction and recap

Welcome back to part 3 of my blog series which is focussed on staff wellbeing in the time of coronavirus and is intended to chronicle and share our approach and learning to inspire a conversation on staff wellbeing more broadly.

If you are new to my blog or a regular reader, I hope that you enjoy reading this blog series and that it sparks ideas for you.  This series has been inspired by my 2016 year-long blog series called ‘How to get more love in the workplace’ which focussed primarily on ways to create organisations where staff can flourish both personally and professionally. This series builds on that idea but in a very different context.

Our staff have had very challenging experiences over the past 3 months caring for patients with COVID-19 (we are a High Consequences Disease Unit so took our first patient in early February).  For many who have been redeployed back into clinical areas this has meant working in environments they are not used to, witnessing far more patient deaths than they have previously had to deal with and working under intense scrutiny and pressure.  Often doing this wearing restrictive, hot and often uncomfortable personal protective equipment for 12 to 14 hours per day.  This is not an ordinary time and so it has required us to create an extra-ordinary response to supporting our staff.

Last week’s blog focussed on gratitude and appreciation; psychological preparedness and support.  This weeks’ reflections go deeper into how we have created safe spaces for staff to get away from the clinical areas to decompress and recharge themselves so they can continue to deliver high quality patient care over a sustained period.

Rest and recharge

On the first week of lockdown, which was a critically busy period for us, we visited the COVID-pathway wards to ask the staff what would help them and what support they required.  In addition to asking for their basic needs to be met (see part one of this series) they also told us that having somewhere to go, to get away from the clinical area to allow them to have a proper rest to recharge before heading back to continue to care for patients would make a huge difference.  Some described this as being ‘like a spa within the hospital’ and we felt we could rise to this challenge and create exactly this kind of space.

Given the nature of the major incident we were in, we had significantly reduced our on-site outpatient activity and therefore, we had quite a few outpatient clinic areas that were not being used.  Over the space of a week we identified three main areas on the Guy’s, St Thomas’ and Evelina London sites and our Space Team set about transforming them from clinical areas to the ‘spa within the hospital’.  The ‘getting away from it all’ ambience was paramount and so we focussed on approaching it from the perspective of each of the five senses:

  • Smell – when you walk in, you are greeted by the scent of essential oils which are emitted via several aromatherapy diffusers. We also have our complementary therapists (who usually support our cancer patients) on hand to support staff to have their own aromatherapy inhaler stick (Aromastick), based on the blend of essential oils unique to you, that when inhaled makes you feel most grounded.
  • Sight – the zones have been kitted out to give a relaxing feel. They look inviting and welcoming.  Armchairs are available with free magazines and daily newspapers to read there or take away.  Separate rooms for staff to have, in the words of Virginia Woolfe, ‘a room to oneself’ to relax and unwind in.
  • Taste – there is free tea, coffee, water and soft drinks, fruit, healthy snacks and porridge pots and throughout Ramadan we have been providing dates and nuts for staff to break their fast.
  • Hearing – relaxing music plays in each of our zones to give that sense of spa that staff wanted. Mostly these are quiet areas as well, away from the constant beeps and hum of the critical care and ward areas.
  • Touch – we have a massage chair in each wellbeing zone, which is incredibly popular with staff. So much so we have had to create a booking system so staff can time a ‘massage’ with their breaks.  Our complementary therapists have supported staff to learn how to use ‘tapping’ to enhance their feeling of wellbeing.

 In addition to this, we also offer elements of support for staff including:

  • Pop up coaching – a short, solution-focussed session with one of our accredited coaches. This can be about anything that the staff member would like to discuss and sometimes staff find just talking their problems through helps them immensely
  • Guided meditation – our complementary therapists run group guided meditations to support staff to feel grounded and present, which helps them to recharge before heading back to their clinical area
  • Advice/ guidance on particular themes – our wellbeing offer has moved into themed weeks based on what staff tell us is going on for them. We have additional advice and guidance available in our rest and recharge zones linked to the themes.  For example, we have just come to the end of Sleeping Well week as we have had feedback so many staff are suffering from disordered sleep and vivid dreams.  Our psychologists with an expertise in sleep were available in the rest and recharge areas and wellbeing zones to discuss sleep problems with staff.  The frequently asked questions will then be put into a webinar form and recorded and posted on our intranet page so that staff have access to information when they need it.

 

rest and recharge zones

From top left – St Thomas’ rest and recharge zone, welcome desk at St Thomas’, our complimentary magazines & newspapers; Guy’s rest and recharge zone; one of our housekeepers enjoying our massage chair in Guy’s; Thought for the Day in St Thomas’; behind the scenes of our Team Brief; our CEO and me enjoying our personalised Aromaticks made by our complementary therapist Juan in our Guy’s rest and recharge zone.

Each Rest and Recharge Zone is open 24/7 and manned by Wellbeing Advisors, from 9am to 8pm, who to support staff to have a conversation and then potentially signposted or referred to other areas of support.  Our Wellbeing Advisors are easy to spot as they all wear yellow Staff Wellbeing Team T-shirts have been dubbed ‘the yellow t-shirt gang’ by our Chief People Officer.   To help staff know what is on offer, we had our first outside broadcast for our monthly CEO Team Brief from our St Thomas’ rest and recharge zone, which took a tour through our offer for staff.  These zones have been really well received and feedback has been astonishing, which shows that this is a meaningful offer for our staff right now.  Quotes include:

“Recharging helps to be able to go back and carry on with a smile

“Aromatherapy and body tapping was amazing!  Very relaxing and can’t wait to use my Aromastick. Staff were great too!”

“We need this to be a regular hub.”

 

Staff thank you messages in the St Thomas’ rest and recharge zone

What next?

Many organisations have created ‘wobble rooms’ where staff can go when they are stressed or anxious to pause and ground themselves.  Our Rest and Recharge Zones have proven themselves to be a much needed place of safety and solace for staff as well as providing a comprehensive wellbeing offer and so are here to stay for the medium term.

The evidence published by the NHS Confederation in 2018 after the tragedies of 2017 terror attacks and Grenfell Tower, showed that staff will start to show signs of distress about 2 months after the incident itself with the peak being six to nine months later.  Already we are starting to see staff showing distress and talking to the Wellbeing Advisors in the Rest and Recharge Zones about greater degrees of support and we expect that this will only be more needed in the future.  Our next focus is to ensure we have a permanently staffed wellbeing offer (we have a volunteer model currently) so that staff can access support exactly when they need it.  Our challenge is as outpatients’ starts to recover, we need to find new areas for them to be a more permanent fixture.

We are also starting to develop an offer for our leaders and managers to ensure that they are equipped to support their staff.  Research has shown that line managers have the biggest impact on the wellbeing of staff.   To accelerate this work, we have been a test organisation for the NHS England/ Improvement Leadership Support Circles, which has identified the 10 evidence-based behaviours for leading through COVID-19.  We are launching this in our organisation this coming week as part of Mental Health Awareness Week to ensure our managers and leaders are starting to think about how they need to be – not necessarily just what they need to do – to be able to support their staff through the next phase of our experience.  More on this next week.

For Mental Health Awareness Week we are undertaking over 25 Executive Wellbeing Walks across all areas of the Trust, visiting many staff in corporate areas and in the more ‘hidden’ departments, all of whom have been an essential part of #TeamGSTT and our response to COVID-19 to say Thank You to them.  Each visit will include a Wellbeing Advisor so that we can support staff with a conversation about their wellbeing and understand what else might help them.  We are hoping to visit c1,500 staff next week and their feedback will help us to continue to adapt and improve our offer as we move through the next phase of the impact of coronavirus.

Behind the scenes in the rest and recharge zone in team brief

Behind the scenes of our CEO Team Brief outside broadcast, touring our St Thomas’ rest and recharge zone with some of our key Wellbeing Advisor team (yellow t-shirt gang)

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust.  In her ‘spare time’ is a Steering Group Member for the RSA Reinventing Work Network and the Chair of the Board of Trustees for Sunday Assembly, a Charity focussed on building community.

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Authentic Leadership, Connection, COVID-19, culture of compassion, Health and Social Care Leadership, healthcare, Leadership, Motivation, NHS Leadership, Organisational development, Resilience, wellbeing

Love (in the workplace) in the time of Coronavirus – Part Two

Introduction and recap

If you are new to my blog or a regular reader, welcome! and I hope you enjoy reading this blog series which was inspired by my previous blog series ‘How to get more love in the workplace’ and my back catalogue of posts on leadership and management in the NHS.

Last week I started this blog series, which focuses on staff wellbeing in the time of coronavirus.  The intention is to share my experience and our organisational learning and to hopefully inspire a conversation and sharing of practice across the NHS and potentially HR and OD communities more broadly.

I have the privilege of being the Director of Organisational Development for a large London teaching hospital which has integrated acute (hospital) and community services with an amazing and diverse workforce of 17,500 staff, who go the extra mile every day to deliver high quality care for patients.  My role has shifted during this time to being focussed on staff wellbeing and ensuring that every single one of our staff have the support they need, when they need it.

Last week part one of this blog series set out our staff wellbeing framework, based on Maslow’s Hierarchy of Needs (1943).  This had an initial emphasis on the physiological support we put in place to ensure that staff had their basic needs met.  A fantastic collaborative team effort meant that within one week of speaking to staff about what support would help them we had designed, built and opened an emergency supplies store to provide staff with the basics of fresh food and staples for themselves and their families.  This was extremely well received by staff and they came in their thousands, clinical and non-clinical alike, to get their supplies.  We also sent food ‘grab bags’ designed by our dieticians to the community and satellite sites locally across Southwark and Lambeth but also to Sidcup in Kent and Tunbridge Wells.

The next phase has shifted to a focus on staff wellbeing in the broader sense and this post sets out how we are helping staff to look after themselves and their mental as well as physical wellbeing during this challenging time.

Valuing our staff

During the ‘active phase’ of the coronavirus pandemic we have focussed on ensuring that every single one of our staff know that we are all in this together and that their individual contribution is valuable and valued.  Everyone is playing an important part in our response to COVID-19.  This has been core to our communications with staff – especially in our daily CEO briefing – and it has been a key plank of our wellbeing offer.

Gratitude and appreciation

It is important that we acknowledge that over 1,500 of our staff have been redeployed within our organisation, many doing jobs that look very different to their normal day job, as part of their #TeamGSTT contribution to our response to COVID-19.  We have been thanking our staff on a regular basis including our senior team creating a video with a special thank you message for staff, which I now show to all our new nurses who come in for our socially distanced clinical induction on Monday and Tuesday of every week.

Visible leadership is an extremely important part of showing staff we care and so we instigated Executive Thank Yous from the first week of lockdown.  These happen at morning or evening shift handover at both hospital sites as well as being distributed via our Evelina London (children) and Integrated Care (community) Executive Teams.  This allows our Executives to personally thank staff and also to enables us to reinforce a particular wellbeing message by handing out a bag of treats which includes a themed wellbeing checklist.

For our first Executive Thank You we focussed on our ‘wellbeing tips for coronavirus’ checklist which is a tailored checklist written by our psychologists to help staff with resilience and to help them to enhance their coping mechanisms during this challenging time.  We also gave out our going home checklist which supports staff to leave the day behind and prepare for being at home and resting well.

Our second Executive Thank You focussed on our HALT take a break campaign which states that if you are hungry, angry, late or tired you should take a break.  Encouraging staff to take a break, particularly those in full PPE who are being put off taking a break due to the time taken to don and doff, is really important for their wellbeing.  We found biscuits were always well received so we gave out heart and star shaped biscuits (as we love our GSTT stars) with a teabag or sachet of coffee with the checklist.  Often in crisis response mode staff do not put themselves first and stop adhering to the ‘put your own mask on before caring for others’ message that we give about how to sustain the consistent delivery of high quality patient care.   A secondary aim of the Executive Thank You was to visibly ‘give permission’ to staff to put themselves first by taking a break.  We had fantastic feedback from staff who really appreciated the thank you messages and so we have a series planned throughout the coming months.

Psychological Preparedness

In order to help staff with their psychological preparedness (often referred to as resilience), we created a spectrum of offers for staff which increase in their intensity and level of support.  This starts with the practical offer outlined earlier and then moves to information giving via checklists and easy access factsheets to help staff build up their coping mechanisms and healthy habits to sustain them through this difficult and high stress working environment.  These include tips on taking a break; sleeping well; eating well including for shift working; specific tips for looking after their wellbeing during coronavirus and going home and reconnecting with life outside of work.

Here for you

Figure 1: Guy’s and St Thomas’ Wellbeing Offer as at 10 May 2020

We have set up a number of wellbeing zones across our hospital and community sites and produced wellbeing packs full of information including apps that are available such as Headspace and Sleepio, which we give out to staff in the wellbeing zones.  Each zone is a drop in area where staff have access to free tea and coffee, wellbeing packs, fresh fruit, snacks and water and importantly a wellbeing advisor.  We have trained over 200 wellbeing advisors to be on hand to support staff with whatever they might need.  In the wellbeing zones we offer pop up coaching which is a fast paced support with a trained coach to help staff problem solve.  We also have psychological / mental health first aiders available to speak to staff to help to identify if they may need more support.   For staff who are shielding, working from home or no longer accessing their workplace in the same way, we have a virtual wellbeing advisory offer which includes access to a wellbeing advisor and online pop-up coaching.

Psychological Support

Although we have created an offer that attempts to target the different wellbeing needs of staff at various times, enabling them to access what they need exactly when they need it, we also know that not all staff may access the support even if they do need it.  Everyone has their individual way of dealing with their experiences.  The research that our psychology teams describe is that often trauma will emerge as a result of a secondary trigger such as stress at home or financial worries.  The evidence from the five terror-related attacks between March and September 2017 – Westminster Bridge, London Bridge, Manchester Arena bombing, Finsbury Park and Parsons Green plus the tragedy of the Grenfell Tower fire – has shown that staff start to process what has happened and show signs of requiring psychological support from 2 months after the initial incident with the peak being between six and nine months.  In preparation for that we have moved to a much more targeted psychological support response with clinical psychologists attached to Critical Care; wards and in the community and a dedicated email address that is triaged by psychologists.

 Heroes to hard times

The reality of working life is currently very difficult for a number of our staff.  For the past two months staff have been heralded as heroes with the claps on a Thursday evening.  As we have started to move into the stabilisation phase, many staff are not working in crisis mode any more and increasingly many do not feel like heroes.  Without the adrenalin and cortisone associated with the ‘always on’ element of crisis management, staff are likely to start to process what they have been through; this may cause them to suddenly show signs of exhaustion and in some extremes start to experience physical and mental burnout.  Through Professor Neil Greenberg’s research we are examining the concept of moral injury.  This is a term that originated in the military, [and] can be defined as the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code is a real one and a response that we are preparing for, for both staff and managers.  I will examine this in more detail in my next blog post.

Where next?

It is clear that our support offer has to be ahead of where the staff are so that we can create the right environment for them to rest, recover and recuperate.

The British Psychological Society (BPS) published guidance at the end of March, which includes a really useful table of the psychological response phases and how staff may be feeling during each phase.  This is important as our current phase – the active phase – splits into two sections that predict staff moving from heroics to disillusionment and exhaustion.  This feels about exactly where we are now.  It is vital that we are all ready to catch our precious staff, if and when, they start to fall.

In my next blog post I will outline how we have started to create safe spaces for staff and moved into our psychological wellbeing offer.

Do share your experiences as well so that we can create a staff wellbeing learning community during this extraordinary time in our history.

 

second blog post inc thank you and wellbeing zones

Photos (from left to right) St Thomas’ and Guy’s Emergency Supply Stores including our CEO Dr Ian Abbs opening Guy’s.   Food grab bags for the community; our STH Wellbeing Zone; Clinical Staff taking away wellbeing packs; Executive Thank Yous at STH and Guy’s

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust and is passionate about creating organisations where everyone can flourish.  In her ‘spare time’ she is a steering group member for the Royal Society of Arts Reinventing Work Network and the Chair of the Board of Trustees for Sunday Assembly, a charity focussed on building community.

 

 

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Community, Connection, culture of compassion, Diversity, Loneliness, Millenial Generation, Motivation, Personal Development, Resilience, self-care, Social cohesion, wellbeing

The importance of community and connection

This morning I listened to the latest Feel Better, Live More podcast from Dr Rangan Chatterjee ‘Why Spending Time with Your Friends is More Important Than You Think’ which was a conversation with Social Entrepreneur and CEO Dhru Purohit.  This podcast really resonated with me and my own journey over the past five years which has made me realise the importance of social cohesion; community and ultimately social connection.  In 2018 this particular journey led me to join the Board of Trustees, and since January 2019, Chair the Sunday Assembly Charity  which focuses on bringing people together to create community, social connection and ultimately friendship in towns and cities in around the world.

Sunday Assembly (SA) itself has been on a very interesting journey of its own since being co-founded in 2013 by two stand-up comedians Pippa Evans and Sanderson Jones.  As the name suggests, it brings people together on a Sunday as well as through a plethora of activities during the week where members of the community get together to live the SA values of live better; help often and wonder more.  The format, which is that of a secular gathering bringing people together without the need for religious affiliation, has been likened to Karaoke with TED talks as it combines communal singing with talks from all branches of philosophy; science; popular culture to name a few.  The aim is to help people to grow, think deeply and personally develop through learning something new and challenging themselves.  All washed down by a vat of tea and cake!

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Inspired by the original London one, there are Assemblies currently running in over 40 locations around the world.  After the first one in London in January 2013 Sunday Assembly took off quickly, filling an obvious societal need and in less than two years over 70 new Assemblies had sprung up around the world from Atlanta through to New Zealand and everywhere in-between.  All Assemblies are run by the community members, for the community members.  As a brand new type of social organisation without the infrastructure of a big institution it is more akin to a social entrepreneur style start-up so keeping the energy going is a challenge as it relies on the love of the community and the friendships it has created, to keep it going.

I think the Sunday Assembly movement is particularly important for everyone but tends to attract young, professional people who have just moved to an area and are seeking connection and like-minded people to make friends; contribute more widely to society and explore new ideas and experiences to develop themselves personally.

My own personal story was that I got married in 2012, but due to work and other circumstances I lived in Manchester and my husband lived in London.  After six months of only seeing each other at weekends, I made the decision to move to London to embrace married life.  This meant changing career as well as city and leaving all my friends and family behind as I moved 200 miles South.  This had been a much harder transition that I’d anticipated (well to be honest I hadn’t thought about it much at all as the overriding need to spend more time with my husband had been my singular focus).

For the first year my job had kept me very busy, working long hours and often at weekends plus being on-call so I had not really had chance to think about the fact I’d not really made friends beyond my husband.  One evening in 2014 I was reading a magazine and came across the mention of a book club for an organisation called Sunday Assembly.  I was intrigued and two days later, having speed read most of the book club choice, I found myself in a pub one cold evening in March looking for a group of strangers clutching copies of the same book.  The organiser Jenny and I hit it off immediately and I found myself spending a fun evening discussing the relative merits of a Maggie O’Farrell novel with a really interesting bunch of strangers!

I found out Sunday Assembly met every first and third Sunday of the month at Conway Hall in Red Lion Square in Holborn, London.  The next Sunday I went along to listen to Lloyd Grossman talk about the importance of architecture in the identity and culture of a city and met a few of my book club people there and so my love for Sunday Assembly grew from there.  I joined the Choir a couple of months later and found myself connecting with even more like-minded people in a City that had previously been closed off to me.

It slowly dawned on me what a momentous change I had made in my life without really giving it much thought.  I hadn’t realised how cut off from the full offer of London I was.  Moving to a new city or town in your mid-30s, without having a natural way to meet new people (i.e. having children) means it can be very difficult to make new friends and find social connection.  I was not alone in this feeling.  Many people who find themselves at Sunday Assembly have made similar changes.  It seems that at a time in our societal history where we are connected 24/7 it seems we are at our most isolated and disconnected.  Social media appears to create an illusion of connection whilst actually having the reverse effect.   There hasn’t been a time where an organisation such as Sunday Assembly which recognises the importance of community and above everything else, friendship, has been needed more.

I’ve now been Chair of the Board for almost a year and what keeps me going is the thought that we are supporting so many people around the world to build the social connection and cohesion that they might not find elsewhere.  Recent research by Bumble BFF and Censuswide published in July this year showed that most Britons feel lonely and said they don’t have enough friends.  Loneliness has been shown to have similar detrimental impacts on the body as smoking 15 cigarettes a day and from my healthcare professional perspective, it is really important that we start to create much better community cohesion and social connection.

My ambition is to spread the reach and impact of social movements such as Sunday Assembly, to start to improve the lives of others and to try and make a difference to those individuals who are suffering chronic loneliness and build a more socially connected society.  As Dr Chatterjee pointed out on his friendship podcast, “We no longer need friends to survive [ref to hunter gatherers] but we do need them in order to thrive.”

 

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Sunday Assembly London meets every first and third Sundays of the month at 11am in Conway Hall, Red Lion Square, Holborn

Not in London?  Search our website to find a Sunday Assembly near you or find out how to set one up.

About the author

Sarah Morgan is the Chair of Sunday Assembly Charity and Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust.  She is passionate about creating organisations and communities where everyone can flourish.

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culture of compassion, Leadership, Resilience, self-care, wellbeing

Self care – the first lesson of being a good leader?

In January 2018, I took a decision that I needed to pay better attention to my health and well-being.  I was working long hours, not making enough time for exercise by continually missing my ‘planned’ gym sessions, not eating as well as could do and not seeing as much of my friends and family as I would like.  All of which was leading to weight gain, irritability, restless sleep and general feeling of heaviness.

I decided I needed to make a change.

I took a decision to focus on eating well, increasing my level of exercise and trying to get into a better sleep routine.  I needed a bit of help and encouragement so opted for an on-line programme that was based around 20 minutes of HIIT sessions rather than gym workouts or long runs as I was short on time and needed a realistic approach.

Being a night owl and self proclaimed ‘not a morning person’, setting my alarm for 30 mins earlier and dragging myself out of bed to do exercise was quite difficult at first but it was so enjoyable that I found myself getting into a routine of the 5 times a week really quickly.  An added motivation was the results were visible within the first couple of weeks.  I had expected to lose weight and get fitter but what I hadn’t expected was all of the other benefits.

After a couple of months I found that I was much more able to take stress at work in my stride.  I was sleeping better and felt much more calm, rational and in control.  My mood was more consistent and I felt happier.  Six months in, I was really starting to notice that I was much more productive at work and at home.  I was managing to fit more into my daily life and feeling better for it.

My team started to notice that I was less chaotic and calmer and I felt  I was able to devote more time to listening to the team and supporting them, which in turn made me feel like I was being a much better leader.

In my organisation, one of the key pillars of our leadership competencies is compassion.  My experience this year has taught me that that is important not just to have compassion for others but crucially, to have compassion for ourselves.  It may feel self-indulgent at first, but taking that essential personal downtime allows us to free up our minds and open our hearts to other possibilities.  This is a crucial tool in a leaders toolkit.  In fact, whilst researching the evidence behind my own experience I came across a wealth of evidence and articles, one of which was in Success magazine earlier this year and explains why self-care is a crucial part of being a good leader.  Concluding, “A leader who prioritizes downtime, relaxation and self-care discovers an increase in overall well-being and in multiple dimensions of performance”.  This is the holy grail for all leaders, so why do so many of us de-prioritise ourselves and end up burning out?

I’ve spent the last 20 years always striving.  A recent reflection I had was the last time I worked a job that was 9 to 5pm was when I was 15 years old and a waitress.  Every part time job I had after that I put in the extra mile and that has continued throughout my career.  This self-care experience has had a profound effect on how I view what is important.   I’m now finding myself making much more time to be with my friends and family; taking more exercise in the great outdoors and sticking to a tip from the Danish way of Hygge by working with a scented candle burning in order to nurture my soul and help me think.

It seems to be working.  I’m now 9 months into this new way of being and I like this new me!  This work/life blend has developed into a new habit for me and one that I intend to keep going with. The world is constantly ‘on’ and that means increasingly we are expected to be always ‘on’, responsive and doing, rather than being.  This is unsustainable and leads to less productive working, high stress and potentially burnout.  All of which is counter-productive.

After nearly 20 years in a leadership role I thought I knew what it meant to be a good leader, however this experience has opened my eyes and taught me that in reality, good leadership starts with self-care.

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About the author

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

She has a passion for supporting visionary and strategic solutions for the health and care sector.  With nearly 20 years experience in healthcare spanning operational management, consultancy, policy making, organisational development and applied research.

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Diversity, Inclusion, Leadership

Diversity Matters

Three and a half years after Roger Kline published the seminal ‘Snowy White Peaks’ report into the discrimination in governance and leadership in the NHS, Sir John Parker has published his Report into the Ethnic Diversity of UK Boards.  Both reports draw exactly the same conclusions which can be summarised into one sentence; the diversity of our most senior people in our country does not reflect our population, and we are the worse for it.

Diversity is a crucial part of an innovative and forward thinking organisational culture.  That is not just cultural, ethnic or gender diversity but also diversity of background, perspective and opinion.  As revealed by Chancellor in the Autumn Statement the UK economy has fallen out of the top 5 of world economies and so a move away from homogenous thinking on Boards, which can reduce the effectiveness of decision-making and as such stifle growth and innovation, is a key factor of in the commercial success UK organisations.

The Kline report’s opening statement was a stark warning to the NHS, “There is increasingly robust evidence that a diverse workforce in which all staff member’s contributions are valued is linked to good patient care.”  The report, which focussed on NHS Trusts in London, highlighted that in 2014 only 8% of Board members were from a black or minority ethnic (BME) background, which had reduced from 9.6% in 2006.  Similarly, the Parker Review found that in 2017 only 8% of FTSE 100 Directors are from a BME background and of those only 2% are UK citizens.  This is a shocking level of under-representation when 14% of the country are from a BME background.

So what is going wrong?

Looking at the latest NHS Workforce Race Equality Standard (WRES) results although there has been slight improvements in the recruitment of nurses and midwives, the NHS has not improved over the past three years with only 6.1% of non-clinical very senior managers being from a BME background.  The same report also shows that white candidates are 1.57 time more likely to be appointed from shortlisting and in some cases up to twice as likely. This suggests that panels are still recruiting in their own image and unconscious (or conscious) bias exists.  In a time when the NHS needs to attract the best talent to be at its most innovative and productive, it seems to be going in the wrong direction.  This will need to be quickly addressed if the NHS is going to realise the potential it has nesting inside its 1.2million strong workforce before it is too late.

The NHS staff survey shows every year that a high proportion of staff do not feel that there is equal opportunities to career progression and many staff cite this as reasons for leaving NHS organisations.   There is enough data telling us about the problem, what needs to be different is what we do about it?

What can we do to change?

If the NHS is to be serious about making a difference, it is time to take a radical and sustained approach to creating compassionate and inclusive cultures.  For this to make a difference notable change will need to be role modelled from the Board-level so as to ensure the right conditions are created throughout the whole organisation.

Taking an action-based approach that demonstrates commitment to improving this situation over a longer period of time will be the most visible and important thing that organisations can do.  Really paying attention to supporting the development of a pipeline of talent for individuals across the organisation from a range of diverse backgrounds that go further than race and gender so as to include social background, generational perspectives and different ways of thinking would be a step forward in creating the inclusive cultures that will foster talent across all levels of organisations.

The Parker Review makes three recommendations which can equally apply to the FTSE as well as the NHS:

  1. Increase the Ethnic Diversity of UK Boards – each FTSE 100 Board should have at least one director of colour by 2021; the same for each FTSE 250 by 2024
  2. Develop candidates for the pipeline and plan for succession – members of FTSE 100 and FTSE 250 should develop mechanisms to develop and promote people of colour within their organisations in order to ensure over time that there is a pipeline of Board capable candidates. This includes the recommendation of mentoring schemes and to grow internal talent through subsidiaries.
  3. Enhance transparency and disclosure – a description of the Board’s policy on diversity should be set out in the company’s annual report and should include description of company’s efforts to increase, amongst other things, ethnic diversity, particularly at Board level. Where the company does not meet the Board composition recommendations by the relevant date this should also be disclosed.

These sound easy but will take a change in attitude from current Boards and senior managers at the top of organisations, including the NHS.  Recognising that there are barriers to progression, seeking to understand these and take action to remove the things that get in the way will take a commitment and energy that previously has not been universally applied.

There are some examples of organisations, both public (including the NHS and Universities) and private sector, who have been at the forefront of striving to improve diversity published by The Royal Society as part of their campaign for developing diversity in science.  Within these case studies there are some great examples of mentoring schemes; flexible working approaches and development programmes that we could all learn from.

The NHS turns 70 next year at a time when it is going through its most difficult time, struggling to recruit and retain the staff needed to continue to deliver the high quality healthcare for our population.  The development of a compassionate and inclusive culture will be the single most important thing that NHS organisations can do to ensure that the NHS remains an employer of choice and continue for the next 70 years.

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust, one of the largest integrated teaching hospital and community services trust in the NHS with 15,000 staff and £1.4bn turnover.

Sarah is passionate about creating a culture of compassion and inclusion in the NHS.

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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

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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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