Leadership

Do we really know the art of happiness or are we artfully dodging it?

A wise man once said “If you want others to be happy, practice compassion. If you want to be happy, practice compassion.”Dalai Lama XIV, The Art of Happiness

Compassion, particularly post-Francis, has been seen as a barometer for good care, enshrined in the 6Cs (care, compassion, competence, communication, courage and commitment) by Jane Cummings NHS England’s Chief Nursing Officer. So, if the giving and receiving of compassion increases levels of happiness, then is the NHS on the right track to support the health and well-being of not only its patients but it’s 1.4million staff as well?

But what exactly is happiness and how do you measure it?

Happiness is becoming an increasing measure across a wide variety of areas.  The CentreForum has just published its new report ‘The pursuit of happiness; a new ambition for our mental health’ (July 2014) http://www.centreforum.org/assets/pubs/the-pursuit-of-happiness.pdf which recommends we must, “prioritise the promotion and protection of wellbeing and mental and social capital of the nation.  The pursuit of happiness should be a goal of the government (p9).”  The report goes on to suggest that £13bn of the NHS budget is being spent on managing the physical manifestations of poor mental wellbeing, which would pay for the estimated budget gap seven times over.  It urges the government to make it a statutory requirement for Directors of Public Health to outline in a public record, their progress towards parity of esteem for physical and mental health.  However, can we and should we start to legislate for happiness?

The government seem to think so.  Three days ago, the Office of National Statistics published its proposed framework for the next edition of the Measuring National Well-Being (MNW) programme called Measuring Social Capital due to be published on 26 September 2014.  This framework was defined by the Organisation for Economic Co-operation and Development (OECD) in 2013 and will provide an international comparative framework across the four domains of:

Personal relationships – ‘the structure and nature of people’s personal relationships’

Social network support – not how many blogs you read or Twitter followers you have but the ‘level of resources or support that a person can draw from their personal relationships’

Civic engagement – ‘the actions and behaviours that can be seen as contributing positively to the collective life of a community or society’

Trust and co-operative norms – ‘shared values that shape the way people behave towards each other and as members of society.’

So if these factors are considered important in the happiness stakes, how do we help our most vulnerable on the road to ‘happiness’?

The CentreForum report suggests that wellbeing is multi-factorial, as does the UN World Happiness Report from 2013. Wellbeing isn’t just a physical or mental health issue, but one that stems from housing, levels of social isolation, frequency of exercise, consumption of alcohol and recreational drug use, access to nutritious food, levels of education, contribution to society and financial security. It can’t be tackled with medication alone, and so it troubles me when I hear service user anecdotes such as the one cited in the CentreForum report “After a number of interviews with the Consultant psychiatrist, nurses, care team . . . not once did anyone ask me about the quality of my diet, question my alcohol consumption (around 40 pints of beer a week) or suggest I do some exercise. I was not once advised to go and hang out with my friends. They just wanted to know if I was suicidal, and could only offer medication—lithium—to help me.” Service User, Mental Health Commission Call for Evidence Survey; CentreForum p13 (2014).

In March 2014, the Office of National Statistics (ONS) published an infographic on what life is currently like in the UK. This highlighted that over 77% of people had someone to rely on and 58% of people were happy with their health.

 

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More starkly this means that almost a quarter of people in our society do not have someone to rely on. This is most likely to be our most vulnerable and almost half of the population do not have good health, which probably reflects an increased use of A&E and services in general, which is causing huge strain in our flat cash years. In reality there is likely to be an overlap between those people who are experiencing financial difficulty, do not have someone to rely on and are not well.

Happiness is important for everyone no matter who we are or what our circumstances.  We all crave human interaction and we can all make our lives and those of someone else just a little bit better by being more compassionate, thinking about our reactions to others and taking a few minutes each day to be grateful for what we do have rather than wishing our lives away about the things that we don’t.  Supporting a better society and collectively helping our vulnerable as well as ourselves.  That way we can know the art of happiness rather than artfully dodging it.

And the final word should go to the wise man himself…….

“So let us reflect on what is truly of value in life, what gives meaning to our lives, and set our priorities on the basis of that. The purpose of our life needs to be positive. We weren’t born with the purpose of causing trouble, harming others. For our life to be of value, I think we must develop basic good human qualities-warmth, kindness, compassion. Then our life becomes meaningful and more peaceful-happier.”

 

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Leadership

What type of NHS leaders do we need to meet the 2020 NHS challenge?

There’s been a lot written about leadership this week, particularly with the publication of the HSJ top 50 most inspirational women for 2014 (see the list at http://www.hsj.co.uk/news/-hsjs-most-inspirational-women-in-healthcare-2014-revealed/5072644.article#.U8LD-nlOVjo).

Culture and leadership are paramount to the future success of the NHS and right now we haven’t got it quite right.  The old command and control culture that previously pervaded may have got us this far but it won’t be able to take us any further and so we need a new type of leader- and fast.

Monitor estimates that by 2020 the NHS will require £30bn worth of savings (Closing the Gap). which will require a completely different way of thinking than we managed for the ‘Nicolson Challenge’ of £15-20bn by 2015.  £30bn cannot be achieved through the optimism bias that we can continue to do more with less, it needs a completely different way of doing things and will require a really innovative way of thinking about how services can be delivered, in order to survive.

There has been a lot of research about the impact of leadership, my favourite is The Fish Rots from the Head by Bob Garratt (2009) based on the Chinese proverb.  Bob makes a compelling case that the culture of the organisation and its subsequent success or failure starts in the Boardroom.  Having spent time both on a Board and working with them, the impact that small number of people has culturally on an organisation should not be underestimated.  Boards need to develop a new way of thinking about and working with their greatest asset – their staff – in order to meet the challenges we face head on.

My personal view is that the best managers work closely with and stand behind the clinicians.  I have always been a firm believer that managers are there to facilitate clinicians delivering the best possible care to patients.  I have always had very good working relationships with my clinicians and have seen what truly great clinical leadership can achieve.  Engaging with staff at all levels is key to improving the quality of service delivery and as the Kings Fund and Michael West have prophesised, “happy staff = happy patients”.

The CQC have their detractors and their sceptics, but as part of their well-led domain assessment, they are starting to see a direct correlation between the relationship the Board has with the consultants and the level of staff engagement on the quality of service delivery.  This is a significant finding.  They will be the first to admit that they haven’t quite got their assessments quite right but they are learning, adapting and improving all the time and isn’t that the sign of good leadership in itself?

Throughout the command and control years, we have developed a culture that is resistance to what some leaders consider to be interference from the Centre, such as CQC inspection.  Yet on the other hand there is a high degree of inertia in the system, as a result of so many years of waiting for the next set of instructions from the Centre with many leaders having an almost ‘learned helplessness’ which means that the much needed change is not happening quickly enough.

It seems to me that we need to make way for the new types of leaders.  Those that can navigate the system and are able to negotiate and collaborate with other health and social care organisations across all of the sectors including voluntary and independent, to form alliances that will bring together all of the resources available to them to deliver the best outcomes for the patient.

When I joined the NHS graduate scheme in 2002, it was considered that you earned your stripes and went up through the acute sector ranks when you would eventually move from a Chief Operating Officer to a Chief Executive Officer role, and the bigger the Trust the better.  This career route doesn’t feel fit for purpose any more and those young ambitious managers that are coming up through the ranks now, who want to work closely with their clinicians in an innovative way, are finding it hard to forge their way through.  We are losing many to the Big 4 consulting firms and the voluntary and independent sector, where they have the freedom to take chances, think differently and make the change they want to see.  This to me is a tragedy for the NHS and could signal its demise if we can no longer retain our talent.

We need to ensure we nurture and manage our talent much more actively within the NHS.  The Graduate Scheme was voted the number 1 best scheme in the country again this year so we can attract the best so how do we retain them?  My view is we need a 4 point plan:

Identify – organisations need a process of identifying who, across all levels and professions, within the organisation is their talent.  A good appraisal system should be able to do this, but identify them quickly let them know you have ‘spotted’ them so they feel appreciated.

Develop – wherever your talent is in your organisations, whether they are clinicians or managers, people need some form of structured development programme to stretch them, help them to learn new things and most importantly try it out and consolidate that learning

Permit – give staff the tools, space and permission to innovate.  Sometimes this may mean that ideas they have don’t go to plan but you learn much more from failure that you do from success

Reward – often staff in the NHS have an intrinsic set of values which means pride in their work and a sense of achievement is worth more than monetary reward.  Promoting the innovative work that staff have done is enough to keep them motivated and to motivate others to achieve more.

If we are able to nurture the talent at all levels in our organisations and recognise that system leadership rather than just good hospital management is the skill set that will drive the change over the next five years, then the NHS just may have a chance of rising to the 2020 £30bn challenge.  The status quo isn’t an option.

 

 

 

 

 

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Leadership

Should Glastonbury be available on prescription?

A week ago today I was stood in a muddy field, beer in hand, watching the sunset accompanied by the dulcet tones of Guy Garvey from Elbow.  As the crowd sang along in perfect harmony to Grounds for Divorce and One Day Like This, it occurred to me that festivals are the perfect retreat from the hustle and bustle of daily life and a way to really reconnect.

For over 40 years Michael Eavis, owner of that infamous Worthy Farm in Pilton, Somerset, has been bringing together people from all over the UK and the world, united by a love of music, contemporary and performing arts and in those early years milk (a free pint with every ticket!).

I’ve been going to Glastonbury for the past 15 years and even volunteered for Oxfam one year when I was a poor student, just so I could get to those amazing fields.   Over that time the festival has changed, it has become less about political activism  and environmental campaigning (although Greenpeace and the Leftfield tent of political debate still have a strong presence) and more about big name bands, attracting a more mainstream crowd.

This year over 200,000 people crowded into those fields, which is bigger than the population of my home town of Blackpool (about 150,000), and large enough to potentially almost warrant it’s own hospital!   As the festival has become more mainstream it inevitably attracts more busy professionals who are looking for an opportunity to step off the treadmill and recharge those batteries (quite literally with EE’s ingenious portal power bar that recharges your phone as you watch the performances).

Working in mental health has taught me that the chance to take stock and reconnect mind and body cannot be underestimated.  Although it is true that there is an elevated level of consumption of alcohol and drugs, there is no sign of aggression or fights that you would expect to see after a Saturday night somewhere like Blackpool, where there has been a similar level of sustained drinking.  So what’s the difference?

It seems to me it’s because it has a vibe of togetherness.  Dolly Parton quoted she thought it would be great if everyone in the world could just get on and there be no fighting just like at Glastonbury Festival and she’s right.  There was a melting pot of Metallica versus Jake Bugg fans, all types of nationality, religion and background and no one cared.

The other element that has improved greatly is the amazing array of healthy food.  You could go vegan, gluten free and raw all weekend and be spoiled for choice.  Then you can walk it all off across the vast distances across the site.  My friend had on a pedometer and clocked up 40 kilometers (that’s about 25 miles to you and me) in the four days there.

All in all I’m of the opinion that Glastonbury festival is very good for the mind, body and soul. So should it be available on prescription? I think so.

 

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Me in Shangri-la at Glastonbury, wine in hand. Couldn’t resist.

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