Leadership, Organisational development, patient centred care, Staff development

OD in the NHS III – visiting OD of the past, present and future

As a social animal I’ve always been a ‘joiner’, wanting to have a sense of belonging and a community to call my own. I’ve not had that feeling in the NHS since I was on the graduate scheme in the early 2000s; that is until today at the third DoOD ‘OD in the NHS’ conference.

The 200 delegates, representing 150 organisations found their way to the centre of London to share, learn, connect and grow. Building on the inspirational conference held in Bristol back in March, this was the ‘coming of age’ and a maturation of the OD community from its inception in February 2013.

After an hour of coffee and networking, the conference opened with plenary session led by the two stars of DoOD Paul Taylor and Karen Dumaine. In typical Paul and Karen style, they started the session by terrifying themselves (and us) by launching with not one but two ignite presentations. I was new to this concept (5 mins, 20 slides and 15 seconds per slide) but I absolutely loved it! It set the tone and energy for the rest of the day as Paul rattled through the story of DoOD – 1 million minutes told in 5 and Karen tantalised us with agenda for the day – a trip through an OD of the past, present and yet to come. The promise was the rare luxury of a safe place to stay sharp. So far, so energised.

Taking a steer from Peter Drucker’s premise that “the best way to predict the future is to create it” an eminent panel of speakers projected themselves to 15 July 2020 to have a rich debate Newsnight style, on how it feels to have achieved the goals of the Five Year Forward View (5YFV). Listening to the panel who spanned acute and mental health providers, Monitor, NHS Employers and the NHS Leadership Academy it was clear that the future is in our hands and OD has a huge part to play in supporting ways of working that bring ‘joy’ back into the workplace. ‘OD is the alchemy of great performance’ coined by Danny Mortimer Chief Executive of NHS Employers (home of DoOD) really resonated and his words ringing in my ears as we moved into our ‘thinking differently workshops’.

Stimulated from the panel discussion I headed into Mike Chitty and Kash Horoon’s session on Systems Thinking. I’ve been wrestling with concept of systems thinking and systems leadership so I’d been looking forward to this session. Kash told us the story of DevoManc and then we examined what this means for systems thinking (apparently different to systems leadership) in a wider discussion. My take away was that in essence in order to be a systems thinker you have to accept that we are in a complex and adaptive system which is unknowable and ask questions to reveal what the change should be. We need to resist the urge to analyse and become reductionist in order to try and solve problems. This made me question whether or not the NHS is ready for this and if not, what would need to be in place for it to become ready? It piqued my interest and I took away more questions than answers, so more musings required.

My mind blown and my tummy empty signalled it was time for lunch. I took the opportunity for some reflection before heading into the session straight after lunch with Practive on the power of changing our language and structuring our dialogue to bring about much more effective conversations.

Based on David Kantor’s Four Player model which examines the roles of Mover; Follower; Opposer and Bystander and how to take a positive position in each one to engender an effective dialogue. Kantor found that ‘when a team is capable of communicative competency, there is an exponential leap to effectiveness. By becoming more competent, the team accelerates it ability to define new outcomes.’ This took me back to the morning session of future-basing for the NHS and the fact that the key to success is not using the same thought processes and methods to define the new world as we have done the old.   Enabling the system to design the new world is a pivotal role for the NHS OD community.

This will require significant culture change, so my next session was perfectly timed. Having attended Stefan Cantore’s session at the last OD conference I was really looking forward to his session on Culture Change using the Theory of U as a change enabler. Stefan took us through a set of provocative questions delivered through a journaling technique that revealed thoughts I did not even realise I had.   I found this incredibly useful to frame a live issue that is on my mind at the moment and coupled with a few minutes of mindfulness, I came away from that session with more clarity than several weeks of thinking in a busy work schedule had managed to generate.

Saving the best until last (and believe me the bar was set high throughout the day) the final session with John Scherer and Amy Barnes took us through the history of OD and how the practice has developed through today and beyond, ‘in order to create the future you must respect the past’. This session gave us practical tools and techniques for how to use action research to really get to the heart of issues and co-create solutions with our clients. My favourite quote was John Scherer who said, ‘it takes courage and heart to be a really good OD consultant’. This was a high energy session where we explored how to formulate quantitative questions using a Likert scale approach and how to have really effective one to one interviews imbibing the ‘Vegas principle’, which is exactly what you think it is!

At the end John challenged us to think about ending every meeting by asking 2 Likert scale based questions:

  1. On a scale of 1 to 5, how interesting or useful was the content/ process of our meeting?
  2. How could we make it better for next time?

I’ll be trying that one out on my team.

I finished the day richer than I started. There were questions whirring through my mind with a hunger to find out more about the things I heard; the networking led to a conversation about the opportunity of a buddying relationship with another teaching hospital and to top it all off I won the prize draw – the book ‘A Field Guide to Organisation Development; Taking Theory into Practice’. A fantastic end to a fantastic day.

The OD community have definitely come of age and I feel honoured and privileged to be part of the movement, with two membership badges to pledge my allegiance.

 

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About the author

Sarah Morgan is the Director of Organisational Development t Guy’s and St Thomas’ NHS Foundation Trust

Blog first published as guest blog on NHS Employers website on 21 July 2015

http://www.nhsemployers.org/campaigns/organisational-development/grow/grow-od-masterclasses/od-in-the-nhs-iii/visiting-od-of-the-past-present-and-future

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continuous improvement, patient centred care, Staff development

Back to the floor

On Friday I had the great pleasure of spending a clinical day going back to the floor, reconnecting with our staff and patients.

When I start in a new organisation the first thing I like to do is to get out and about to the clinical areas to get a real feel for the place. This is a habit I developed when I was a graduate and spent three months on my orientation exploring all jobs in the hospital and wider system.

I spent the morning in our children’s hospital, the Evelina London, shadowing their Director of Nursing. We headed onto Savannah ward, our cardiology high dependency ward. Starting out at the top of the ward we examined the stock cupboard and tested the stock system – quite tricky! We examined the cleanliness of the ward – a deep clean was in progress – and checked the kitchen and clinical areas. This gave us a good feel for the management of the ward.

Next stop was to meet the patients and their parents. We met Kayla, a 17 month old little girl with heart failure, who was on the transplant list and had been in our care since Monday. We chatted to Kayla’s mum who told us that she was usually cared for at Great Ormond Street. This presented a great opportunity to find out what we were doing well, but more importantly, what we could improve. Kayla’s mum was hugely complimentary about the nurses and the care they had shown by laundering her clothes, as she was sleeping on the ward on the pull down beds next to the cot. She was also impressed by the deep clean she had seen going on over the past couple of days. It was great to hear about such good care, although we also learned a lot about how we could do better.

We then chatted to the ward sister about her patients and the integrated care record. I asked her what brings her joy at work, at which point she completely lit up and talked about how much she loved her job and the nursing team at the Evelina (she is a Nurse Educator). She spoke about the wards, staff and patients with such love. It really gave me a sense of what a happy team the Savannah ward are.

We then had a further walk through the orthopaedic ward and met the matron who told me an equally heartwarming and heartbreaking story about a little boy – Ewan – who was born with a genetic condition that is severely disabling and means his life expectancy is very short. Whilst on our ward, the staff organised a christening for him. The parents had written to the Chief Executive and Chief Nurse complimenting all the staff on the ward on the care they had given and enclosed a photograph of the family on their Christening Day, which she showed me. It was truly humbling.

As we carried on through the ward I saw our Quality Fellow who invited us to one of the paediatricians’ Safety Huddles. They have developed a 6 point checklist to improve patient safety which they run through every day. This includes examining the Paediatric Early Warning Scores for each patient; highlighting any planned high risk procedures to be undertaken on the ward and flags any other teams the ward need to communicate with, such as Theatres. This only took 15 minutes and gave me a real sense of the team being on top of every patient.

After lunch I headed up to our Theatres suite. We have 44 theatres, 60% of which run 6 days a week and we support our neighbouring hospital with their trauma lists as well.

Kitted out like an extra in Casualty (or more likely Scrubs) I spent a fascinating afternoon in Theatres, starting out with a tour of the day surgery unit accompanied by the Nurse in Charge (NiC). I think it’s really important to not just have a ‘royal’ visit but to see what it’s really like for the staff on the frontline. As we walked around the unit the NiC was approached from all sides with all sorts of problems and requests for information, and I observed him trying very hard to not just take on all of this but support the staff to think for themselves and try and solve their own problems. Not easy in a busy clinical environment!

He was clearly passionate about the development of his staff and talked me through the new clinical educator role they have introduced to quickly train up staff as they have such as high turnover in Theatres. This has proved to be a great success in the last three months.

I was lucky enough to observe a clinical procedure in one of the theatres for a patient with chronic pain. It was great to see the WHO checklist being used to cross check the procedure even as a day surgery. There was an anaesthetist on standby in case the patient went off, but the patient was coping very well so he had the time to talk me through the details of the procedure in-between reassuring the patient, which made it even more interesting. I had to wear a heavy lead apron as interventional imaging was being used as the procedure was so intricate it needed constant images available. I was absolutely in awe of the precision with which the consultant worked.

It is twelve years since I was last in theatres as an observer and it was incredibly interesting how much things have moved on. I came out of my time at theatres with a much richer appreciation of the pressure that our theatres teams work under, but everyone I met was friendly, welcoming and made time to speak to me.

My whole day was humbling and awe inspiring. I am proud to work in the NHS and think it’s vital for managers to make the time to walk the clinical areas and speak to staff to see what it’s really like for them day to day.

Get out there.

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Acknowledgements

A big thank you to all the staff, patients and parents that made time to speak to me on Friday 31 July 2015, I really appreciated it and I am in awe of the work you do every day.

About the author

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

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