Leadership, System Leadership

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

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

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

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

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

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

 

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

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

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

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

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

 

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

2017-07-20 13.09.35

About the author

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

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

Staff engagement – a matter of life and death part 2

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

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

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

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

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

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

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

Equal opportunities to career progression

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

Staff experiencing discrimination from staff or patients

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

Staff working long hours

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

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

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

About the author

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

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Authentic Leadership, culture of compassion, Leadership, staff engagement

Staff engagement – a matter of life and death?

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

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

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

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

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

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

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

About the author

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

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

 

 

 

 

 

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

2017 – My year of Focus

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

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

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

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

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

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

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

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

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

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

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

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

 

About the author

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

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

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

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continuous improvement, Leadership

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

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

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

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

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

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

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

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

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

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

 

 

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

 

About the author

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

Follow Sarah on Twitter @SarahMorganNHS

 

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Authentic Leadership, Diversity, Inclusion, Leadership, NHS Leadership

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

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

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

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

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

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

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

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

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

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

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 Participants of the GSTT Inclusion Staff Engagement Masterclass 13 July 2016

 About the author

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

 

 

 

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Authentic Leadership, culture of compassion, Leadership, NHS Leadership, Organisational development

Move away from fear – how to get more love in the workplace – part 6

Earlier this week research showed that there are high levels of perceived bullying in the NHS workplace.  According to the research by NHS Employers 20% of NHS staff report that they have been bullied by other staff and 29.9% indicated that they had some element of psychological distress. Managers and supervisors were perceived to be the most common source (51%).

This is quite a shocking statistic and one that begs the question ‘why?’. What drives, seemingly normal people, who work in a compassionate profession and are probably lovely outside of work, to behave in a bullying manner in the workplace?

My guess is that it is based in fear.

Fear of missing the target; fear of the ramifications of spending too much money; fear of losing job/ reputation/ career that you’ve spend decades building; fear of rocking the boat or speaking up. What fuels these fears?

Fear is toxic; it creates a unconscious psychological response in our amygdala or ‘reptile brain’ which is fight; flight; freeze. This is helpful when a sabre toothed tiger is bearing down on you but has no place in today’s healthcare environment except in extreme circumstances. We are starting to see some of the unintended consequences such as a recent CQC report awarding a requires improvement rating citing ‘learned helplessness’ as one of the cultural indicators created by the senior leadership team.

So, how can we support our leaders to move away from fear and start to create the right conditions for staff to be able to operate to their full potential?

As we know culture is the shadow of the leadership and if the shadow that is being cast is one of fear; perceived lack of ability to control or influence; driving for results no matter what the cost and an inability to listen to ideas or thoughts that differ from the cultural norms; then the conditions that are being created for staff to work in are oppressive; toxic and limiting.

Having grip and telling staff what to do can work for a short period of time, particularly in a crisis. However, over a longer period will lead to reduced results and a culture of escalation to the organisation as paralysis will seep in and staff will start to fear making the wrong decision and therefore will make no decisions.

To move away from fear takes a huge amount of courage and the ability to trust in others. Although the current regulatory environment means that there needs to be an Accountable Officer so it is clear where the buck stops, this does not mean that this person has to do everything; quite the opposite.

The key to that opposite approach is enabling the Executive Team to feel it is safe to let go. A recent interesting article by the Harvard Business Review (1) on exactly this, highlighted the rules of ‘self organisation’ the main element of which is communicating intent. This is a very different approach to delegation. One which establishes a set of principles and a clear framework from within which all staff are able to take decisions.

Many of the organisations featured in Fredric La Loux’s inspiring ‘Reinventing Organizations’ (2) have in common a clearly set out vision and principles and enable their staff to make decisions based within the simple framework that they have established. All of the organisations have established approaches to dealing with performance issues and with those people who do not make decisions according to the agreed doctrine, quickly and simply. This clear and simple approach appears to be yielding amazing results the world over.

It is often argued that this is much easier in organisations such as Google and Amazon and in healthcare organisations such as Buurtzorg in the Netherlands (3) as they are all start up companies and had the opportunity to set things up right from the beginning.

So how easy is it to introduce this new way of working into a well established; heavily regulated environment such as the NHS where everything that is paid attention to, measured and rewarded is the opposite? Well the answer is that it is not easy – but rarely is anything worth having easy to achieve. If it was we would have done it already!

Collaboration is the key. Today’s healthcare environment is too complex to rely upon the leadership approaches that worked for complicated problems. Complicated problems can be solved through processes and linear solutions. Complex problems are worsened if this thinking is applied as there are too many factors and variables and therefore a more emergent approach is necessary.

The fear many leaders will have to face is that their ‘tried and tested’ methodologies that worked for yesterday’s problems no longer work and they have no more tools in their toolkit to rely upon. This can often be the root of fear that drives the ‘tell’ culture and often leaders struggle to understand why these methods, previously so successful don’t work in today’s technology driven, disrupted environment. They interpret the lack of results as due to the way the staff are implementing their instructions rather than it being the wrong approach and so give further, more detailed instructions.  Thus creating a vicious circle of decline.

The simple truth is we need a new toolkit and manual for ‘letting go’. Bringing together clinicians and giving them the tools and techniques to enable them to improve how they deliver care and trusting them to come up with the answers, is the first stage to truly transforming the culture in the NHS.

We need leaders that can:

  • lead from behind, rather than in front
  • pose questions rather than offers solutions as they recognise wicked problems require emergent solutions
  • truly collaborate with the workforce and inspire them with purpose and commitment.

These are the leaders that will create the right conditions to replace the fear currently being felt in the NHS workplace with love and compassion, both for staff and patients.

(1)   How Leaders Can Let Go Without Losing Control; Mark Bonchek; Harvard Business Review; 2 June 2016

(2)  La Loux F; Reinventing organizations; A guide to creating organizations inspired by the next generation of human consciousness; 2014

(3) Community nursing organisation in the Netherlands based on the principles of self managed teams which achieves high levels of patient satisfaction, improved clinical outcomes and reduced cost. Featured in La Loux’s book as referenced above

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust and passionate about creating happy workplaces

 

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