culture of compassion, Leadership, Organisational development, patient centred care, Staff development

My New Year’s Resolution: To Get More Love into The Workplace

December is the month that most people spend more time socially with their work colleagues than any other period in the year.   Increasingly outlandish Christmas jumpers are worn, Secret Santas are drawn and many after work drinks imbibed. Come the New Year, it’s all back to normal and the joy we find in the workplace in December is lost in the cold, dark months of the winter.

I’m fascinated by the need to get more love and joy into the workplace. I’ve been struck this year by the work of Frederic Laloux, whose book Reinventing Organizations – A Guide to Creating Organizations inspired by the next stage of human consciousness has been my most inspirational read of the year. So this coming year, 2016, I’ve decided that my New Year’s Resolution is to get more love into the workplace!

Many of us go to work having created an image of ourselves that is our ‘work persona’. I’m as guilty as everyone else; I have my ‘work wardrobe’ and I don’t mix my work clothes with my ‘fun’ clothes. Anyone else do that?

I think being yourself in the workplace is incredibly important and the way to developing a culture of trust and authenticity. According to the Collins dictionary[1] the definition of authentic isgenuine… accurate in representation of the facts; trustworthy; reliable;” all of which are characteristics of people I want to spend a considerable amount of my time with.     

I’ve been giving a lot of thought over the past year as to how we develop a culture of compassion in our NHS organisation and I’ve concluded that authentic leadership is a vital component. Going hand in hand with this is collective leadership, where everyone takes personal responsibility for the success of the organisation (definitely worth reading Michael West’s work in this area[2]). This is particularly important in an environment where many of the staff enjoy professional autonomy. Ensuring that every one of our 13,650 staff feel part of the organisation and take responsibility for the success of the whole organisation, is crucial to our continued success.

It’s been a challenging year in the NHS and despite the welcome additional £3.8bn from the Treasury in the Spending Review, it feels as though next year will continue to be a huge challenge for its 1.4 million staff. Bringing love and joy into our NHS organisations will be a really important factor in keeping up the morale of our staff.

There was a lot of love for the NHS this Christmas as the NHS Choir beat all the odds and made it to the Christmas No1, with Bridge Over You selling over 127,000 copies and raising money for charities such as MIND and Carers UK. (Watch the video here https://www.youtube.com/watch?v=T8qHXlShfUQ). Keeping that feel good factor and that overwhelming feeling of joy of really being part of something that matters I see as a key priority for our NHS organisation, and the NHS as a whole this year.

So where to start? It was Peter Drucker who said, “The best way to predict the future is to create it.”

I intend to start by building a culture of compassion. Ensuring we have the right culture, driven by our visible values and behaviours; encouraging a culture of authentic and collective leadership; supporting our teams with the development of emotional intelligence and seeing the individuals in front of them rather than just following a policy is this years’ focus.

I’ll keep you up to date on progress; what works (and what doesn’t) throughout 2016 on this blog and my Twitter account @sarahmorgannhs.

This year, I can’t wait to achieve my New Year’s Resolution!

[1] http://www.collinsdictionary.com/dictionary/english/authentic Accessed on 28 December 2015

[2]West M et al; Developing collective leadership for healthcare; The King’s Fund and Centre for Creative Leadership; May 2014

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

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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.

 2015-07-31 16.44.39

 

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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continuous improvement, Leadership, Organisational development, patient centred care, Staff development

What does it take to get truly patient centred care?

“People are not cars”

This week I’ve had the privilege of being part of a team hosting colleagues from the Seattle-based, world renowned, healthcare provider Virginia Mason (VM). VM have earned their reputation through the development and implementation of the Virginia Mason Production System (VMPS), which has enabled them – in a relatively short period of time – to move from being a high cost, average quality provider that was losing money to becoming the US hospital of the decade, with the highest quality, lowest cost and best patient and staff experience. The holy grail for most healthcare providers. So how have they achieved this?

The VMPS has its roots firmly planted in the LEAN-based Toyota Production System, to the point that they even use the Japanese terms in their everyday language. So what has this to do with healthcare? People are not cars! This is true, but as one Virginia Mason senior surgeon observed, ‘if we treated our patients with as much love and respect as Toyota treat their cars, we could become the best health system in the world!’

So what is the VMPS and what can the NHS truly learn from it?

About 15 years ago, Virginia Mason were in financial difficulty. A new CEO, Gary Kaplan MD was voted in and he knew that if the hospital was going to still be there in 100 years time, they needed to ‘change or die’. The Board had also levied a challenge that said, ‘if you’re really patient focussed, why does care look the way it does at Virginia Mason?’ This was a reference to the long waiting times patients were experiencing both before, during and after treatment. The Executive Team knew they needed a systematic improvement methodology if they were going to make the wholesale change they required. After two years of careful study they identified the Toyota Production System as the one they felt would get them the results they wanted – truly patient focussed care.

The team went to Japan to witness this at first hand and were inspired by the Toyota way. With that, the Virginia Mason strategic plan was born and to be honest, it is very hard to argue with.

VM strategic plan

Their strategic plan has remained the same for the last 15 years and as such forms the bedrock of the mindset and approach to everything that VM stand for and are trying to achieve.

The VMPS is not just a set of LEAN tools and techniques, it’s a mindset. It’s not an addition to the day job, it’s absolutely how everyone at VM does their work, it’s the management method and decision making framework. The most important factor is its consistency of application. It starts with the Board and flows through the organisation and is adhered to with rigour and discipline.

One of the first things that Virginia Mason did was to develop ‘compacts’ or agreed ways of working for their physicians, leaders and the Board. This defines what is expected of employees at VM and what they, in turn, can expect from the organisation. Showing Respect is a huge part of the culture at VM and they have found that this has gone a long way in supporting their staff to feel confident to speak up with concerns; have ideas and be creative; and bring their best to work every day. All of this has culminated in an improved patient experience at the same time as a reduction in their cost base, generating enviable profits to reinvest in patient care.

Everybody who works for VM is trained in the techniques and they are now starting to train their suppliers and partner organisations as well. All managers and supervisors (clinical and non-clinical) are required to have the more detailed training for leaders and run at least one 2-day improvement event (known as a Kaizen event) every year to remain at VM. All directors and senior clinicians must be certified and run a 5 day rapid improvement workshop every year to stay employed. This means, everyone speaks the same language, everyone knows what to expect including the Executive Team, who are also bound by the same expectation and run at least one 5 day event every year.

The whole system is underpinned by the principle that those than run the business, improve the business. Decision-making is devolved down to the lowest level and the staff that are on the frontline, doing the job, are empowered to make changes as long as they add value to the patient.

Part of this methodology includes a standardised approach to how everyone does their work called ‘the standard work’. This element is a very different way of thinking than we are used to in the NHS. The underlying principle is that the more work that is standardised, the more the time is freed up for creative thinking. Examples of this are: walking the wards and clinic areas (or the Genba as VM describe it) at 8am every morning so problems can be immediately resolved; every Wednesday, recognising and appreciating a staff member who has made an outstanding contribution to patient care or analysing the data regarding your service at 11am every day so you can spot trends early.

Supervisors generally have 75 – 90% of what they do standardised and they are freed up to spend the majority of their time on the frontline supporting and enabling the staff. They ask their staff every day, ‘what is the rock in their shoe’ and take a coach not tell approach by asking, ‘what ideas have you had and how can I best support you?’ The principle is to support staff to start working to solve live problems that may impact on patient experience rather than looking at retrospective data and taking many months worth of meetings to resolve it.

Even directors have 10% of their work standardised. Again, this is also about how often they walk the wards, recognise and appreciate their staff and how much time they spend prepping for meetings etc.

VM describe this as their World Class Management System and it includes the principle of daily management. The 5 principles of daily management are designed with the patient at the centre as set out in Fig 1.

5 principles of daily management

Figure 1: The principles of daily management

This took VM 5 years to develop and they have subsequently realised that this has been their most important work and now recommend other organisations to implement this far sooner to get to the high impact changes much faster.

Their approach can be summarised into 6 words:

  • Go See
  • Ask Why
  • Show Respect

The US healthcare system is very different to ours and although heavily regulated, they have the ability to take decisions about changes to healthcare more easily, so how would this even be accepted as a way of working? How do you manage the risk of not undermining the professional autonomy of your most senior clinicians?

Well, the basic VM approach is about putting the patient at the heart of everything you do and getting rid of the waste in the processes that support the patient experience so you can spend more time caring for patients. Not only is this hard to argue with, it’s also the reason many of the 1.4m people who work in the NHS get out of bed in the morning and continue to choose to work in healthcare.

Understanding how the principles apply in our legislative and regulatory regime is the next key stage, however it is clear that the Secretary of State is a big fan of Virginia Mason so the timing may be right for a change in the way we work.

What is clear to me is that having a cultural mindset of truly putting the patient first and explicitly showing respect for work colleagues is a must do. Our interpretation of what that means needs more careful definition, but starting with the end in mind, I find this a compelling vision of the future. There will be many who say we have this now, but having seen the achievements of VM, in reality we are just at the start of that journey.

It’s not necessary to be a slave to the VM Way but it is important that organisations do have a prescribed improvement methodology and decision making framework so it is clear how clinicians and managers take decisions and make change. Agility is the key. The NHS is not really fleet of foot and hasn’t always been clear about expectations. This has led to cumbersome change management often taking years; a large change programme and many committee meetings.

Having spent time with the Virginia Mason Faculty this week I can absolutely see why people are queuing up to work at VM and their patient satisfaction scores are so high. Today the NHS turns 67 and this is a compelling vision of the future to ensure the NHS is still delivering high quality healthcare for our population in another 67 years.

We’re at the start of that journey and I personally am looking forward to the day we treat our patients with as much care and attention as Toyota treat their cars.

With special thanks to:

Cathie Furman, RN – Member of the Faculty of the Virginia Mason Institute and former Senior Vice President for Quality and Compliance. Cathie was part of the original Executive Team who made the decision to adopt the VMPS

Henry Otero, MD – Medical Oncologist and Faculty member of the Virginia Mason Institute. Henry was the clinical lead for Cancer and an early adopter of the VMPS. He is a Kaizen Fellow.

About the author

Sarah Morgan is the Director of Organisational Development at Guy’s and St Thomas’ NHS FT.  GSTT are currently developing an organisational development strategy to enable the transformation to a culture of continuous improvement.

Further reading:

Plesk P; Accelerating Healthcare Innovation with Lean and Innovation: The Virginia Mason Experience; 2014

Kenney C; Transforming Healthcare: Virginia Mason Medical Centre’s Pursuit of the Perfect Patient Experience; 2010

Web links for more information

http://www.virginiamasoninstitute.org/

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