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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culture of compassion, Leadership, wellbeing

Put your energy in the right place – how to get more love in the workplace – part 5

I had a revelation this week; one of those Aha! moments that come along very infrequently but when they do they make a significant difference. It was about energy and the need to put your energy in the right place to increase your work productivity and sense of well-being.

It emerged during a coaching session when I was thinking about how to more effectively lead the programme that I am currently directing. What became clear was that as the programme is in the start-up stage and does not have a full team in place, my energy has been spent in the mechanics of the programme, administrating and being ‘in the weeds’ of the day to day rather than strategising and thinking through the policy implications.

My preference is for global (strategic) thinking, which is right brain dominant and leads to a focus on the future state; the big picture and people with this preference thrive on experimenting and spend time ‘thinking’ rather than ‘doing.’ This means that when I put my energy into detail; reactive activities and short term tasks, it results in a drain in my energy.

I had convinced myself that I was getting to the end of the week exhausted and lacklustre due to the fact I had been spending all of my time on intellectually challenging activities; however when I really thought about it and closely examined how I spend my time during the week it became clear that the majority of my time is spent in meetings and working on the mechanics of setting up the programme leaving only a small amount of time left for thinking and working on strategy and policy development.

This has started me thinking about energy and how to use it more wisely to be more productive in the workplace by focusing it in the right places. A further look into some tools and techniques for how to do this best revealed a really informative Harvard Business Review article about ‘how to manage your energy not your time.’ The article identifies that energy is defined in physics as the capacity to work, and comes from four main wellsprings in human beings: the body, emotions, mind, and spirit. It suggests that it is possible to systematically expand and regularly renew energy through specific rituals, which are described as behaviours that are intentionally practiced and intentionally practices so as to become unconscious thinking.

This article summed it up for me: “To access the energy of the human spirit, people need to clarify priorities and establish accompanying rituals in three categories: doing what they do best and enjoy most at work; consciously allocating time and energy to the areas of their lives—work, family, health, service to others—they deem most important; and living their core values in their daily behaviors.” Take their test to see if you are heading for an energy crisis and for top tips on how to prevent it.

My revelation has made me think more widely about the fact that, despite having the highest staff engagement scores in the country, my organisation is in the lowest 20% of Trusts scoring that staff are working long hours and we are noticing that for the first time stress due to workload is on the rise. Finding the approaches that are going to make the difference in busy, healthcare environments is very difficult. Working on helping staff to manage their energy may be the completely different approach we might need to consider.

Over the next few months I’m going to be trying out some of the new techniques coupled with applying the learning from Covey’s 7 Habits of Highly Effective People (more on this in a future blog) to see if I can change my energy balance; be more productive and fulfilled and hopefully make more quality time for my team and colleagues.

Resources used:

Identify the difference between strategic and global thinking http://www.selfgrowth.com/articles/are-you-a-linear-or-global-thinker

Test whether you have a strategic or a linear thinking preference http://www.harvardbusiness.org/blog/are-you-strategic-thinker-test-yourself

 Full article from Schwartz and McCarthy; 2007; Manage your energy not your time; Harvard Business Review https://hbr.org/2007/10/manage-your-energy-not-your-time

Covey; Stephen R; The 7 Habits of Highly Effective People; Rosetta; 1989 

About the author

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

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NHS Leadership

Move forward by stepping back – How to get more love into the workplace – Part 4

The world of healthcare delivery is becoming much more complex, and so the leadership style that worked well to reduce waiting times, increase quality and move to a system of earned autonomy (Foundation Trust status) is no longer effective. The phrase VUCA – volatile, uncertain, complex and ambiguous – better describes the world we now find ourselves in.

So what type of leadership can prevail in this challenging and unknown environment?

The leadership skills that will be needed in the NHS to deliver high quality patient care in an environment that is becoming increasingly constrained both financially and politically are different to those that have been employed over the past decade.

Recently I’ve been exploring the concept of Host Leadership[1] which suggests that the leader needs to understand both when to step forward and more importantly, when to step back.

McKergow and Bailey’s 2014 book ‘Host’[2] introduces the metaphor of the ‘Host Leader’. This builds on the thinking of the leader as ‘hero’ and ‘servant’, which have been the two popular metaphors in leadership theory. The leader as ‘hero’ has been particularly dominant in the healthcare environment, but over the past few years it’s become apparent that the heroic leadership style is too simplistic an approach. The increasingly complex world of chronic, co-morbid healthcare needs, delivered across health and social care systems with an expectation of delivering more with less funding, requires a much more adept, flexible and engaged style of leadership. Leaders will need to have the ability to work across organisational boundaries into systems, whilst at the same time maintaining an engaged and high performing organisational workforce – quite a challenging ask.

The leader as ‘host’ gives the flexibility of approach required to work in this new and emerging environment. Knowing when to step forward to initiate; take the lead; drive forward and when to step back to create the space for others to generate ideas; encouraging debate; and explore options is a very delicate balance and one that getting right will enable leaders to navigate this VUCA world.

McKergow and Bailey describe the six roles of the Host Leader:

Initiator – noticing what needs to be done; the ‘call to action’ and getting things going

Inviter – ask people to participate; make a compelling offer and enable invitees to consider their contribution

Space Creator – create a useful space; hold the space to enable a generative and emergent approach

Gatekeeper – draw boundaries that help to create and sustain progress; create identity; know when to step forward and exclude, and step back to include

Connector – enable connections through people; information; outside usual hierarchies; make links between different scenarios or problems

Co-participator – engage with people, ask questions and seek opinions; both lead and follow

The final one, co-participator, reminds me of a ‘back to the floor’ blog that I wrote in August 2015, which focussed on the importance of connecting with staff; asking their opinions and creating the environment for them to make change. It is the most vital one when it comes to really engaging the health and social care workforce in the design of the solutions.

Enabling the NHS to move forward by stepping back is the key leadership challenge of today.

 

About the author

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

[1] http://www.hostleadership.com

[2] McKergow M; Bailey H; Host – Six New Roles of Engagement; Solutions Books; 2014

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Leadership

Change for change’s sake? – how to get more love into the workplace – part 3

Aloha from the beautiful Hawaiian island of Maui.

Aloha means love and is the traditional Hawaiian greeting for friends, loved ones and strangers. This universal approach to love fosters fellowship and kindred understanding within Hawaiian culture; a culture of love which I think we need to bring into the workplace. Catch up with Part One and Part Two.

I was in the US on ‘Super Tuesday’ (Tuesday 1 March 2016), when eleven states voted for their favourite Republican and Democratic candidate. What fascinated me more than anything were the two questions that pollsters were asking:

“Do you think this candidate best represents change?”

Do you think this candidate best represents your values?”

The results were quite astounding. More people rated Donald Trump as the candidate that represented change, however rated him least aligned with their values. Despite this lack of alignment with values he went on to win the majority of the states that day.

This started me thinking about what we mean by change and how that aligns with our values.

In the NHS we talk a lot about ‘culture change’ and ‘transforming services’ however we often can’t articulate a change from ‘what to what’ or describe what transforming services will mean for our patients and staff.

Is it good enough to have a culture that is strong on values; patient centric and spends a considerable amount of time getting the basics right rather than consistently striving for change?

Patients can find it difficult to judge great patient care as they are often having a once in a lifetime experience. What patients do know is how the staff make them feel, whether the healthcare provider feels like a good place to work and if the staff feel valued. Having a culture that is values-driven, brings more love into the workplace and has the ability to unleash the intrinsic motivation of staff to deliver the best quality care that they can is surely the Holy Grail for every healthcare provider?

This sounds a sensible and obvious approach, however it is not one that is found universally throughout our health system. Why is that the case when it seems to be a winning formula?

Well going back to the Super Tuesday, change is often regarded as the main requirement regardless of what the change will bring. Leaders have to be seen to be doing something and with the average tenure of a Chief Executive in the NHS being 700 days; then they have to be seen to be doing something quickly. Discovering the values of an organisation takes time and patience and therefore often doesn’t yield the results quickly enough. So how do we put values first?

Changing organisational culture through values was the topic of a Royal College of Physicians Future Hospital Journal article I contributed to in October 2015. This charted the leadership journey of Guy’s and St Thomas’ NHS Foundation Trust which spanned almost a decade to drive a values based culture. This work was undertaken with the staff through a process of discovery and has taken patience; fortitude and an unrelenting focus on the basics by the leadership team (1). The leadership team at Guy’s has been relatively stable with only a recent change in Chief Executive Officer after eight years.

This patience, hard work and focus on values has paid off. In the 2015 staff survey results, Guy’s and St Thomas’ came out top in acute and community trusts for staff engagement. The basics of staff feeling able to speak up; recommending the Trust as a place to work or receive treatment and feeling that the Trust considers patient care a priority were all top in class scores.

This approach has not been easy and, like many other organisations, in order to keep pace with the NHS finances and upward demand, we will need to adapt our approach, however we will do this through a continued focus on our staff and our values.

One thing is for sure, change for change’s sake has no place in high quality healthcare provision.

Aloha!

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(1) 2006 Infection control
2012 Fit for the Future – quality, safety and efficiency
2013 Barbara’s story – focus on dementia patients 2013
2015 Speaking up

 

About the author

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

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culture of compassion, Leadership, Organisational development, Staff development

How to get more love into the workplace – Part Two

What better day to talk about love in the workplace than Valentine’s Day? The day when we profess our undying love for the focus of our affection; we can choose to keep our identity a secret or reveal all; we wear our hearts on our sleeve and chance rejection. We take that risk in the name of love.

The workplace can be a minefield to navigate. There are different ‘tribes’; power dynamics and unsaid rules. It often takes courage to say what you really think; stand up for what you believe in and wear your heart on your sleeve. The question is why? Why do you sometimes feel psychologically unsafe if you speak out? Why are diverse views shied away from rather than encouraged? I can’t profess to fully know the answers to these questions, but I do suspect that it stems from a need to belong and our tribal instincts kicking in. This can lead to bad behaviour; exclusion and a general lack of compassion towards our workmates. There’s an interesting Switch and Shift article on this if you want to read more.

So, if it’s an innate part of us, how do we get more love and compassion into the workplace?

Well to me it’s about appreciating what others have to offer. There’s an old African proverb that says, “If you want to go fast, go alone. If you want to go far, go together.” This sums it up for me. Often we are imbibed with a sense of urgency; short deadlines; stretching targets and the volume of work and weight of expectations is ever increasing. Naturally, this gives us a tendency to lean towards the ‘going fast’. Other people, who may have a valid, but different point of view, could slow us down, and we haven’t got the time to ‘bring them round to our way of thinking’ so instead, divergent views are at best ignored or worse ridiculed and those offering them made to feel inferior or stupid.

Over time, divergent views stop being offered, which gives rise to a different challenge, that of ‘groupthink’. This was described by ACCA in their December 2015 article on the need to diversify Boards as a “psychological behaviour of minimising conflict and reaching consensus without critically evaluating alternative ideas.” Often this is found in highly regulated, performance target-led environments such as banking and healthcare.

The predominant leadership style in the NHS is ‘pace setting’(1) . At first glance this sounds like a style that would get results; sets high performance standards whilst exemplifying delivery themselves; however over time it can have detrimental impact as it depersonalises the work environment, making it all about hitting the targets whilst forgetting about the human aspects.

In healthcare, we talk a lot about the need for compassionate care but often we overlook the need to have compassion in our everyday interactions with our colleagues. We need a more human touch in the workplace. To me this includes treating others as you would want to be treated and showing compassion in meetings as much as on the wards. It also means having honest conversations with people, especially if they are not performing as expected, rather than avoiding the difficult issues and potential conflict and then letting things escalate, potentially leading to festering resentment.

To summarise I think compassion in the workplace involves the following three aspects:

1. Treating people as individuals – acknowledging we are all different and have divergent views and opinions. Building relationships and trust on this basis and being as open and honest as possible.

2. Being open and honest – it’s often much easier to develop a ‘parent/ child’ relationship between manager and staff member than it is to have an adult to adult relationship (2) . Having honest conversations and being open when things are not going as well they might takes quite a lot of courage for some managers. It is far easier to not address issues but this just builds ill will over time. Voicing your opinion and being true to yourself, colleagues and staff, will enable a much more positive and transparent environment.

3. Valuing others’ opinion – as well as voicing your own opinion, allowing others to voice theirs without immediately responding or trying to bring people round to your way of thinking. Often this is more difficult than it sounds, but really listening to other people and opening your mind to other possibilities is the key to working with colleagues from different professional backgrounds, organisations and industries. Working out how to collaborate and work through the net benefit, so there is a shared and collective understanding and an agreed way forward, takes real skill.
I think if we all listen a little more; talk a little less and think of the person in front of us as a fellow human being, we might just start to get a little more love in the workplace.

Happy Valentine’s Day!

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1   Leadership that gets results; Daniel Goleman; Harvard Business Review; March 2000.

2.Eric Berne; Transactional analysis (parent, adult, child model); 1957.

About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust and a passionate advocate of creating conditions in the workplace to enable creativity and innovation to flourish

 

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Authentic Leadership, culture of compassion, Leadership

How to get more love into the workplace – Part One

In my last blog post I shared my new years resolution for 2016, which is to get more love into the workplace.  This is part one of my approach.

I’m posting this from a snowy Colorado mountain on Martin Luther King Day; which seems very apt as MLK once said, “I have decided to stick with love. Hate is too great a burden to bear.”

MLK was a truly authentic leader who spoke out for what he believed in and empowered people to think and act in a different way.

It’s been a tricky start to 2016. With industrial action from junior doctors and the continued struggle with waiting times and financials; it’s starting to feel as though the old methods just aren’t working for us anymore and a new approach is needed.

It seems to me what is needed is a new leadership approach that moves away from traditional pace-setting, command and control styles that have dominated the NHS for at least the past decade, to a more authentic leadership style – MLK style. One that supports staff with the right tools and techniques to make the changes needed on a day-to-day basis, without the bureaucracy of committees that are – in some cases – far removed from the frontline.

The NHS has a good track record of supporting staff with training in tools and techniques, but what has always been lacking is a systematic way of improving the services and solving problems as they happen. Many healthcare organisations have trained up hundreds of their staff in various quality improvement techniques, though few have managed to leverage the benefits. What has been missing is the infrastructure and governance that allows decisions to be taken quickly, at the frontline, at the time it’s needed.

In the past, managers such as myself were trained to be ‘heroic leaders;’ i.e. it was their job to solve the problems (otherwise what are they doing?); however the time for this has now passed – if it ever really was the right approach – and it’s time to really think differently about how we support our staff.

In my view, there are three steps that leaders could take to become more authentic and to enable more effective decisions to be taken as close to the patients as possible:

Step One admit you don’t know all the answers and place the decision making in the hands of those who do; especially those at the frontline. That is a very big ask in this world of accountability and takes bravery; however it has been proven to yield effective results in healthcare systems elsewhere in the world.

Step Two give the staff the tools and techniques to make the necessary change. Supporting clinical staff by training them in quality improvement techniques; using data effectively and understanding how to manage change has the potential to make more of a difference in two months than a year’s worth of committee meetings.

Step Three take the governance to them. Don’t expect clinicians to navigate the intricacies of the corporate governance that many of us spend our days steeped in. Work with intention and develop a systematic approach that allows decisions to be taken quickly and easily. If needed, schemes of delegation can be drawn up to keep everyone safe. Knowing that the intention behind the decision is to ‘make things better’ for patients and staff whilst supporting clinicians to understand the constraints will unleash their creativity. As the saying goes ‘innovation loves constraint’. A really successful example of this is the Virginia Mason test: ‘What can you do with half the money, half the staff, half the space?’ This has supported them to radically change how they deliver healthcare at the same time as increasing quality and reducing cost – the holy grail.

In my view, these three steps will go a long way to bring about a more authentic leadership approach which will lead to a better engaged and enabled workforce and overall more love and wellbeing into the workplace. The question is, can we do it quickly enough to make the difference? In reality, do we have a choice?

I’ll leave you with the words of Mark Twain; “There isn’t time, so brief is life, for bickerings, apologies, heartburnings, callings to account. There is only time for loving, and but an instant, so to speak, for that.”

About the author

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

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Leadership

2015 in review

The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 2,700 times in 2015. If it were a cable car, it would take about 45 trips to carry that many people.

Click here to see the complete report.

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