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

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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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Leadership, Millenial Generation, Organisational development, Staff development

All present and correct?

In today’s increasingly fast paced; always connected, always ‘on’ world, it feels as though there are never enough hours in the day to get done what needs to get done. Time feels like it slips through the fingers like sand but suffers from the polarity of being both fiercely protected and recklessly squandered. A way of making the most of the time we have; our precious 168 hours a week; is to improve our work/life balance, but is that as easy as it sounds?

Work/ life balance is something we all talk about, but achieving the perfect balance appears to be the Holy Grail. The Millennial generation (those born between 1980 and 1995) are particularly protective over their work/life balance and as the Deloitte Millennial Survey (2014) highlighted, by 2020 75% of the global workforce will be millennial, and so understanding what they are looking for in the workplace is increasingly important.

An international study published in the Harvard Business Review report from February 2015 (https://hbr.org/2015/02/what-millennials-want-from-work-charted-across-the-world) demonstrated that the term work/life balance means different things in different parts of the world. Many interpret it as work/me time. Interestingly, except for Central/ Eastern Europe, in every other region, over half the respondents said they would give up a well-paid and prestigious job to get better work/life balance.

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Source: Harvard Business Review, What Millennials Want From Work Charted Across the World; February 2015

Broadly speaking, most Millennials across the world cited spending time with family and to grow and learn new things as the most important to them, if they could prioritise in life.

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Source: Harvard Business Review, What Millennials Want From Work Charted Across the World; February 2015

 

This is great in theory, and companies such as Google and Apple are famous for having mastered it, however many organisations still have a prevailing culture of presenteeism i.e. I have to be able to physically see you to know you are working. Frederic Laloux’s fabulous book Reinventing Organizations tries to tackle this very issue, citing the companies around the world that have moved to self-management; putting the power in the hands of the staff rather than the management. He describes these types of organisation as being evolutionally teal, the characteristics of which appear to be looking after the spiritual well-being as well as the emotional and financial well-being of their workforce.  In reality, these organisations are the exception rather than the rule, so the real challenge is how to move away from a culture of presenteeism to one that values effective outputs.

This demands a different kind of leader; one that is comfortable with a more collective or distributed type of leadership; who moves the power to where the skills, energy and motivation lie and creates the right conditions for innovation to flourish (West and Dawson 2014; Kings Fund).

Enabling staff to have more flexible and agile working practices is crucial to ensuring the recruitment and retention of the best talent. Unusually for an NHS organisation, over half of our staff are under the age of 40 (54% against the NHS average of 41%) and so understanding what is important to different generations, particularly millennials, is an important part of our workforce strategy. We are about to undertake some research looking at what is meaningful to the different generations and different professional groups in our organisation, so that we are better able to tailor our training and development; workforce policies and support different working practices. Moving our managers away from a prevailing culture of presenteeism to one where they are comfortable in treating staff as individuals; interpreting policy and managing staff on the basis of the quality and timeliness of their outputs will require investment in supporting our managers to think differently and will require our leaders to change the ‘ask’ in the organisation.

This feels like the right direction of travel and should enable a different type of workforce to emerge to ensure that we remain one of the best employers in the NHS and are growing a workforce that has the work/life balance they both want and deserve.

About the author

Sarah Morgan is the Director of Organisational Development for 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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Leadership, Organisational development, Staff development

Are human beings all just creatures of habit?

How do we foster a culture of innovation in healthcare?

I’m writing this as I fly back from my holiday in Crete. While I was there I couldn’t help noticing that every day the same people sat in the same places for each meal and lay on the same sun loungers by the pool. That started me thinking: are humans really just creatures of habit? Is change considered scary in organisations because, in reality, humans seek comfort in routine? Organisations are made up of human beings – and in order to have real, sustainable change the alternative has to be demonstrably better than the status quo.

A recent study into modern healthcare innovations by disruptive innovation guru and Harvard Professor Clayton Christensen concluded that, “Health care may be the most entrenched, change-averse industry in the United States.”[1]  England is arguably no different. Healthcare has been delivered in more or less the same way for decades, and in some cases even longer. Getting people to change their habits and move out of their comfort zone is a full-time occupation for many managers and leaders. Forward-thinking leaders have been using techniques such as visioning and future-basing[2] to try and get the workforce to ‘buy in’ to this change.

But are we just fighting against the tide? How easy is it to get people to really think about the future in a different way? What’s in it for them? Is this just working against human nature?

Virginia Mason, a world renowned leading US healthcare provider, would argue not. They have managed to transform how their people think about healthcare delivery over the past 20 years through the application of the healthcare version of the Toyota Production System method, or ‘Lean’ to you and me. This has enabled them to systematically integrate innovative structures, methods and lean cultural practices into their everyday ways of working. Their experience has increased the nursing to patient time from 40% to over 90%.[3] So, shouldn’t the NHS be beating a path to their door?

In my view, the answer is unquestionably ‘yes’. Once you get past all the usual arguments about why the ‘Virginia Mason Way’ would not work in the NHS, and when you strip it all back, it’s because their workforce all BELIEVE. They believe there is a better way, they believe they can improve patient experience and they believe they can always do things more efficiently and effectively. This means that the workforce are not only engaged in the change, they are the change they want to see.

As Mark Hutcheson (previous Virginia Mason Medical Centre Board Chair) said of the birth of the philosophy of the VM production system, “We want to make sure we are in existence 100 years from now, and you can only do that if you are innovative. You cannot just tread water and not embrace change because you will die. So, you’ve got to always be figuring out some way to grow, and that requires being willing to look at some things differently.” [4]

How do we start to engender the much needed change in the NHS to make sure it still exists in 100 years time? According to author Rolf Smith, from his book The Seven Levels of Change: Different Thinking for Different Results, the 7 levels of change are:

Level 1: Doing the right things: effectiveness, focus and working to priorities

Level 2: Doing things right: Efficiency, standards and variation reduction

Level 3: Doing things better: improving, thinking logically about what we are doing and listening to suggestions

Level 4: Doing away with things: cutting; asking ‘Why do we do this?’; simplifying and stopping what really doesn’t matter

Level 5: Doing things that other people are doing: observing, copying and seeking out best practices

Level 6: Doing things no one else is doing: being really different, combining existing concepts and asking ‘why not’

Level 7: Doing things that cannot be done: doing what is commonly thought to be impossible questioning basic assumptions, breaking the rules and being a bit crazy

The NHS is pretty good at the first three, but really needs to work on Levels 4 – 7 if it is going to see any discernible change.

Getting to Level 7 – really seeking to unleash the creative spirit of our staff and being ‘a bit crazy’ – is what the NHS needs. Trying to do that within the current regulatory and inspection regime is going to be the tricky bit.

Learning from the Virginia Mason experience is part of our strategy, as well as forming a learning collaborative with Sunderland NHS Foundation Trust, who are five years ahead of us on this journey. Underpinning all of this with a robust, organisational development programme that takes our 13,500 staff out of their comfort zone and unleashes their creativity whilst at the same time convincing our 900 strong medical workforce that (in the words of Dr Atul Gawande) “standardization has led to vastly better outcomes,” will be a tightrope that our organisation’s leadership will need to walk for the foreseeable future.

I aim to share our experiences in order to help leaders across the NHS learn from our experience and our (hopefully not too many) mistakes. For now I’ll leave the last word to a staff member from Virginia Mason who said, “To me, an innovative culture is one where anyone can bring up new, creative and sometimes even backward ideas, without fear of being thought of as crazy, strange or funny…. a culture where innovation is rewarded and celebrated.”

Now I bet they sit on a different sun lounger by the pool every day.

2015-06-23 09.28.44

[1] As quoted in Plesk, P; Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience (2014) p19 -20

[2] A organisational development technique where you get people to imagine they are in the future, what that looks and feels like and the barriers they have overcome to get there

[3] Plesk, P; Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience (2014)

[4] Plesk, P; Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience; (2014)

About the author

Sarah Morgan is the Director of Organisational Development at Guy’s and St Thomas’ NHS Foundation Trust and passionate about innovation and change.

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