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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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, 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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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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