Leadership, Organisational development, Staff development

Increase your creativity & productivity – reclaim your lunch break!

I decided to reclaim my lunch break today. It was completely unplanned as I, probably like the majority of you dear readers, spend most of my lunchtimes fork in one hand, mouse in the other, glued to my computer screen.

I’d reluctantly left an interesting conference early with the view of attacking my To Do list with gusto and on my way back to the office I popped into a well know purveyor of ‘good natural food’ for some lunchtime sustenance. The girl behind the counter asked me if I was going to eat lunch in the park and as I heard myself utter the words , ‘no sadly I’m going back to my windowless office to eat it’ I caught myself and thought “WHY????.” Right there and then I resolved to eat said lunch al fresco.

I’m luckier than most as, although a rare occurrence, lunch al fresco for me is either by the Thames at London Bridge (home of the windowless office) or opposite the Houses of Parliament on Westminster Bridge (upmarket hotdesking).

The minute I sat down to admire the view and ponder this afternoon’s tasks ahead, my creative juices started flowing and this blog popped into my head. Stylist magazine started a Reclaim Your Lunch Break campaign in January 2015, backed by Deputy Prime Minister Nick Clegg. This was on the back of a recent study that said by not taking our lunch break we work an additional 19 days per year! Shocking really and if you’re interested in finding out more go to http://www.stylist.co.uk/life/reclaim-your-lunch-break/sign-up.

If the working for free isn’t enough of an incentive to unchain you from your desk, there is a growing body of evidence that suggests that our brains are not designed to work solidly for eight or more hours a day and that breaks make us more productive and creative. In fact, brief and rare mental breaks actually keep you more focussed, not less according to an article in Cognition in 2011 from Alejandro Lleras, a psychology professor from the University of Illinois http://www.sciencedirect.com/science/article/pii/S0010027710002994

Still not convinced? Well my own mini experiment meant that my 20 minutes of fresh air and vitamin D by the river not only created this blog but also cleared my head for the mammoth task of tackling that To Do list this afternoon.

We have 13,500 staff in my organisation and as the Director of Organisational Development, how to improve the working lives of our staff; keep them psychologically resilient as well as physically healthy and motivate them so that they continue to provide excellent patient care is constantly on my mind.

As Spring turns to Summer I’m thinking of starting a Reclaim Your Lunch Break revolution of our own. What with that and our Associate Director of Equality and Human Rights promotion of walking meetings it feels like we could be on the cusp of releasing an amazing level of creativity and innovation in workforce that mean fantastic things happen.

Oh and if you’re wondering I managed to whizz through my To Do list and even managed to leave work on time for a change. I’m converted.

Join the lunch break revolution!

reclaim your lunchbreak

Me earlier today enjoying my lunch break on Queen’s Walk by the Thames with Tower Bridge and the Tower of London in the background


What is the psychological impact of caring?

It is hard to open a paper, read Twitter or listen to the radio without hearing about the pressure that the NHS is under, particularly in A&E. The King’s Fund released its Quarterly Monitoring Report of Finance Directors today which also highlighted that not only is A&E under pressure but also elective care.  The report highlights 12.5% of patients waiting more than 18 weeks; the breach of the 18 week outpatient target; only 83.5% of patients accessing cancer treatment within the target access times and the number of delayed discharges hitting 5,000 per day in November, an increase of more than 20% from the January in the same year. The full report can be found here http://qmr.kingsfund.org.uk/2015/14/.

John Appleby’s foreword gives a stark message, “Services are stretched to the limit. With financial problems also endemic among hospitals and staff morale a significant cause for concern, the situation is now critical.”


With all of this media frenzy over missed targets, we may potentially lose sight of the psychological impact of an already overstretched workforce, caring in this environment. Often resulting in them not delivering the kind of care they would professionally and personally want to deliver, which can have its own psychological impact.

‘Staff morale a significant cause for concern’ is a stark and worrying statement. What is the NHS if it’s not the staff who care for the sick and vulnerable patients? Looking after the mental and physical wellbeing of our staff is critical at times of  immense pressure. Unfortunately, the unintended consequences of such times are that the support tools we have in place for our staff i.e. clinical supervision, debriefing and one to ones become the ‘luxury’ that is the first thing to go. This is short-sighted and needs a different approach that gives the staff opportunity to have time to think, reflect, re-gain perspective and access advice and guidance if required.

This is not just confined to clinical staff. Many staff who work in the NHS have difficult roles such as porters, domestics, receptionists, security and managers. All staff need an opportunity to work through the psychology of the challenges they encounter on a day to day basis.

One approach to this is the introduction of Schwartz Rounds.  These give staff an opportunity to share an experience of a situation they have encountered recently with a wider audience and the focus is on reflection rather than advice or guidance to give a greater amount of support. (More information in the Staff Care report from the Point of Care Foundation http://www.engageforsuccess.org/ideas-tools/point-care-foundation-report-nhs-performance/#.VMF0tv-a3IU). This technique is starting to become more frequently undertaken with proven positive results.

Last year, in my previous role as the Exec Director for Development in a mental health and community trust as part of our organisational development strategy we started to become a little bit more flexible in our thinking. We knew that despite best efforts one to ones were not always achievable on the over-stretched wards and this could lead to less reflection time for staff. The Forensics team had implemented an approach, known as See Think Act, with extremely positive results.  Whilst acknowledging the differences in patient cohort and clinical model between Forensics and mental health and even more so community services we decided to pilot learning from this framework. The philosophy is based on a positive approach to relational security and helps staff to manage the psychological impact of caring in a challenging environment. More information is available here


Surprisingly – given the difference in the patient cohort and clinical model – the community teams (physical healthcare) really embraced the approach and could see how this approach could positively impact on how they worked as a team as well as in their interactions with patients. The learning for me throughout this process was that flexibly supporting staff to access the support they need through a range of approaches is crucial rather than just following a single method that may no longer connect with staff needs and ways of working.

How staff feel about their relationships with their patients; the family and carers; their team and the wider organisation has a significant impact on the quality of care delivered. Caring in the best of times can psychologically affect the staff and in challenging times such as these, this can be even more starkly affecting.

Whilst the old mantra ‘keep calm and carry on’ is commendable, organisations need to start looking after the psychological as well as the physical wellbeing of their workforce. This will involve being flexible in approach, recognising the art of the possible and ensuring that staff don’t just ‘carry on regardless’ but are given some space and time to reflect, enabling them to continue to be able to deliver the quality of care they are proud of both professionally and personally.


Are we mindfully leading or just minding the gap?

My blog has been a bit quiet in recent weeks due to two reasons. The first being the night I posted my last blog, we got burgled and they stole both my personal and my work laptop. Secondly, I’ve have the privilege over the last six months to lead a national review into options and opportunities for providers of NHS care – or the Dalton Review for shorthand – which in recent weeks has eaten into my brain capacity and time somewhat. If you’re interested in reading further here’s the link https://www.gov.uk/government/publications/dalton-review-options-for-providers-of-nhs-care

This lack of time and capacity to actually write my blog and do other things that I love to do, such as exercise, got me thinking about how this lack of time affects our ability to do our jobs well and our ability to lead effectively.

When I was University and directly afterwards, I got interested in meditation and Buddhism and the art of just being still. I spent time living and working in New Zealand and became a trained as a Reiki practitioner. When I returned to the UK, I joined the NHS graduate training scheme and although I remained a member of the UK Reiki Federation for many years, the relentlessness of operational management meant I spent less and less time thinking about meditation and making time to be still. In fact being still is the antithesis of what it means to be working in frontline services in the NHS.

Mindfulness is being thought about and discussed more and more as a leadership tool and during the work I did on the Dalton Review, we looked into the characteristics of High Reliability Organisations. These are organisations that consider safety paramount such as the aviation industry and in North America, healthcare, and there are certain characteristics, one of which is mindful leadership. This started me thinking about the NHS and the experience I had before I joined and fire-fighting got in the way.

High reliability organisation characteristics

Image from High Reliability Organisations – A literature review, Health and Safety Executive, 2011)

Mindful leadership pays attention to what matters. Jon Kabatt-Zinn who has been the guru on mindfulness for over 40 years, describes it as ‘paying attention in a particular way: on purpose, in the present moment and non-judgementally’. This is a pretty tough ask for today’s NHS.

The NHS deficit is outstripping its surplus this year for the first time and includes a larger number of trusts predicting a deficit. The National Audit Office report into the financial sustainability of the NHS published in November makes gloomy reading http://www.nao.org.uk/report/financial-sustainability-nhs-bodies-2/. There was welcome news in the Autumn Statement with George Osborne announcing an additional £2bn funding for the NHS. Whilst the full £2bn may not all be ‘new money’, there is a welcome £200m for transformation and taking forward the clinical models outlined in the NHS Five Year Forward View http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf. Although the cash injection goes someway to help, it does feel as though the majority of our NHS leaders are minding the (financial) gap rather than being enable to lead mindfully, paying attention to what matters.

So how do our NHS leaders move from minding the gap to mindful leadership?

An article by Erica Garms on practicing mindful leadership points to the fact that effective leadership requires, “self-knowledge, self-awareness and centredness and an ability to manage the constant onslaught of inputs and stimuli and maintain good brain health so that clarity of decision-making can prevail.” https://www.td.org/Publications/Magazines/TD/TD-Archive/2013/03/Practicing-Mindful-Leadership

So how do we achieve this when we are running from crisis to crisis and meeting to meeting?

Answer – Meditation

So back to my days at University, practicing meditation – which doesn’t necessarily need to involve sitting in the lotus position, in a dark room chanting ‘Om’ – but rather, just taking a few precious moments to centre yourself, concentrate on the breath and calm your mind. Erica Garms points to examples such as doing a ‘body scan’ sitting in traffic or just taking the time from walking from one meeting to another to calm the mind and take a minute. I find staring at the clouds moving in the sky often helps to clear the mind.

Building this into daily life and work has proven to help many managers become much more effective. The problem is that’s not how we are wired in the NHS. Fire-fighting and solving problems is our modus operandi and stopping to think is really not part of our psyche.

So how do our leaders make the time to pay attention to what matters and to not just mind the ever widening gap in the NHS finances? In fact, paying attention may help to close the gap.

This will be down to individual leaders deciding what is important and taking the time to take a moment to really think about what they need to pay attention to. As I’ve blogged about before, the skills that we will need for the future leadership challenge are different to those that we have today https://sarahmorgannhs.wordpress.com/2014/07/13/what-type-of-nhs-leaders-do-we-need-to-meet-2020-nhs-challenge/.

My personal view is that leadership in the NHS needs to become much more strategic and regularly plan for the medium to long term. The political environment will always be uncertain and ambiguous but the idea that this leads to only being able to plan on the short term is a false one. Good leadership is about determining the long term vision for the organisation and focussing on that. Adapting this strategy and being agile to the changing environment is part of the planning process. Horizon scanning and scenario planning to test what would happen if certain changes came into play is good strategy development and should be integral to the process.

Leaders taking time to think and to pay attention to what matters and really consider the options should be the priority. These skills will take time to develop, but if the research is correct, will lead to better patient experience, better staff engagement and a brighter future for the NHS.