Flying High

Humankind has been interested in flying for a long time. Leonardo Da Vinci in the 15th century drew pictures of what a flying machine might look like. He had studied the flight of birds for his work. In the early years of the 20th century the Wright brothers managed to get a plane they had built to fly a few hundred feet. Before the century was out we were not just flying planes in the air but space ships to the moon. The ancient literature of the world also speaks of flight in powerful engaging ways. In ancient Greece there is the story of Icarus who flew with wings made by his father. He ignored his father's instructions and flew too close to the sun and fell down into the sea. The Book of Psalms also speaks of  flying. It says, 'Oh, that I had the wings of a dove! I would fly away and be at rest.  I would flee far away and stay in the desert;  I would hurry to my place of shelter, far from the tempest and storm.' (Psalm. 55:6-8).

 What is this attraction to flying and rising up to the heavens? It marks the centuries and as a race we have dreamed about, written about and worked to fly. There are probably multiple reasons for this interest. One as the Psalmist records is to escape from problems and dangers and find a place of rest. Another is that we have an inborn ( it seems ) need to rise and reach out. To ascend and transcend. To fly a bird needs wings. If a wing is badly broken it may not be able to take flight or fly again. While we do not as humans have wings the analogy is an interesting one connected to work and work values. It is a useful framework in which to ask the perennial question of what is a good health worker. What does great nursing and GP work look like? What are its component parts? What makes the difference between the average and the exceptional?

Louise and myself met recently and talked about the themes of this post. Louise is a third year nurse student at Wolverhampton University and I, a manager at York Street Practice, part of Leeds Community Healthcare NHS Trust. We will try to point to the two wings of good health work. We reckon that there are also the wings of good social work, care work and every valuable human endeavor. We believe these two wings enable those who discover and exercise them wisely and well to soar and move forward. This post is a distillation of the words of the emails and tweets we have sent to each other. In them we were asking what makes us fly - what makes us do the incredible.

The first wing is compassion. Compassion means to care for another. It means that heart connection that moves us to help and support another. The word compassion is from the Latin words for 'with' and 'suffer' or 'suffering'. So we have the idea of suffering with or being alongside someone in pain or difficulty. Recently I attended the NHS England event on NHS Citizenship in London. This event was to support and develop the public voice in the NHS. We broke into small discussion groups and our first task was to draw what the NHS meant for us or what we wanted from it. In a group of 6 people (mostly public and patients) three of us drew a heart. Another person drew a picture of matchstick men and women all holding hands in a circle. We know instinctively our service is all about compassion and care. The NHS in its intent, constitution and purpose is founded on principles of compassion and care where need is the basis. 

In response to the question of why she was wanted to be a nurse, Louise offers three reasons: 

 (1) "To care for patients and their families in time of need. no matter what their social background,ethnicity or choice in life. I believe we all need someone to care and who cares."

 (2) "To make a difference. I am keen to become a change maker, in that I really want to help and guide others, not just stand for the norm, be proactive in the face of adversity. I really want to make that difference, and inspire many who doubt that they can. If I can they they can! We can all be change makers. To stick our heads above the parapet is an immense feeling; one that at times I would love to hide from. But I myself am out there now, and I will make a difference, somewhere, somehow."

 (3) "Because this is all I have ever wanted to do! If I can help then it would really make me happy
  These sentiments are not rare. We find them across the NHS and in many places. Compassion is the heart we bring to a world in pain and worry. We really can be that difference. Healthcare without compassion has no values, focus or future."

The second wing is true leadership. We say true as there is unfortunately some confusion around leadership. People think leadership is management. We would rather say that the difference is management deals with systems and leadership works with people. One can be a good manager and poor leader and vice versa. To place an equals sign between manager and leader is a mistake. Leadership is a presence which we bring. Leadership is about people. It's seeing the best and bringing out the best in others and also seeing the best in ourselves. The best leaders are people of vision, values, care and compassion. It's what we learn and give that makes good leadership. Some leaders are quiet, some are not. Leadership is a possibility to us all. Like the cosmos with its stars, meteorites, suns , planets and galaxies it takes a myriad of forms and expressions. The trick is to see the possibility of leadership and keep our minds open to this and see what happens. We may find doors open today, tomorrow or in the future. We may not sometimes be the first to see it. People (usually fellow leaders who instinctively know it when they see it) may see in us what we may not at that moment see in ourselves. Leadership like life is all about us seeing, owning and releasing our gifts.

When people start to see our leadership emerging they will often say very nice and affirming things. We may find this difficult to see and accept. We may struggle with their compliments and affirmations. This is understandable. It is a sign however that our gifts and identity are starting to express themselves in visible and effective ways. We need to listen to the praise and compliments others give. We are always greater than we think ( much much greater, despite all our faults and flaws ) but we need to remain modest and humble when we start to see it too. So authentic leadership is the other wing. These wings fly together. Great leadership is compassionate and to inspire others is a truly compassionate act. Compassion feeds good leadership as fuel a fire.

Compassion and true leadership offer a vision of what the NHS is and can be. It offers the greatest perspective of all. That is transformation. The spiritual writer Richard Rohr talks of how it is transformed people who transform others. It's those who are themselves transformed that transform situations and support others to make that journey also. When we find our wings we find energy, meaning and direction. When compassion and good leadership are our wings we fly and fly high.

John Walsh. York Street Health Practice. 

Louise Goodyear, Student Nurse at Wolverhampton University

A vision of care

Representatives from CaSH ( Contraception and Sexual Health service ) and York Street Health Practice met over coffee to talk and listen. Both are Leeds Community Healthcare NHS Trust services. CaSH  provides effective, accessible and non-discriminatory contraception and sexual health services to improve the sexual health and wellbeing of both young people and those who are vulnerable in Leeds. CaSH includes a consultant, doctors, nurses, clinical support workers and a youth worker. York Street is the medical team for people who are homeless, vulnerably housed and in the asylum system in the Leeds area. Both teams operate across the city.

The meeting had three great outcomes. The first was a commitment to find new ways to work together and support the Leeds Health and Wellbeing Board vision for the poor and vulnerable in our city. We recognised the potency that our services together working for best health outcomes and care offers. Two are better than one and the specialisms of both services working alongside each other offers much. The second thing is that both services have the quality mark for working in domestic violence. We discussed how we can work together to obtain level two of this quality mark. The third aspect of the discussion was what we might call 'the deep stuff' - how we work and support not just good housing, medication and services but how we help support people find identity, focus and purpose.

In this last aspect we touched on three elements - responsibility, respect and relationships. These '3 R's' offer a possibility of what can happen. The first was responsibility. This is the moment when we really make that commitment to be adult and act as adults. To stop blaming and undermining others. To accept ourselves and life as it is and work from there for the best. It's amazing how we as adults can act as children. The call to be an adult and responsibly act is rarely a once and for all reality. It must be something we do and renew each day and week - sometimes against great stress and challenges. To move away from behaviour that is not adult and responsible to be honest and authentic people is a journey. Our good friend, Anne Cooper, the Lead Nurse for Informatics for NHS England, wrote a very powerful blog about this road to being authentic.  Anne ends it with these wonderful words, 'So authentic leadership is, I believe critical; the ability to be myself and be human, not to be a robotic corporate being, to help others to understand the whole me, flawed as I am.' To be responsible is to own ourselves and take responsibility for one's self. It's actually to love ourselves just as we are but also to love ourselves enough to want to change and develop too.

Respect. What does respect look like? Perhaps it can be defined by what it does, not look like. The subject of domestic violence and abuse we discussed offers a contrary opposite picture of what respect isn't. Those words, attitudes, actions, undermining, bullying, nastiness and hate are what we find at the heart of domestic violence and abuse. The opposite of these may be deemed acceptance, developing, affirming, kindness, love, gentleness and goodness. This to us is respect and whenever humans find these values they usually start to warm up themselves and open up like new flowers to the sun. These things - kindness, respect, gentleness - are infectious and can change so much.

What about relationships? Any one who has worked in care for a while and who has really been listening and learning knows that relationships are the heart of all that good care work is all about. We can do the work it's true but we can't do work that connects and changes people without positive therapeutic relationships. At York Street one of the theoretical images of the work we use is that of the circle. The circumference is the doctor giving the prescription, the nurse bandaging the wound and the support worker filling in the form. Yet the centre of the circle is and has to the rapport, the connectivity, the relationship. All good health work has to focus on creating and sustaining this relationship. It's the relationship that makes the difference. After the tragedy of Mid Staffs we have a real call to ensure person centred dominate all our work.

So how do we become conduits for responsibility, respect and positive relationships? There are a number of ways. In fact each of us receive dozens of opportunities every day for this to happen. A story might help here. Last year at a conference outside Leeds one of the authors was approached by a student studying health asking to visit their service. A few weeks later the student arrived and had a tour and talk about the service. After this the young student started to talk about an issue she was facing in her placement. She saw a clash between what she was learning in her classes and what she saw in her present health placement. We were able to say two things. The first is that what she saw in her placement was culture. She mustn't think the great things she learnt in class - the patient centred approach, great team work, vision and values - were just ideas that couldn't work in the real world. What she was looking at in the placement was culture and that culture had been made by human beings. And it could be unmade or remade by human beings too. The second thing was that in the NHS that there is an army of us - thousands and thousands working for better cultures and care. She was part of this movement and she could be - indeed was - the change needed. The call was to light a candle rather than curse the darkness. That young student - with no power and authority - went back to her placement and course to be that difference. That's not good leadership - that's really great leadership. What we see in this young woman is how to be a transmitter of the responsibility, respect and relational approach that we are talking about in this blog. Great leadership isn't about where we are - it's about what we are. We can be people who own their own being and potency to serve and care for others. If we can do this we don't have many worries that the '3 R's' - responsibility, respect and empowering relationships - will quickly start to appear. 

Dr Farah Haider, CaSH,

John Walsh, York Street Health Practice

The Power of Listening

Wouldn't it be great to be a really good listener?
 
Someone  once described Sigmund Freud, the 'Father of psychoanalysis', as such, "He struck me so forcibly that I shall never forget him. His eyes were mild and genial. His voice was low and kind. His gestures were few. But the attention he gave me, his appreciation of what I said, even when I said it badly, was extraordinary. You've no idea what it meant to be listened to like that." Wow! What an incredible listener and power of listening.

Most of us think we are good listeners but are we? We probably often go into situations with minds full of ideas, hearts full of emotions and actions full of agendas and what we want from the meeting. Doesn't this block real deep listening? Is it is possible to deeply listen if we are full of all this stuff? Perhaps it's when we put to one side all our drives and wants and really become present to the other or others that the real gold standard listening really walks on stage. What is certain is that people usually pick up when they are not listened to. The refrain of 'He's not listening' is usually connected to ' He doesn't care'. This is a real issue as listening really is connected to caring for someone.

We recently heard a moving story about listening that we would like to share. Someone known to both of us had to go to a meeting where a team was going through a tough time. This person started to feel the trepidation and anxiety most of us would feel. What to say ? What to do? The friend concerned spoke to a wise colleague. The idea that came through was that the person should go to the meeting but not to offer solutions and 'magic answers' but rather themselves in presence and listening. They would go and listen and be there with people even if it was difficult. This just 'being there' and 'just listening' was what our friend did. Our friend describes the effect of this approach. 'I have to say that this was one of the most invigorating and humbling days of my career. All I did was listen and be with those individuals. They achieved what they wanted to achieve, but more importantly for me, they had the space to be themselves.'

There are three fundamental lessons here for us all. The first is that when our friend had a problem she spoke freely about her feelings to someone she trusted. That person listened and supported the emergence of possible approaches. Here we see the therapeutic process in a nutshell. Honesty, feelings, trust , listening and answers emerging from the encounter. Here we have a framework to create solutions and possibilities. We would guess that this is bit like a wizards spell in a fairy story book. If one of the ingredients is missing, it doesn't work or doesn't work fully. However, when all the components are there that's when the magic of options opening up starts. The second thing that we see is our friend decided to be part of the process rather than a 'fixer' or 'outsider'. She decided to go to the meeting to be present, to be alongside, to listen. A psychiatric social worker known to one of the writers used to do what he called 'the practice of presence'. He would visit patients on wards who had serious mental health problems and just be with them. He didn't seek to offer forms or solutions but himself as positive and listening presence. We are sure his presence was a healing and helpful one. This sort of listening and being present can only come from the depths of who we are. It really does mean putting aside our robe of importance and talking and 'just being there...just listening'. The third life lesson is what the result of this approach was. Our friend had an experience which was invigorating and humbling. The team did what they needed to do and were able to be themselves. This isn't a guaranteed result every time but there is something about humility, listening and openness to others that can help clear a way through difficult times.

Can we develop fantastic listening skills? Can we really move away from being people who are desperately waiting for the pause in another words to jump in with our words and statements? The good news is that we can. There are probably many things that can help this. We will pinpoint two. We will call them the direct and indirect approaches. The direct approach is to try to do what our friend actually did. To sit and listen and be open to the other person. To try to avoid the distractions - the looking at our watches, checking our phones and thinking about something else. If we try this again and again we will probably find out how difficult it is to really listen and be present. This practice will however start to sow the seeds that makes us great listeners. From these small acorns great trees can grow.

The indirect approach is that if we focus on developing ourselves in an authentic way we will become skilled listeners because to develop ourselves we have to listen to ourselves. Those on this journey will find their listening faculty developing as they progress. Not because they work on it but because they work on themselves. It reminds us a bit of students coming to York Street. They were totally focused on ticking certain competency boxes. We would tell them not to worry about this. They would tell us they had to get these competences passed. We would say 'Do the work and the boxes will get ticked. Focus on the work and you'll display the competences' and they always did. If we work on ourselves we will have to do a lot of humble listening and just being there with ourselves and others.

Is it worth walking this path of developing ourselves? Yes it is. Abraham Maslow, the eminent psychologist, did his studies not so much with the mentally unwell but rather those who had good mental health and stability. He spoke about the greatest of these people as those who were 'self actualized'. He went on to describe this state of self actualization - ' What a man can be, he must be. This need we may call self-actualization...It refers to the desire for self-fulfillment, namely, to the tendency for him to become actualized in what he is potentially. This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming.'  This promise and possibility is what will make us not just the best listeners possible but the best people possible too. And surely that's worth it.   

Lisa Falkingham, LCH Service Improvement Team

John Walsh, York Street Health Practice  

Alice in Workland

Anyone reading this title may think we have mis-quoted the title of the Lewis Carroll classic 'Alice in Wonderland' (actually the full title is 'Alice's Adventures in Wonderland'). Others may ask that we are not surely saying there is some cross over between Wonderland and the workplace - between Alice and the actual daily life we all have. Well actually, we are saying this. Books and stories like dreams carry inner meanings. Some branches of psycho-therapy, especially the Jungian school,  recognise not just the power and relevance of stories but how the stories we tell and the stories that move us are resonating because they link in with our own stories and journeys seeking wholeness, identity and meaning. At the end of the story, Alice runs off to tea while her sister starts to have the same dream. The story goes on. So what does this novel written in 1865 teach us in 2014? What lessons can this young girl lost in a world where the incredible is commonplace give us today? We cannot cover a whole book but offer a few themes which we hope may resonate with some. We will give a quote and then offer a few words on it's importance. 

“Who in the world am I? Ah, that's the great puzzle.” asks Alice.

This is interesting as it brings us to the question of identity - who and what we actually are. A few months ago one of the writers sat in a coffee shop with a leading national figure in the NHS. The conversation turned to identity and how it was so vital that people found out who they really were. The national figure went on to say these words 'It's only when we find ourselves that everything makes sense. It's only when we find ourselves that it all fits together'. This is so true not just of individuals but also of services. We can walk around in the words of the Tom Cruise film with 'Eyes Wide Shut'. This is something truly tragic. It's only when we know ourselves that our gifts and potential can really start to function and flow as they should. This is not a new idea. It is said by some that The Temple of Apollo at Delphi in Ancient Greece had over its entrance the amazing words 'Know thyself and all the mysteries of the gods and the universe will reveal themselves to you.' Self knowledge is the key. The magic starts when we start to see who and what we truly are. The Temple builders knew this and Alice points to this too. 

“You used to be much more..."muchier." You've lost your muchness.” said the Mad Hatter.

Muchness. What can this mean? We would offer the following definition. Muchness is who we have become through our life journey. Yes, its who we are at work , what we do at work but its more than that. It’s what we stand for and how we offer our own self into the community we live in. It is about all the learning we have done in our whole lives , the ups and the downs,  not just our work lives. It’s about what we choose to pay attention to, give our attention and our effort to. In the recent past one of the authors was fortunate enough to be trained in ‘social movement methods’  , this approach  developed by Marshall Ganz at Harvard Business School and brought to the NHS by Helen Bevan (Chief Transformation Officer, NHSIQ). This approach offers us the opportunity to view all the resources we have within ourselves. These resources of  time, skills, knowledge,  and most importantly our passion are powerful  resources we can offer if we choose to. This is important learning as we often think about resources in the public sector as access to budgets, but actually the resource we have within our own selves are often much more potent.  

We would suggest that these are the things of our muchness. Our best business is to make sure our muchness remains intact in the struggles and vicissitudes of life and work. That's what our focus should be. The Duchess in the novel says, 'If everybody minded their own business, the world would go around a great deal faster than it does.' Maybe if our focus was on our own development what challenges us most would change too.

So Alice points us to  our muchness and links to the point above about identity. In chapter two ,Alice grows to massive size. Her body fills the house and her head hits the ceiling. She becomes very unhappy and starts to cry.

Out of control ego is an awful thing. We hear phrases like 'He's full of himself' and 'Her ego is so big it can be seen from space'. This sort of ego takes us to places where we cannot see others or really care for them. Like poor Alice, ego fills a room with our importance, position, title and demands. It also like Alice brings us to tears. Ego could stand for 'Edging good out'. It looks away from others and their good and riches and wants all the glory and limelight. Usually those who follow this path end up very disappointed as the world will not follow and dance around them. This genus of ego is also such a destructive thing. It's the power that won't forget, won't forgive and won't share. The hard knocks at work are not easy to take but they do help us to realise that we are not the chain just a link. They have the power and energy to teach us humility.

'How puzzling all these changes are! I'm never sure what I'm going to be, from one minute to another.' said Alice.

Change is a fact of our life and work. We probably undergo more changes in our lives than any of our ancestors and certainly at a more rapid rate. In the story Alice has to learn each game and its rules. She has to learn how to adapt and cope with each changing and bewildering event. Not easy but doable. There is an adaptability alongside a questioning and searching in Alice. Neither a passive 'going along with things as they are' nor a fiery refusal and confrontation but rather a learning, questioning and further search.

There is also the deep truth about change from Alice. She says, 'I can't go back to yesterday because I was a different person then.' There are actually two deep truths here. The first is the power of today. A famous actress once spoke of her fight with alcohol. She said that one of the valuable lessons she learnt was that she didn't have a time machine to go back and change the past. Neither did she have a crystal ball to see the future. What she had was today and she could make the very best of that to herself and others. Alice's point that we can't go back should challenge us to live in the now. The second thing is that we are not static unchangeable fixed objects. We can change and we do change. The challenge is will we take the direction and initiative to direct that change? Becoming a different person - a better person is certainly possible but it  doesn't come free or without a price tag. In times of change we need the acceptance and learning spirit of Alice. We also need to seek whatever change and growth we ourselves may need.

So Alice points to our need to discover our true self. To own, nurture and protect our muchness. To control our egos. To work with change and even change ourselves. Some one may still ask 'What has this to do with work?' Here we come to the chasm separating those who see work mainly as concerned with systems and those who see work as centrally about people. For those of us in the latter camp - and we are proud to be there - the story of Alice points to what we all should be and can be. Just think what life and work would be like then.

John Walsh, York Street Health Practice

Dr Maxine Craig, Head of Organisation Development at South Tees NHS Trust and Visiting Professor at Sunderland University.            

The top four myths about great leaders

Myths are funny things. We can believe things about ourselves or others which are just not true. Not only can we believe them but we can keep on holding them year after year. There are myths about all sorts of things including what great leaders and great leadership looks like. Here is my list of the top four myths about great leaders. I do not pretend this is the best list or the most comprehensive one. If you've got your own list that's great, it shows you are at least thinking about leadership and what it means. So hold onto your hats as we go into the land of make believe - a land that can seem so real that we believe it is. I'll leave the most fatal and deadly myth of all until the very end.

Myth Number One: Great leaders always get it right.

That's not true. Good and great leaders get it wrong and fail at things. Great leadership is not the absence of failure. It is the presence of effort, commitment and overcoming difficulties. Abraham Lincoln, one of the most celebrated American presidents lost his job, failed in business, had a breakdown, was defeated for nomination to congress, defeated at least twice for the US Senate and was defeated for nomination as Vice President. Alongside these failures were great successes too and eventually the Presidency. If we think great leadership is about never getting it wrong I think we are describing perfection rather than leadership.

Myth Number Two: Great Leaders always get results. They inspire everyone and win everybody over.

Again not true. Great Leaders often get into trouble because of their honesty and integrity. Their leadership challenges the existing set ups and people don't like that. If you think of Jesus, Gandhi and Martin Luther King, we see some interesting commonalities. They were all great leaders - men of inspiration, vision and care. All three changed the world. All three were also killed by those who opposed them. In Buddhism, there are the tales of the cousin of the Buddha who tried to split the community, turn people against Buddha and tried to have him killed three times. Leadership that shapes and changes things for the better will always have those who oppose it. Great leadership does not escape opposition. It works and goes ahead despite it.  

Myth Number Three: Great Leaders always have the answers. They are the ones in the know.

Don't think so. If great leaders had all the answers they would have stopped growing and learning and that never happens. It would be quite frightening if a leader had all the answers. It would mean they were cut off from the riches and depths of other people. The opposite is actually true here. Great leaders know they don't have all the answers. That's why they are always open and listening to what others say and do. Great leaders are perpetual learners and in that learning their great leadership lies. 

Myth Number Four: You will never be a great leader

This is the real 'serpent in the Garden of Eden' falsehood. It often births the others and is fed by them. Whatever you do, don't believe it. Leadership is when a person sees, owns and releases their own gifts. As we all have gifts we can all be great leaders. It isn't the lack of qualities and gifts - it's that we don't realize them and know how to let them manifest. I can honestly say I have worked with hundreds of homeless people over the years (people with the poorest backgrounds and worst odds against them usually from early years) and have never met one who did not have great gifts when you really got to know them. Great leadership is the point where the gifts come to the surface and start functioning. It's the shining of what is within.

We may not be like Napoleon who when he escaped from Elba in 1815 was met by an army regiment sent to stop him. He spoke to them, inspired them and won them all over. Napoleon then marched on Paris with this army whereupon the King fled. We may not be the unique special witness to justice and equality that Nelson Mandela was. However, if we can activate our gifts and make our contribution to making the world a better and brighter place and we can do this day in day out then something amazing will happen. We won't be great leaders - we will be the best.  

John Walsh, York Street Practice

Culture Change in the NHS

Leeds Community Healthcare is currently working in partnership with NHS Employers and Southampton University on a project to understand and support culture changes in the NHS. The project will run until November 2014 with specific outputs on tools for development of new cultural paradigms across the health economy.

The project team comprises of Catherine Hall (Service Manager for Specialist Services), Caroline McNamara (Senior Clinical Lead), Julie Mountain (Head of Adult Neighbourhood Services),  Julie Thornton (Development Lead) and myself.

Much emphasis has been placed on 'culture change' over the past couple of years in the NHS and we have seen forensic examination of system failures across the NHS. The outcome of this has immediate impact on patients and their families and the importance of putting these terrible events right is critical. One of the more astonishing and distressing facts to emerge from the Francis Report for example was the number of instances of not only poor care, but inhumane care. Patients were left lying in their own urine, or were left for hours without food or drink. Psychological studies have helped to shed light on the mechanisms underlying inhumane behaviour, such as ignoring distress and harm to an individual, although it is worth bearing in mind that none of them were caring for vulnerable patients.

Particularly pertinent is the ‘bystander effect’, in which individuals stand by and fail to help a victim in distress. Relevant variables (see Fischer et al, 2011) include the number of bystanders present (more means it is less likely that a victim will be helped); the ambiguity of the situation (more ambiguity leads to less help); and the similarity of the victim to the bystander (the greater the similarity, the more likely that help will be offered). Research has also shown that pressing situational factors may readily override explicitly enounced value systems and beliefs, such that a person in great distress is ignored (Darley & Batson, 1973), something that could find parallels in busy clinical settings.

Also relevant is Philip Zimbardo’s Stanford Prison Experiment (Haney & Zimbardo, 1998) where those who were put in charge of prisoners subjected them to inhumane treatment that seemed to transcend all moral boundaries. Relevant issues are discussed by Miller (2011) and by Haslam and Reicher (2012). The latter’s findings indicate that a positive hospital culture of strong leadership in human values and appropriate peer support should help to counteract any negative tendencies.

The vast majority of NHS organisations run perfectly smoothly and cope extremely well under the pressures that are currently being experienced by staff.  When we hear talk 'in the system' of culture change what do they or we precisely mean? It’s useful to nail down a definition here:

"Culture is a set of shared, taken-for-granted implicit assumptions that members of an organisation hold and that determines how they perceive, think about and react to things (Schein 1992)." In other words it’s 'The way we do things around here'. 

In a recent accompanied visit with a District Nurse to one of the poorer districts within Leeds we visited an elderly couple. The patient we had gone to visit had the start of small ulcer around his bottom and the Nurse had visited to offer treatment and reassurance. We had gone only to see the man for treatment but it quickly became apparent that both needed some form of care. Whilst Elaine was attending to the 'real' patient I chatted to his wife. A large portion of what we both did that morning was not only attending to the patient’s clinical needs but also a whole range of social and psychological support. Most of that was through being interested, curious and listening to stories about their journey through life; where they grew up, which school they went to, what their parents did and noticing the pictures on the wall.  Each photograph telling a story about their lives, the histories of their families and how they had grown up in Leeds. 

Often with huge pressure on their time, nurses (and other care professionals) do this day in day out with care, compassion and attention. This is clearly technical clinical competence done with kindness. We could say that kindness is something, which is generated by an intellectual and emotional understanding that self-interest and the interests of others are bound together, and by acting upon that understanding. Human beings have enormous capacity for kindness. It is this essence that is at the core of our change work in LCH.

If we are to support the changes that are necessary and needed within the NHS we also have to be mindful and supportive about the millions of positive interactions that take place every day across the country. The danger is that we become embroiled in negativity regarding the terrible events such as Mid Staffs without paying attention to the amazing work that takes place. There are things that we are doing and can do provided they make sense to staff and patients and also connect to our values and behaviours.

Culture change is happening all the time and as a reminder of this we only have to look back to how things used to be.  The essence of what we stand for in the NHS will never change, this is the greatest of all platforms with which we can truly 'stand on the shoulders of giants'.

‘We are living in a world of change - the tempo of life has quickened considerably. The wheels of “possibility” in our world of nursing would appear to be turning more swiftly. Many hospitals have been enlarged and new departments have sprung up within them. There is a new look in many of the Wards and Nurses' Homes. Revolution is in progress, and like every transitional condition, it has an upsetting and almost bewildering effect on the various members of our profession. Is it not all the more necessary, therefore, that everything possible should be done to ensure stability and continuity? But one of the main foundations is a sense of community, and all efforts should be made to foster and strengthen the feeling that we are all part of a whole, with a common centre and mutual purpose.’ (The British Nursing Journal September 1951)

Steve Keyes, Head of Organisational Development

 

References  

Darley, J. & Batson, C. (1973). ‘From Jerusalem to Jericho’: A study of situational and dispositional variables in helping behaviour. Journal of Personality and Social Psychology, 27, 100–108.

Fischer, P., Krueger, J., Greitemeyer, T. et al. (2011). The bystander-effect: A meta-analytic review on bystander intervention in dangerous and nondangerous emergencies. Psychological Bulletin, 137, 517–537.

Haney, C. & Zimbardo, P. (1998). The past and the future of U.S. prison policy. Twenty-five years after the Stanford Prison Experiment. American Psychologist, 53, 709–727.

Haslam, S.A. & Reicher, S. (2012). Contesting the ‘nature’ of conformity: what Milgram and Zimbardo’s studies really show. PLoS Biology, 10, e1001426.

Miller, G. (1969). Psychology as a means of promoting human welfare. American Psychologist, 24, 1063–1075.

Schein E (1992). Organizational culture and leadership. San Francisco: Jossey Bass

The British Nursing Journal, September, 1951.

Happy birthday NHS

Margaret Thatcher retired from the House of Commons at age 66. Many people used to retire at 65. The NHS is 66 on July 4. Rather than retirement, a recent study by a prestigious American health body suggests the opposite is the case. The report actually points to vitality, life and plenty of work to do yet. The Commonwealth Fund is a non partisan and private health foundation based in New York. Its mission is 'to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.' Its board includes key health experts such as James R Tallon. A report called 'Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally' makes some interesting points. It compares the USA health system with 10 other health systems including our own. The other countries are Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden and Switzerland. The really key point is that the study looked at what really matters. Key elements such as access, health care quality, equity, efficiency and key indicators of healthy lives (e.g. infant mortality) were used. The result was that the best overall health ranking was......the NHS. Switzerland and Sweden were second and third respectively. (http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror).

When we often hear how bad things are in the NHS, this health specialist study says something else. So how do we square the bad news we hear and the scholarly study done by this Foundation? One doesn't have to be a genius to see that bad things happen in good services. That things in a service may be wrong yet a service can be right and good. This leads to the need for renewal and reform not ditching the service. I hope if we found a dirty plate at home we would wash it, not smash it. The study also suggests that there are powerful energies and practices in the NHS that are working well. If there wasn't, how could it be rated the best in overall health ranking?

The NHS is where ordinary people do extraordinary things everyday. The NHS is a sign of what a civilized nation looks like. It embodies the highest principles - social care, social justice and social equality. It says that health should be based on our need not our bank account. The NHS is ours - it belongs to the people. This report says she is still delivering 66 years on. We know that she is what her best practice and foundation express - great vision, values, care and compassion. That's why so many of us are so proud of the NHS and so many of us are humbled to be part of her service.

 

Happy birthday NHS - thanks for all you do and have done for people. 

 

John Walsh, York Street Practice

What can we see?

I was invited to meet the members of the Executive Coaching Register at the NHS Leadership Academy. These are top coaches from around the UK who work with the academy to support and coach NHS colleagues. The executive coaches' are experienced in working with the most senior leaders in the public and private sector and will support healthcare staff in developing into the high quality leaders the NHS needs (http://www.leadershipacademy.nhs.uk/support/executive-coaching-register/) Over dinner, it was a real privilege to meet such inspirational people as Julie Hickton and Neslyn Watson-Druee. I was invited to this event by Yvonne Coghill who is the Senior Programme Lead for Inclusion and Coaching at the NHS Leadership Academy. As a grateful beneficiary of coaching (via LCH's Liz Whitworth), it was great to meet and talk with these good people.  

I was sat most of the evening next to Elaine Patterson. Elaine is an executive coach and has just finished her Masters on the theme of reflection and leadership. Her research question was 'What are leaders experiences of reflection?'. Elaine's website describes her practice as specialising 'in enabling leaders and practitioners to become all of 'who they are' because 'who you are' directly shapes 'how you work', your impact on others, your results and your reputation.' Speaking to Elaine was one of those conversations where new mental vistas open up and one saw the value and vitality of reflective practice much more clearly than ever before. We had a long conversation full of insights and ideas from Elaine. The following are some of the things that really struck me:

(1) Reflection is not an added extra. I don't think anyone thinks reflection is a bad thing. Many of us may regard it as a luxury - some of us maybe as not the best use of our time. Elaine's argument is that reflection should be and always is at the heart of good practice. Reflection is the act of creation. It is in reflection that we see ourselves and our work and the possibility of new options and practice arise. Habitual ways of thinking and acting get challenged and new insights emerge.  Through reflection we create the possibility of bringing something new into the world. Elaine quotes Einstein as saying, ''problems cannot be solved from the same level of thinking which created them; they cannot be changed without changing our thinking (http://www.elainepattersonexecutivecoaching.com/real-work-leaders/)

(2) Leadership is always connected to reflection. Who we are is how we lead. There is circular reality here. Good leaders are born from reflection. Great reflection is generated by good leaders. Not so much chicken and egg as how leadership and reflection both nurture and develop each other. I asked Elaine what the opposite of good reflective practice was? Her answer was 'that leaders stumble'. I thought this was a very interesting and important answer. Leaders, staff and mangers stumble because we don't reflect. Reflection gives us focus and vision. Without it we can only stumble. 

(3) Reflection is a constant practice and more. Reflection should be a daily practice. This leads to it being a being more and more a state of consciousness / a way of work life. My guess is some of the best reflectors do their reflection anywhere - on a bus, train or walking to the office. Of course, the need of conducive space and the use of exercises such as journaling can be of great assistance. I once heard the analogy of firing an arrow applied to meditation. The idea is that we withdraw, retreat in a sense. Yet it is precisely this withdrawal that gives the arrow it's power and energy. Similarly reflection is that retreat and withdrawal that gives our work practice energy and power. If we don't use these moments we either won't reflect at all or end up in negative reflection by just letting worries and problems dance around our minds.

(4) If we want good leadership, better staff morale and more innovative practice reflection will be a great key to this. I asked Elaine if the Mid Staffs tragedy would have happened if all the staff had been involved in reflective conversations and practice. Her answer was 'No, I believe not'. If we can create reflective culture and consciousness we can start to build the best services for all including staff. Elaine’s research also uncovered that costs of not reflecting. These were identified as poor decision-making and losses in understanding, creativity, relationship, energy and productivity.

Elaine's website is here - http://www.elainepattersonexecutivecoaching.com/ - and plans to publish her full research findings in the autumn. I hope colleagues will hear the message this all points to - we lead as we are. Reflection can be a great friend in the process of us being the best people we can be and creating the best cultures and outcomes for our services.

 

John Walsh, York Street Practice

 

Leading when you feel useless

John Walsh speaking to guests at a Men's Health Week
event at the Crypt

Many good leaders - even great leaders can sometimes feel useless or hopeless. The same has happened to me. I remember a while ago I did a leadership development talk and came back to York Street feeling all positive and inspirational. I had a client booked in to see me so I went into the one of the rooms at York Street to see her. After we sat down, she shared some awful news with me. She was devastated and not seeing any hope or way forward. I suddenly felt very useless, having no words or easy options to offer. The positivity and inspiration evaporated very quickly as the story unfolded and I saw in this woman's face and features deep grief. I listened and offered words of support that seemed so weak and ineffective when compared to the anguish this woman bore. We talked for a while and then she left. I left the room feeling of no use at all to a fellow human being in need. 

I have thought about this incident since. I have got to a place where I think feeling useless is actually OK. What isn't OK is not managing it and working to transform it. To feel negative emotions is part of being human - it's what we do with them that makes or breaks us. There are personal and organisational behaviours that facilitate the transformation of these negative states. If we practice these consistently and patiently we start to build good cultures and practice. We also end up better people as we are focused on the positive. The great thing about these things is they cost nothing and can change everything.  So what are these actions or approaches? I'll touch on a few.

The most wonderful thing we can offer someone is not our words or sentiments (although they can be really helpful and powerful). The greatest thing we can offer someone else is our presence, listening and attention. A friend of mine was a psychiatric social worker in Bradford. He's retired now. He told me the story of meeting a homeless man and sitting on a wall in Bradford talking and listening to this man. The man spoke of his story and life. After half an hour my friend explained he had to go and instinctively put his hand in his pocket to offer some change. The man looked at him with deep and sad eyes and said, 'Put your money away my friend. You've given me what I really needed. You gave me yourself'. When my friend described the man, I actually recognised him. I was inwardly surprised as there is no way this man would ordinarily have turned down a 'hand out' but he did. Probably because he found something better - something more healing and helpful. I'm not advising people to approach homeless men on their own in Bradford or any other city, it's always safer to do this work with others through an organisation. What I am saying is we bring to every conversation, meeting and consultation what we are. We can be like my friend - a presence that brought peace and connection or the opposite. That's the power we hold in our hands. It's actually an awesome responsibility. So reflecting on the sort of presence we will be today is no small thing.

Another thing is that we can be a mirror to people struggling. This mirror reflects back to them what they cannot see at the moment or are not hearing. A friend of mine who is a mental health chaplain in a hospital outside Leeds will often talk to the nurses on the wards. The nurses tell him of their work. He tells them they are doing a fantastic job and sometimes he thanks them for all their care for the patients. The nurses tend to light up and are clearly thrilled to hear these words. My friend usually then says, 'Doesn't your manager say these things to you?' The answer is always the same, 'Never.'  This is so sad. We need desperately to re-discover the beautiful art of affirming others. We need to speak truth to feelings of uselessness in ourselves or others. We need to help others see what we see in them. Negative emotional states blind us to what we have and are. We can see so easily the gnat and miss the elephant. I have been very fortunate to have had such great NHS colleagues as Yvonne Coghill at the NHS Leadership Academy, Catherine Hall at York Street and Andrea North at LCH Specialist Services speak to me of my own gifts and qualities in ways that nurture and develop. This really is transformational work. People start to see who they are and what that means. Accepting at times our own feelings of inner poverty is fine as long as we don't stay there. We have to own them to transform them. Own it but go through it. See it but then look up and onwards.

The woman at York Street I mentioned early on in this post got through the incident, we were able to offer support and she moved on to a life and place of recovery. York Street is somewhere where we see again and again people face the worst and somehow get through it. It's incredible how things can turn around and work out as we work it through.

If you are reading this and feeling not too great about yourself and your leadership skills and practice, take heart, good and even world class leaders go though the same. You're in good company! There's an Oscar Wilde quote that says, 'We are all in the gutter, but some of us are looking at the stars.' I hope no one reading this is in the gutter. I also hope next time you feel useless you also look at the stars too. 

 

John Walsh, York Street Practice