No.

On a bus in 1955 in Montgomery, Alabama a bus driver ordered a black woman to stand up and give her seat to a white passenger. This was the rule of bus segregation introduced in 1900. The woman, a seamstress called Rosa Parks, looked at the driver and said 'No'. As a result she was arrested and the civil rights movement in the United States developed to a new level. It resulted into a bus boycott that lasted a year. Rosa explained her word, 'I had given up my seat before, but this day, I was especially tired. Tired from my work as a seamstress, and tired from the ache in my heart.' She also said, 'All I was doing was trying to get home from work'.

Rosa's 'No' changed the world. It played a pivotal role in the movement led by Martin Luther King for racial equality and respect. Today where she boarded the bus there is a plaque to Rosa. Her statue is in the US Capitol Building in Washington DC. She received countless awards, met American presidents and had streets named after her. What Rosa symbolises is an ordinary person doing an extraordinary thing. Here was a black woman who said 'No' because her conscience wouldn't allow her to go along any longer with a system that discriminated against people on the basis of their skin colour. Rosa is a call to integrity. Her name is a byword for having principles and holding them when the going gets tough.

Principles and values are what make us what we are. They shape and hold us. There is a saying that says, 'To betray oneself in order not to betray another is the greatest betrayal of all’. This is a very insightful comment. It tells us that there has to be some space or line written within us that is inviolable. This line says that we may compromise on some or even many things but not on this. We all need this line. Without it we have no deep identity. The word integrity comes from the word integer meaning whole or complete. Without integrity we cannot have completeness or wholeness. Without a core set of values or principles we cannot have what we all seek in so many different ways- that sense of oneness, wholeness and completion.

At work and life we can be challenged to go along with things that may conflict with our centre. There is a point when we have to make a stand for what we are. There is a time to say 'No.' Without this possibility we are not really free. We are not of course advocating that people fight everyone and everything. What we do assert is that principles are key and without them and standing for them we find something fundamentally missing in our life and what we can bring to work.

So how do we keep our principles? Rosa's life and words gives us some clues. She didn't go looking for trouble or fights with authority. 'All I was doing was trying to get home from work.'  She had given up her seat before but now knew she couldn't to be true to herself and her values of justice and fairness if she did. A moment may come for us all when we have to make a stand or lose our integrity. Rosa was filled with a sense of what was right. 'You must never be fearful about what you are doing when it is right',   She also said,  'I have learned over the years that when one's mind is made up, this diminishes fear; knowing what must be done does away with fear.' This to us adds us to the following. We need to have our core values and know them deeply - not just on an intellectual level but on a intuitional one also. There is nothing wrong with avoiding trouble and confrontation. However if we are faced with a situation where we need to make a stand then we need to do that  - trying to have sensitivity,grace and dignity. There is a moment when the issue that faces us is a values question and our answer is about whether we are true to ourselves or not.

This article is all about Rosa but it's also about you and us. It's about the sort of people we will choose to be. And the sort of people we decide to be is the sort of world we will create for ourselves and others.We started with Rosa and we will finish with Rosa. In doing so we dedicate this piece of writing to her and all the other Rosa's who say 'No' to whatever is wrong in our world. They are the real heroes and heroines. Rosa expresses this better then we ever can. 'Stand for something or you will fall for anything. Today's mighty oak is yesterday's nut that held its ground.'

Lisa Falkingham, Service Improvement Team, Leeds Community Healthcare

John Walsh, York Street Health Practice, Leeds Community Healthcare

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

Day at the Opera

On Monday 7 July we attended the annual NHS Organisational Development conference - DoOD. This saw 200 staff from the NHS gather to look at the issues and direction of organisational development (OD). It was a great event, which featured Professor Michael West and Dr Pat Oakley as keynote speakers. It was good to meet or re-meet colleagues such as Paul Taylor from NHS Employers, Karen Dumain from the NHS Leadership Academy and Dr Maxine Craig from Sunderland University. We were happy that colleagues from our own organisation, LCH could also join the conference.

We were to present the after lunch session on 'Finding Our Voice'. We did this work with Tracey Gray, Head of Head of Education at Doncaster and Bassetlaw Hospitals and her daughter, Victoria. Tracey shared her personal and professional story of vulnerability, growth and finding her voice. She then introduced her daughter as her inspiration and 'rock'. Victoria emerged from the back of the room and started to sing from 'Carmen'. Victoria is an opera singer and went through the audience singing. She then, from the stage, shared her story of vulnerability and finding her voice. The audience were then invited to find their voice and Victoria led us in singing the chorus from the opera, 'Carmen' by Bizet.

We spoke to the audience about how we can create the cultures to find our voices and support staff to grow. We started to outline what good OD work looked like. There were three things OD practitioners could do and were doing. The first was visibility. To go out into the highways and byways of the service and talk and engage with staff. To be a presence that offered options, hope and possibilities. The greatest thing we can offer another is our own self and an OD practice that doesn't offer this has both missed the opportunity and lost the heart of the work. The second was vision. The call was to let a vision inspire us and then let others hear our passion and catch the fire. Movements for deep cultural and organisational change will not emerge from weighty documents but where individuals and groups see a vision and ignite it in others. The third was making the space for the voice of the staff. OD practitioners had to be able to create a positive circle and invite others into it for the OD dialogue to start and spread. This work created the ever increasing circles, like a rock thrown into a pond, drawing in more hearts and minds into making compassionate OD a reality. We then spoke of how we can create the cultures where OD can flourish and grow. 

The basic message was that culture doesn't fall ready made from the heavens. It is constructed and made by all of us and therefore we all hold in our hands an awesome power. We can create the best or worst cultures. Every time we open our mouth we create culture. Every time we act we create culture. The challenge was to be the best people and staff we can be. We might sometimes miss the mark but our work for best practice and best culture would bear fruit and make these things start to happen. 

It came down to - if we want the most inclusive and supportive cultures we need to be truly inclusive and supportive. We need to make the difference every day for the better. We ended by asking the audience to talk with people on their tables about what conversations they should have 'to make the difference for the better' in their practice and services.

We ended by offering the acronym OPERA as a sign of great OD work.


   O - Open to Possibilities

   P - Persistence

   E - Emotion and Passion

   R - Receiving and Giving Feedback

   A - Awareness of Self and impact on others

When we think of the conference this was what resonated in the speeches and also in many of the private discussions too. OPERA is an OD charter. It calls us to be what we are and can be. To be flexible to options and opportunities. To not see organisational life as a static fixed entity. To see, as Hegel the philosopher would, reality and organisations as in movement and development. To see life and where we work as dynamic realities which we can work in and direct. We can only be open if we are humble and create a space for the richness of others. We need to be a people of patience and persistence. Rome was not built in a day and cultures will not be changed by next Tuesday. We need to be a people of passion and commitment working for a cause greater than ourselves. The feedback and awareness are really key here. We are not called to be lone ranger figures riding into town to sort out the bad guys. We need a deep awareness of our own weak points. This is about 'us' not 'them'. This can demand radical honesty, deep and authentic self-reflection and the courage to start to change oneself. Big stuff really but then the best OD is transformation not tinkering.

The presentation had a quote from the great Dr Viktor Frankl - 'When we are no longer able to change the situation - we are challenged to change ourselves'. This is an interesting enigmatic statement. Maybe Dr Frankl was pointing to a secret but not stating it. The secret is - if we change ourselves the world will change and we will find that either the situation has resolved or we are able to deal with it in new and better ways. The conference was for us all about the power, potency and possibility we all hold in our hands. One person tweeted that she had realised she was holding power, potency and possibility as a result of her learning at the conference. That's the message and the means. We hope - we really hope - we can use these incredible energies wisely and kindly for this service that means so much to us. A big thank you to all who made this conference possible.

Steve Keyes, Head of Organisational Development, Leeds Community Healthcare

John Walsh, York Street Health Practice, Leeds Community Healthcare