One of the real pleasures of my work as a team coach and facilitator has been supporting teams to get back in the room together, face to face over the last few months, after in many cases well over a year of staring at each other through a computer screen. Teams are rediscovering the joys of connecting, having informal conversations over a coffee, and allowing themselves time to ‘be’ rather than constantly ‘do’. Conversations are deeper and more insightful, and solutions to sticky issues are more easily found.
One issue that comes up repeatedly in the teams I am working with, is the issue of transition. Teams that have formed during the pandemic are now finding that Tuckman’s observation of storming before you can get to norming is very real, and team leaders are facing ambiguity about roles, responsibilities and expectations, structural reorganisations, and the challenges of a VUCA (volatile, uncertain, complex, and ambiguous) world.
Organisational Health has been defined as the ability of organisations to align, execute, and renew themselves faster than their competitors can to sustain exceptional performance over time. To sustain high performance, organisations must build the capacity to learn and keep changing and this involves investment in the people-oriented aspects of leading an organisation and connecting them to performance. It comprises core organisational skills and capabilities, such as leadership, coordination, or external orientation that traditional metrics don’t often capture.
Patrick Lencioni, in his excellent book “The Advantage: Why Organisational Health trumps everything else in business” (John Wiley & Sons; 2012) highlights stories of healthy organisations as places where politics and confusion have all but been eliminated and as a result, productivity and morale soar, and good people almost never leave. You’re now probably thinking, tell me something new and if all this is true, then why haven’t more organisations embraced and reaped the benefits of organisational health?
And of course the simple reason is it’s hard. It requires real work and discipline, over a period of time, and it must be maintained. It needs sustained leadership, relentless focus and absolute clarity of expectations at every level. Lencioni talks of four key steps you can take, and encourage your peers to do the same:
1. Build a Cohesive Leadership Team – This first step is about getting the leaders of the organisation to behave in a functional, cohesive way. If the people responsible for running your business are behaving in dysfunctional ways, then that dysfunction will cascade into the rest of the organisation and prevent Organisational Health;
2. Create Clarity – The second step for building a healthy organisation is ensuring that the members of that leadership team are intellectually aligned around six simple but critical questions:
- Why do we exist?
- How do we behave?
- What do we do?
- How will we succeed?
- What is most important, right now?
- Who must do what?
Leaders need to eliminate any gaps that may exist between them, so that people one, two or three levels below have complete clarity about what they should do to make the organisation successful.
3. Over-Communicate Clarity – Once the behavioural and intellectual alignment is under way, leaders need to over-communicate the answers to questions above. Leaders of a healthy organisation constantly repeat themselves and continually reinforce what is true and important.
4. Reinforce Clarity – In addition to over-communicating, leaders must ensure that the answers to the six critical questions are reinforced repeatedly using simple human systems. That means any process that involves people, from recruitment and disciplinary to performance management and decision-making, is designed in a custom way to intentionally support and emphasise the uniqueness of the organisation.
So as the hard work of the autumn months kicks in,
- How Healthy is your Organisation?
- How do you re-focus your efforts on the people-oriented aspects just as much as the strategic or operational?
- What actions could or must you take now?
Healthskills were commissioned in early 2020 to support the four CCGs in the Black Country and West Birmingham as they form a single collaborative commissioning organisation. Mark, Dawn and the team are currently providing executive team development, supporting staff with Managing Change and Interview workshops, and shaping the organisational development strategy for the next two years. We are thoroughly enjoying working with such skilled and energised leaders and being part of a long-term collaboration to make an impact on reducing health inequalities.
I notice regularly in my work doing coaching, working with Governing Bodies or helping teams, how the organisation I am working in (let’s call them Organisation A) often views Organisation B as “the enemy”. If not the enemy, then the cause of many of Organisation A’s difficulties and certainly an easy target for blame. Of course there may be some truth in those assertions but the qualifying word “some” is an important one here.
Too often I think that Organisation B can be used as a sloppy scapegoat for issues that have failed to be addressed in Organisation A or for outcomes that were less than satisfactory. This also applies inside organisations where another directorate or team is the “whipping boy” because of perceived weaknesses or failings. Pointing this out as a coach or facilitator is rarely popular. It is sometimes helpful therefore to draw leaders’ attention to the fact that this concept of Organisation A as the “in-crowd” and Organisation B as the “out-crowd” has a sociological and psychological basis.
The notion of in-groups and out-groups was made popular by Henri Tajfel (a social psychologist) in 1971 in developing social identity theory. As we – on many occasions – get our social identity from the groups we belong to, people form self-preferencing in-groups very quickly. They may do this because of arbitrary or invented characteristics that discriminate their group from another. The theory also asserts that as we (in Organisation A) make group evaluations we do it in a comparative way that can easily lead to biases favouring our group in terms of the judgements we make and the behaviours we display. Put simply our (Organisation A’s) success is down to our qualities and abilities and any failures are down to bad luck and/or issues outside our control. In contrast any success for Organisation B is down to luck or the help they received. Their lack of success is because of innate personality and/or ability failings.
This bias (or rather a combination of biases) is damaging for team and organisation growth and development. While accepting that there can be comfort in formulating in-group/out-group distinctions, these barriers prevent understanding and dialogue between organisations, reinforce negativity and limit cohesion.
SO WHAT CAN YOU DO ABOUT IT?
These 3 tips (from from Susan Krauss Whitbourne) may make you hold back in joining the clamour of negativity about a team/department/organisation that can otherwise easily occur….
- Recognise the arbitrary nature of many in-group/out-group distinctions. The example of pedestrians and motorists is perhaps the easiest one for understanding this point. As a motorist you may be frustrated by the activities of some pedestrians at junctions but when you become a pedestrian you may be concerned about the way motorists act and the danger that causes. Your in-group at one moment may be your out-group the next.
- Put yourself in the place of the out-group members. Think about times when you’ve been put in an out-group position and remember how painful that was. Try to think about your inner security by being confident about your own identity rather than denigrating others.
- Look for commonalities between the “in-crowd” and the “out-crowd”. What binds them together, where are they striving for the same goal, how has bias played a role in manufacturing division rather than seeking agreement and coming together?
But of course none of these can be acted upon unless the issue is recognised and challenged, and that would seem to me to be an important part of any leadership role. Stop the collusion, groupthink and the race to attribute blame for failings or lack of delivery outside your own team or organisation.
Austerity, uncertainty and other pressures can drain energy and sap our resilience. And yet we know that energy and resilience are fundamental to delivering positive results, well-being and engagement. Here we offer a few ideas of how sustainable resilience can be fostered in a difficult workplace climate.
What is resilience?
Many define resilience as about ‘bounce back’; this is fine in respect of a trauma and significant life events. However the focus here is on resilience in the context of grinding workplace pressures, uncertainty and regular change. This type of environment needs people who can maintain their well-being and keep positive, every day. Thus we regard resilience as being about strength and flexibility.
What are the benefits of resilience in the workplace?
The benefits can be summarised as:
- Individual: reduced burnout; higher attendance levels and increased motivation;
- Team: positive team work; increased collaboration and a greater ability to manage complexity;
- Business/ organisational: higher productivity, improved customer service and greater workplace safety.
How can resilience in the workplace be developed?
We can each do something to strengthen our personal resilience, however difficult the current situation.
A good first step is to be self-aware. To understand one’s own triggers and what works for you. Each of us responds differently, the important point is to know ourselves and be aware what triggers may get us thinking negatively and going down that path of limitation. The inner voice can be powerful, loud and destructive. We need to understand our own thinking patterns and notice when we are giving ourselves negative messages – be they about ourself or our situation. Once noticed, at least one can recognise it. That is the start of choosing to change one’s thinking patterns. Not easy but do-able.
It is equally important to focus on our strengths and to ensure that regularly we do tasks that we enjoy and make us feel good. As part of developing our self-awareness we can ask: what do I REALLY enjoy doing? What qualities do I have that motivate and energise me? By drawing on these one can add some positive aspects to each day.
Resilience is vital to personal well-being and to team performance. It can be fostered and encouraged, whatever the context. The starting point is for each of us to acknowledge it is important and to keep attention on how they can strengthen own resilience. As this habit develops, others will appreciate the shift and gradually it becomes like a pebble in a pool – go on, drop a pebble and see where your ripples reach.
Merton Community Education Provider Network has worked closely with Melanie Warner of Healthskills, mainly in delivering one of the core components of the GPFV training around active signposting. Melanie has been a real pleasure to work alongside, I am able to give her my vision for the program required and she turns into a great workshop for which we have received really positive feedback and evaluations. I have found Melanie to be approachable and accessible, working against tight deadlines at times, she certainly is able to engage with all the stakeholders within the program. More over her interaction with the delegates has had had such a great impact on our programs.
An OD intervention working with 5 CCGs and the County Council aiming to achieve a shared OD Plan to enhance integrated commissioning
What was the issue?
The Hampshire Better Care Fund programme included a work stream to deliver integrated commissioning with the aspiration that 4 local integrated commissioning ‘hubs’ would be established across the county. Integrated commissioning is a key component of the wider Out of Hospital care strategy, that many health and care economies have been pursuing over recent years.
Hampshire County Council and its 5 partner CCGs were seeking an OD partner organisation to enhance their own strengths, capabilities and capacity to deliver a coherent OD programme which would run through their own programme work-streams as a coherent ‘golden’ thread.
The aims of the project were:
- An OD plan owned by all partner organisations to enable a ‘joined-up’ and integrated health and social care system
- To capture the honest views and ambitions of all key stakeholders to the stated approach to integrating health and social care commissioning in our approach
- To begin to develop the leadership behaviours and relationships that will model and sustain the required culture and system change
What did Healthskills do?
- Undertook a quick review of the case for change by highlighting recent national research and evidence for improving services to patients, users, carers and relatives by joining up commissioning
- Produced a simple checklist of success criteria for integrating commissioning which emerge from this research and evidence, spanning leadership, organisation, and system wide factors
- Conducted a series of 20+ semi structured interviews with stakeholders in the system to explore assumptions, aspirations, success factors and challenges, which were thematically analysed using the checklist of criteria
- Facilitated a number of perceived ‘difficult conversations’ between partner organisations and different professional perspectives. This helped to surface underlying concerns and differences on how the shared vision should be achieved, and helped to steer dialogue in a more honest and collaborative approach
- Distilled a set of outstanding questions and activities that will support the development of joined up commissioning and the overall capacity and capability within the system
What is different as a result?
A sense of collaboration has emerged that has provided a solid foundation on which to build the STP process.
An OD plan that summarised the key steps to be taken on the journey to wider service integration was shared with all partner organisations.
The partner organisations and key decision makers recognised the value to taking time to increase their face to face contact, building levels of trust and transparency between organisations across the system.
Specifically, they identified:
- Further work was required to agree a shared definition of, and goals for, integrated commissioning across the stakeholders
- There was a need to clarify what should be delivered at scale e.g. county-wide, on a sub county level, and locally determined (CCG or smaller locality)
- The complexity of agreeing a common pace and scale of desired change across the stakeholders, and a view on whether change should be incremental or of a larger more radical scale
- New initiatives such as Vanguards and devolved powers were seen as either helpful or confusing depending on which part of the system you were talking to. Further engagement work was needed to mainstream these initiatives into governance and strategic planning processes
We proposed that a number of organisation and system development interventions be considered beyond our project to develop and support the process of achieving a ‘joined-up’ and integrated Hampshire health and social care commissioning system, these were:
- System wide learning network
- System leadership development and planning
- Strengthened Governance systems between organisations
- New Ways of Working across professional and organisational boundaries
- Developing a common data platform
An ongoing Leadership, Organisational Development and Strategic Change programme in support of significant change within and external to the profession and practice of Pharmacy in the UK
What was the issue?
The profession and practice of Pharmacy has been a mainstay and core delivery of health and wellbeing in the UK for 175 years; and of course more latterly embedded in the NHS since its inception in the late 1940s. The supply and sale of safe and effective use of medicines for the prevention and treatment of illness is delivered by Pharmacists and Pharmacy Technicians in a wide variety of settings from front-line Community Pharmacy and Primary Care, through Secondary care to R&D, Manufacturing and Professional Support. Like all sectors in modern healthcare there is increasing pressure to deliver better quality, safety, efficiency, plus save money and reduce costs, whilst maintaining the highest of professional standards. The first intervention came from a joint initiative between Healthskills and The Royal Pharmaceutical Society in the shape of a Leadership and Change programme called ‘Pharmacy Revolution’, supported and sponsored by MSD.
What did Healthskills do?
Initial consultation and co-design of a series of workshops focusing on Leadership, the leadership of Change and developing skills and competencies in line with the Pharmaceutical Society’s Professional Standards.
The workshops focused on:
- Developing a Vision
- Strategy and leading Change
- Supportive management skills
to equip and enable Pharmacy leaders in the present and for the future. This programme has been delivered as a series of one-day workshops in various locations across the UK and uniquely was made available to multi-sector and non-pharmacist key stakeholders in local provision of integrated care.
What are the outcomes?
The programme has had a considerable impact in support of the change agenda in Pharmacy and has additionally evolved because further needs were identified in the early workshops … the outcomes are still having impact and there is an ongoing demand for this valuable work.
Key outcomes include the development of local visions, strategies and action plans to support the change agenda. Cross-sector working has greatly increased the collaboration, understanding and links between the various specialties and professional bodies within Pharmacy. Leadership skills have been enhanced and the increase in understanding of fundamental skills in communication, leadership of change and development of strategy have all been visible in the cohorts who have attended workshops.
What have the clients said?
As president of the RPS I intend to better integrate and support branches of pharmacy taking every opportunity to promote the whole profession, to health professionals and the public, helping us reach our goal in being a fully integrated part of the health and social care teams. I commit to championing the RPS and leading the transition of the society into a Royal College by committing to inclusivity and taking equal pride in the many varied roles of pharmacists working together across all sectors. I believe this program will aid leadership development as well as strengthening local pharmacy networks.
Ashok Soni, OBE, President, Royal Pharmaceutical Society
Thank you so much for organising today, I found the facilitation and input invaluable, I thought we achieved a lot particularly with the challenges around engagement, one learning for me is bigger isn’t always better and quality will always trump quantity, I see today as the first step in an area wide change program for pharmacy, thank you as always for your valued support.
Chair, Local Pharmacy Network
Chelsea and Westminster NHS Hospital NHS Foundation Trust are implementing a new Performance and Development Review (PDR) process. The Trust has developed a clear policy and Healthskills were invited to shape a development day to focus on the new approach and to enable managers to ‘re-energise’ their engagement with staff. Aligning and motivating the workforce to deliver business objectives within the challenging context of the NHS is important work. Valuing the workforce in the fast pace targeted acute environment can be forgotten unless we pay attention to ‘ourselves and relationships’.
Healthskills worked in collaboration with the senior OD staff at the Trust to provide an engaging day to develop the confidence and capabilities of more than 500 managers to undertake the PDR. We aimed to support managers to understand the process but more importantly focus their energies on the individual staff member and their work within teams and the organisation. Clarity of performance expectations and delivery but also to creatively consider how development opportunities could be explored and targeted.
Our day explored how managers could refresh and develop their skills; communicating well, giving and receiving feedback, and in summary exploring how good coaching skills can help shift cultures. We created a safe and fun learning environment with a range of approaches supported by clear theoretical models. The outcomes of our work was well received:
‘Excellent standard of teaching; pitched at correct level and information well delivered’
‘Session was well run and both were engaging and interacted well with the group’
‘Training on understanding my role really helps to enable me to work efficiently’
‘Made me think of about of departmental and team goals and how this may impact on employees PDRs’
The initial outcomes of our work are positive. We hope we have left managers with ‘growth’ mindsets to begin to shift how they work as individuals and in teams at the Trust. The Trust have begun a positive journey as a result of the passion and commitment of senior OD staff at the Trust, the collaborative approach with Healthskills and the commitment from managers to change. The work in the Trust is ongoing.
The single greatest advantage any company can achieve is organisational health. Yet it is ignored by most leaders even though it is simple, free and available to anyone who wants it.
The Healthskills approach to Organisational Health ensures that our client organisations create positive working environments, encouraging and enabling the achievement of goals and objectives.
We support empowering, collaborative and compassionate Leadership to develop high-performing and cohesive Teams. We enable our clients to apply a relentless focus on Organisational Development to improve performance and encourage a Coaching culture.
We know that the achievement of business goals is brought about by people. They are the critical success factor in any business and often the single most important focus for continuous quality improvement. But do all the pieces of the jigsaw slot together and are all of your people working together cohesively, with clarity on expectations of roles, responsibilities and results?
The interventions that we can use to help you develop your Organisational Health could include:
- An initial review of your organisational challenges, typically lasting 2-4 days with an outline action plan and recommendations for improving your organisational health
- Organisational development needs and planning
- A high-impact team development programme
- Bespoke leadership development programmes designed to meet individual and organisational development needs
- Critical management skills workshops tailored for individuals working at all levels in organisations
- Design and facilitation of events, timeouts and away-days
To discuss how a tailor-made programme can benefit your organisation please get in touch:
Design and development of a motivational interviewing programme to support multi-disciplinary professionals to facilitate self-management in patients with long-term conditions.
What was the issue?
There is significant evidence to suggest that current demands on primary care are high and that primary care clinicians are struggling to fit multiple agenda items into 10 or 15-minute appointments. It is therefore unrealistic to meet every need of patients with chronic conditions in such as short space of time. Bennett et al (2010) stated that half of patients left primary care visits not fully understanding what their GP had told them. Furthermore, whilst shared decision-making is associated with better outcomes, only 9% of patients participate in decisions. Primary care practitioners need to work with patients to ensure that they understand agree with and participate in the management of their chronic condition. Health coaching and motivational interviewing is one way to achieve this.
Research (Macadam, 2015; Coulter, 2013) has demonstrated that working with patients in a more collaborative way can yield better health outcomes.
The aims of the project were:
- To enable course participants to understand what motivational interviewing and health coaching is, and how it can be used within primary care in supporting patients to collaboratively set health and wellbeing goals.
- To understand some coaching models and frameworks that can be practically applied to enable goal setting and action planning with patients.
- To have the opportunity to practise core health coaching skills including: listening, questioning, and building rapport, goal setting and action planning.
What did Healthskills do?
Healthskills designed a bespoke one-day interactive programme aimed at nursing and other allied health professionals – “Motivational Interviewing for Management of Patients with Chronic Conditions”.
The course was designed combining both theory of health coaching and motivational interviewing blended with a strong practical component to provide attendees with space to practice new skills and theory. We believe this is a positive way to enable participants to build confidence to apply their newly acquired skills on return to work.
What our participants said
The course was really interesting and made you think about how you are with people.
I will now get patients to find more solutions rather than telling them what to do.
I have learnt to listen to patients more.